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Objectives Pre-eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure stage B (HF-B). In this study we assessed the relation between endothelial function, by means of flow-mediated dilation (FMD), and HF-B at 4 years postpartum. Methods In 67 formerly PE women and 37 healthy parous controls, we ultrasonographically assessed cardiac function, geometry and FMD. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) >95 g/m2), concentric remodelling (relative wall thickness (RWT) >0.42 and LVMi ≤95 g/m2), mild systolic dysfunction (left ventricular ejection fraction (LVEF) >40 and

The term “Big Data” refers to massive volumes of data that grow at an increasing rate and encompass complex data types such as audio and video. While the applications of Big Data and analytic techniques for business purposes have received considerable attention, it is less clear how external sources of Big Data relate to the transaction processing-oriented world of accounting information systems. This paper uses the Resource-Event-Agent Enterprise Ontology (REA) (McCarthy 1982; International Standards Organization [ISO] 2007) to model the implications of external Big Data sources on business transactions. The five-phase REA-based specification of a business transaction as defined in ISO (2007) is used to formally define associations between specific Big Data elements and business transactions. Using Big Data technologies such as Apache Hadoop and MapReduce, a number of information extraction patterns are specified for extracting business transaction-related information from Big Data. We also present a number of analytics patterns to demonstrate how decision making in accounting can benefit from integrating specific external Big Data sources and conventional transactional data. The model and techniques presented in this paper can be used by organizations to formalize the associations between external Big Data elements in their environment and their accounting information artifacts, to build architectures that extract information from external Big Data sources for use in an accounting context, and to leverage the power of analytics for more effective decision making.

Objectives Pre-eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF-B). In this study, we assessed the relationship between endothelial function, measured by flow-mediated dilation (FMD), and HF-B in women with a history of PE. Methods This was an observational study in which 67 formerly pre-eclamptic women (>= 4 years postpartum) and 37 healthy parous controls were assessed ultrasonographically for cardiac function and geometry, as well as for endothelial function by means of brachial artery FMD. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m(2)), concentric remodeling (relative wall thickness> 0.42 and LVMi 40% and < 55%) or asymptomatic valvular disease. Cardiovascular and metabolic syndrome variables were compared between women with history of PE and controls, as well as between those in the formerly pre-eclamptic group who had HF Stage A, HF-B or no HF. Logistic regression analysis was performed to assess the associations of FMD with PE, metabolic syndrome risk factors and obstetric parameters. Results The prevalence of HF-B amongst formerly pre-eclamptic women was three-fold higher than that observed for controls (25% vs 8%, P < 0.05), while FMD was lower in formerly pre-eclamptic women compared with controls (6.12% vs 8.22%, P < 0.01); history of PE remained associated independently with lower FMD after adjusting for metabolic syndrome risk factors and obstetric parameters (beta, -1.88; 95% CI, -3.59 to -0.18). However, HF-B did not relate to low FMD in formerly pre-eclamptic women. Conclusions Years after pregnancy, formerly preeclamptic women have lower FMD and have HF-B more often compared with healthy parous controls. Nonetheless, HF-B was not related to reduced FMD. Copyright c (C) 2017 ISUOG. Published by John Wiley & Sons Ltd.

OBJECTIVE: To examine the effects of cigarette, marihuana and methamphetamine smoking and consumption of alcohol during pregnancy on maternal serum alpha-fetoprotein (MSAFP) levels at 20-24 weeks. STUDY DESIGN: In the Safe Passage Study (SPS) more than 12,000 pregnant women were prospectively followed up during pregnancy and until the infant was one year old to examine the effects of exposure to alcohol during pregnancy on stillbirth and sudden infant death syndrome. The present study is a cross-sectional secondary analysis of MSAFP analyses done at 20-24 weeks gestation in 1,679 SPS participants, recruited at the Bishop Lavis Community Health Centre, Cape Town, South Arica. RESULTS: Low or moderate alcohol consumption with or without smoking, nor methamphetamine or marihuana use affected mean MSAFP levels. High MSAFP levels were associated with high alcohol consumption, young age, low body mass index (BMI) (

Objective To examine the effects of cigarette, marihuana and methamphetamine smoking and consumption of alcohol during pregnancy on maternal serum alpha-fetoprotein (MSAFP) levels at 20-24 weeks. Study design In the Safe Passage Study (SPS) more than 12,000 pregnant women were prospectively followed up during pregnancy and until the infant was one year old to examine the effects of exposure to alcohol during pregnancy on stillbirth and sudden infant death syndrome. The present study is a cross-sectional secondary analysis of MSAFP analyses done at 20-24 weeks gestation in 1,679 SPS participants, recruited at the Bishop Lavis Community Health Centre, Cape Town, South Arica. Results Low or moderate alcohol consumption with or without smoking, nor methamphetamine or marihuana use affected mean MSAFP levels. High MSAFP levels were associated with high alcohol consumption, young age, low body mass index (BMI) (

Pre-eclampsia (PE) is associated with both postpartum endothelial dysfunction and asymptomatic structural heart alterations consistent with heart failure Stage B (HF-B). In this study, we assessed the relationship between endothelial function, measured by flow-mediated dilation (FMD), and HF-B in women with a history of PE.This was an observational study in which 67 formerly pre-eclamptic women (≥ 4 years postpartum) and 37 healthy parous controls were assessed ultrasonographically for cardiac function and geometry, as well as for endothelial function by means of brachial artery FMD. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) 95 g/mThe prevalence of HF-B amongst formerly pre-eclamptic women was three-fold higher than that observed for controls (25% vs 8%, P 0.05), while FMD was lower in formerly pre-eclamptic women compared with controls (6.12% vs 8.22%, P 0.01); history of PE remained associated independently with lower FMD after adjusting for metabolic syndrome risk factors and obstetric parameters (β, -1.88; 95% CI, -3.59 to -0.18). However, HF-B did not relate to low FMD in formerly pre-eclamptic women.Years after pregnancy, formerly pre- eclamptic women have lower FMD and have HF-B more often compared with healthy parous controls. Nonetheless, HF-B was not related to reduced FMD. Copyright © 2017 ISUOG. Published by John WileySons Ltd.

Recently, technological developments, such as radio frequency identification (RFID), have facilitated the identification of individual things and information sharing regarding their behavior throughout the supply chain. Such developments have generated the capabilities of a highly visible supply chain (HVSC): a supply chain where the location of arbitrary individual things can be determined at any point in time by all appropriate supply chain partners, made possible by an “Internet of Things” for the supply chain, referred to as a “Supply Chain of Things.” A critical component of a Supply Chain of Things is an ontology to facilitate the visibility and interoperability of things along the supply chain. As a result, the objective of this paper is to define an ontology that leverages the availability of an individual thing's (object) identification information within the context of a standard set of economic phenomena that support multiple views in a range of data architectures. Our design science approach begins with a set of ontological primitives and gradually defines structuring principles that provide guidance for the design of supply chain systems that are characterized by increased visibility and interoperability and which facilitate management of and collaborative decision making about supply chain activities. The EAGLET ontology is named after its five primitives: E vent, AG ent, L ocation, E quipment, and T hing. The following are some of its unique characteristics: location and equipment are recognized as ontological primitives, and creating and destroying of containment structures is explicitly modeled; the economic phenomena underlying the supply chain are defined from an independent view, as opposed to a trading-partner view; the supply chain is defined from three different perspectives: the physical flow, the chain of custody, and the chain of ownership; event sequences that resemble the economic scripts underlying the supply chain are defined.

Background. Neural tube defects (NTDs) are an important category of birth defect, but surveillance remains inadequate in South Africa. Objectives. To assess the identification of NTDs at a tertiary hospital using a range of prenatal, perinatal and postnatal data sources, and to estimate the impact of prenatal diagnosis and birth prevalence for the referral area. Methods. Cases of anencephaly, encephalocele and spina bifida (SB) in a 6-year period were retrospectively identified from 5 data sources covering prenatal, perinatal and postnatal care. These were cross-correlated to avoid duplicate entries and to determine the contribution of different data sources. Details of prenatal diagnosis and termination of pregnancy (TOP) were obtained for 10 years, and birth prevalence over 2 years. Results. During a 6-year period 195 NTDs were identified at a Western Cape Province tertiary hospital. These included 59 (30%) cases of anencephaly, 28 (14%) of encephalocele and 108 (55%) of SB. The majority of NTDs (71%) were detected prenatally, although SB was less commonly diagnosed prenatally than cranial defects (56% v. 88%; p

SYNOPSIS As information and communication technologies (IT) become more deeply ingrained and inextricably woven into the fabric of organizations, more perplexing research and practice questions emerge. This commentary applies an organizing information systems research framework to accounting. The framework explicitly recognizes that complexities of the accounting value chain define relevant practice issues for research. We demonstrate application of the framework with examples that integrate different accounting disciplines and different research methodologies. Using a select number of prior research studies, we emphasize how design science, archival, and behavioral research paradigms work together to advance theory and inform practice. We also demonstrate how the framework directs future research for both well-established and emerging practice issues. JEL Classifications: M15; M41.

Discovering business rules is a complex task for which many approaches have been proposed including analysis, extraction from code, and data mining. In this paper, a novel approach is presented in which business rules for an enterprise model are generated based on the semantics of a domain ontology. Starting from an enterprise model for which the business rules need to be defined, the approach consists of four steps: (1) classification of the enterprise model in terms of the domain ontology (semantic annotation), (2) matching of the enterprise model constructs with ontology-based Enterprise Model Configurations (EMCs), (3) determination of Business Rule Patterns (BRPs) associated with the EMCs, and (4) use of the semantic annotations to instantiate the business rule patterns; that is, to specify the actual business rules. The success of this approach depends on two factors: (1) the existence of a semantically rich domain ontology, and (2) the strength of the knowledge base consisting of EMC-BRP associations. The focus of this paper is on defining and illustrating the new business rule discovery approach: Ontology-Driven Business Rule Specification (ODBRS). The domain of interest is enterprise systems, and an extended version of the Resource-Event-Agent Enterprise Ontology (REA-EO) is used as the domain ontology. A small set of EMC-BRP associations—i.e., an example knowledge base—is developed for illustration purposes. The new approach is demonstrated with an example.

Contains fulltext : 182443.pdf (Publisher’s version ) (Closed access) OBJECTIVE: The aim of this systematic review and meta-analysis was to describe comprehensively the pattern of cardiac remodeling during normotensive human singleton pregnancy and to compare it with that of pregnancy complicated by hypertension. METHODS: We performed a meta-analysis of the current literature on cardiac remodeling during normotensive and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and EMBASE (Ovid) databases. Included studies needed to report a reference measurement (matched non-pregnant control group, prepregnancy or postpartum) and measurements made during predetermined gestational-age intervals. Mean differences between reference and pregnancy data were calculated using the random-effects model described by DerSimonian and Laird. RESULTS: Forty-eight studies were included in the meta-analysis, with publication dates ranging from 1977 to 2016. During normotensive pregnancy, most geometric indices started to increase in the second trimester. Left ventricular mass (LVM) increased by 28.36 (95% CI, 19.73-37.00) g (24%), and relative wall thickness (RWT) increased by 0.03 (95% CI, 0.02-0.05) (10%) compared with those in the reference group. During hypertensive pregnancy, LVM and RWT increased more than during normotensive pregnancy (92 (95% CI, 75.46-108.54) g (95%) and 0.14 (95% CI, 0.09-0.19) (56%), respectively). CONCLUSIONS: During normotensive pregnancy, most cardiac geometric indices change from the second trimester onwards. Both LVM and RWT increase, by 20% and 10%, respectively, consistent with concentric rather than eccentric remodeling. Cardiac adaptation in hypertensive pregnancy deviates from that in healthy pregnancy by a greater change in LVM (95% increase from reference) and RWT (56% increase from reference). Copyright (c) 2017 ISUOG. Published by John Wiley & Sons Ltd.

The expansion of oxygen minimum zones (OMZ's) in estuaries can be harmful for ecology and economy, prompting the demand for expensive measures. Here we look at the oxygen dynamics in two northern temperate European estuaries, the Schelde (The Netherlands/Belgium) and the Elbe (Germany) and analysed data from the period of 2004e2009. The Schelde is characterized by two zones of increased oxygen consumption; the Elbe shows one zone of increased oxygen consumption. Despite reduction in biochemical oxygen demand in both estuaries, oxygen conditions improved in the Schelde estuary, while the oxygen minimum zone persisted in the Elbe estuary. To understand these different oxygen dynamics, we applied a one-dimensional reactive transport model to both estuaries. In the Schelde we found low oxygen concentrations to be related to organic matter and ammonium input from the major tributaries. In the Elbe, additionally to a high input of organic matter from upstream, oxygen dynamics were influenced by abrupt changes in estuarine morphology. Next, the origin of the organic matter substrate differs between the two estuaries. In the Elbe, the organic matter imported is mostly composed of algal die-off produced in the Elbe River upstream. In the Schelde the organic matter and ammonium input is mostly related to sewage input of anthropogenic origin. This implies that waste water treatment will be more effective to remediate hypoxia related problems in the Schelde than in the Elbe.

Doppler examination of the fetal middle cerebral artery (MCA) is considered highly reliable in detecting severe fetal anaemia. We present a case of a mother with severe pre-eclampsia at 32 weeks’ gestation and non-immune fetal hydrops without obvious cause. Since the MCA peak systolic velocity (PSV) was normal, severe anaemia was not considered as a possible cause, but after delivery the infant was found to be severely anaemic and died. Histological examination of the placenta revealed multiple extensive haemorrhages (subchorionic, intraparenchymal and intravillous), and autopsy indicated that the most likely cause of death was severe anaemia and hypoxia due to multiple and extensive placental haemorrhages, which had developed over the course of several days. We postulate that the MCA PSV failed to indicate severe anaemia because of the combination of subacute anaemia with severe profound hypoxia due to placental insufficiency.

The KaDo case, designed for either an advanced undergraduate AIS class or a graduate AIS class, has four parts: enterprise modeling, relational database design, integration of legacy systems, and information retrieval. The first part exposes students to advanced enterprise modeling concepts such as subtypes and advanced REA concepts such as policy specifications. The second part asks students to translate advanced modeling concepts such as subtypes into relational database structures. The objective of the third part is for students to learn how to use database software to integrate legacy systems. Their task involves two steps: importing data and integrating data. The fourth part involves information retrieval where students map information requirements into queries that can be executed by the computer. The advanced query techniques that students apply include multi-column join definitions, union, and view hierarchies. KaDo is a dynamic case that allows instructors to create a version of the case adapted to their own learning objectives. KaDo's Web Environment (KWE) further enables them to create and deliver case materials online.

The main purpose of this paper is to provide design and implementation guidance to those interested in utilizing blogs as a collaborative learning tool in any given field of study. We created the Sarbanes-Oxley Blog (SoxBlog), a web-based forum for asynchronous student-instructor-expert collaboration. Given the recent scandals and publication of the Sarbanes-Oxley Act of 2002 (SOX), we increased our emphasis on integrating corporate governance and ethics issues into the financial accounting curriculum. Students new to financial accounting were asked to research a number of targeted issues related to the accounting environment and corporate governance and to discuss them with their peers, instructor, and experts. Some of the items to be discussed include: the relationship between task and learning objectives, students’ engagement in the collaboration process, the structuring of the collaboration process, and the technological simplicity of creating and using blogs. Overall, students perceived the SoxBlog collaboration as a positive learning experience.

The Resource-Event-Agent (REA) enterprise model is a widely accepted framework for the design of the accountability infrastructure of enterprise information systems. Policy-level specifications define constraints and guidelines under which an enterprise operates, and they are an extension to the REA enterprise model, adding the “what should, could, or must be” to the “what is.” This paper aims both at comprehensive understanding of policy-level definitions as part of REA enterprise systems and at understanding of the semantic constructs that enable such definitions. We first explore two distinctive semantic abstractions essential to policy-level specifications: typification and grouping. The typification abstraction links instances of an object class to concepts for which they are concrete realizations, while the grouping abstraction aggregates objects into collections. We next present a number of patterns for the semantic modeling of policies. Following, we look at policy-level applications for REA enterprise information systems. We explore type and grouping definitions for the REA primitives (resource, event, agent) and discuss enterprise applications for three different kinds of policy definitions: knowledge-intensive descriptions, validation rules, and target descriptions. Our discussion of specific enterprise applications includes internal control applications (e.g., limit checks), variance analysis based on standard specifi-cations (e.g., bills of materials), and budgeting applications.

Objectives To predict when delivery will occur, within 48 h and 7 days of presentation and before 35 weeks’ gestation in women presenting with threatened preterm labor. Methods Sonographic measurement of cervical length was carried out in 510 women with singleton pregnancies presenting with threatened preterm labor and intact membranes at 24 to 33 + 6 weeks of gestation. The measurement was not taken into account in the subsequent management of the pregnancies. The outcome measures were delivery within 48 h and 7 days of presentation and delivery before 35 weeks. Results The median gestation at presentation was 30 + 1 (range, 24 to 33 + 6) weeks and the median cervical length was 25 (range, 1–51) mm. Delivery within 48 h of presentation occurred in 21 (4.1%) cases, delivery within 7 days occurred in 43 (8.4%) and delivery before 35 weeks occurred in 76 (14.9%). Logistic regression analysis demonstrated that the only significant independent predictor of delivery within 48 h was cervical length (odds ratio (OR), 0.73; 95% CI, 0.65–0.81) and for delivery within 7 days the independent predictors were cervical length (OR, 0.69; 95% CI, 0.63–0.76) and vaginal bleeding (OR, 19.42; 95% CI, 3.87–97.4). In the subgroup of women who did not deliver within 7 days of presentation, the incidence of delivery before 35 weeks was 7.1% (33 of 467) and the only significant independent predictor of such delivery was cervical length (OR, 0.92; 95% CI, 0.88–0.96, P < 0.0001). There was no significant independent contribution to any of the outcome measures from ethnic group, maternal age, gestational age, body mass index, parity, cigarette smoking or use of tocolytics.

Congenital rubella infection has been associated with a number of abnormalities including cardiac, central nervous system and placental complications. We present a case with multiple fetal abnormalities detected on prenatal ultrasound, and confirmed postnatally, that included a single umbilical artery, severe tricuspid regurgitation, micrognathia and agenesis of the inferior cerebellar vermis. Postnatal echocardiography additionally revealed unobstructed total anomalous pulmonary venous drainage (TAPVD) into the coronary sinus. Placental examination showed signs of placentitis, and polymerase chain reaction on neonatal serum was positive for rubella. Following a multidisciplinary team review, it was decided to provide only supportive care, and the infant died at 6 months of age owing to a respiratory tract infection. To our knowledge, TAPVD and agenesis of the inferior cerebellar vermis have not been reported previously in association with congenital rubella infection. This case illustrates how congenital infection may present in atypical ways and stresses the importance of considering congenital infection in the differential diagnosis of fetal anomalies when multiple features are present.

Cardinalities specify business rules as part of a conceptual schema. This paper presents a structured approach to teaching cardinalities in the accounting information systems (AIS) class. First, cardinalities are explained – why they are important, what they are and what notations exist to define them. Next, a three-step approach to teaching cardinalities is presented: syntactic, semantic and heuristic. Visual and syntactic representations help students understand the cardinality concept and cardinality notation. During the semantic phase, students learn to define business rules in terms of cardinalities. Heuristics help students recognize domain-specific stereotypical cardinality patterns. Such a generalization requires the existence of a semantic framework, and the REA model is used to define cardinality heuristics for enterprise systems. Finally, inter-relationship constraints, which represent participation dependencies across two or more relationships, are discussed. Introduction he data modeling approach to accounting information systems (AIS) has become increasingly popular among AIS educators (Hollander et al., 2000; Romney and Steinbart, 2003). Data models are used for the specification of conceptual schemas which represent a specific portion of reality. Conceptual schemas have a dual role (Taylor, 1990; Batini et al., 1992; Teorey, 1994; Jacobson et al., 1995; Eriksson and Penker, 2000). First, they provide a definition of the enterprise model; that is, the description of the phenomena to be captured in the information system such as the economic activities of a company. Second, they provide a starting point for the actual design of the information system. A data model provides a set of modeling constructs such as entity, relationship and cardinality to define conceptual schemas. Entities depict the basic things that need to be represented in the information system, and relationships depict associations among two or more entities. Cardinalities define participation constraints for relationships and have two specific roles: (1) they are used to primarily define business rules as part of the enterprise model specifications, and (2) they can be used as part of a top-down normalization process during the actual design of the information system (Nijssen and Halpin, 1989; Batini et al., 1992). The objective of this paper is to present a structured approach for teaching students how to use cardinalities to define business rules as part of the enterprise model. What are cardinalities? Romney and Steinbart (2003) define cardinalities as follows: “Cardinalities indicate how many instances of one entity can be linked to one specific instance of another entity” (p.123). Stated differently, cardinalities express constraints on the participation of instances of an entity in a relationship. There are two different types of constraints and thus two different types of cardinalities: the minimum cardinality and the maximum cardinality. A minimum cardinality defines whether an instance has to participate in a relationship. If “yes,” the participation is mandatory. If “no,” the participation is optional. Therefore, the minimum cardinality defines a dependency. Put another way, the following question arises: can an instance exist without participating in the relationship? “Yes” means that participation is optional while “no” means that participation is mandatory. The maximum cardinality defines the number of times an instance can participate in a relationship. A constraint exists if an instance can participate only once in a relationship. No constraint exists if an instance can participate many times in a relationship. Figure 1 illustrates the definition of cardinalities using the Batini et al. (1992) notation. Both a minimum and a maximum cardinality are defined for each entity that participates in the relationship. Binary relationships, like the one in Figure 1, connect two entities and thus have four cardinalities defined. Instances of entity A do not have to participate in the relationship (MIN: “O”), but if they do, they can participate only once T The Review of Business Information Systems Volume 8, Number 4

XML (eXtensible Markup Language) is an emerging technology that is extensively used in enterprise application integration and e-business collaborations. This paper presents an integrated case, SportsStuff.com (SSC), that exposes students to “native” XML technologies (those technologies that are based on the XML specification) and illustrates how they can support innovative e-business applications. First, the case introduces three native XML technologies that facilitate data exchange between networked applications: XML documents, XML Schema, and XSLT. Second, the case explores the uses of these technologies in an e-business collaboration scenario.

Aims To examine the prevalence of chromosomal defects and outcome of fetuses with megacystis at 10-14 weeks of gestation.Methods At the 10-14-week scan fetal megacystis was defined by a lontitudinal bladder diameter of 7 mm or more. In 145 such fetuses the fetal karyotype and pregnancy outcome were examined in relation to the longitudinal diameter of the fetal bladder.Results Chromosomal defects, mainly trisomies 13 and 18, were present in 30 cases. In the group with longitudinal bladder diameter of 7-15 mm the incidence of chromosomal defects was 23.6% (26/110), whereas in those with bladder diameter >15 mm the incidence was 11.4% (4/35). The fetal nuchal translucency (NT) was above the 95th centile of the normal range for crown-rump length in a higher proportion of cases with abnormal rather than normal karyotype (76.7% compared to 31.3%; Chi-square P 15 mm demonstrated spontaneous resolution of the megacystis.Conclusions In fetal megacystis with longitudinal bladder diameter of 7-15 mm there is a risk of about 25% that the fetus will have a chromosomal defect but in the chromosomally normal group there is spontaneous resolution of the megacystis in about 90% of cases. If the bladder diameter is > 15 mm the risk of chromosomal defects is about 10% and in the chromosomally normal group the condition is invariably associated with progressive obstructive uropathy. Copyright (C) 2003 ISUOG. Published by John Wiley Sons, Ltd.

Instructors increasingly use a data modeling approach to teach accounting information systems (AIS). An important part of data modeling is the specification of cardinalities. Cardinalities represent constraints on the participation of entities in a relationship and are used to express business practices. Stevie is an Internet tool that helps students learn cardinalities. Stevie has a number of unique features. First, Stevie is a collaborative effort; its content is created by a number of instructors. Second, Stevie is a dynamic Internet application. Dynamic Internet technology enables instructors to manage student accounts, add exercises, and create customized assignments. Further, customized assignments make it easy for instructors to adapt Stevie's content to specific learning objectives for their AIS course. For example, instructors can create assignments where students have to define stereotypical cardinality patterns or heuristics for REA relationships. Finally, Stevie supports accounting-specific classifications that make the creation of customized assignments for the AIS class easier.

This paper describes the design, capabilities, strengths and weaknesses of a tool that collects data from subjects through the Internet. The Internet tool was designed for students studying cardinalities, a difficult data modeling topic frequently taught in the accounting information systems course. The Internet tool was able to observe usage and task accomplishments of subjects. We used these observations to learn characteristics about tool usage and to compare computer-recorded and self-reported data. These comparisons allow us to evaluate the Internet tool as a data collection device.

Objective To determine whether the incidence of preeclampsia is different in dichorionic compared to monochorionic twin pregnancies. Methods The study involved 666 twin pregnancies resulting in two live births after 24 weeks of gestation. Ultrasound examination at 10–14 weeks of gestation demonstrated that 171 (25.7%) were monochorionic and 495 (74.3%) were dichorionic twins. Pregnancy outcome information regarding the development of pre-eclampsia was obtained from the maternity units. The incidence of pre-eclampsia in the dichorionic and monochorionic twin pregnancies was compared. Results The incidence of pre-eclampsia in monochorionic twin pregnancies (9.4%) was not significantly different from that in dichorionic pregnancies (7.3%) ( P = 0.48). Multiple logistic regression revealed that chorionicity has no effect on the development of pre-eclampsia after adjusting for maternal age, ethnic group, maternal smoking, parity and gestational age at delivery (P = 0.6; odds ratio for monochorionic compared with dichorionic twin pregnancies, 1.19; 95% confidence interval, 0.61–2.3). Conclusion In twin pregnancies chorionicity does not affect the incidence of pre-eclampsia.

Objective To determine the effects of chromosomal defects on fetal heart rate at 10–14 weeks of gestation. Methods Fetal heart rate at 10–14 weeks of gestation in 1061 chromosomally abnormal fetuses was compared to that from 25 000 normal pregnancies. The chromosomally abnormal group included 554 cases of trisomy 21, 219 cases of trisomy 18, 95 of trisomy 13, 50 of triploidy, 115 of Turner syndrome and 28 of sex chromosome abnormalities other than Turner syndrome. Results In the normal group, fetal heart rate decreased from a mean value of 170 beats per minute (bpm) at 35 mm of crown–rump length to 155 bpm at 84 mm crown–rump length. In trisomy 21, trisomy 13 and Turner syndrome fetal heart rate was significantly higher, in trisomy 18 and triploidy the heart rate was lower and in other sex chromosome defects it was not significantly different from normal. Fetal heart rate was above the 95th centile of the normal range in 10%, 67% and 52% of fetuses with trisomy 21, trisomy 13 and Turner syndrome, respectively. The fetal heart rate was below the 5th centile in 30% of fetuses with triploidy and 19% of those with trisomy 18. Conclusions Trisomy 21, trisomy 13 and Turner syndrome are associated with fetal tachycardia, whereas in trisomy 18 and triploidy there is fetal bradycardia. Inclusion of fetal heart rate in a first-trimester screening program for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness is unlikely to provide useful improvement in sensitivity. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology

A limitation of existing accounting systems is their lack of knowledge sharing and knowledge reuse, which makes the design and implementation of new accounting systems time-consuming and expensive. An important requirement for knowledge sharing and reuse is the existence of a common semantic infrastructure. In this article we use McCarthy's (1982) Resource-Event-Agent (REA) model as a common semantic infrastructure in an accounting context. The objective is to make knowledge-intensive use of REA to share accounting concepts across functional boundaries and to reuse these concepts in different applications and different systems, an approach we call augmented intensional reasoning. Intensional reasoning is the active use of conceptual structures in information systems operations such as design and information retrieval. For augmented intensional reasoning, the conceptual structures are extended with domain-specific REA knowledge. Sections II and III describe different dimensions of augmented intensional reasoning: the REA primitives, the technological features needed to support augmented intensional reasoning, the need for epistemologically adequate representations to make augmented intensional reasoning feasible, and the practical necessity of implementation compromises. Sections IV and V explore two uses of augmented intensional reasoning: design and operation of knowledge-based accounting systems. The example in Section V explains how augmented intensional reasoning works: (1) define the conceptual schema, (2) structure the conceptual schema in terms of REA (knowledge augmentation), (3) define a shareable and reusable accounting concept (claim), and (4) use the concept (claim) to derive information in different accounting cycles (revenue and acquisition).

The Belgian Chocolate Company (BCC) case was designed to be used in an accounting information systems (AIS) class with strong emphasis on the Resource-Event-Agent (REA) model, data modeling, and database design. Students are asked to design, implement, and use an accounting database. A unique feature of the case is its delivery through the Internet by means of a dynamic web site. Instructors are able to adapt the content of the case to their specific needs and to create individualized assignments for students.

This paper presents the Internet as an alternative mechanism for delivering Accounting Information Systems (AIS) study tools. First, a comparison between Internet and tradi-tional delivery methods, such as pencil and paper, disk and CD-ROM is presented. The main advantages of the Internet over the other delivery forms are increased flex-ibility and ease of distribution. Next, we present an Internet study tool that was devel-oped for students learning cardinalities, which is a difficult data modeling topic cov-ered in many AIS courses. We first look at the design of the study tool. Then, we dis-cuss some of the features of the study tool: interactivity, multimedia, distribution and flexibility. Finally, we report some of the lessons learned from the actual delivery of the AIS study tool through the Internet.

The article discusses various reports published within the issue, including one by Frederik Gailly, Wim Laurier, and Geert Poels on the Resource-Event-Agent (REA) model, another by Tod Sedbrook and Richard I. Newmark on automation in the REA model, and one by A. Faye Borthick, Paul L. Bowen, and Gregory J. Gerard on the use of the REA model in semantic web technologies.

In a previous study conducted in the UK we demonstrated that only 8% of women with threatened preterm labor deliver within 7 days. Furthermore, delivery within 7 days occurred in less than 1% of women presenting with a sonographically measured cervical lengthor = 15 mm, compared to 37% in those with cervical length15 mm. In this study we investigate the potential value of cervical length in the prediction of outcome of threatened preterm labor in a South African population.We examined 63 women with singleton pregnancies presenting with regular and painful uterine contractions at 24-36 (mean, 31) weeks of gestation. Women in active labor, defined by the presence of cervical dilatationor = 3 cm, and those with ruptured membranes were excluded. On admission to the hospital a transvaginal scan was performed to measure the cervical length. The subsequent management was determined by the attending obstetrician. The primary outcome was delivery within 7 days of presentation.Delivery within 7 days of presentation occurred in 20/63 (32%) pregnancies, including 20 of the 30 (67%) cases with cervical length15 mm and none of the 33 cases with cervical lengthor = 15 mm. Logistic regression analysis demonstrated that the only significant contributor in the prediction of delivery within 7 days was cervical length (odds ratio 0.67; 95% CI 0.54-0.85; P = 0.001) with no significant independent contribution from maternal age, gestational age, body mass index, parity, use of antibiotics, previous history of preterm delivery, cigarette smoking, contraction frequency or use of tocolytics.In this South African population, which had a high incidence of delivery within 7 days of presentation with threatened preterm labor, sonographic measurement of cervical length is equally effective as in a lower-risk population in distinguishing between true and false labor.

Congenital rubella infection has been associated with a number of abnormalities including cardiac, central nervous system and placental complications. We present a case with multiple fetal abnormalities detected on prenatal ultrasound, and confirmed postnatally, that included a single umbilical artery, severe tricuspid regurgitation, micrognathia and agenesis of the inferior cerebellar vermis. Postnatal echocardiography additionally revealed unobstructed total anomalous pulmonary venous drainage (TAPVD) into the coronary sinus. Placental examination showed signs of placentitis, and polymerase chain reaction on neonatal serum was positive for rubella. Following a multidisciplinary team review, it was decided to provide only supportive care, and the infant died at 6 months of age owing to a respiratory tract infection. To our knowledge, TAPVD and agenesis of the inferior cerebellar vermis have not been reported previously in association with congenital rubella infection. This case illustrates how congenital infection may present in atypical ways and stresses the importance of considering congenital infection in the differential diagnosis of fetal anomalies when multiple features are present.

Blackfan-Diamond anemia is a congenital hypoplastic anemia with a birth prevalence of about 1 in 200,000, usually presenting in the first few months of life and commonly associated with cardiac, urogenital and digital anomalies. Congenital dyserythropoietic anemias are a group of rare congenital anemias characterized by ineffective erythropoiesis. We report on two cases of congenital fetal anemia, one with Blackfan-Diamond anemia and one with dyserythropoietic anemia, presenting with increased nuchal translucency at 12 weeks of gestation.

The Unified Modeling Language (UML) has been widely accepted as the standard object-oriented language for modeling various aspects of software and information systems. The UML is an extensible language in the sense that it provides mechanisms to introduce new elements for specific domains; these include business modeling, database applications, data warehouses, software development processes, and web applications. Also, UML provides different diagrams for modeling different aspects of a software system. However, in most cases, not all of them need to be applied. Further, UML has grown more complex over the years, and new approaches are needed to effectively deal with these complexities. In general, we need heuristics and design guidelines that drive the effective use of UML in systems modeling and development.

This study reports the ultrasound findings and pregnancy outcome for a series of monoamniotic twin pregnancies diagnosed at 11-14 weeks' gestation. Of 315 monochorionic twin pregnancies examined, there were 12 (3.8%) monoamniotic, including four sets of conjoined twins (1.3%). The parents opted for termination of pregnancy in all cases of conjoined twins. In four other cases, there was discordancy for major structural fetal abnormality (kyphoscoliosis, anencephaly, body stalk defect, diaphragmatic hernia), and the cotwin was structurally normal. In the four cases in which both twins were structurally normal, ultrasound examination demonstrated normal nuchal translucency thickness in all cases but cord entanglement was demonstrated from the first trimester. Two cases were managed expectantly; one resulted in livebirth of both twins at 31 weeks' gestation and the second in intrauterine death of both fetuses at 21 weeks. Two pregnancies were treated with Sulindac; one resulted in a single intrauterine death at 30 weeks and delivery of a normal cotwin, the other, in intrauterine death of both fetuses at 31 weeks'. Monoamniotic twin pregnancies are associated with a high risk of fetal abnormalities and perinatal death and the mortality rate is higher than previously reported from series with recruitment later in gestation.

Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia. Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n=12) and major morbidity (n=62) were related to findings at recruitment and on the last assessment preceding delivery. In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P

A young, apparently healthy woman from a rural area in South Africa presented in the third trimester of pregnancy with a symptomatic abdominal mass between the uterine fundus and liver. The etiology was established to be an echinococcus cyst of the liver and medical treatment was initiated. The fetal outcome was good but the mother died 3 days postpartum due to an unusual but devastating complication of the hydatid cyst.

To predict when delivery will occur, within 48 h and 7 days of presentation and before 35 weeks' gestation in women presenting with threatened preterm labor.Sonographic measurement of cervical length was carried out in 510 women with singleton pregnancies presenting with threatened preterm labor and intact membranes at 24 to 33 + 6 weeks of gestation. The measurement was not taken into account in the subsequent management of the pregnancies. The outcome measures were delivery within 48 h and 7 days of presentation and delivery before 35 weeks.The median gestation at presentation was 30 + 1 (range, 24 to 33 + 6) weeks and the median cervical length was 25 (range, 1-51) mm. Delivery within 48 h of presentation occurred in 21 (4.1%) cases, delivery within 7 days occurred in 43 (8.4%) and delivery before 35 weeks occurred in 76 (14.9%). Logistic regression analysis demonstrated that the only significant independent predictor of delivery within 48 h was cervical length (odds ratio (OR), 0.73; 95% CI, 0.65-0.81) and for delivery within 7 days the independent predictors were cervical length (OR, 0.69; 95% CI, 0.63-0.76) and vaginal bleeding (OR, 19.42; 95% CI, 3.87-97.4). In the subgroup of women who did not deliver within 7 days of presentation, the incidence of delivery before 35 weeks was 7.1% (33 of 467) and the only significant independent predictor of such delivery was cervical length (OR, 0.92; 95% CI, 0.88-0.96, P0.0001). There was no significant independent contribution to any of the outcome measures from ethnic group, maternal age, gestational age, body mass index, parity, cigarette smoking or use of tocolytics.In women with threatened preterm labor sonographic measurement of cervical length helps to distinguish between true and false labor and to predict early preterm delivery.

Perinatal hypophosphatasia is a lethal autosomal recessive skeletal abnormality with a birth prevalence of about 1 per 100 000. It is characterized by deficiency of the tissue-nonspecific isoenzyme of alkaline phosphatase causing abnormal bone mineralization. In the two affected fetuses from the same family ultrasound examination at 14 and 12 weeks, respectively, demonstrated increased nuchal translucency thickness, hypomineralization of the skull and spine, narrowing of the chest and shortening of the limbs.

Blackfan-Diamond anemia is a congenital hypoplastic anemia with a birth prevalence of about 1 in 200,000, usually presenting in the first few months of life and commonly associated with cardiac, urogenital and digital anomalies. Congenital dyserythropoietic anemias are a group of rare congenital anemias characterized by ineffective erythropoiesis. We report on two cases of congenital fetal anemia, one with Blackfan-Diamond anemia and one with dyserythropoietic anemia, presenting with increased nuchal translucency at 12 weeks of gestation.

To determine whether the incidence of pre-eclampsia is different in dichorionic compared to monochorionic twin pregnancies.The study involved 666 twin pregnancies resulting in two live births after 24 weeks of gestation. Ultrasound examination at 10-14 weeks of gestation demonstrated that 171 (25.7%) were monochorionic and 495 (74.3%) were dichorionic twins. Pregnancy outcome information regarding the development of pre-eclampsia was obtained from the maternity units. The incidence of pre-eclampsia in the dichorionic and monochorionic twin pregnancies was compared.The incidence of pre-eclampsia in monochorionic twin pregnancies (9.4%) was not significantly different from that in dichorionic pregnancies (7.3%) ( P = 0.48). Multiple logistic regression revealed that chorionicity has no effect on the development of pre-eclampsia after adjusting for maternal age, ethnic group, maternal smoking, parity and gestational age at delivery ( P = 0.6; odds ratio for monochorionic compared with dichorionic twin pregnancies, 1.19; 95% confidence interval, 0.61-2.3).In twin pregnancies chorionicity does not affect the incidence of pre-eclampsia.

This study reports the ultrasound findings and pregnancy outcome for a series of monoamniotic twin pregnancies diagnosed at 11-14 weeks' gestation. Of 315 monochorionic twin pregnancies examined, there were 12 (3.8%) monoamniotic, including four sets of conjoined twins (1.3%). The parents opted for termination of pregnancy in all cases of conjoined twins. In four other cases, there was discordancy for major structural fetal abnormality (kyphoscoliosis, anencephaly, body stalk defect, diaphragmatic hernia), and the cotwin was structurally normal. In the four cases in which both twins were structurally normal, ultrasound examination demonstrated normal nuchal translucency thickness in all cases but cord entanglement was demonstrated from the first trimester. Two cases were managed expectantly; one resulted in livebirth of both twins at 31 weeks' gestation and the second in intrauterine death of both fetuses at 21 weeks. Two pregnancies were treated with Sulindac; one resulted in a single intrauterine death at 30 weeks and delivery of a normal cotwin, the other, in intrauterine death of both fetuses at 31 weeks'. Monoamniotic twin pregnancies are associated with a high risk of fetal abnormalities and perinatal death and the mortality rate is higher than previously reported from series with recruitment later in gestation.

To determine the effects of chromosomal defects on fetal heart rate at 10-14 weeks of gestation.Fetal heart rate at 10-14 weeks of gestation in 1061 chromosomally abnormal fetuses was compared to that from 25,000 normal pregnancies. The chromosomally abnormal group included 554 cases of trisomy 21, 219 cases of trisomy 18, 95 of trisomy 13, 50 of triploidy, 115 of Turner syndrome and 28 of sex chromosome abnormalities other than Turner syndrome.In the normal group, fetal heart rate decreased from a mean value of 170 beats per minute (bpm) at 35 mm of crown-rump length to 155 bpm at 84 mm crown-rump length. In trisomy 21, trisomy 13 and Turner syndrome fetal heart rate was significantly higher, in trisomy 18 and triploidy the heart rate was lower and in other sex chromosome defects it was not significantly different from normal. Fetal heart rate was above the 95th centile of the normal range in 10%, 67% and 52% of fetuses with trisomy 21, trisomy 13 and Turner syndrome, respectively. The fetal heart rate was below the 5th centile in 30% of fetuses with triploidy and 19% of those with trisomy 18.Trisomy 21, trisomy 13 and Turner syndrome are associated with fetal tachycardia, whereas in trisomy 18 and triploidy there is fetal bradycardia. Inclusion of fetal heart rate in a first-trimester screening program for trisomy 21 by a combination of maternal age and fetal nuchal translucency thickness is unlikely to provide useful improvement in sensitivity.