Maternal Sex Chromosome Aneuploidy Identified through Noninvasive Prenatal Screening: Clinical Profile and Patient Experience.

OBJECTIVE: Noninvasive prenatal screening (NIPS) may incidentally identify maternal aneuploidies that have health implications. We evaluated patients' experience with counseling and follow-up diagnostic testing after NIPS flags a potential maternal sex chromosome aneuploidy (SCA). STUDY DESIGN: Patients who underwent NIPS at two reference laboratories between 2012 and 2021 and had test results that were consistent with possible or probable maternal SCA were contacted with a link to an anonymous survey. Survey topics included demographics, health history, pregnancy history, counseling, and follow-up testing. RESULTS: A total of 269 patients responded to the anonymous survey, and 83 of these individuals also completed one follow-up survey. Most received pretest counseling. A total of 80% were offered fetal genetic testing during the pregnancy, and 35% of patients completed diagnostic maternal testing. Monosomy X-related phenotypes such as short stature or hearing loss prompted follow-up testing that led to a diagnosis of monosomy X in 14 (6%) cases. CONCLUSION: Follow-up counseling and testing after a high-risk NIPS result suggestive of maternal SCA is heterogenous in this cohort and may be frequently incomplete. Health outcomes may be affected by these results and additional research could improve the provision, delivery, and quality of posttest counseling. KEY POINTS: · NIPS results showing potential SCA could have maternal health implications.. · Variations in counseling and testing after NIPS were observed for women with suspected SCA.. · Comprehensive counseling and diagnostic testing strategies are critical for these patients..

Health Care Disparities and the Emergency Management of Postpartum Patients with Cardiovascular Complaints.

OBJECTIVE: This study aimed to determine health care disparities in evaluation and admission among underserved racial and ethnic minority groups presenting with cardiovascular complaints during the first postpartum year according to patient and provider demographics. STUDY DESIGN: A retrospective cohort study was performed on all postpartum patients who sought emergency care between February 2012 and October 2020 in a large urban care center in Southeastern Texas. Patient information was collected according to International Classification of Diseases 10th Revision codes and individual chart analysis. Race, ethnicity, and gender information were self-reported for both patients on hospital enrollment forms and emergency department (ED) providers on their employment records. Statistical analysis was performed with logistic regression and Pearson's chi-square test. RESULTS: Of 47,976 patients who delivered during the study period, 41,237 (85.9%) were black, Hispanic, or Latina and 490 (1.1%) presented to the ED with cardiovascular complaints. Baseline characteristics were similar between groups; however, Hispanic or Latina patients were more likely to have had gestational diabetes mellitus during the index pregnancy (6.2 vs. 18.3%). There was no difference in hospital admission between groups (17.9% black vs. 16.2% Latina or Hispanic patients). There was no difference in the hospital admission rate by provider race or ethnicity overall (p = 0.82). There was no difference in the hospital admission rate when a patient was evaluated by a provider of a different race or ethnicity (relative risk [RR] = 1.08, CI: 0.6-1.97). There was no difference in the rate of admission according to the self-reported gender of the provider (RR = 0.97, CI: 0.66-1.44). CONCLUSION: This study illustrates that disparities did not exist in the management of racial and ethnic minority groups who presented to the ED with cardiovascular complaints during the first postpartum year. Patient-provider discordance in race or gender was not a significant source of bias or discrimination during the evaluation and treatment of these patients. KEY POINTS: · Adverse postpartum outcomes disproportionately affect minorities.. · There was no difference in admissions between minority groups.. · There was no difference in admissions by provider race and ethnicity..

Maritime autonomous surface ships: can we learn from unmanned aerial vehicle incidents using the perceptual cycle model?

Interest in Maritime Autonomous Surface Ships (MASS) is increasing as it is predicted that they can bring improved safety, performance and operational capabilities. However, their introduction is associated with a number of enduring Human Factors challenges (e.g. difficulties monitoring automated systems) for human operators, with their 'remoteness' in shore-side control centres exacerbating issues. This paper aims to investigate underlying decision-making processes of operators of uncrewed vehicles using the theoretical foundation of the Perceptual Cycle Model (PCM). A case study of an Unmanned Aerial Vehicle (UAV) accident has been chosen as it bears similarities to the operation of MASS through means of a ground-based control centre. Two PCMs were developed; one to demonstrate what actually happened and one to demonstrate what should have happened. Comparing the models demonstrates the importance of operator situational awareness, clearly defined operator roles, training and interface design in making decisions when operating from remote control centres. Practitioner Summary: To investigate underlying decision-making processes of operators of uncrewed vehicles using the Perceptual Cycle Model, by using an UAV accident case study. The findings showed the importance of operator situational awareness, clearly defined operator roles, training and interface design in making decisions when monitoring uncrewed systems from remote control centres.

Articulating ethical principles guiding Target Malaria's engagement strategy.

Progress in gene drive research has engendered a lively discussion about community engagement and the ethical standards the work hinges on. While there is broad agreement regarding ethical principles and established best practices for conducting clinical public health research, projects developing area-wide vector control technologies and initiating ambitious engagement strategies raise specific questions: who to engage, when to engage, and how? When responding to these fundamental questions, with few best practices available for guidance, projects need to reflect on and articulate the ethical principles that motivate and justify their approach. Target Malaria is a not-for-profit research consortium that aims to develop and share malaria control and elimination technology. The consortium is currently investigating the potential of a genetic technique called gene drive to control populations of malaria vectoring mosquito species Anopheles gambiae. Due to the potentially broad geographical, environmental impact of gene drive technology, Target Malaria has committed to a robust form of tailored engagement with the local communities in Burkina Faso, Mali, and Uganda, where research activities are currently taking place. This paper presents the principles guiding Target Malaria's engagement strategy. Herein the authors (i) articulate the principles; (ii) explain the rationale for selecting them; (iii) share early lessons about the application of the principles. Since gene drive technology is an emerging technology, with few best practices available for guidance, the authors hope by sharing these lessons, to add to the growing literature regarding engagement strategies and practices for area-wide vector control, and more specifically, for gene drive research.

The quest for the ring: a case study of a new submarine control room configuration.

Submarine control room layouts have remained similar across decades of operation, despite the introduction of new technologies that allow for the co-location of the sound and control room. Operation of an inwards, rather than outwards, facing ring control room configuration was examined in three scenarios: Return to Periscope Depth, Inshore Operations, and Dived Tracking. A case study design employed a serving team of qualified submariners participated in all three scenarios with high and low demand. Communications and activities in the control room were recorded and analysed using the Event Analysis of Systemic Teamwork (EAST) method. EAST models collaborative teamwork through social, information, and task networks. The results from the ring configuration were compared to an outward facing baseline of the contemporary control room layout with a separate sound and control room. The ring control room configuration increased communications between operators, leading to a more information exchanged, and more tasks completed. Practitioner summary: Control room design on submarines, and other domains, has traditionally been outward facing with supervisory staff looking over the shoulders of their subordinates. In this paper, and inward looking control room design was explored, with subordinate staff facing their supervisors. This design resulted in more information exchange and productive work.

State of science: models and methods for understanding and enhancing teams and teamwork in complex sociotechnical systems.

This state of the science review brings together the disparate literature of effective strategies for enhancing and accelerating team performance. The review evaluates and synthesises models and proposes recommended avenues for future research. The two major models of the Input-Mediator-Output-Input (IMOI) framework and the Big Five dimensions of teamwork were reviewed and both will need significant development for application to future teams comprising non-human agents. Research suggests that a multi-method approach is appropriate for team measurements, such as the integration of methods from self-report, observer ratings, event-based measurement and automated recordings. Simulations are recommended as the most effective team-based training interventions. The impact of new technology and autonomous agents is discussed with respect to the changing nature of teamwork. In particular, whether existing teamwork models and measures are suitable to support the design, operation and evaluation of human-nonhuman teams of the future. Practitioner summary: This review recommends a multi-method approach to the measurement and evaluation of teamwork. Team models will need to be adapted to describe interaction with non-human agents, which is what the future is most likely to hold. The most effective team training interventions use simulation-based approaches.

A review of the toxicology of oil in vertebrates: what we have learned following the Deepwater Horizon oil spill.

In the wake of the Deepwater Horizon (DWH) oil spill, a number of government agencies, academic institutions, consultants, and nonprofit organizations conducted lab- and field-based research to understand the toxic effects of the oil. Lab testing was performed with a variety of fish, birds, turtles, and vertebrate cell lines (as well as invertebrates); field biologists conducted observations on fish, birds, turtles, and marine mammals; and epidemiologists carried out observational studies in humans. Eight years after the spill, scientists and resource managers held a workshop to summarize the similarities and differences in the effects of DWH oil on vertebrate taxa and to identify remaining gaps in our understanding of oil toxicity in wildlife and humans, building upon the cross-taxonomic synthesis initiated during the Natural Resource Damage Assessment. Across the studies, consistency was found in the types of toxic response observed in the different organisms. Impairment of stress responses and adrenal gland function, cardiotoxicity, immune system dysfunction, disruption of blood cells and their function, effects on locomotion, and oxidative damage were observed across taxa. This consistency suggests conservation in the mechanisms of action and disease pathogenesis. From a toxicological perspective, a logical progression of impacts was noted: from molecular and cellular effects that manifest as organ dysfunction, to systemic effects that compromise fitness, growth, reproductive potential, and survival. From a clinical perspective, adverse health effects from DWH oil spill exposure formed a suite of signs/symptomatic responses that at the highest doses/concentrations resulted in multi-organ system failure.

Planktonic Fiddler Crab (Uca longisignalis) Are Susceptible to Photoinduced Toxicity Following in ovo Exposure in Oiled Mesocosms.

Benthic organisms may be exposed to polycyclic aromatic hydrocarbons (PAHs) in marine sediments as the result of oil spills. PAH photoinduced toxicity, which has been documented in a wide range of early life stage (ELS) aquatic biota, is a phenomenon by which ultraviolet (UV) radiation potentiates the toxicity of photodynamic PAHs (often leading to mortality). Fiddler crabs (Uca longisignalis) are important ecosystem engineers that influence biogeochemical cycles via burrowing. As gravid females burrow, their eggs may bioaccumulate PAHs from contaminated sediments, leading to in ovo exposure. Consequently, free-swimming larvae exposed to intense UV may be at risk for photoinduced toxicity. In the present study, mature fiddler crabs were bred on oiled sediments contaminated via simulated tidal flux. Gravid females were transferred to clean water after 10 days, and larvae were collected at hatch. While in ovo exposures to oil alone did not affect survival, offspring that were subsequently exposed to full spectrum sunlight in clean water experienced significant mortality that corresponded with in ovo exposures to sediments containing ≥1455 µg/kg tPAH50. Results presented here provide evidence for the potential of photoinduced toxicity to occur in benthic organisms with free-swimming early life stages.

Exposure to Crude Oil Induces Retinal Apoptosis and Impairs Visual Function in Fish.

Polycyclic aromatic hydrocarbons (PAHs) present in crude oil are known to impair visual development in fish. However, the underlying mechanism of PAH-induced toxicity to the visual system of fish is not understood. Embryonic zebrafish (Danio rerio) at 4 h post fertilization were exposed to weathered crude oil and assessed for visual function using an optokinetic response, with subsequent samples taken for immunohistochemistry and gene expression analysis. Cardiotoxicity was also assessed by measuring the heart rate, stroke volume, and cardiac output, as cardiac performance has been proposed to be a contributing factor to eye-associated malformations following oil exposure. Larvae exposed to the highest concentrations of crude oil (89.8 µg/L) exhibited an increased occurrence of bradycardia, though no changes in stroke volume or cardiac output were observed. However, genes important in eye development and phototransduction were downregulated in oil-exposed larvae, with an increased occurrence of cellular apoptosis, reduced neuronal connection, and reduced optokinetic behavioral response in zebrafish larvae.

Mapping physical functions of the shoulder to American Shoulder and Elbow Surgeons and Patient-Reported Outcomes Measurement Information System scores.

BACKGROUND: We sought to correlate physical functions of the shoulder to American Shoulder and Elbow Surgeons (ASES) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. METHODS: We reviewed 3300 patient encounters with completed ASES scores, representing 2447 patients. Patients were seen for shoulder-related complaints. The most common diagnoses were rotator cuff disease (56%) and arthritis (9%); 54% and 46% of encounters were in operatively and nonoperatively treated patients, respectively. A total of 2632 PROMIS Physical Function (PF), 2574 PROMIS Pain Interference (PI), and 959 PROMIS Upper Extremity (UE) scores were simultaneously collected with the ASES form. The ASES form specifically asks about the ability to perform 8 physical functions. Receiver operating characteristic curves were calculated to determine 90% positive predictive value (PPV) and 90% negative predictive value (NPV) cutoffs for the ability to perform at high function for the ASES and PROMIS-PF, -UE, and -PI scores for the entire shoulder cohort and for rotator cuff disease and arthritis subgroups. RESULTS: ASES scores had consistently excellent ability, PROMIS-UE scores had reasonable to excellent ability, and PROMIS-PF and PROMIS-PI scores had overall reasonable ability to determine high- and low-function states. For reaching a high shelf in the rotator cuff disease subgroup, the 90% NPV and PPV cutoff scores were 41 and 66, respectively, for the ASES instrument. For reaching a high shelf in the arthritis subgroup, the cutoff scores were 50 and 78, respectively, for the ASES instrument. The 90% NPV and PPV cutoffs for each score, physical function, and diagnosis group were depicted by visual representations ("maps") for easier interpretation. CONCLUSION: Shoulder physical functions were mapped to outcome scores. Physical function mapping adds clinical meaning to the orthopedic literature, facilitating improved, more-informed decision making between physicians and patients.

Mahi-mahi (Coryphaena hippurus) life development: morphological, physiological, behavioral and molecular phenotypes.

BACKGROUND: Mahi-mahi (Coryphaena hippurus) is a commercially and ecologically important fish species that is widely distributed in tropical and subtropical waters. Biological attributes and reproductive capacities of mahi-mahi make it a tractable model for experimental studies. In this study, life development of cultured mahi-mahi from the zygote stage to adult has been described. RESULTS: A comprehensive developmental table has been created reporting development as primarily detailed observations of morphology. Additionally, physiological, behavioral, and molecular landmarks have been described to significantly contribute in the understanding of mahi life development. CONCLUSION: Remarkably, despite the vast difference in adult size, many developmental landmarks of mahi map quite closely onto the development and growth of Zebrafish and other warm-water, active Teleost fishes.

Better together? Investigating new control room configurations and reduced crew size in submarine command and control.

The separation of the sound and control rooms in Royal Navy submarines seems to be artefactually reducing the effectiveness of information transition and the overall productivity of the team. A proposed integrated sound and control room was tested in three scenarios: Return to Periscope Depth (RTPD), Inshore Operations (INSO) and Dived Tracking (DT). The activities and communications of a team of serving submariners were recorded in a control room, in a single case study design, comparing co-location and reduced crewing with a baseline of the separate sound and control room configurations that is representative of current submarines. The Event Analysis of Systemic Teamwork (EAST) method was used to examine changes in social, information and task networks. In general terms, the co-location of the submariner team led to more efficient communication and completion of tasks. Reducing the crew was more challenging in the higher demand scenarios. Practitioner Summary: There are constraints acting on control rooms, both in terms of physical space and crew size. This study compared conventional control room with co-location and reduced crew in turn. Teamwork improved in the collocated control room but the reduced crew struggled most under conditions of high demand. Abbreviations: DT: dived tracking; EAST: event analysis for systemic teamwork; H: high; INSO: inshore operations; L: low; OOW: office of the watch; OpsO: operations officer; Peri: periscope operator; RTPD: return to periscope depth; RN: royal navy; SoC: sonar controller; SoP: sonar operator; TMA: time-motion analyst.

Correction to: Mercury accumulation, speciation, and temporal trends in Atlantic Stingrays (Hypanus sabinus).

The corrections are: In the 2nd sentence of the Statistical Analyses section, the current sentence lacks important statistical assumption wording.

Mercury accumulation, speciation, and temporal trends in Atlantic Stingrays (Hypanus sabinus).

Mercury (Hg) deposited into aquatic sediments can be converted into the more toxic methylmercury (MeHg) by microbial activity. Atlantic stingrays (Hypanus sabinus) are an estuarine and nearshore species found in coastal regions of the western North Atlantic, occurring in multiple habitat types, and feeding mainly on benthic invertebrates. Mercury dynamics and speciation in stingrays have not been well examined. This study quantified total Hg and Hg species (Hg (II) and MeHg) in Atlantic stingrays sampled from Florida's Indian River Lagoon (IRL) from 2012 to 2013. Tissues (muscle and liver) collected from 29 stingrays were lyophilized and homogenized before being analyzed using a direct mercury analyzer. Concentrations of total Hg in muscle were positively related to stingray disk width, but concentrations in liver were not. Mean (±SD) total Hg in muscle (0.56 ± 0.30 mg/kg dw) was significantly higher than mean total Hg in liver (0.23 ± 0.19 mg/kg dw). Within liver tissue, percent MeHg (of total Hg) ranged from 31 to 99%. The ratio between total Hg in liver and total Hg in muscle was <1 for nearly all individuals, suggesting a lack of active hepatic demethylation and sequestration mechanisms. Concentrations of Hg in IRL Atlantic stingrays fall below concentrations known to result in direct toxicity to fishes; however, effects thresholds are not well understood for elasmobranchs. Comparisons of Hg concentrations in IRL Atlantic stingrays sampled previously (37 individuals in 1994) indicate that total Hg concentrations in muscle of Atlantic stingrays have decreased over the past two decades, suggesting a reduction in the bioavailable Hg in the IRL ecosystem.

Environmental Pollution, Management, and Sustainable Development: Strategies for Vietnam and Other Developing Countries.

This editorial introduces the issue of selected papers that were presented at the third International Conference on Environmental Pollution, Restoration, and Management in Quy Nhon, Vietnam on 6-10 March 2017. While environmental problems caused by diverse municipal, industrial, and other economic development activities continue to increase in many Asian countries, public awareness about environmental management for public health and the environment remain at levels that favor accepting environmental degradation and impacts for tradeoffs with economic values. This special issue resulted from a conference that was organized to bringing scientists from developed and developing countries to Vietnam to share experiences, discuss environmental problems, and enhance future collaborations for research and training in support of better management plans for the environment and health. Papers published in this issue present original results from diverse research on current environmental management challenges in Vietnam and other Asian countries. The research areas include environmental contamination in groundwater and diet that affect human health, waste composting, and effects of wastewater effluent, which is one of the greatest challenges in most Asian countries. In addition, impacts of hazardous chemical emissions and related environmental management efforts, and sustainable development approaches are included.

Use of Highways in the Sky and a virtual pad for landing Head Up Display symbology to enable improved helicopter pilots situation awareness and workload in degraded visual conditions.

Flight within degraded visual conditions is a great challenge to pilots of rotary-wing craft. Environmental cues typically used to guide interpretation of speed, location and approach can become obscured, forcing the pilots to rely on data available from in-cockpit instrumentation. To ease the task of flight during degraded visual conditions, pilots require easy access to flight critical information. The current study examined the effect of 'Highways in the Sky' symbology and a conformal virtual pad for landing presented using a Head Up Display (HUD) on pilots' workload and situation awareness for both clear and degraded conditions across a series of simulated rotary-wing approach and landings. Results suggest that access to the HUD lead to significant improvements to pilots' situation awareness, especially within degraded visual conditions. Importantly, access to the HUD facilitated pilot awareness in all conditions. Results are discussed in terms of future HUD development. Practitioner Summary: This paper explores the use of a novel Heads Up Display, to facilitate rotary-wing pilots' situation awareness and workload for simulated flights in both clear and degraded visual conditions. Results suggest that access to HUD facilitated pilots' situation awareness, especially when flying in degraded conditions.

Changes in microRNA-mRNA Signatures Agree with Morphological, Physiological, and Behavioral Changes in Larval Mahi-Mahi Treated with Deepwater Horizon Oil.

In this study, we performed a systematic evaluation of global microRNA-mRNA interactions associated with the developmental toxicity of Deepwater Horizon oil using a combination of integrated mRNA and microRNA deep sequencing, expression profiling, gene ontology enrichment, and functional predictions by a series of advanced bioinformatic tools. After exposure to water accommodated fraction (WAF) of both weathered slick oil (0.5%, 1%, and 2%) and source oil (0.125%, 0.25%, and 0.5%) from the Deep Water Horizon oil spill, four dose-dependent miRNAs were identified, including three up-regulated (miR-23b, miR-34b, and miR-181b) and one down-regulated miRNAs (miR-203a) in mahi-mahi hatchings exposed from 6 h postfertilization (hpf) to 48 hpf. Consistent with morphological, physiological, and behavioral changes, the target genes of these miRNAs were largely involved in the development of the cardiovascular, visual, nervous system and associated toxicity pathways, suggesting that miRNAs play an essential role in regulating the responses to oil exposure. The results obtained from this study improve our understanding of the role of miRNAs and their target genes in relation to dose-dependent oil toxicity and provide the potential of using miRNAs as novel biomarkers in future oil studies.

Alterations to the Intestinal Microbiome and Metabolome of Pimephales promelas and Mus musculus Following Exposure to Dietary Methylmercury.

Mercury is a global contaminant, which may be microbially transformed into methylmercury (MeHg), which bioaccumulates. This results in potentially toxic body burdens in high trophic level organisms in aquatic ecosystems and maternal transfer to offspring. We previously demonstrated effects on developing fish including hyperactivity, altered time-to-hatch, reduced survival, and dysregulation of the dopaminergic system. A link between gut microbiota and central nervous system function in teleosts has been established with implications for behavior. We sequenced gut microbiomes of fathead minnows exposed to dietary MeHg to determine microbiome effects. Dietary exposures were repeated with adult CD-1 mice. Metabolomics was used to screen for metabolome changes in mouse brain and larval fish, and results indicate effects on lipid metabolism and neurotransmission, supported by microbiome data. Findings suggest environmentally relevant exposure scenarios may cause xenobiotic-mediated dysbiosis of the gut microbiome, contributing to neurotoxicity. Furthermore, small-bodied teleosts may be a useful model species for studying certain types of neurodegenerative diseases, in lieu of higher vertebrates.

Effects of Deepwater Horizon crude oil on ocular development in two estuarine fish species, red drum (Sciaenops ocellatus) and sheepshead minnow (Cyprinodon variegatus).

Polycyclic aromatic hydrocarbons (PAHs) present in crude oil have been shown to cause the dysregulation of genes important in eye development and function, as well as morphological abnormalities of the eye. However, it is not currently understood how these changes in gene expression are manifested as deficits in visual function. Embryonic red drum (Sciaenops ocellatus) and sheepshead minnow (Cyprinodon variegatus) were exposed to water accommodated fractions (WAFs) of weathered crude oil and assessed for visual function using an optomotor response assay in early life-stage larvae, with subsequent samples taken for histological analysis of the eyes. Larvae of both species exposed to increasing concentrations of oil exhibited a reduced optomotor response. The mean diameters of retinal layers, which play an important role in visual function and image processing, were significantly reduced in oil-exposed sheepshead larvae, though not in red drum larvae. The present study provides evidence that weathered crude oil has a significant effect on visual function in early life-stage fishes.

Photo-induced toxicity in early life stage fiddler crab (Uca longisignalis) following exposure to Deepwater Horizon oil.

The 2010 explosion of the Deepwater Horizon (DWH) oil rig led to the release of millions of barrels of oil in the Gulf of Mexico. Oil in aquatic ecosystems exerts toxicity through multiple mechanisms, including photo-induced toxicity following co-exposure with UV radiation. The timing and location of the spill coincided with both fiddler crab reproduction and peak yearly UV intensities, putting early life stage fiddler crabs at risk of injury due to photo-induced toxicity. The present study assessed sensitivity of fiddler crab larvae to photo-induced toxicity during co-exposure to a range of environmentally relevant dilutions of high-energy water accommodated fractions of DWH oil, and either <10, 50, or 100% ambient sunlight, achieved with filters that allowed for variable UV penetration. Solar exposures (duration: 7-h per day) were conducted for two consecutive days, with a dark recovery period (duration: 17-h) in between. Survival was significantly decreased in treatments the presence of >10% UV and relatively low concentrations of oil. Results of the present study indicate fiddler crab larvae are sensitive to photo-induced toxicity in the presence of DWH oil. These results are of concern, as fiddler crabs play an important role as ecosystem engineers, modulating sediment biogeochemical processes via burrowing action. Furthermore, they occupy an important place in the food web in the Gulf of Mexico.