Fetal brain imaging in isolated congenital heart defects – a systematic review and meta-analysis

Congenital heart defects (CHDs) are associated with neurodevelopmental (ND) delay. This study aims to assess evidence for impaired prenatal brain development, in fetuses with CHD. A systematical search was performed, and 34 studies evaluating the fetal brain [magnetic resonance imaging (MRI) or ultrasound] in isolated CHD were included (1990–2015). Data regarding cerebral abnormalities, head circumference growth and middle cerebral artery flow were extracted. Prenatal MRI was studied in ten articles (445 fetuses), resulting in a pooled prevalence of 18% (95%CI −6%; 42%) for combined structural and acquired cerebral abnormalities. Prenatal head circumference was studied in 13 articles (753 fetuses), resulting in a pooled z-score of −0.51 (95%CI −0.84; −0.18). Doppler was studied in 21 articles (1412 fetuses), resulting in a lower middle cerebral artery pulsatility index (z-score −0.70 95%CI −0.99; −0.41) in left-sided CHD only. We conclude that prenatal MRI and ultrasound demonstrate brain abnormalities, delay in head growth and brainsparing in subgroups of CHD. However, large MRI studies are scarce, and ultrasound data are biased towards severe and left-sided CHD. Long-term follow-up studies correlating prenatal findings with postnatal ND outcome are limited, and data are lacking to support counseling families regarding ND outcome based on prenatal findings suggestive of altered brain development. © 2016 John Wiley & Sons, Ltd.     

Assessing of Environmental Quality in Six Areas in India,Sri Lanka and Bangladesh

Environmental quality for environmental health has been examined visually by describing general conditions and drinking water supply, sanitation and solid waste treatment conditions and practices in six South-East Asian villages with a dense population. The environmental review was supplemented by discussions with local people and political and administrative decision makers. Some drinking water analyses were done in order to show the water quality to the local people. The quality of the general conditions and the conditions and practices of drinking water supply, excreta disposal and solid waste treatment practices have been graded with the grading system presented below. The grading could be done in 1 or 2 days in each area by two persons, of which one was an environmental scientist and the other a social scientist, who also knew the local culture and worked as a translator.     

Innovations in the water chain – experiences in The Netherlands

Innovations in water chain are discussed based on experiences in the Netherlands. The available and new technological options, as well as their dissemination in the Netherlands, are presented for the prevailing system with add-on technologies (elongation), and for the emerging separation system with technologies at the source. Numerous new options are available for both systems but these options are rarely used. The low use is explained using economic theories and with practical examples from the Netherlands. In order to foster innovations, the mainstream, evolutionary, and behavioral theories pinpoint respectively the pricing of common goods, broad support of concerted action, and support for innovators’ entry. These actions may all be needed. Experiences with a stakeholder cluster in water management suggest that markets for high value water use invoke innovations and low-cost technology adaptations. The systematic development of services that foster high value water-based activities is recommended.