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Urbanization can dramatically alter stormwater, both the quantity and quality, by engendering larger peak flows and through the introduction of contaminants into runoff. The current study builds on previous research that developed relationships between a suite of nonpoint source contaminants, known as trace organic contaminants (TOrCs), and hydrologic measurements for a series of storms (one site had 15 storms and the other had 19 storms) in Madison, WI, by creating statistical and deterministic models. Correlations and regressions were calculated between TOrC loads and hydrologic measurements for a series of storms for both a commercial site and a high-density residential site. From the regressions, it became evident that loading responses to precipitation were not the same between the two land covers for some TOrCs, indicating varying load responses for TOrCs depending on land cover. The regressions were utilized in the Source Loading and Management Model for Windows (WinSLAMM), an event-based hydrologic and water-quality model, to demonstrate that it can be used to model novel contaminants. The regressions were also used to estimate mean annual loads of TOrCs from all commercial and high-density residential areas in Madison, WI, for the watersheds to which Madison discharges its stormwater. The mean annual loads varied between grams per year to tens of thousands of grams per year depending on the TOrC and watershed. This work will ultimately allow managers to simulate the presence of, establish total maximum daily loads for, and mitigate the loads of TOrCs through stormwater best management practices.

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OBJECTIVE: To determine whether cerclage based on serial transvaginal ultrasound (STVUS) vs. cerclage based on obstetric history (prior multiple midgestation losses) is superior for treatment of cervical insufficiency. STUDY DESIGN: This retrospective study evaluated all history-based or ultrasound-based cerclages in singleton pregnancies over a 5-year period at the University of Mississippi Medical Center. Demographic statistics, interval from cerclage placement to delivery, and gestational age at delivery were recorded, as were neonatal factors such as birthweight, morbidity, and mortality. RESULTS: No significant difference was found in regard to gestational age at delivery between the history-based cerclage and the ultrasound-based groups. The number of patients delivered before 24 weeks or after 34 weeks was similar. Birth weights, Apgar scores, and the number with growth restriction were similar between the two groups, as were perinatal loss and significant morbidity. In the ultrasound-based cerclage group, 52.1% did not require cerclage placement despite a history consistent with cervical insufficiency. CONCLUSION: There were no statistical differences between history-based and ultrasound-based cerclage in regard to obstetric or neonatal outcome. Using STVUS instead of cerclage procedures based on obstetric history, unnecessary procedures can be avoided in more than half the patients.

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We sought to determine if maternal body mass index (BMI; kg/m (2)) identifies newborns with abnormal fetal growth (small for gestational age [SGA], large for gestational age [LGA], or macrosomia) at ≥37 weeks. Singletons with reliable gestational age and without diabetes or hypertension were analyzed. Areas under the receiver-operating characteristic (AUC) curves were calculated for BMI (first visit, delivery, and the change during pregnancy) to identify abnormal growth. If the AUC was ≤0.75 then the diagnostic test was not useful. Among 3582 cohorts, SGA occurred in 10%, LGA in 9%, and 11% were macrosomic. AUC indicates that BMI at delivery is significantly better than BMI at first visit for identification of aberrant growth, but their AUCs were less than 0.75, indicating it is not a useful diagnostic test. Maternal BMIs (at first visit, delivery, or the change during pregnancy) are poor predictors of abnormal fetal growth.

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OBJECTIVES: Little is known about the psychologic effects on obstetricians and gynecologists of adverse maternal or fetal outcome and malpractice claims. METHODS: An anonymous survey regarding the psychologic effects of professional liability claims, as measured by 19 items which were used to create four composites rated on a 5-point scale, was mailed to the members of the Central Association of Obstetricians and Gynecologists. RESULTS: Among respondents, 78% had at least one malpractice claim, and 9% experienced a patient death, 12% a fetal demise, and 21% neonatal neurologic damage. In general, professional liability claims had significant effects on psychologic trauma (P < 0.001), shame/doubt (P < 0.005), and active coping (P < 0.05), but not on job stress, whereas patient death, but not fetal death or neonatal neurologic injury, had significant effects on all 4 composite variables. CONCLUSION: Physicians experience psychologic trauma influenced by patient death and professional liability actions.

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