Contingent screening for down syndrome is an efficient alternative to non-disclosure sequential screening

Objective To present a first and second trimester Down syndrome screening strategy, whereby second-trimester marker determination is contingent on the first-trimester results. Unlike non-disclosure sequential screening (the Integrated test), which requires all women to have markers in both trimesters, this allows a large proportion of the women to complete screening in the first trimester. Methods Two first-trimester risk cut-offs defined three types of results: positive and referred for early diagnosis; negative with screening complete; and intermediate, needing second-trimester markers. Multivariate Gaussian modelling with Monte Carlo simulation was used to estimate the false-positive rate for a fixed 85% detection rate. The false-positive rate was evaluated for various early detection rates and early test completion rates. Model parameters were taken from the SURUSS trial. Results Completion of screening in the first trimester for 75% of women resulted in a 30% early detection rate and a 55% second trimester detected rate (net 85%) with a false-positive rate only 0.1% above that achievable by the Integrated test. The screen-positive rate was 0.1% in the first trimester and 4.7% for those continuing to be tested in the second trimester. If the early detection rate were to be increased to 45% or the early completion rate were to be increased to 80%, there would be a further 0.1% increase in the false-positive rate. Conclusion Contingent screening can achieve results comparable with the Integrated test but with earlier completion of screening for most women. Both strategies need to be evaluated in large-scale prospective studies particularly in relation to psychological impact and practicability.

Citizens’ attitudes toward public services. Satisfaction in 2009-2011

The aim of this paper is to study the recent changes on citizens’ satisfaction with the performance ofpublic services, in the period 2009-2011 in Spain. Using data from the surveys on Quality of PublicServices, developed by the Sociological Research Center jointly with the National Agency for theEvaluation of Public Services and Quality of Services, our results show that the level of satisfactionhas slightly increased, which seems to display a greater tendency to positively value public servicesduring economic retrenchment. A major determinant of high satisfaction is self-reported ideology.Besides, immigrants display higher levels of satisfaction than Spaniards.

PAD combination therapy (PS-341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myeloma

Summary Bortezomib (formerly PS-341) has significant activity in patients with relapsed multiple myeloma (MM), its efficacy is increased with the addition of dexamethasone and it demonstrates synergy with doxorubicin, thus providing the rationale for combination therapy with bortezomib, doxorubicin and dexamethasone (PAD). Patients with untreated MM received four 21-d cycles of PAD, comprising bortezomib 1·3 mg/m2 on days 1, 4, 8 and 11, along with dexamethasone 40 mg on days 1–4, 8–11 and 15–18 during cycle 1 and days 1–4 during cycles 2–4. During days 1–4, patients also received 0, 4·5 or 9 mg/m2 of doxorubicin at dose levels 1, 2, and 3 respectively. Following peripheral blood stem cell (PBSC) collection, patients received high-dose melphalan (MEL200) with PBSC transplantation (PBSCT). After PAD induction alone, 20 of 21 patients (95%) achieved at least a partial response (PR), including complete response (CR) in five patients (24%). Twenty of 21 had PBSC mobilized, and 18 of 20 received MEL200/PBSCT. In an intention-to-treat analysis, response rates were: CR 43%, near CR 14%, very good PR 24%, PR 14% and stable disease 5%. PAD was effective, did not prejudice subsequent PBSC collection, and should be further evaluated in prospective randomized trials.

A Novel Quad-Polarization Agile Patch Antenna

In this communication we present a novel polarization-agile microstrip antenna design. To dynamically change the polarization state, the radiating patch is fed by a tunable quasi-lumped coupler. The whole structure can be dynamically altered to radiate electromagnetic waves with vertical linear, horizontal linear, right-handed circular or left-handed circular polarization simply by changing the operating mode of the quasi-lumped coupler. Due to its topology the coupler is simply reconfigured by switching the bias of two varactor diodes via a very simple DC bias circuitry: no additional capacitors or inductors are required. A prototype is fabricated with a 0.762-mm-thick upper layer substrate for the radiating element and a 0.130-mm-thick layer substrate for the coupler circuit, both with the same dielectric material relative permittivity of 2.22. The simulated and measured scattering parameters, the axial ratio in circular radiation-mode and the cross-polarization level in linear mode, the gain and the radiation patterns are presented. The agile polarization capabilities of this new antenna, as demonstrated in this communication, underscore its suitability for modern wireless communications in a multi-path propagation environment.

Becoming private property: custom, law, and the geographies of ‘ownership’ in 18th- and 19th-century England

The making private of hitherto public goods is a central tenet of neoliberalism. From land in Africa, Asia, and South America to the assertion of property rights over genes and cells by corporations, the process(es) of making private property matters more than ever. And yet, despite this importance, we know remarkably little about the spatial plays through which things become private property. In this paper I seek to address this imbalance by focusing upon the formative context of 18th- and early-19th-century England. The specific lens is wood, that most critical of all ‘natural’ things other than land in the transition to market-driven economies. It is shown that the interplay between custom, law, and local practices rendered stable and aspatial definitions of property impossible. Whilst law was the key technology through which property was mediated, the cadence of particular places gave these mediations distinctive forms. I conclude that not only must we take property seriously, but we must also take the conditions and contexts of its making seriously too.

Probing aggressive motivation in a cichlid fish

The duration of startles provides an inverse measure of motivation to resume the previous activity. Here, we use a novel method in which one convict cichlid fish (Amatitlania nigrofasciata) of a competing pair was startled independently of the opponent. Fish were given various opponents and the mean startle duration determined. This mean was negatively correlated with the mean use of highly escalated 'frontal activities' such as biting and frontal display, but not the less escalated lateral displays or tail beating. Thus the startle duration was a reliable surrogate measure of the most escalated components of aggressive interactions. That is, it provided a motivational probe for aggressiveness of individual fish. Fight motivation is often determined in terms of fight duration or physiological costs for losers, who reveal the costs they are prepared to pay. We discuss various potential advantages of the motivational probe over previous measures, particularly with respect to winners and losers and different times during the interactions.

Vitamins C and E for prevention of pre-eclampsia in women with type 1 diabetes (DAPIT): a randomised placebo-controlled trial.

Background
Results of several trials of antioxidant use during pregnancy have not shown a reduction in pre-eclampsia, but the eff ect in women with diabetes is unknown. We aimed to assess whether supplementation with vitamins C and E reduced incidence of pre-eclampsia in women with type 1 diabetes.

Methods
We enrolled women from 25 UK antenatal metabolic clinics in a multicentre randomised placebo-controlled trial. Eligibility criteria were type 1 diabetes preceding pregnancy, presentation between 8 weeks’ and 22 weeks’ gestation, singleton pregnancy, and age 16 years or older. Women were randomly allocated in a 1:1 ratio to receive1000 mg vitamin C and 400 IU vitamin E (a-tocopherol) or matched placebo daily until delivery. The randomisation sequence was stratifi ed by centre with balanced blocks of eight patients. All trial personnel and participants were masked to treatment allocation. The primary endpoint was pre-eclampsia, which we defi ned as gestational hypertension with proteinuria. Analysis was by modifi ed intention to treat. This study is registered, ISRCTN27214045.

Findings
Between April, 2003, and June, 2008, 762 women were randomly allocated to treatment groups (379 vitamin supplementation, 383 placebo). The primary endpoint was assessed for 375 women allocated to receive vitamins, and 374 allocated to placebo. Rates of pre-eclampsia did not differ between vitamin (15%, n=57) and placebo (19%, 70)groups (risk ratio 0·81, 95% CI 0·59–1·12). No adverse maternal or neonatal outcomes were reported.

Interpretation
Supplementation with vitamins C and E did not reduce risk of pre-eclampsia in women with type 1 diabetes. However, the possibility that vitamin supplementation might be benefi cial in women with a low antioxidant status at baseline needs further testing.