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Morrison I, Schwartz P, Yankelovich D. Healthcare in the new millennium: the long boom meets the civil society. Healthc Forum J 1998; 41:18-22, 70, 72-7. [PMID: 10180187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- I Morrison
- Global Business Network, Emeryville, CA, USA
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Manning FA, Bondaji N, Harman CR, Casiro O, Menticoglou S, Morrison I, Berck DJ. Fetal assessment based on fetal biophysical profile scoring. VIII. The incidence of cerebral palsy in tested and untested perinates. Am J Obstet Gynecol 1998; 178:696-706. [PMID: 9579431 DOI: 10.1016/s0002-9378(98)70479-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The intent of this comparative clinical study was fourfold: (1) to determine the incidence of cerebral palsy in a large obstetric population, (2) to compare the incidence of cerebral palsy in patients at high risk referred for and managed according to the fetal biophysical profile score result with the incidence among unreferred and untested patients, (3) to determine the relationship, if any, between the last fetal biophysical profile score and the incidence of cerebral palsy, and (4) to categorize cases of cerebral palsy according to the clinical parameters and the probable time and nature of the damaging insult. STUDY DESIGN In this retrospective 5-year comparative study (1987 to 1991) the incidence of cerebral palsy was determined by analysis of International Classification of Diseases, Ninth Revision, -coded related medical services. The clinical records were then sought and reviewed in index cases and obstetric, neonatal, and postnatal clinical data were abstracted. Cross-correlation with partial registries was done to confirm completeness of capture of index cases. The population of referred high-risk patients who received serial fetal biophysical profile scoring and were managed according to test results was determined by review of a prospective computer-stored database and by review of patient log books. The population of untested patients was calculated as the residual of total cases minus tested cases. The rate of cerebral palsy for all patients and for the tested and untested population was calculated and compared. The tested and untested perinates were compared for birth age, weight, and assigned timing or etiology of cerebral palsy. In the tested population the distribution of test results by last recorded biophysical profile score was determined and the relationship between the last test result and cerebral palsy and predictive accuracy parameters of the fetal biophysical profile score were calculated. RESULTS The incidence of cerebral palsy among the 84,947 live births was 3.68 per 1000 live births (313 cases). The rate of cerebral palsy in the 26,290 referred high-risk tested patients was 1.33 per 1000 (35 cases) compared with a rate of 4.74 per 1000 live births in the 58,657 untested mixed low-risk/high-risk patients (278 cases). These differences were highly significant. A significant declining trend in the annual incidence of cerebral palsy was observed in the total population and the untested population, whereas the rate in the tested population remained relatively constant over the 5-year study interval. The differences in the cerebral palsy rate between the tested and untested population were not related to differences in gestational age, birth weight, or assigned timing or etiology category. In the tested population the relationship between the incidence of cerebral palsy and the last test fetal biophysical profile score was inverse, exponential, and highly significant. CONCLUSIONS Antepartum assessment by fetal biophysical profile scoring is associated with a significant reduction in the incidence of cerebral palsy compared with untested patients. The relationship between the last test score and the incidence of cerebral palsy is inverse and exponential, suggesting that antenatal asphyxia is an important and potentially avoidable cause of cerebral palsy.
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Affiliation(s)
- F A Manning
- Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Canada
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Manning FA, Bondagji N, Harman CR, Casiro O, Menticoglou S, Morrison I. Fetal assessment based on the fetal biophysical profile score: relationship of last BPS result to subsequent cerebral palsy. J Gynecol Obstet Biol Reprod (Paris) 1998; 26:720-9. [PMID: 9436057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The prime intent of this study was to determine the relationship if any between the last fetal biophysical profile score and the risk of cerebral palsy at age 3 years. The secondary objective was to examine the clinical characteristics of infants with cerebral palsy whose obstetric management included serial fetal biophysical profile scores. STUDY DESIGN The incidence of a high risk pregnant population whose antenatal assessment was by serial fetal biophysical profile scoring was determined by cross-referencing two discrete data bases. The completeness and reliability of the data bases was confirmed by secondary audit. Obstetrical, neonatal and post-natal clinical records of index cases of cerebral palsy were subsequently reviewed, categorized and analyzed. RESULTS Fetal biophysical profile scores (BPS) were recorded in 22,336 high risk pregnancies: 27 patients delivered an infant subsequently identified as having cerebral palsy (rate 1.21 per 1000). The relationship between last BPS result and cerebral palsy was inverse, exponential and highly significant (R2 = 0.987; p < 0.001). Affected infants with a last abnormal BPS result were significantly more likely to exhibit fetal distress (88.8%), acidosis (77.7%), and have neonatal seizures (88.8%). Antenatal asphyxia was the apparent cause of cerebral damage in 29.6% of cases. CONCLUSION The last fetal biophysical profile score is a predictor of the risk of cerebral palsy.
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Affiliation(s)
- F A Manning
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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Affiliation(s)
- I. Morrison
- Department of Pure and Applied Physics, University of Salford, Salford M5 4WT, U.K
| | - J.-C. Li
- Department of Pure and Applied Physics, University of Salford, Salford M5 4WT, U.K
| | - S. Jenkins
- Department of Pure and Applied Physics, University of Salford, Salford M5 4WT, U.K
| | - S. S. Xantheas
- Environmental Molecular Science Lab., Battelle Boulevard, MS K1−96, Richland, Washington 99352
| | - M. C. Payne
- Cavendish Laboratory, University of Cambridge, Cambridge CB3 OHE, U.K
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Innocent G, Morrison I, Brownlie J, Gettinby G. A computer simulation of the transmission dynamics and the effects of duration of immunity and survival of persistently infected animals on the spread of bovine viral diarrhoea virus in dairy cattle. Epidemiol Infect 1997; 119:91-100. [PMID: 9287949 PMCID: PMC2808828 DOI: 10.1017/s0950268897007723] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This paper describes a computer model that mimics the spread of bovine viral diarrhoea virus (BVDV) infection through a closed herd. The model is able to simulate the spread of infection when a persistently infected (PI) animal is introduced into an infection-free herd, and it is used to investigate the role of persistently infected animals, seroconverting animals, loss of PI calves and duration of immunity on the level of infection within the herd. Under typical management conditions one persistently infected animal poses a real threat to a herd, and the prospect of the herd becoming infection free in a 10-year period without intervention is remote. Seroconverting animals are found to be an important source of infection in herds with few immune animals. The increased loss of PI calves is likely to restrict the numbers of PI animals in a herd, and loss of immunity is important since it increases the possibility of a PI calf being born.
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Affiliation(s)
- G Innocent
- Department of Statistics & Modelling Science, University of Strathclyde, Glasgow, UK
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Innocent G, Morrison I, Brownlie J, Gettinby G. The use of a mass-action model to validate the output from a stochastic simulation model of bovine viral diarrhoea virus spread in a closed dairy herd. Prev Vet Med 1997; 31:199-209. [PMID: 9234444 DOI: 10.1016/s0167-5877(96)01129-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The spread of bovine virus diarrhoea virus (BVDV) in a closed dairy herd maintained under typical management conditions is studied using two approaches. In the first instance a stochastic computer model is used to simulate the month-to-month changes in the infection status of each animal. These results are contrasted with the results of a mass-action model which uses three differential equations. A comparison of the two approaches indicates that the results are in broad agreement. The stochastic approach has the benefit of providing an estimate of the probability of the infection becoming extinct and the herd becoming BVDV-free for different herd sizes.
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Affiliation(s)
- G Innocent
- Department of Statistics and Modelling Science, University of Strathclyde, Glasgow, UK
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Bondagji N, Manning FA, Martel J, Harman CR, Morrison I. Complete resolution of CMV-associated acute hydramnios by single large volume reduction amniocentesis and maternal indomethacin. A case report. Fetal Diagn Ther 1996; 11:345-7. [PMID: 8894630 DOI: 10.1159/000264339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Acute hydramnios is a rare complication of pregnancy, usually of idiopathic etiology and associated with a very poor perinatal prognosis. In this single case report, acute hydramnios at 21 weeks' gestation, associated with fetal CMV infection, was treated by a single large volume reduction amniocentesis combined with maternal indomethacin therapy and result in delivery of a near term survivor.
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Affiliation(s)
- N Bondagji
- Division of Maternal and Fetal Medicine, University of Manitoba, Winnipeg, Canada
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Abstract
OBJECTIVE The second stage of labor has been thought of as a time of particular asphyxial risk for the fetus. This perceived risk has been invoked to justify arbitrary time limits and high rates of operative vaginal delivery. The purpose of this study was to determine whether perinatal outcome worsened as the second stage lengthened. STUDY DESIGN Over a 5-year period at one university teaching hospital, 6041 nulliparous women reached the second stage of labor with a live singleton cephalic fetus with birth weight > or = 2500 gm. A retrospective review of perinatal morbidity and mortality was performed and the results related to the duration of the second stage. RESULTS The second stage lasted > 3 hours in 11% of nulliparous women and > 5 hours in 2.7%. There were no perinatals death unrelated to anomaly. There was no significant relationship between second-stage duration and low 5-minute Apgar score, neonatal seizures, or admission to the neonatal intensive care unit. CONCLUSION Operative intervention in the second stage is not warranted merely because some set number of hours has elapsed.
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Affiliation(s)
- S M Menticoglou
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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Craig AL, Morrison I, Baird E, Waugh R, Coleman M, Davie P, Powell W. Expression of reducing sugar accumulation in interspecific somatic hybrids of potato. Plant Cell Rep 1994; 13:401-405. [PMID: 24193911 DOI: 10.1007/bf00234147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/1993] [Revised: 10/10/1993] [Indexed: 06/02/2023]
Abstract
A somatic hybridisation programme was undertaken to evaluate the expression of reducing sugar accumulation in potato. Interspecific hybrids created between the Solanum tuberosum cultivar Record and the diploid species Solanum phureja were evaluated at the morphological and molecular levels. These analyses indicated that the protoplast regenerants were partial (asymmetric) hybrids which had undergone elimination of S. phureja chromosomes. Tubers of the parents exhibited significant differences for reducing sugar accumulation during cold storage with S. phureja having lower levels of glucose and fructose than Record. The somatic hybrids resembled the S. phureja parent in terms of reducing sugar accumulation demonstrating that low reducing sugar accumulation is dominant to high reducing sugar accumulation in these particular genotypes. These results are discussed in relation to the exploitation of asymmetric hybridisation for the production of potato genotypes for the potato processing industry.
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Affiliation(s)
- A L Craig
- Scottish Crop Research Institute, Invergowrie, DD2 5DA, Dundee, Scotland, UK
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Barer M, Morrison E, Morrison I. Canadian physicians may hear footsteps of change as US tiptoes toward health care reform. CMAJ 1994; 150:980-7. [PMID: 8131135 PMCID: PMC1486707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- M Barer
- Institute for the Future, Menlo Park, Calif
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Phelps P, Morrison I. Fast spin echo MRI in otology. Clin Radiol 1993. [DOI: 10.1016/s0009-9260(05)81395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Manning FA, Snijders R, Harman CR, Nicolaides K, Menticoglou S, Morrison I. Fetal biophysical profile score. VI. Correlation with antepartum umbilical venous fetal pH. Am J Obstet Gynecol 1993; 169:755-63. [PMID: 8238129 DOI: 10.1016/0002-9378(93)90002-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our objective was to determine the relationship, if any, between the fetal biophysical profile score and antepartum umbilical venous pH. STUDY DESIGN This was a prospective observational study conducted concurrently in two centers and involving two discrete high-risk groups of fetuses. Fetal biophysical profile scores were compared with umbilical venous pH values measured in blood obtained by immediate cordocentesis. A total of 493 paired observations of biophysical profile score and pH were made; 104 observations were of fetuses with intrauterine growth retardation and 389 observations were of fetuses with alloimmune anemia. RESULTS In both data sets there was a highly significant linear correlation between biophysical profile score and umbilical venous pH. Poor biophysical profile score performance (a score of 0 of 10) was always associated with a pH < 7.20, whereas the pH was always > 7.20 when the biophysical profile score was 10 of 10. Sequenced sensitivity of short-term biophysical variables in the detection of acidemia was observed. CONCLUSION The fetal biophysical profile score accurately predicts antepartum umbilical venous pH.
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Affiliation(s)
- F A Manning
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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Kuyucak S, Morrison I. Medium-energy hadron-nucleus scattering in the 1/N expansion formalism. Phys Rev C Nucl Phys 1993; 48:774-784. [PMID: 9968889 DOI: 10.1103/physrevc.48.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Blendon RJ, Donelan K, Leitman R, Epstein A, Cantor JC, Cohen AB, Morrison I, Moloney T, Koeck C, Levitt SW. Physicians' perspectives on caring for patients in the United States, Canada, and West Germany. N Engl J Med 1993; 328:1011-6. [PMID: 8450854 DOI: 10.1056/nejm199304083281407] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The United States is considering enacting a national health plan and global health care budget similar to those in other countries. There are few data on the effects of such policies on physicians and patients. METHODS We conducted a telephone survey of 602 physicians in the United States, 507 physicians in Canada, and 519 physicians in the former West Germany from February through May 1991; the response rates were 44 percent, 49 percent, and 41 percent, respectively. Among other topics, the questionnaire included measures of satisfaction with the health care system and with medical practice. RESULTS In the United States, 23 percent of the physicians surveyed thought the health care system worked well, as compared with 33 percent in Canada and 48 percent in West Germany. Seventy-three percent of U.S. physicians reported that patients' inability to afford necessary treatment was a serious problem, as compared with 25 percent in Canada and 15 percent in West Germany. Seventy-seven percent of West Germany physicians, 56 percent of Canadian physicians, and 54 percent of U.S. physicians said the shortage of competent nurses was a serious problem. In Canada, 50 percent of the respondents cited the lack of well-equipped medical facilities as a problem, as compared with 14 percent in the United States and 20 percent in West Germany. CONCLUSIONS Programs of universal coverage and cost containment necessitate important trade-offs. In Canada and West Germany, physicians do not report serious problems of access to care for the poor and uninsured. In the United States, doctors do not face the limited access to sophisticated forms of medical technology that was reported in Canada or the diminished quality of some services reported in West Germany.
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Affiliation(s)
- R J Blendon
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115
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Morrison I, Bylander DM, Kleinman L. Nonlocal Hermitian norm-conserving Vanderbilt pseudopotential. Phys Rev B Condens Matter 1993; 47:6728-6731. [PMID: 10004645 DOI: 10.1103/physrevb.47.6728] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Abstract
OBJECTIVE The objective of this observational study was to document the frequency of biophysical activities such as breathing and body movements during spontaneous labor in the low-risk, term fetus. STUDY DESIGN The fetuses of truly low-risk patients without medication during labor were observed serially with real-time ultrasonography for fetal breathing or body movements for a maximum scanning time of 1 hour. Fetal breathing movements, hiccups, and fetal body movements were recorded, as were cervical dilatation, status of the fetal membranes, and Apgar scores. RESULTS Fetal breathing activity was recorded in 76% of fetuses in early labor and 90% in advanced labor. Fetal body movements were present during 85% of the observations. All babies had 5-minute Apgar scores > 7. CONCLUSION Ultrasonographic evaluation of fetal breathing and body movements during spontaneous labor was associated with normal birth outcome in this low-risk population. The clinical utility of this noninvasive method in determining intrapartum fetal health remains to be tested in an unselected population.
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Affiliation(s)
- K M Ash
- Department of Obstetrics, Gynecology, and Reproductive Sciences, St. Boniface General Hospital, University of Manitoba, Winnipeg, Canada
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Blendon RJ, Donelan K, Leitman R, Epstein A, Cantor JC, Cohen AB, Morrison I, Moloney T, Koeck C. Health reform lessons learned from physicians in three nations. Health Aff (Millwood) 1993; 12:194-203. [PMID: 8244232 DOI: 10.1377/hlthaff.12.3.194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To explore the concerns of practicing physicians as a way to inform the health reform debate, the authors conducted a survey of physicians in the United States, Canada, and Germany. Survey results indicate that U.S. physicians are most likely to view affordability as the greatest barrier to access to care for their patients. However, unavailability of services and long waiting times were cited most often by Canadian physicians. German physicians did not cite access problems as frequently as Canadian physicians did; other measures of satisfaction were closer to U.S. levels, suggesting fewer trade-offs if the United States were to adopt aspects of the German health care system.
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Affiliation(s)
- R J Blendon
- Department of Health Policy and Management, Harvard School of Public Health
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Abstract
Although tocolytic drugs are widely used to try to stop preterm labor, their actual contribution to preventing preterm deliveries is unknown. Since tocolytic drugs are not used at the University of Manitoba, it was possible to estimate the proportion of preterm deliveries that might have been eligible for tocolytic drug therapy. Of 364 consecutive preterm deliveries between 24 and 35 weeks, only 9% would have been eligible for, let alone prevented by, tocolytic drug therapy, and even a smaller percentage of babies would actually have benefitted from their use. The use of tocolytic drugs can, at best, benefit only a very small percentage of babies born preterm. Whether the risks of treatment justify this small benefit is arguable.
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Affiliation(s)
- S M Menticoglou
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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Menticoglou SM, Manning FA, Morrison I, Harman CR. Must macrosomic fetuses be delivered by a caesarean section? A review of outcome for 786 babies greater than or equal to 4,500 g. Aust N Z J Obstet Gynaecol 1992; 32:100-3. [PMID: 1520190 DOI: 10.1111/j.1479-828x.1992.tb01917.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Because difficult vaginal delivery is more frequent with macrosomic fetuses, some writers recommend routine Caesarean section for the delivery of fetuses greater than or equal to 4,500 g. The purpose of this study was to evaluate the appropriateness of this recommendation. A retrospective review was undertaken to determine how many fetuses born in our hospital weighing greater than or equal to 4,500 g died or were permanently damaged as a consequence of mechanical difficulties at delivery. During a 10-year period, 590 (75%) of 786 cephalic babies weighing greater than or equal to 4,500 g and alive at the start of labour were born vaginally. No baby died or was permanently damaged as a consequence of mechanical difficulties at delivery. Routine Caesarean section for macrosomic fetuses to prevent death or damage from difficult delivery is not warranted by our results.
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Affiliation(s)
- S M Menticoglou
- Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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Affiliation(s)
- J N Edwards
- Harvard Program on the Future of Health Care
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Abstract
We report a full-scale calculation of the third-order susceptibility, X((3)), in GaAs-AlAs superlattices. We present the frequency dependence of X((3)) and find a favorable figure of merit for near-resonant enhancement of X((3)).
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Manning FA, Harman CR, Menticoglou S, Morrison I. Assessment of fetal well-being with ultrasound. Obstet Gynecol Clin North Am 1991; 18:891-905. [PMID: 1803308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The practice of medicine is undergoing marked changes fueled by the infusion of vast amounts of new information concerning the etiology, the progressive pathophysiology, and the complexity of host response to disease states. It is only recently that we have begun to examine the present extent of fetal disease and to determine the characteristics of its advancements. This information now permits new and rational approaches to the management of fetal disease. Clinical significance, both real and potential, of this new wealth of information in reducing perinatal mortality and morbidity is difficult to overestimate. Cumulative experience with fetal biophysical scoring as a method for antepartum fetal risk assessment is now extensive. The cumulative data indicate that the method is sensitive for recognizing both the normal and the compromised fetus. Moreover, the method appears to offer the advantage of grading various degrees of fetal compromise. The additional information gained by real-time ultrasound scanning (gestational age determination, fetal morphometrics, and fetal anomaly screening), although not an integral part of the fetal biophysical profile score, nevertheless remains a critical aspect of antepartum fetal assessment. These data are collected simultaneously with fetal biophysical profile scoring. It is impossible to separate cleanly the advantage of fetal biophysical profile scoring in isolation of this additional information. It would, however, seem that such attempt at separation is artificial because the data in combination provide the key information that the physician needs to guide fetal management. It seems more reasonable to expect that continued modification and improvement of the existing fetal biophysical profile scoring method with inclusion of new testing techniques will be the steps that will occur to improve testing accuracy (Fig. 3). In medical schools in the 1960s, it was generally taught that the concept of "irreducible" perinatal mortality existed and that this figure was usually set at a perinatal mortality of around 8 per 1000. Now in the 1990s that perinatal mortality has already fallen below this irreducible level and continues to fall. We now observe perinatal mortality among tested fetuses of less than 7 per 1000 and corrected perinatal mortalities of less than 2 per 1000. These remarkable results strongly underscore the advantages obtained by ultrasound assessment of the fetus.
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Affiliation(s)
- F A Manning
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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Kuyucak S, Morrison I, Sebe T. Hexadecapole systematics in the interacting boson model. Phys Rev C Nucl Phys 1991; 43:1187-1200. [PMID: 9967160 DOI: 10.1103/physrevc.43.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Morrison I, Brown LD, Jaros M. Valley-mixing effects in (GaAs)l(AlAs)m superlattices with microscopically imperfect interfaces. Phys Rev B Condens Matter 1990; 42:11818-11825. [PMID: 9995490 DOI: 10.1103/physrevb.42.11818] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Morrison I, Jaros M. Microscopic theory of enhanced nonlinear refraction in semiconductor superlattices. Phys Rev B Condens Matter 1990; 42:3749-3752. [PMID: 9995893 DOI: 10.1103/physrevb.42.3749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Morrison I. Power brings out the worst in women. NLN Publ 1990:270-1. [PMID: 2235397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Kuyucak S, Morrison I. SU(3) limit of the interacting boson model as a 1/N expansion. Phys Rev C Nucl Phys 1990; 41:2936-2939. [PMID: 9966679 DOI: 10.1103/physrevc.41.2936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Kuyucak S, Morrison I. Band mixing effects in mean field theories. I. E2 transitions in the interacting boson model 1. Phys Rev C Nucl Phys 1990; 41:1803-1821. [PMID: 9966529 DOI: 10.1103/physrevc.41.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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86
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Manning FA, Morrison I, Harman CR, Menticoglou SM. The abnormal fetal biophysical profile score. V. Predictive accuracy according to score composition. Am J Obstet Gynecol 1990; 162:918-24; discussion 924-7. [PMID: 2327462 DOI: 10.1016/0002-9378(90)91292-k] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The relationship between last abnormal biophysical profile score, in total and by variable composition, and a spectra of abnormal perinatal outcome end points was examined in 525 fetuses. Highly significant inverse relationships between last test score and outcome were observed; relationships were linear for most end points and exponential for perinatal mortality end points. For biophysical profile scores less than or equal to 6, 25 of the 26 possible variable combinations were observed, at varying frequencies. For a biophysical profile score of 6, the positive predictive accuracy for some end points was significantly higher with either nonreactive nonstress test/fetal tone absent or nonreactive nonstress test/absent fetal breathing movement, and significantly lower with absent fetal breathing movement and decreased amniotic fluid volume. For a biophysical profile score of 4, the positive predictive accuracy for some end points was significantly higher with nonreactive nonstress test/absent fetal breathing movement/decreased amniotic fluid and was significantly lower with absent fetal movement/fetal breathing movement/fetal tone. No significant variation was observed for a biophysical profile score of 2. These data indicate that not all abnormal biophysical profile scores are equal.
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Affiliation(s)
- F A Manning
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba School of Medicine, Winnipeg, Canada
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87
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Manning FA, Harman CR, Morrison I, Menticoglou SM, Lange IR, Johnson JM. Fetal assessment based on fetal biophysical profile scoring. IV. An analysis of perinatal morbidity and mortality. Am J Obstet Gynecol 1990; 162:703-9. [PMID: 2316574 DOI: 10.1016/0002-9378(90)90990-o] [Citation(s) in RCA: 153] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The relationship between the last biophysical profile score result and perinatal outcome was determined among a large referred population of high-risk pregnancies. A highly significant inverse linear correlation was observed for fetal distress, admission to neonatal intensive care unit, intrauterine growth retardation, 5-minute Apgar score less than 7, and umbilical cord pH less than 7.20 but not for the incidence of meconium or major anomaly. A highly significant inverse exponential (log 10) relationship was observed for perinatal mortality in total and by component parts and cause. These data strongly suggest the biophysical profile scoring method of fetal risk assessment is accurate and also provides insight into the extent of fetal compromise.
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Affiliation(s)
- F A Manning
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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88
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89
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Manning FA, Harman CR, Morrison I, Menticoglou S. Fetal assessment based on fetal biophysical profile scoring. III. Positive predictive accuracy of the very abnormal test (biophysical profile score = 0). Am J Obstet Gynecol 1990; 162:398-402. [PMID: 2309823 DOI: 10.1016/0002-9378(90)90395-n] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The relationship between complete absence of all components of the fetal biophysical profile score (biophysical profile score = 0) and adverse perinatal outcome was examined. Twenty-nine of 28,655 fetuses studied (0.092%) had a last biophysical profile score of 0; 48.3% of these perinates died (14 of 29 fetuses), the majority of whom (11 of 14) were stillborn, with death occurring as early as 30 minutes to as long as 11 days after the last test. Three asphyxia-related neonatal deaths occurred despite aggressive and immediate intervention. All survivors exhibited at least one of the five discrete markers used to assess perinatal morbidity. The positive predictive accuracy of a biophysical profile score of 0, with mortality and morbidity used as end points, was 100%. These data indicate the very abnormal fetal biophysical profile score to be a perinatal emergency.
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Affiliation(s)
- F A Manning
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Canada
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90
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Affiliation(s)
- R J Blendon
- Department of Health Policy and Management, Harvard School of Public Health
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91
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Geyer HB, Morrison I. Seniority mapping of single fermion operators. Phys Rev C Nucl Phys 1989; 40:2383-2389. [PMID: 9966237 DOI: 10.1103/physrevc.40.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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92
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Menticoglou SM, Manning FA, Harman CR, Morrison I. Severe fetal brain injury without evident intrapartum asphyxia or trauma. Obstet Gynecol 1989; 74:457-61. [PMID: 2761930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Two appropriate-for-dates term infants were born after uncomplicated labors and atraumatic deliveries. They were depressed at birth, developed seizures on the first day of life, and followed clinical courses compatible with hypoxic-ischemic encephalopathy. However, the umbilical cord vessel pH and blood gases were normal. The children are now severely retarded and have cerebral palsy. These cases prove that the events of labor and delivery may not be responsible for all cases of brain damage in surviving children.
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Affiliation(s)
- S M Menticoglou
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, Canada
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93
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94
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Kuyucak S, Morrison I. beta -band moment of inertia anomaly. Phys Rev C Nucl Phys 1988; 38:2482-2485. [PMID: 9955088 DOI: 10.1103/physrevc.38.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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95
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Turton RJ, Jaros M, Morrison I. Electronic band structure and nonparabolicity in strained-layer Si-Si1-xGex superlattices. Phys Rev B Condens Matter 1988; 38:8397-8405. [PMID: 9945598 DOI: 10.1103/physrevb.38.8397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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96
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Wu HC, Dieperink AE, Scholten O, Harakeh MN, Pignanelli M, Morrison I. E4 properties in deformed nuclei and the sdg interacting boson model. Phys Rev C Nucl Phys 1988; 38:1638-1648. [PMID: 9954975 DOI: 10.1103/physrevc.38.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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97
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Wong KB, Jaros M, Morrison I, Hagon JP. Electronic structure and optical properties of Si-Ge superlattices. Phys Rev Lett 1988; 60:2221-2224. [PMID: 10038291 DOI: 10.1103/physrevlett.60.2221] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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98
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Morrison I, Jaros M. Electronic and optical properties of ultrathin Si/Ge (001) superlattices. Phys Rev B Condens Matter 1988; 37:916-921. [PMID: 9944587 DOI: 10.1103/physrevb.37.916] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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99
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Manning FA, Morrison I, Harman CR, Lange IR, Menticoglou S. Fetal assessment based on fetal biophysical profile scoring: experience in 19,221 referred high-risk pregnancies. II. An analysis of false-negative fetal deaths. Am J Obstet Gynecol 1987; 157:880-4. [PMID: 3674161 DOI: 10.1016/s0002-9378(87)80077-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The incidence of false-negative fetal death, which is defined as stillbirth unrelated to major anomaly or alloimmunization occurring after a last normal fetal biophysical score, was determined in 19,221 referred high-risk pregnancies. The calculated rate of fetal death after a last normal test was 0.726/1000 (14 deaths), which remained relatively constant despite a progressive increase in tests and patients studied. We conclude that a normal fetal biophysical profile score confers a high probability of perinatal survival.
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Affiliation(s)
- F A Manning
- Division of Maternal-Fetal Medicine, University of Manitoba, Winnipeg, Canada
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100
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Kuyucak S, Morrison I. Algebraic solution of a general quadrupole Hamiltonian in the interacting boson model. Phys Rev C Nucl Phys 1987; 36:774-777. [PMID: 9954137 DOI: 10.1103/physrevc.36.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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