What is the real “price” of more prenatal screening and fewer diagnostic procedures? Costs and trade-offs in the genomic era

Any screening approach, including with cell-free DNA, will have an inferior detection rate compared with 100% diagnostic testing with chromosomal microarrays. Cell-free DNA-based screening, however, should not be seen as a threat to informed choice or maximising the benefits of diagnostic testing. Screening methods have become so much better that more women are now comfortable relying on such screening and do not need the certainty of a diagnostic test. This has not lead to a decline in detection of fetal chromosome abnormalities—in fact, we are now seeing historically high yields from prenatal screening. There are both economic and ethical consequences of offering universal diagnostic testing and abandoning the presumption of a normal infant in otherwise uncomplicated pregnancies. However, for some women, comprehensive information and diagnostic accuracy are important. Offering these women all options, with a careful and comprehensive explanation of the risks and benefits of each, results in outcomes that are best aligned with woman's preferences while at the same time requiring fewer diagnostic tests and lowering costs. It is one of the primary challenges of the modern era of prenatal testing to ensure that women receive sufficient information on which to make informed decisions.     

What can economic experiments tell us about institutional change in social–ecological systems?

Today, economic experiments are well accepted in mainstream economics. They are also widely applied in ecological economics, often focusing on institutions. Yet, many empirical studies in this field lack a sound theoretical foundation of institutions and institutional change. In this paper, I show that in a structure–agency framework three theoretical viewpoints on institutions can be distinguished. They can be viewed as (1) structures that shape incentives, (2) cognitive media, embedded in beliefs and cognition of agents, or (3) evolving from a process of agents’ choices and structural aspects. Using examples from the empirical experimental literature, I argue that all three viewpoints are mirrored in experimental practice, and that these can be organized into an institutional typology of economic experiments. Placing special emphasis on experiments with endogenous institutional choice and their relationship to evolutionary economic theory, I discuss under which conditions experiments are a useful method for the analysis of social–ecological systems, concluding that methodological and methodical innovations are an important prerequisite for challenging the dominant paradigm of neoclassical economics.     

Temperament in bullheads: do laboratory and field explorative behaviour variables correlate?

The relevance of temperament traits for life history strategy or productivity is increasingly acknowledged. Temperament traits are often either observed in captivity or in the wild, but studies combining both observations are very rare. We examine whether exploratory behaviour in the bullhead (Cottus perifretum), assayed under laboratory conditions, predicts this behaviour under field conditions. Forty-three PIT-tagged individuals were first assayed for exploration of a novel environment in the aquarium and then released into an unfamiliar stream stretch, where they were later relocated using a mobile antenna. Explorative behaviour assayed in the laboratory was significantly positively related to the exploration in the field, thus predicting distance moved in the field release. Both in the laboratory and in the field, explorative behaviour was not related to individual body length. When bullheads that did not leave the refuge in the aquarium (laboratory assay) and, therefore, did not explore the new environment were excluded from the analysis, the correlation between laboratory and field explorative behaviour variables became weaker. However, overall, our results illustrate that exploration rate of bullheads in isolated single-individual experiments can be used to predict this behaviour in the natural ecosystem.     

Role of the second-trimester ‘genetic sonogram’ for Down syndrome screen in the era of first-trimester screening and noninvasive prenatal testing

Ultrasonography for the screening of Down syndrome was first introduced about 25 years ago. Different combinations of markers detectable at second-trimester ultrasonography have been proposed under the banner of ‘genetic sonogram’. In recent years, several developments in first-trimester screening and the recent introduction of noninvasive prenatal testing for aneuploidy screening have had important implications for the prevalence of these conditions in the second-trimester and the screening performance of a genetic sonogram. Several second-trimester sonographic markers for Down syndrome have been reported; meta-analysis has shown that the most powerful predictors are mild ventriculomegaly, increased nuchal fold, hyperechoic bowel, and absent or hypoplastic nasal bone. Whereas use of individual markers should be discouraged and scoring systems of multiple markers are now obsolete, use of combined likelihood ratio and logistic regression analysis formulae provides better accuracy. However, there is significant heterogeneity in results among studies. Despite such limitations, the genetic sonogram will continue to have a place in prenatal screening, particularly in twin and higher-order multiple pregnancies, in countries with limited access to the most recent genetic screening tests, in cases with borderline results at maternal serum screening tests, and as noninvasive supplementary test for high-risk women reluctant to undergo invasive diagnostic testing. © 2014 John Wiley & Sons, Ltd.