Fetal spina bifida: What we tell the parents

Worldwide, about 150 000 infants are born with spina bifida yearly, making this condition one of the most common fetal central nervous system anomalies compatible with life. Over the last decade, major changes have been introduced in the prenatal diagnosis and management of spina bifida. In this review, we provide a brief summary of the current management of fetal spina bifida and present essential information that should be provided to expecting parents when their fetus has been diagnosed with spina bifida. This information is focused around common parental questions, as encountered in our typical clinical practice, to facilitate knowledge translation.     

Burden of skin lesions of arsenicosis at higher exposure through groundwater of taluka Gambat district Khairpur, Pakistan: a cross-sectional survey

Prior surveys conducted have found higher proportion of arsenic-contaminated wells in villages along river Indus in Pakistan. This study aims to determine the prevalence of arsenicosis skin lesions among population exposed to higher exposure in taluka Gambat district Khairpur in Sindh. The cross-sectional survey was conducted from August 2008 to January 2009 among 610 households. A total of 707 water sources (hand pumps/wells) were tested from the villages of union councils of Agra and Jado Wahan for arsenic levels with Quick rapid arsenic field test kits. A total of 110 households exposed to arsenic levels >50 ppb were identified. Case screening for arsenic skin lesions was performed for 610 individuals residing in these 110 high-risk households. Information regarding household and socio-demographic characteristics, height and weight measurements and arsenic exposure assessment were collected. Physical examinations by trained physicians were carried out to diagnose the arsenic skin lesions. After data cleaning, 534 individuals from all age groups were included in the final analysis which had complete exposure and outcome information. Overall prevalence of arsenicosis skin lesions was 13.5 % (72 cases). Of the 534 individuals, 490 (91.8 %) were exposed to arsenic levels of ≥100 ppb in drinking water (8.2 % to >50–99 ppb, 58.6 % to 100–299 ppb, 14.6 % to 300–399 ppb and 18 % to ≥400 ppb). Prevalence rate (per 100 population) of arsenicosis was highest at arsenic levels of 100–199 ppb (15.2 cases) followed by ≥400 ppb (13.5 cases) and 300–399 (12.8 cases). Prevalence rate was higher among females (15.2) compared to males (11.3). Our study reports arsenicosis burden due to exposure to higher arsenic levels in drinking water in Pakistan. Exposure to very high levels of arsenic in drinking water calls for urgent action along river Indus. Prevalence of skin lesions increases with increasing arsenic levels in drinking groundwater. Provision of arsenic-free drinking water is essential to avoid current and future burden of arsenicosis in Pakistan.     

R/S法的土石坝施工期沉降规律及预警标准研究

为提高施工期土石坝沉降安全性,研究其具有复杂非线性特征的施工期沉降规律和相应的预警标准。基于国内某在建高土石坝的沉降数据,采用R/S法分析坝体不同高程测点、同高程测点和同测点不同时期沉降数据的Hurst指数及分形维数,提出评价坝体施工期沉降安全性的预警标准。结果表明:各测点的Hurst指数最小值为0.763,坝内各处沉降仍处于快速增长阶段;坝体下部比上部、中部比下游堆石区沉降能更快趋于稳定,且坝体下部的沉降速率已经渐趋平缓。     

民营企业安全文化模型及其实证分析

针对民营企业特点,基于交互安全文化模型,建立民营企业安全文化模型并辨识 关键元素,以赛轮金宇股份有限公司为例进行实证分析。在广泛参考国内外相关研究的 基础上,设计调查问卷,运用粗糙集ROSETTA软件对测量结果进行属性简约,最终确定 15个安全文化元素;借助MATLAB,采用熵权法确定各元素权重,然后进行可拓综合评价 。评价结果表明该企业的“高层管理者重视”一项得分为4.82,水平较高,整体文化等 级属于“良”,级别特征变量j*=3.138 1。“创造安全舒适的工作环境”、“建立合理 的奖惩制度”、“定期进行应急演练”3个方面得分偏低,是安全文化建设需要重点加 强的方面。     

Performance of comprehensive first trimester fetal anatomy assessment

Objective

Ultrasound assessment of the fetal anatomy and fetal echocardiography are feasible in the first trimester of pregnancy. This study was designed to assess the performance of a comprehensive fetal anatomy assessment in a high-risk population at a tertiary fetal medicine unit.

Methods

A retrospective review of high-risk patients undergoing comprehensive fetal anatomy ultrasound assessment between 11 weeks and 13 + 6 weeks of gestation was conducted. Findings of the early anatomy ultrasound scan were compared with those of the second trimester anatomy scan, and birth outcomes or post-mortem results.

Results

Early anatomy ultrasounds were performed in 765 patients. The sensitivity of the scan for detecting fetal anomalies compared to the birth outcome was 80.5% (95% CI 73.5–86.3) and specificity was 93.1% (95%CI 90.6–95.2). Positive and negative predictive values were 78.5% (95% CI 71.4–84.6) and 93.9% (95% CI 91.4–95.8), respectively. The most missed and overdiagnosed abnormalities were ventricular septal defects. The second trimester ultrasound had sensitivity of 69.0% (95% CI 55.5–80.5) and specificity of 87.5% (95% CI 84.3–90.2).

Conclusions

In a high-risk population, early assessments had similar performance metrics as the second trimester anatomy ultrasound. We advocate for a comprehensive fetal assessment in the care of high-risk pregnancies.     

Conceptualizing sustainable–responsible tourism indicators: an interpretive structural modeling approach

Environment, Development and Sustainability - Despite decades of debate and theoretical and practical activity related to the sustainability of tourism, its implementation remains difficult. The...     

Sample preparation methods for the analysis of microplastics in freshwater ecosystems: a review

Environmental Chemistry Letters - The vast amount of plastic waste emitted into the environment is of increasing concern because there is mounting evidence for various toxic effects of...