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Notes: Objectives To document the duration of fetal cardiac time intervals in uncomplicated singleton pregnancies using a novel non-invasive fetal electrocardiography (fECG) system and to demonstrate this technique's ability to acquire recordings in twin and triplet pregnancies.Design Prospective cross sectional observational study.Setting Antenatal wards and clinics, day assessment unit and centre for fetal care at a tertiary referral hospital, London, UK.Population or Sample Three hundred and four singleton and multiple pregnancies, 15–41 weeks of gestation.Methods Using electrodes sited on the maternal abdomen, a fetal electrocardiography (fECG) system was developed and tested on 304 pregnant women from 15 to 41 weeks of gestation, of whom 241 were uncomplicated singletons, 58 had twin and 5 had triplet pregnancies. The composite abdominal signals were stored on a laptop computer and the fECG derived off-line using a digital signal processing technique. For singletons, linear regression was used to analyse PR, QRS, QT and QTc intervals, and construct time-specific reference ranges.Main outcome measure Duration of fECG time intervals as a function of gestational age. Success of signal seperation in singleton, twin and triplet pregnancies.Results For singletons, a total of 250 recordings was obtained from 241 individuals with a signal separation success rate of 85% (213/250). Success rates were significantly poorer between 27 and 36 weeks of gestation (2 × k χ2, P 〈 0.0001), with 84% (31/37) of separation failures occurring during this period. P, Q, R and S waves were seen in all cases where fetal signals were separated and were used to generate fECG time interval reference ranges. In 22% (43/199) of analysed cases, no T waves were identified, 63% (27/43) of whom were ≤24 weeks of gestation. In twins and triplets, separate fetal signals were obtained in 78% (91/116) and 93% (14/15), respectively; P, Q, R and S waves were evident in all averaged fECGs, while T waves were identified in 59% (54/91) and 57% (8/14).Conclusions This study provides reference ranges with gestation for fECG intervals derived non-invasively from normal singleton pregnancies and demonstrates the feasibility of obtaining complete fECG recordings non-invasively across a wide gestational range in pregnancies of all pluralities. The fECG time intervals described will enable the identification of pathological fECG recordings from high risk pregnancies where fECG abnormalities are suspected.

Notes: A project conceived as finding expert common ground on the future evolution of facilities management (FM) revealed, instead, differing perceptions of the FM role rooted in different backgrounds, mind-sets, and cultures, and held by the business, property, and FM disciplines. We report it in the hope of starting the change process which will allow the changing facilities needs of businesses and clients to be met.

Notes: A business organization should consistently meet the needs of its stakeholders. Any sub-optimal position suggests that enhancement of business performance is possible in at least two areas: the effectiveness of the routes to achieving those stakeholder needs, and the efficiency of those routes. The support activities constitute an environment created by the integration and co-ordination of people, processes and places. The challenge is to create the support environment that consistently meets the needs of the business, and then to manage it through the optimum use of resources. An organization that has created, sustained and managed a business-aligned support environment is likely to have a competitive advantage over those that have not done so. If the author is able to confirm this assertion through his research, then the desired outcome would be a framework for achieving such alignment. This paper briefly describes the concept of Business Support Optimisation as an approach to improving such alignment at a moment in time, and suggests how it can be operationalised using value mapping to realise stakeholder expectations.

Notes: Background: Patients affected with tuberous sclerosis complex (TSC) are prone to the development of multiple benign tumors of the skin and other organs. Tuberin, the protein product of the tuberous-sclerosis-complex-2 tumor suppressor gene (TSC2) has been shown to inhibit cell proliferation. In TSC associated kidney tumors and sporadic brain tumors the loss/reduction of tuberin has been shown. Methods: Specimens of nine squamous cell carcinomas (SCC) and five basal cell carcinomas (BCC) from patients without TSC and six biopsies of connective tissue nevi (CTN) of patients with TSC were obtained. Specimens were analyzed by immunoblotting for the expression of tuberin. Results: Absent or reduced levels of tuberin were detected in the dermal parts of three of six shagreen patches, two of five BCC, and four of nine SCC. Conclusions: In tumors/hamartomas of patients with TSC the complete loss of TSC2 and tuberin is a mechanism which could be shown for CTN, thereby excluding the possibility of haploinsufficiency of TSC2. In a substantial number of cutaneous BCC and SCC the loss or downregulation of tuberin seems to be epigenetic, as alterations of TSC2 are not known in these tumors. The absence or reduction of tuberin might contribute to their proliferation.