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Preeclampsia (PE) is characterized by placental and maternal endothelial dysfunction, and associated with fetal growth restriction (FGR), placental abruption, preterm delivery and stillbirth. The angiogenic factors soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) are altered in pregnancies complicated by placental-related disorders. In this review, we summarize existing literature examining the performance of maternal PlGF, sFlt-1 and sFlt-1/PlGF ratio for a) screening and diagnosing PE, b) predicting PE development in the short term, c) monitoring established PE and d) predicting other placental-related disorders. We also discuss the performance of PlGF and the sFlt-1/PlGF ratio for predicting PE in twin pregnancies. For first trimester screening, a more accurate way of identifying high-risk women than current practices is to combine PlGF levels with clinical risk factors and ultrasound markers. To support diagnosis of PE later in pregnancy, the sFlt-1/PlGF ratio has advantages over PlGF because it has a higher pooled sensitivity and specificity for diagnosing and monitoring PE. The sFlt-1/PlGF ratio has clinical value because it can rule out the development of PE in the subsequent 1-4 weeks after the test. Once diagnosis of PE is established, repeated measurement of sFlt-1 and PlGF can help monitor progression of the condition and may inform clinical decision-making around optimal time for delivery. The sFlt-1/PlGF ratio is useful for predicting FGR and preterm delivery, but the association between stillbirth and the angiogenic factors remains unclear. The sFlt-1/PlGF ratio can also be used to predict PE in twin pregnancies, although different sFlt-1/PlGF ratio cut-offs to those of singleton pregnancies should be applied for optimal performance. In summary, PlGF, sFlt-1 and the sFlt-1/PlGF ratio are useful for screening, diagnosing, predicting, and monitoring placental-related disorders in singleton and twin pregnancies; we propose further integration of these angiogenic factor tests in clinical practice. This article is protected by copyright. All rights reserved.

To promote the expansion of interprofessional training objectives in the curriculum of health professions curriculum at the Medical Faculty, University of Leipzig, the interprofessional teaching project between the Department of Obstetrics, the Skills and Simulation Centre and the School of Midwifery was selected to promote innovative teaching projects, supported by the University of Leipzig [https://www.stil.uni-leipzig.de/] grant "StiL - Studying in Leipzig". Using scenarios with simulated patients, students were to recall and apply theoretically learned procedures and immediate measures in an obstetric emergency under supervision and to communicate these clearly in the team. Final-year medical students from the Medical Faculty (n=15) and midwifery students (n=17) from the vocational school went through teaching situations together, in which two simulation scenarios (shoulder dystocia and postpartum haemorrhage) were implemented. The aim of the project was to integrate interprofessional collaboration into training and to learn together under simulated conditions in the Skills and Simulation Center protected environment. The following questions was intended to be clarified in the project in addition to the establishment of a sub-professional teaching unit What do students benefit most from in interprofessional teaching units? Are there differences between midwifery and medical students? Is the learning success the same for team-communicative and professional learning goals? To clarify the questions, an evaluation was carried out using an exploratory questionnaire with a Likert scale. All students particularly liked the exchange and contact with other professional groups, the communicative aspect and situational action in unforeseen emergency situations. The participants stated that they had benefited from both interprofessional teaching units, in terms of team communication as well as in professional terms. However, medical students experienced significantly higher cognitive overload regarding prior acquired knowledge compared to vocational midwifery students. Overall, the team communication learning objectives were more difficult to fulfill. Zur Förderung des Ausbaus interprofessioneller Ausbildungsziele im Curriculum der Gesundheitsberufe an der Medizinischen Fakultät in Leipzig wurde das interprofessionelle Lehrprojekt zwischen Abteilung für Geburtsmedizin, Lernklinik und Hebammenschule im Rahmen von "StiL - Studieren in Leipzig" der Universität Leipzig zur Förderung innovativer Lehrprojekte ausgewählt [https://www.stil.uni-leipzig.de/]. Anhand von Szenarien mit Simulationspatient*innen sollten Studierende und Auszubildende unter Supervision theoretisch erlernte Abläufe und Sofortmaßnahmen im Notfall abrufen, anwenden und im Team klar kommunizieren. Hierbei durchliefen PJ Studierende der medizinischen Fakultät (n=15) und Hebammenschülerinnen der Berufsfachschule (n=17) gemeinsam Lehrsituationen, in denen zwei Simulationsszenarien zum Einsatz kamen. Ziel des Projektes war es, interprofessionelle Zusammenarbeit in die Ausbildung zu integrieren und unter realitätsnahen Bedingungen im geschützten Bereich des Skills- und Simulationszentrums kennenzulernen. Folgende Fragen sollten, neben der Etablierung der interprofessionellen Lehreinheit, im Projekt geklärt werden: Wovon profitieren Studierende in interprofessionellen Lehreinheiten am meisten? Gibt es Unterschiede zwischen Hebammenschülerinnen und Medizinstudierenden? Ist der Lernerfolg für teamkommunikative und fachliche Lernziele derselbe? Zur Klärung der Fragen wurde eine Evaluation durch einen explorativen Fragebogen mit einer Likert-Skala durchgeführt. Allen Studierenden gefiel besonders der Austausch und Kontakt mit anderen Berufsgruppen, der kommunikative Aspekt und das situative Handeln in unvorhergesehenen Notfallsituationen. Die Teilnehmer gaben an, dass sie von beiden interprofessionellen Unterrichtseinheiten sowohl in Bezug auf die Teamkommunkation als auch in fachlicher Hinsicht profitiert haben. Hinsichtlich des Vorwissen erlebten die Medizinstudierenden verglichen zu den Hebammenschülerinnen eine signifikant höhere kognitive Überforderung. Insgesamt waren die Lernziele im Bereich der Teamkommunikation schwieriger zu erfüllen.

Made available in DSpace on 2022-04-28T19:29:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Medical Research Council Canada National Institute for Health Research Objectives: To develop consensus definitions for the core outcome set for pre-eclampsia. Study design: Potential definitions for individual core outcomes were identified across four formal definition development initiatives, nine national and international guidelines, 12 Cochrane systematic reviews, and 79 randomised trials. Eighty-six definitions were entered into the consensus development meeting. Ten healthcare professionals and three researchers, including six participants who had experience of conducting research in low- and middle-income countries, participated in the consensus development process. The final core outcome set was approved by an international steering group. Results: Consensus definitions were developed for all core outcomes. When considering stroke, pulmonary oedema, acute kidney injury, raised liver enzymes, low platelets, birth weight, and neonatal seizures, consensus definitions were developed specifically for low- and middle-income countries because of the limited availability of diagnostic interventions including computerised tomography, chest x-ray, laboratory tests, equipment, and electroencephalogram monitoring. Conclusions: Consensus on measurements for the pre-eclampsia core outcome set will help to ensure consistency across future randomised trials and systematic reviews. Such standardization should make research evidence more accessible and facilitate the translation of research into clinical practice. Video abstract can be available at: www.dropbox.com/s/ftrgvrfu0u9glqd/6.%20Standardising%20definitions%20in%20teh%20pre-eclampsia%20core%20outcome%20set%3A%20a%20consensus%20development%20study.mp4?dl=0. Nuffield Department of Primary Care Health Sciences University of Oxford Institute for Women’s Health University College London Department of Women and Children’s Health School of Life Course Sciences King’s College London Department of Obstetrics and Gynecology Amsterdam UMC Academic Medical Center Academic Neonatal Medicine Imperial College London Department of Renal Medicine St George Hospital and University of New South Wales Department of Obstetrics and Gynaecology Feinberg School of Medicine Northwestern University Health Services Research Unit Nuffield Department of Population Health University of Oxford Cedars-Sinai Medical Center London North West University Healthcare NHS Trust Women’s Health Care Research Group Department of Obstetrics and Gynaecology Monash University Department of Obstetrics and Gynaecology University of Adelaide Women’s Health Research Unit Barts and The London School of Medicine and Dentistry School of Health and Related Research University of Sheffield MRC North West Hub for Trials Methodology Research Department of Biostatistics University of Liverpool Centro Rosarino de Estudios Perinatales Chelsea and Westminster Hospital NHS Foundation Trust Babcock University Ailem Academic Counselling KU Leuven Universidad Nacional de Colombia Northwell Health University of Oxford Université de Montréal University of Montreal Hospital Centre Ondokuz Mayıs University Prince Sultan Military Medical City Postgraduate Institute of Medical Education and Research King's Fertility Fetal Medicine Research Institute University Hospital Limerick Drexel University University of Aberdeen University of Groningen University of Auckland Haaglanden Medisch Centrum Nottingham University Medical School Utrecht University King Edward Memorial Hospital for Women Imperial College Healthcare NHS Trust Jean-Verdier Hospital Downland Practice University of Campinas Université Lyon University of North Carolina School of Medicine South Ural State Medical University Stellenbosch University Irish Neonatal Health Alliance University of Rzeszow Royal Brisbane and Women’s Hospital Nottingham University Hospitals NHS Trust University Hospitals of Leicester North Bristol NHS Trust University of Nottingham Soroka University Medical Center Ben Gurion University of the Negev St George’s University Hospitals NHS Foundation Trust Hospitalsenhed Midt University of Glasgow Amsterdam Universitair Medische Centra All India Institute of Medical Sciences Patna Luton and Dunstable University Hospital Khyber Medical University Institution of Medical Sciences Midwife Mid Essex Hospitals NHS Trust University of Oulu University of Michigan Bastyr University Irish Nurses and Midwives Organisation University of Toronto Barts Health NHS Trust University Hospitals Plymouth NHS Trust Burnet Institute Aga Khan University Medical University of Graz Homerton University Hospital NHS Foundation Trust Mount Royal University Université de Paris Royal Surrey County Hospital University Hospital Southampton NHS Foundation Trust University of Washington School of Nursing Evelina London Children's Hospital Neonatal Unit University of Sydney University of Leicester Academic Hospital of Udine NHS Borders Weill Cornell Medical College University of Dundee University of Edinburgh South Australian Health and Medical Research Institute University of Sheffield Monash University and Monash Health United Lincolnshire Hospitals NHS Trust University of Kwa Zulu-Natal Beatrix Hospital Keele University Government Medical College Institut Catala de la Salut. IdiapJgol University College London National Center for Child Health and Development Basavatarakam Indo-American Cancer Hospital and Research Institute Axon Anaesthesia Associates Pennine Acute Hospitals NHS Trust St George's University of London Norfolk and Norwich University Hospital Jichi Medical University School of Medicine São Paulo State University National Institute of Public Health University of Kyrenia King Edward Memorial Hospital Amsterdam University Centres University of British Columbia Chulalongkorn University University of Brescia University Of British Columbia University of Montreal Women's Clinic of Tartu University Hospital Universidade Federal de São Paulo Université de Sherbrooke University Hospital of Wales University of Iowa King's College London Westmead Hospital Princess Royal Maternity Leipzig University Centre Hospitalier Public du Cotentin Lewisham and Greenwich NHS Trust Juntendo University Faculty of Medicine Western Sydney University National Institute of Health Research University of Washington Baylor College of Medicine Capelle aan den Ijssel Sanatorio Anchorena Oxford University Hospitals NHS Foundation Trust University of Leeds Institute of Medical Sciences UPMC Magee Womens Hospital Penn Medicine Princeton Health University of North Carolina at Chapel Hill São Paulo State University

Purpose . To analyze the mechanism of work of embankments, to model three-dimensional models and to compare methods of their reinforcement on transitional areas on approaches to railway bridges using the Lira software based on finite element method (FEM). To do comprehensive analysis of results and comparison of constructive performance of different reinforcement methods. Methodology . Numerical finite element modeling (FEM) had been performed to study the work of embankments in transition sections on approaches to railway bridges. Four three-dimensional models of the construction of the transitional section, corresponding to the real bridge, had been constructed. These models had been tested for nominal load to evaluate their performance relative to each other. Findings . As a result of the calculations, the deformation characteristics for the basic model and each of the reinforcement types had been obtained, and their comparisons had been made by determining the maximum vertical deformations and vertical deformations at key points. The analyze of feasibility of using the tested reinforcement methods under different real initial conditions had been performed. Originality . The main aspects of the work of the transition sections over long periods of time had been revealed. Comparisons of fundamentally different methods and types of reinforcement of sections with transient stiffness had been made. The expediency of the methods of reinforcement of the embankment construction in the transitional sections that had been proposed in previous works had been tested. Practical value . The proposed reinforcement methods may be used depending on the specific design conditions, the budget, and other factors. Evaluating the work of different types of reinforcement during numerical analysis makes it possible to move away from large-scale field trials and focus on other methods, which significantly reduces time spent on solving current problems.

Purpose. To analyze the problem of areas with a transitional stiffness on the approaches to the bridges based on the experience of European and American bridge-building. To find out the root causes and methods for detecting track defects in transitional stiffness zones. To propose a pilot model for the development of transitional stiffness areas based on the experience of developed countries in Europe. Methodology. Collection of data on the causes and nature of the occurrence of bumps on approaches to bridges based on the experience of specialists in the design, construction and operation of railway and highway bridges. Analysis of methods of arrangement of transition areas on approaches to bridges in European countries. Results. An analysis of the literary sources of developed countries of the world on the problem of the origin and methods of detection of bumps in areas with transitional stiffness on the approaches of bridges was performed. The results were collected on ways to identify problems in areas with transient stiffness and how to solve them. A model for mathematical and experimental studies was proposed. Originality. Scientific interest is that, despite the extensive experience of developed countries of the world, the Ukrainian norms still do not have a clear mechanism for identifying and characterizing problems of track geometry in sections with transitional stiffness. Thus, studying the experience of more advanced countries in the field helps to con-sider the problem more clearly and standardize its definition. Practical value. If proposed model of reinforcement of transition stiffness areas will be confirmed it allows to reduce the cost of maintaining of the track and to solve the problems of the transitional areas at the stage of bridge construction, that is, before its immediate occurrence.

Objective\ud To develop a core outcome set for pre‐eclampsia.\ud \ud Design\ud Consensus development study.\ud \ud Setting\ud International.\ud \ud Population\ud Two hundred and eight‐one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated.\ud \ud Methods\ud Modified Delphi method and Modified Nominal Group Technique.\ud \ud Results\ud A long‐list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre‐eclampsia trials with those derived from thematic analysis of 30 in‐depth interviews of women with lived experience of pre‐eclampsia. Forty‐seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small‐for‐gestational‐age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support.\ud \ud Conclusions\ud The core outcome set for pre‐eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies.