Fetal cardiac intervention—Perspectives from a single center

Fetal cardiac intervention was first proposed in the early 1990s to impact cardiac development and survival of fetuses with fetal aortic stenosis and evolving hypoplastic left heart syndrome (HLHS). Although initial attempts of fetal aortic valvuloplasty were unsuccessful and carried a high rate of morbidity and mortality, our collaborative group at the Brigham and Women's Hospital and Boston Children's Hospital have reinvigorated the procedure using improvements in imaging, anesthesia, balloon catheters, and surgical techniques. Two decades of experience have now allowed us to document the safety of in utero intervention and to achieve a better understanding of the impact of midgestation intervention on developing HLHS. Research into underlying genetics, predictive biomarkers, and ways to incorporate stem cell technology will hopefully allow us to further refine the procedure to most benefit children with this historically lethal disease.     

Restoration of riparian forest using irrigation,artificial disturbance,and natural seedfall

In interior western North America, many riparian forests dominated by cottonwood and willow are failing to reproduce downstream of dams. We tested the hypothesis that establishment is now prevented by absence of the bare, moist substrate formerly provided by floods and channel movement. Along Boulder Creek, a dammed stream in the Colorado plains, we tested the effects of disturbance (sod removal), irrigation, and addition of seed on the establishment of seedings of plains cottonwood (Populus deltoides subsp.monilifera) and peachleaf willow (Salix amygdaloides). In unirrigated, undisturbed plots, mean cottonwood density was 0.03 seedlings/m². Irrigation or disturbance alone produced mean cottonwood densities of 0.39 and 0.75 seedlings/m². Plots that were both irrigated and disturbed produced a mean cottonwood density of 10.3 seedlings/m². The effects of irrigation and disturbance on cottonwood establishment were significant (P<0.005); added seed had no significant effect (P=0.78). The few cottonwood seedlings in unirrigated plots were in low positions susceptible to scour by future moderate flows. We conclude that cottonwood establishment along Boulder Creek is limited by the scarcity of bare, moist sites safe from future scour. Establishment of peachleaf willow was significantly affected only by disturbance; daily sprinkler irrigation did not provide sufficient moisture to increase survival of this species. Our results demonstrate the feasibility of restoring plains cottonwood forests using natural seedfall, even where only widely scattered adult trees are present. Because use of natural seedfall conserves the genetic makeup of the local population, this method may be preferable to the use of imported cuttings.     

Fetal karyotype following ascertainment of fetal anomalies by ultrasound

Data pooled from contributors to a Registry for Cytogenetic Abnormalities and PKU (ReCAP) shows an unbalanced chromosome abnormality rate of 27 per cent (29 fetuses) for 107 fetuses with ultrasonically diagnosed fetal anomalies. Of the abnormal, 12 were trisomic, 6 were monosomy X and 6 were structural abnormalities, 4 were mosaics and one triploid.     

Metabolic enzyme activities in shallow- and deep-water chondrichthyans: implications for metabolic and locomotor capacity

Biochemical indices of white (WM) and red muscle (RM) aerobic and anaerobic metabolic capacity were measured in 14 species of benthic and benthopelagic chondrichthyans from a depth of ~90 to 2,200 m to evaluate the relationship between metabolic capacity and depth of occurrence, phylogeny, and locomotor mode. Maximal activities of the enzymes citrate synthase, malate dehydrogenase (MDH), lactate dehydrogenase (LDH), and pyruvate kinase (PK) were analyzed in muscle tissue at 10 °C. These were combined with previously published elasmobranch data in order to represent a comprehensive range of depths, phylogeny, and locomotor modes (i.e., benthic, benthopelagic, pelagic). Significant decreases in WM PK and LDH activities and a lack of significant trends in RM enzyme activities with increasing median depth of occurrence (MDO) indicate a depth-related reduction in both burst-locomotor and metabolic capacity. These trends are consistent with the “visual-interactions hypothesis.” Phylogeny and locomotor mode had little influence on enzyme activities compared to MDO, and the present study suggests similar activities in co-occurring demersal sharks and rays. Overall, the present study indicates low metabolic capacities in deep-sea chondrichthyans, which is important to consider when managing deep-sea fisheries.     

Equity trade‐offs in conservation decision making

Conservation decisions increasingly involve multiple environmental and social objectives, which result in complex decision contexts with high potential for trade‐offs. Improving social equity is one such objective that is often considered an enabler of successful outcomes and a virtuous ideal in itself. Despite its idealized importance in conservation policy, social equity is often highly simplified or ill‐defined and is applied uncritically. What constitutes equitable outcomes and processes is highly normative and subject to ethical deliberation. Different ethical frameworks may lead to different conceptions of equity through alternative perspectives of what is good or right. This can lead to different and potentially conflicting equity objectives in practice. We promote a more transparent, nuanced, and pluralistic conceptualization of equity in conservation decision making that particularly recognizes where multidimensional equity objectives may conflict. To help identify and mitigate ethical conflicts and avoid cases of good intentions producing bad outcomes, we encourage a more analytical incorporation of equity into conservation decision making particularly during mechanistic integration of equity objectives. We recommend that in conservation planning motivations and objectives for equity be made explicit within the problem context, methods used to incorporate equity objectives be applied with respect to stated objectives, and, should objectives dictate, evaluation of equity outcomes and adaptation of strategies be employed during policy implementation.     

Prenatal diagnosis of familial congenital pyloric atresia

Familial congenital pyloric atresia is a rare malformation of the fetal gastrointestinal tract. It usually manifests as maternal polyhydramnios and enlarged fetal stomach on ultrasound scan. Sonographic prenatal diagnosis and management of a pregnancy complicated by familial congenital pyloric atresia are presented.     

School Principal Burnout: The concept and its components

This study attempted to identify the unique components of burnout among school principals using Facet Theory as a theory construction tool. A total of 571 elementary and secondary school principals in Israel completed a questionnaire containing items relating to their feelings about themselves, their environment and work. Data were analyzed employing Small Space Analysis (SSA). Results indicated that burnout among school principals may be presented in a two-dimensional space, incorporating: experiences (weariness or discontent), and the focus (internal or external) of those experiences. Four components of the burnout phenomenon in principals emerged in this two-dimensional space: exhaustion, self-discontent, aloofness, and deprecation.