Lower vitamin D status in early pregnancy was associated with a significantly increased risk of subsequent gestational diabetes that was independent of race, age, season and maternal weight. This study suggests that vitamin D may influence glucose tolerance during pregnancy and provides support for studies of vitamin D as a potential intervention to prevent gestational diabetes.

We appreciate the attention given by Andy Haines and Philip J Landrigan to the findings of The Lancet's Taskforce on NCDs and economics and our Series paper. 1 Haines and Landrigan emphasise our main findings that many premature NCD deaths will occur in lowincome and middle income countries by 2030, and that investments to manage NCDs cannot only reduce those premature deaths, but also provide economic gains and help achieve SustainableThe Lancet Taskforce on NCDs and economics could substantially enhance its influence and further increase the return on investment in NCD prevention if it were to expand its scope to include a new focus on prevention of pollution. The greatest beneficiaries will be people in the world's most rapidly developing and severely affected countries.We declare no competing interests.

BackgroundTo characterize clinically significant diagnostic imaging (DI) discrepancies by radiology trainees and the impact on emergency department (ED) patients.MethodsConsecutive case series methodology over a 6-month period in an urban, tertiary care teaching hospital. Emergency physicians (EPs) were recruited to flag discrepant DI interpretations by radiology trainees that the EP deemed clinically significant. Cases were characterized using chart review and EP interview.ResultsTwenty-eight discrepant reports were identified (representing 0.1% of 18,185 images interpreted). The mean time between provisional discrepant diagnosis (PDDx) and revised diagnosis (RDx) by attending radiology staff was 8.6 h (median 4.8 h, range 1.1-48.4), and 67.9% (n = 19) of the patients had left the ED by time of notification. The most frequently reported PDDx was CT abd/pelvis (32.1%, n = 9) and CT head (28.6%, n = 8). The impact of RDx was deemed major in 57.1% (n = 16) for reasons including altered admitting status (32.1%, n = 9), immediate subspecialty referral (n = 16, 57.1%), impact on management (25%, n = 7), and surgical management (21.4%, n = 6). EPs reported likely perceived impact of PDDx as resulting in increased pain (17. 9%, n = 5), morbidity (10.7%, n = 3), and prolonged hospitalization (25%, n = 7), but not altered long-term outcome or mortality.ConclusionsRelatively few clinically important discrepant reads were reported. Revised diagnosis (RDx) was associated with major clinical impact in 57.1% of reports, but few patients experienced increased morbidity, and none increased mortality. The importance of expedient communication of discrepant reports by staff radiologists is stressed, as is EP verification of patient contact information prior to discharge.

Flexible bronchoscopy with BAL is relatively safe and helps to guide medical management among patients with AL admitted to the ICU.