The benefit of active management in true knot of the umbilical cord: a retrospective study.

PURPOSE: To compare perinatal outcomes between active and routine management in true knot of the umbilical cord (TKUC). METHODS: A retrospective study of singletons born beyond 22 6/7 weeks with TKUC. Active management included weekly fetal heart rate monitoring(FHRM) ≥ 30 weeks and labor induction at 36-37 weeks. Outcomes in active and routine management were compared, including composite asphyxia-related adverse outcome, fetal death, labor induction, Cesarean section (CS) or Instrumental delivery due to non-reassuring fetal heart rate (NRFHR), Apgar5 score < 7, cord Ph < 7, neonatal intensive care unit (NICU) admission and more. RESULTS: The Active (n = 59) and Routine (n = 1091) Management groups demonstrated similar rates of composite asphyxia-related adverse outcome (16.9% vs 16.8%, p = 0.97). Active Management resulted in higher rates of labor induction < 37 weeks (22% vs 1.7%, p < 0.001), CS (37.3% vs 19.2%, p = 0.003) and NICU admissions (13.6% vs 3%, p < 0.001). Fetal death occurred exclusively in the Routine Management group (1.8% vs 0%, p = 0.6). CONCLUSION: Compared with routine management, weekly FHRM and labor induction between 36 and 37 weeks in TKUC do not appear to reduce neonatal asphyxia. In its current form, active management is associated with higher rates of CS, induced prematurity and NICU admissions. Labor induction before 37 weeks should be avoided.

Combining cognitive work analysis and empirical evaluations to understand map use by operators of small carry-on unmanned aerial systems.

Operating a small carry-on unmanned aerial system (UAS) alone is challenging. Research on facilitating single-operator work has focused mainly on payload operation and health monitoring. Little focus has been given to mission-related aspects and how the command and control (C2) map display contributes to mission accomplishment. This study uses cognitive work analysis (CWA) to describe the operational work of the mission operator of a Skylark miniature UAS system. Three CWA phases were conducted - work domain analysis, control task analysis and strategy analysis - providing a rich framework of operational mission phases, task components, processes and the physical interface-objects in use. These representations highlight the operators' extensive use of the C2 map during all mission phases, for all object-related processes. To further enhance the outcomes of the CWA, and prior to outlining specific design requirements, an empirical investigation was conducted in which the eye movements of five experienced operators were obtained during a simulated mission. The empirical results confirm and further specify the work patterns that operators adopt. Quantitative analysis shows operators' extensive focus on the map, especially during mission-critical phases. These analyses led to the conclusion that a significant change in the way operators interact with the C2 map, or alternative designs to enhance map-based information utilization, should be applied. Insights drawn from this analysis can be applied to other aerial surveillance work domains, and adding empirical evaluations is helpful to further refine and reinforce the CWA outcomes.