Influence of moderate maternal nutrition restriction on the fetal baboon metabolome at 0.5 and 0.9 gestation.

BACKGROUND AND AIMS: Moderately reduced maternal nutrient availability during pregnancy has adverse effects on the fetuses' growth and metabolism during and after pregnancy. The aim of this study was to explore effects of maternal nutrition restriction (MNR) on key metabolites of the fetal energy metabolism, particularly amino acids (AA), nonesterified fatty acids (NEFA), acylcarnitines and phospholipids. These effects may reflect mechanisms relating MNR to later adverse outcomes. METHODS AND RESULTS: Plasma and liver samples of fetal baboons, whose mothers were fed ad libitum (CTR) or MNR (70% of CTR), were collected at 0.5 and 0.9 gestation (G - term 184 days). Metabolites were measured with liquid chromatography coupled to mass spectrometry. In both, CTR and MNR, fetal metabolic profiles changed markedly between 0.5G and 0.9G. Fetal liver glucose concentrations were strongly increased. Hepatic levels of NEFA, sphingomyelins, and alkyl-linked phospholipids increased while plasma NEFA and acyl-linked phospholipids levels decreased with progression of gestation. At 0.5G, MNR fetal plasma levels of short- and medium-chain acylcarnitines were elevated, but did no longer differ between groups at 0.9G. At 0.9G, plasma levels of methionine and threonine as well as hepatic threonine levels were lower in the MNR group. CONCLUSION: Small differences in the concentrations of plasma and liver metabolites between MNR and CTR fetuses reflect good adaptation to MNR. Fetal liver metabolic profiles changed markedly between the two gestation stages, reflecting enhanced liver glucose and lipid levels with advancing gestation. Decreased concentrations of AA suggest an up-regulation of gluconeogenesis in MNR.

Predicting patient arrivals to an accident and emergency department.

OBJECTIVES: To characterise and forecast daily patient arrivals into an accident and emergency (A&E) department based on previous arrivals data. METHODS: Arrivals between 1 April 2002 and 31 March 2007 to a busy case study A&E department were allocated to one of two arrival streams (walk-in or ambulance) by mode of arrival and then aggregated by day. Using the first 4 years of patient arrival data as a "training" set, a structural time series (ST) model was fitted to characterise each arrival stream. These models were used to forecast walk-in and ambulance arrivals for 1-7 days ahead and then compared with the observed arrivals given by the remaining 1 year of "unseen" data. RESULTS: Walk-in arrivals exhibited a strong 7-day (weekly) seasonality, with ambulance arrivals showing a distinct but much weaker 7-day seasonality. The model forecasts for walk-in arrivals showed reasonable predictive power (r = 0.6205). However, the ambulance arrivals were harder to characterise (r = 0.2951). CONCLUSIONS: The two separate arrival streams exhibit different statistical characteristics and so require separate time series models. It was only possible to accurately characterise and forecast walk-in arrivals; however, these model forecasts will still assist hospital managers at the case study hospital to best use the resources available and anticipate periods of high demand since walk-in arrivals account for the majority of arrivals into the A&E department.

[German-speaking midwifes prefer vaginal mode of delivery to elective Caesarean]. / Hebammen präferieren vaginale Geburt statt Wunschsektio1.

Increasing ceasarean section rates are a world wide concern in obstetrics. One of the latest contributing factors is the elective caesarean section in uncomplicated singleton pregnancy at term. The preference for this mode of delivery was primarily brought forward by obstetric practitioners (Al Mufty, McCarthy, Fisk 1996). A questionnaire, which mainly aimed to ask germanspeaking midwifes in Austria, Germany and Switzerland about their personal choice of delivery mode, was included in one of the issues of the German-language midwifery journal "Die Hebamme". This questionnaire contained 5 half-closed/half open questions describing specific obstetric occurrences. The midwifes were asked to express their preferred mode of delivery and describe their reason for choosing. 446 questionnaires (12 %) were returned. The majority (100 %) of the german speaking midwifes preferred a normal vaginal delivery in an uncomplicated singleton pregnancy at term with a child in cephalic presentation. The rating was about the same (97 %) in the presence of general risk factors which don't indicate a primary caesarean section. Breech presentation and macrosomia are a matter of concern to the midwifes. Midwifes arguing for a first child in breech presentation or with macrosomia > 4.5 kg vote highly significantly more frequently for elective caesarean section than midwifes arguing for at least the second child. The first-rate reasons for the preference of vaginal delivery concern the natural and physiological way of delivery, the personal experience of delivery, the higher risks of caesarean section and the possibility of a later caesarean section in case of fetal distress during first or second stage of labour. Concerns are expressed about the maintenance of competence amongst practitioners, thus influencing the choice of mode of delivery in obstetrics.