Development of a simulator for training of fetoscopic myelomeningocele surgery

Objective

To develop a realistic simulation model for laparotomy-assisted fetoscopic spina bifida aperta (SBa) surgery, to be used for training purposes and preoperative planning.

Methods

The predefined general requirement was a realistic model of an exteriorized uterus, allowing all neurosurgical steps of the intervention. The uterus was modelled using ultrasound and MRI images of a 25 weeks’ gravid uterus, consisting of flexible polyurethane foam coated with pigmented silicone. The fetal model, contained an opening on the dorsal side for a customizable spinal insert with all the aspects of a SBa, including a cele, placode, and myofascial and skin layer. The model was assessed in a series of validation experiments.

Results

Production costs are low, uterus and fetus are reusable. Placental localization and the level and size of the spinal defect are adjustable, enabling case-specific adaptations. All aspects of the simulator were scored close to realistic or higher for both appearance and functional capacities.

Conclusions

This innovative model provides an excellent training opportunity for centers that are starting a fetoscopic SBa repair program. It is the first simulation model with adjustable spinal defect and placental localisation. Further objective validation is required, but the potential for using this model in preoperative planning is promising.     

Costs of expanding the network of protected areas as a response to climate change in the Cape Floristic Region

The expansion of protected areas is a critical component of strategies to promote the continued existence of biodiversity (i.e., life at all levels of biological organization) as climate changes, but scientific, social, and economic uncertainties associated with climate change are some of the major obstacles preventing such expansion. New models of climate change and species distribution and new methods of conservation planning now make it possible to explore the uncertainties associated with climate changes and species responses. Yet few reliable estimates of the costs of expanding protected areas and methods for determining these costs exist, largely because of the many (and uncertain) determinants of these costs. We developed a cost-accounting model to estimate the range in costs of various options for expanding protected areas and to explore the variables that drive these costs. Model development was informed by an existing plan to expand protected areas in the Cape Floristic Region of South Africa to address species conservation under a scenario of climate change. The 50-year present value of total costs varied from US$260 million ($1077/ha) for an off-reserve option that involves agreements with landowners and no compensation of forgone production and associated revenue to $1020 million ($4228/ha) for an on-reserve option that involves land acquisition and protection. The costs of acquiring land or compensating landowners for forgone production and development opportunities were the major drivers of the total costs across all options because most of the area identified in the protected-area expansion plan consisted of urban and high-quality agricultural lands. Total costs were also affected by changes in protected area extent and discount rate. Model-generated outputs such as these may be useful for informing implementation strategies and the allocation of future efforts in monitoring, data collection, and model development.     

Foreign egg retention by avian hosts in repeated brood parasitism: why do rejecters accept?

Great reed warblers (Acrocephalus arundinaceus) are frequently parasitized by egg-mimetic common cuckoos (Cuculus canorus) in Hungary, and these hosts reject about a third of parasitic eggs. The timing of parasitism is important, in that the probability of rejection decreases with advancing breeding stages in this host. Also, egg rejection is more common when a clutch is parasitized by a single foreign egg, compared to parasitism by multiple eggs. We repeatedly parasitized great reed warbler clutches with moderately mimetic foreign eggs, either with (1) one foreign egg (single parasitism) and, after 3 days, by all foreign eggs (multiple parasitism), or (2) all foreign eggs and, 3 days later, by only one foreign egg. Hosts ejected 26–53 % of the experimental parasitic eggs in the first stage of the repeated parasitism, but almost all eggs were accepted in the second stage, irrespective of whether the clutch was singly or multiply parasitized. Video-taping of the behavioural responses of hosts to experimental parasitism revealed no evidence for sensory constraints on foreign-egg recognition, because hosts recognized and pecked the parasitic eggs as frequently in the second stage of repeated parasitism, as they did in the first stage. We suggest that the relative timing of parasitism (laying vs. incubation stage), rather than learning to accept earlier-laid foreign eggs, results in higher acceptance rates of cuckoo eggs in repeated parasitism, because there is decreasing natural cuckoo parasitism on this host species and, hence, less need for antiparasitic defences, with the advancing stages of breeding.     

A laboratory study of bacteria-facilitated cadmium transport in alluvial gravel aquifer media

Colloids, including bacteria, can dramatically accelerate the transport of heavy metals in ground water. Batch and column experiments were conducted to investigate adsorption of cadmium (Cd) onto Bacillus subtilis spores or Escherichia coli vegetative cells and Cd transport in alluvial gravel aquifer media in the presence of these bacteria. Results of the batch experiments showed that adsorption of Cd onto the bacteria was (i) positively related to solution pH, bacterial concentration, and negative surface charge, but inversely related to Cd concentration and (ii) a rate-limited nonlinear process, but adsorption onto E. coli was much less. For column influent Cd concentrations of about 4 mg/L and bacterial concentrations of > or = 10(5) colony-forming units (cfu)/mL, there was a significant increase in total Cd effluent concentrations. In comparison with controls that did not have bacteria-facilitated transport, Cd traveled 17 to 20 times faster when it traveled with mobile bacteria. However, Cd traveled mostly 2 to 3 times slower during the desorption phase under the influence of bacteria retained in the column. The difference between total and dissolved Cd concentrations was significant during Cd cotransport with B. subtilis spores, but this concentration difference was very small during Cd cotransport with E. coli, suggesting an adsorption-dominant mechanism during Cd cotransport with the spores and the possibility of Cd chelation by the dissolved membrane vesicles secreted from E. coli cell walls. Bacteria-facilitated transport of heavy metals may pose a threat to ground water quality in sites such as landfills and following land disposal of industrial and domestic effluent and sludge.     

Preliminary investigation of air bubbling and dietary sulfur reduction to mitigate hydrogen sulfide and odor from swine waste

When livestock manure slurry is agitated, the sudden release of hydrogen sulfide (H(2)S) can raise concentrations to dangerous levels. Low-level air bubbling and dietary S reduction were evaluated as methods for reducing peak H(2)S emissions from swine (Sus scrofa) manure slurry samples. In a first experiment, 15-L slurry samples were stored in bench-scale digesters and continuously bubbled with air at 0 (control), 5, or 10 mL min(-1) for 28 d. The 5-L headspace of each digester was also continuously ventilated at 40 mL min(-1) and the mean H(2)S concentration in the outlet air was <10 microL L(-1). On Day 28, the slurry was agitated suddenly. The peak H(2)S concentration exceeded instrument range (>120 microL L(-1)) from the control treatment, and was 47 and 3.4 microL L(-1) for the 5 and 10 mL min(-1) treatments, respectively. In a second experiment, individually penned barrows were fed rations with dietary S concentrations of 0.34, 0.24, and 0.15% (w/w). Slurry derived from each diet was bubbled with air in bench-scale digesters, as before, at 10 mL min(-1) for 12 d and the mean H(2)S concentration in the digester outlet air was 11 microL L(-1). On Day 12, the slurry was agitated but the H(2)S emissions did not change significantly. Both low-level bubbling of air through slurry and dietary S reduction appear to be viable methods for reducing peak H(2)S emissions from swine manure slurry at a bench scale, but these approaches must be validated at larger scales.     

The European perspective on nitrogen emission and deposition

Europe has been successful in reducing the emissions of several nitrogenous pollutants over recent decades. This is reflected in concentrations and deposition rates that have decreased for several components. Emissions of nitrogen containing gases are estimated to have decreased in Europe by 10%, 21% and 14% for N(2)O, NO(x) and NH(3), respectively, between 1990 and 1998. The main reductions are the result of a decrease in industrial and agricultural activities in the east of Europe. The reductions are a result of the economic situation, measures in the transport sector, industry, and the agricultural sector, with only a small part of the reduction due to specific measures designed to reduce emissions. The reduction is significant but far from the end goal for large areas in Europe, in relation to different environmental problems. The Gothenburg Protocol will lead to reductions of 50% and 12% in 2010 relative to 1990 for NO(x) and NH(3), respectively. The N(2)O emissions are expected to grow by 9% between 1998 and 2010. Further reductions are necessary to reach critical limits for ecosystem protection, air quality standards, and climate change. Emissions of nitrogen compounds result from an overload of reactive nitrogen that is produced by combustion processes, by synthesis of ammonia, or by import from other areas as concentrated animal feeds. Some improvements can be made in the efficiency of combustion processes and agricultural systems. However, measures to reduce emissions substantially need to focus on decreasing the production or import of reactive N. Reactive N ceilings for regions, based on critical limits for all N-related effects, can help to focus such measures. An integrated approach might have advantages over the pollutant-specific approach, to combat nitrogen pollution. This could provide the future direction for European policy to reduce the impacts of excess nitrogen.     

Fate of products of degradation processes: consequences for climatic change

The end products of atmospheric degradation are not only CO2 and H2O but also sulfate and nitrate depending on the chemical composition of the substances which are subject to degradation processes. Atmospheric degradation has thus a direct influence on the radiative balance of the earth not only due to formation of greenhouse gases but also of aerosols. Aerosols of a diameter of 0.1 to 2 micrometer, reflect short wave sunlight very efficiently leading to a radiative forcing which is estimated to be about -0.8 watt per m2 by IPCC. Aerosols also influence the radiative balance by way of cloud formation. If more aerosols are present, clouds are formed with more and smaller droplets and these clouds have a higher albedo and are more stable compared to clouds with larger droplets. Not only sulfate, but also nitrate and polar organic compounds, formed as intermediates in degradation processes, contribute to this direct and indirect aerosol effect. Estimates for the Netherlands indicate a direct effect of -4 watt m-2 and an indirect effect of as large as -5 watt m-2. About one third is caused by sulfates, one third by nitrates and last third by polar organic compounds. This large radiative forcing is obviously non-uniform and depends on local conditions.     

Contextualisation of policy and law in sustainable urban development

The old tension between planning and law is revived in current practices of sustainable development. Urban professionals often blame central regulation for frustrating an inventive integration of local initiatives and policies. Against this background, the authors focus on the potential of ‘legal contextualisation’: the challenge of how to improve on regulation in such a way that it guides local practices in a normative sense but simultaneously enables optimal use of local – context bounded – option space. In order to make legal contextualisation researchable, the next four operational avenues of analysis are constructed in this paper: the normative dimension (requiring quality of legal norms); the relational dimension (studying the alignment of norms in different positions, such as the legislation, the court, and social compliance); the temporal dimension (searching the alignment of different moments of legal validation); and the functional dimension (making transparent the different roles that government agencies may take).     

River Basin Export Reduction Optimization Support Tool; a tool to screen options for reducing nutrient loads while minimizing cost

Excess loading of nitrogen and phosphorus to river networks causes environmental harm, but reducing loads from large river basins is difficult and expensive. We developed a new tool, the River Basin Export Reduction Optimization Support Tool (RBEROST) to identify the least-cost combinations of management practices that will reduce nutrient loading to target levels in downstream and mid-network waterbodies. We demonstrate the utility of the tool in a case study in the Upper Connecticut River Basin in New England, USA. The total project cost of optimized lowest-cost plans ranged from $18.0 million to $41.0 million per year over 15 years depending on user specifications. Plans include both point source and non-point source management practices, and most costs are associated with urban stormwater practices. Adding a 2% margin of safety to loading targets improved the estimated probability of success from 37.5% to 99%. The large spatial scale of RBEROST, and the consideration of both point and non-point source contributions of nutrients, make it well suited as an initial screening tool in watershed planning.