ObjectiveEstimated fetal weight (EFW) and fetal biometry are complementary measures used to screen for fetal growth disturbances. Our aim was to provide international EFW standards to complement the INTERGROWTH‐21st Fetal Growth Standards that are available for use worldwide.MethodsWomen with an accurate gestational‐age assessment, who were enrolled in the prospective, international, multicenter, population‐based Fetal Growth Longitudinal Study (FGLS) and INTERBIO‐21st Fetal Study (FS), two components of the INTERGROWTH‐21st Project, had ultrasound scans every 5 weeks from 9–14 weeks' until 40 weeks' gestation. At each visit, measurements of fetal head circumference (HC), biparietal diameter, occipitofrontal diameter, abdominal circumference (AC) and femur length (FL) were obtained blindly by dedicated research sonographers using standardized methods and identical ultrasound machines. Birth weight was measured within 12 h of delivery by dedicated research anthropometrists using standardized methods and identical electronic scales. Live babies without any congenital abnormality, who were born within 14 days of the last ultrasound scan, were selected for inclusion. As most births occurred at around 40 weeks' gestation, we constructed a bootstrap model selection and estimation procedure based on resampling of the complete dataset under an approximately uniform distribution of birth weight, thus enriching the sample size at extremes of fetal sizes, to achieve consistent estimates across the full range of fetal weight. We constructed reference centiles using second‐degree fractional polynomial models.ResultsOf the overall population, 2404 babies were born within 14 days of the last ultrasound scan. Mean time between the last scan and birth was 7.7 (range, 0–14) days and was uniformly distributed. Birth weight was best estimated as a function of AC and HC (without FL) as log(EFW) = 5.084820 − 54.06633 × (AC/100)3 − 95.80076 × (AC/100)3 × log(AC/100) + 3.136370 × (HC/100), where EFW is in g and AC and HC are in cm. All other measures, gestational age, symphysis–fundus height, amniotic fluid indices and interactions between biometric measures and gestational age, were not retained in the selection process because they did not improve the prediction of EFW. Applying the formula to FGLS biometric data (n = 4231) enabled gestational age‐specific EFW tables to be constructed. At term, the EFW centiles matched those of the INTERGROWTH‐21st Newborn Size Standards but, at < 37 weeks' gestation, the EFW centiles were, as expected, higher than those of babies born preterm. Comparing EFW cross‐sectional values with the INTERGROWTH‐21st Preterm Postnatal Growth Standards confirmed that preterm postnatal growth is a different biological process from intrauterine growth.ConclusionsWe provide an assessment of EFW, as an adjunct to routine ultrasound biometry, from 22 to 40 weeks' gestation. However, we strongly encourage clinicians to evaluate fetal growth using separate biometric measures such as HC and AC, as well as EFW, to...

ObjectivesThere are no international standards for relating fetal crown–rump length (CRL) to gestational age (GA), and most existing charts have considerable methodological limitations. The INTERGROWTH-21st Project aimed to produce the first international standards for early fetal size and ultrasound dating of pregnancy based on CRL measurement.MethodsUrban areas in eight geographically diverse countries that met strict eligibility criteria were selected for the prospective, population-based recruitment, between 9 + 0 and 13 + 6 weeks' gestation, of healthy well-nourished women with singleton pregnancies at low risk of fetal growth impairment. GA was calculated on the basis of a certain last menstrual period, regular menstrual cycle and lack of hormonal medication or breastfeeding in the preceding 2 months. CRL was measured using strict protocols and quality-control measures. All women were followed up throughout pregnancy until delivery and hospital discharge. Cases of neonatal and fetal death, severe pregnancy complications and congenital abnormalities were excluded from the study.ResultsA total of 4607 women were enrolled in the Fetal Growth Longitudinal Study, one of the three main components of the INTERGROWTH-21st Project, of whom 4321 had a live singleton birth in the absence of severe maternal conditions or congenital abnormalities detected by ultrasound or at birth. The CRL was measured in 56 women at < 9 + 0 weeks' gestation; these were excluded, resulting in 4265 women who contributed data to the final analysis. The mean CRL and SD increased with GA almost linearly, and their relationship to GA is given by the following two equations (in which GA is in days and CRL in mm): mean CRL = −50.6562 + (0.815118 × GA) + (0.00535302 × GA2); and SD of CRL = −2.21626 + (0.0984894 × GA). GA estimation is carried out according to the two equations: GA = 40.9041 + (3.21585 × CRL0.5) + (0.348956 × CRL); and SD of GA = 2.39102 + (0.0193474 × CRL).ConclusionsWe have produced international prescriptive standards for early fetal linear size and ultrasound dating of pregnancy in the first trimester that can be used throughout the world. © 2014 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Over the last decade, blockchain technology has emerged to provide solutions to thecomplexity and privacy challenges of using distributed databases. It reduces cost for customers byeliminating intermediaries and builds trust in peer-to-peer communications. Over this time, theconcept of blockchain has shifted greatly due to its potential in business growth for enterprisesand the rapidly evolving applications in a collaborative smart-city ecosystem, healthcare, andgovernance. Many platforms, with different architectures and consensus protocols, have beenintroduced. Consequently, it becomes challenging for an application developer to choose the rightplatform. Furthermore, blockchain has misaligned with the goals for an efficient green collaborativedigital ecosystem. Therefore, it becomes critical to address this gap and to build new frameworks toalign blockchain with those goals. In this paper, we discuss the evolution of blockchain architectureand consensus protocols, bringing a retrospective analysis and discussing the rationale of theevolution of the various architectures and protocols, as well as capturing the assumptions conduciveto their development and contributions to building collaborative applications. We introduce aclassification of those architectures helping developers to choose a suitable platform for applicationsand providing insights for future research directions in the field to build new frameworks.

BackgroundThe World Health Organization recommends that human growth should be monitored with the use of international standards. However, in obstetric practice, we continue to monitor fetal growth using numerous local charts or equations that are based on different populations for each body structure. Consistent with World Health Organization recommendations, the INTERGROWTH-21st Project has produced the first set of international standards to date pregnancies; to monitor fetal growth, estimated fetal weight, Doppler measures, and brain structures; to measure uterine growth, maternal nutrition, newborn infant size, and body composition; and to assess the postnatal growth of preterm babies. All these standards are based on the same healthy pregnancy cohort. Recognizing the importance of demonstrating that, postnatally, this cohort still adhered to the World Health Organization prescriptive approach, we followed their growth and development to the key milestone of 2 years of age.ObjectiveThe purpose of this study was to determine whether the babies in the INTERGROWTH-21st Project maintained optimal growth and development in childhood.Study DesignIn the Infant Follow-up Study of the INTERGROWTH-21st Project, we evaluated postnatal growth, nutrition, morbidity, and motor development up to 2 years of age in the children who contributed data to the construction of the international fetal growth, newborn infant size and body composition at birth, and preterm postnatal growth standards. Clinical care, feeding practices, anthropometric measures, and assessment of morbidity were standardized across study sites and documented at 1 and 2 years of age. Weight, length, and head circumference age- and sex-specific z-scores and percentiles and motor development milestones were estimated with the use of the World Health Organization Child Growth Standards and World Health Organization milestone distributions, respectively. For the preterm infants, corrected age was used. Variance components analysis was used to estimate the percentage variability among individuals within a study site compared with that among study sites.ResultsThere were 3711 eligible singleton live births; 3042 children (82%) were evaluated at 2 years of age. There were no substantive differences between the included group and the lost-to-follow up group. Infant mortality rate was 3 per 1000; neonatal mortality rate was 1.6 per 1000. At the 2-year visit, the children included in the INTERGROWTH-21st Fetal Growth Standards were at the 49th percentile for length, 50th percentile for head circumference, and 58th percentile for weight of the World Health Organization Child Growth Standards. Similar results were seen for the preterm subgroup that was included in the INTERGROWTH-21st Preterm Postnatal Growth Standards. The cohort overlapped between the 3rd and 97th percentiles of the World Health Organization motor development milestones. We estimated that the variance among study sites explains only 5.5% of the total variability in the length of the children between...

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Over the last decade the blockchain technology has emerged to provide solutions to the complexity and privacy challenges of using distributed databases. Its adoption is motivated by cost reduction for customers. Over this time, the concept of blockchain has shifted greatly due to its potential in business growth for enterprises and the rapidly evolving applications in a collaborative smart cities ecosystem, healthcare, and governance. Many platforms, with different architectures and consensus protocols, have been introduced. Consequently, it becomes challenging for an application developer to chose the right platform. Furthermore, blockchain has misaligned with the goals for efficient green collaborative digital ecosystem. Therefore, it becomes critical to address this gap and to build new frameworks to align blockchain with those goals. In this paper, we discuss the evolution of blockchain architecture and consensus protocols, bringing a retrospective analysis and discussing the rationale of the evolution of the various architectures and protocols, as well as capturing the assumptions conducting to their development and contributions to building collaborative applications. We introduce a classification of those architectures, helping developers to chose a suitable platform for applications and providing insights for future research directions in the field in building new frameworks. blockchain architecture and consensus protocol, it becomes more and more difficult to foresee the uses and applications of blockchain, therefore compounding the difficulty in achieving the goals. In 2017, the bitcoin mining used around 30.14 TerraWatt hours (TWh) of energy, which is equivalent to energy usage of the entire Ireland in a year [3]. According to a research, the annual carbon dioxide emissions by the bitcoin network are as high as 22.9 million metric tons, almost equivalent to the amount produced by the countries like Sri Lanka and Jordan [4].Further challenges have been placed on distributed applications by the expanding industrial market growth to serve a wide number of customers. Growing business requires trust and transparency between the customers and business providers. Customers require to eliminate intermediaries to reduce transactions cost. The issues of data communication overhead with increasing number of network participants further hinders the real-time services of the developed applications. Addressing these problems of energy consumption and scalability often trades off with security, and privacy. As such, the goals of this paper are four-fold: 1) we aim to provide a temporal evolution of blockchain applications development platforms architectures and consensus protocols with a retrospective analysis to their introduction. We classify the platforms and the consensus protocols under unifying architectures, and discuss various existing and upcoming blockchain applications, 2) help developers to choose the right platform architecture for applications, 3) we evaluate the current research on the topic, blockchai...

Diabetes is the leading cause of severe health complications and one of the top 10 causes of death worldwide. To date, diabetes has no cure, and therefore, it is necessary to take precautionary measures to avoid its occurrence. The main aim of this systematic review is to identify the majority of the risk factors for the incidence/prevalence of type 2 diabetes mellitus on one hand, and to give a critical analysis of the cohort/cross-sectional studies which examine the impact of the association of risk factors on diabetes. Consequently, we provide insights on risk factors whose interactions are major players in developing diabetes. We conclude with recommendations to allied health professionals, individuals and government institutions to support better diagnosis and prognosis of the disease.

Healthcare data management has been gaining a lot of attention in recent years because of its high potential to provide more accurate and cost-efficient patient care. The traditional client-server and cloud-based healthcare data management systems suffer from the issues of single point of failure, data privacy, centralized data stewardship, and system vulnerability. The replication mechanism, and privacy and security features of blockchain have a promising future in the healthcare domain as they can solve some of the inherent issues of the health management system. However, most of the recent research works on blockchain in the healthcare domain have primarily focused on the permission-less Bitcoin network that suffers from drawbacks such as high energy consumption, limited scalability, and low transaction throughput. Consequently, there is a need for a scalable, fault-tolerant, secure, traceable and private blockchain to suit the requirements of the healthcare domain. We propose a lightweight blockchain architecture for the healthcare data management that reduces the computational and communication overhead compared to the Bitcoin network by dividing the network participants into clusters and maintaining one copy of the ledger per cluster. Our architecture introduces the use of canal, that allows secure and confidential transactions within a group of network participants. Furthermore, we propose a solution to avoid forking which is prevalent in the Bitcoin network. We demonstrate the effectiveness of our proposed architecture in providing security and privacy compared to the Bitcoin network by analyzing different threats and attacks. We also discuss how our proposed architecture addresses the identified threats. Our experimental results demonstrate that our proposed architecture generates 11 times lower network traffic compared to the Bitcoin network as the number of blocks increases. Our ledger update is 1.13 times faster. Our architecture shows a speedup of 67% in ledger update and 10 times lower network traffic when the number of nodes increases.