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.     

Mason Valley Groundwater Model: Linking Surface Water and Groundwater in the Walker River Basin,Nevada1

Carroll, Rosemary W.H., Greg Pohll, David McGraw, Chris Garner, Anna Knust, Doug Boyle, Tim Minor, Scott Bassett, and Karl Pohlmann, 2010. Mason Valley Groundwater Model: Linking Surface Water and Groundwater in the Walker River Basin, Nevada. Journal of the American Water Resources Association (JAWRA) 46(3):554-573. DOI: 10.1111/j.1752-1688.2010.00434.x Abstract: An integrated surface water and groundwater model of Mason Valley, Nevada is constructed to replicate the movement of water throughout the different components of the demand side of water resources in the Walker River system. The Mason Valley groundwater surface water model (MVGSM) couples the river/drain network with agricultural demand areas and the groundwater system using MODFLOW, MODFLOW’s streamflow routing package, as well as a surface water linking algorithm developed for the project. The MVGSM is capable of simulating complex feedback mechanisms between the groundwater and surface water system that is not dependent on linearity among the related variables. The spatial scale captures important hydrologic components while the monthly stress periods allow for seasonal evaluation. A simulation spanning an 11-year record shows the methodology is robust under diverse climatic conditions. The basin-wide modeling approach predicts a river system generally gaining during the summer irrigation period but losing during winter months and extended periods of drought. River losses to the groundwater system approach 25% of the river’s annual budget. Reducing diversions to hydrologic response units will increase river flows exiting the model domain, but also has the potential to increase losses from the river to groundwater storage.     

Small female rib cage fracture in frontal sled tests

Objectives: The 2 objectives of this study are to (1) examine the rib and sternal fractures sustained by small stature elderly females in simulated frontal crashes and (2) determine how the findings are characterized by prior knowledge and field data.

Methods: A test series was conducted to evaluate the response of 5 elderly (average age 76 years) female postmortem human subjects (PMHS), similar in mass and size to a 5th percentile female, in 30 km/h frontal sled tests. The subjects were restrained on a rigid planar seat by bilateral rigid knee bolsters, pelvic blocks, and a custom force-limited 3-point shoulder and lap belt. Posttest subject injury assessment included identifying rib cage fractures by means of a radiologist read of a posttest computed tomography (CT) and an autopsy. The data from a motion capture camera system were processed to provide chest deflection, defined as the movement of the sternum relative to the spine at the level of T8.

?A complementary field data investigation involved querying the NASS-CDS database over the years 1997–2012. The targeted cases involved belted front seat small female passenger vehicle occupants over 40 years old who were injured in 25 to 35 km/h delta-V frontal crashes (11 to 1 o'clock).

Results: Peak upper shoulder belt tension averaged 1,970 N (SD = 140 N) in the sled tests. For all subjects, the peak x-axis deflection was recorded at the sternum with an average of ?44.5 mm or 25% of chest depth. The thoracic injury severity based on the number and distribution of rib fractures yielded 4 subjects coded as Abbreviated Injury Scale (AIS) 3 (serious) and one as AIS 5 (critical). The NASS-CDS field data investigation of small females identified 205 occupants who met the search criteria. Rib fractures were reported for 2.7% of the female occupants.

Conclusions: The small elderly test subjects sustained a higher number of rib cage fractures than expected in what was intended to be a minimally injurious frontal crash test condition. Neither field studies nor prior laboratory frontal sled tests conducted with 50th percentile male PMHS predicted the injury severity observed. Although this was a limited study, the results justify further exploration of the risk of rib cage injury for small elderly female occupants.     

Risk of motor vehicle accident death among 1.3 million veterans of the Iraq and Afghanistan wars

Objective: We conducted a cohort study of recent wartime veterans to determine the postservice mortality risk due to motor vehicle accidents (MVAs).

Methods: Veterans were identified from the Defense Manpower Data Center records. Deployment to te Iraq or Afghanistan war zone was determined from the Contingency Tracking System. Vital status of 317,581 deployed and 964,493 nondeployed veterans was followed from their discharge dates between 2001 to 2007 until earlier of date of death or December 31, 2009. Underlying causes of death were obtained from the National Death Index Plus.

Results: Based on 9,353 deaths (deployed, 1,650; nondeployed, 7,703), of which 779 were MVA deaths as drivers (166; 613), both cohorts had 25 to 24% lower mortality risk from all causes but had 44 to 45% higher risk of MVA deaths relative to the U.S. general population. The higher MVA mortality risk was not associated with deployment to the war zone. After controlling for age, sex, race, marital status, branch of service, and rank, the risk for deployed veterans was comparable to that of nondeployed veterans (hazard ratio = 0.91; 95% confidence interval, 0.77–1.09).

Conclusions: Veterans exhibit significantly higher risk of MVA deaths compared to the U.S. general population. However, deployment to the Iraq or Afghanistan war was not associated with the excess risk.     

A flexible spatio-temporal model for air pollution with spatial and spatio-temporal covariates

The development of models that provide accurate spatio-temporal predictions of ambient air pollution at small spatial scales is of great importance for the assessment of potential health effects of air pollution. Here we present a spatio-temporal framework that predicts ambient air pollution by combining data from several different monitoring networks and deterministic air pollution model(s) with geographic information system covariates. The model presented in this paper has been implemented in an R package, SpatioTemporal, available on CRAN. The model is used by the EPA funded Multi-Ethnic Study of Atherosclerosis and Air Pollution (MESA Air) to produce estimates of ambient air pollution; MESA Air uses the estimates to investigate the relationship between chronic exposure to air pollution and cardiovascular disease. In this paper we use the model to predict long-term average concentrations of \(\text {NO}_{x}\) in the Los Angeles area during a 10 year period. Predictions are based on measurements from the EPA Air Quality System, MESA Air specific monitoring, and output from a source dispersion model for traffic related air pollution (Caline3QHCR). Accuracy in predicting long-term average concentrations is evaluated using an elaborate cross-validation setup that accounts for a sparse spatio-temporal sampling pattern in the data, and adjusts for temporal effects. The predictive ability of the model is good with cross-validated \(R^2\) of approximately \(0.7\) at subject sites. Replacing four geographic covariate indicators of traffic density with the Caline3QHCR dispersion model output resulted in very similar prediction accuracy from a more parsimonious and more interpretable model. Adding traffic-related geographic covariates to the model that included Caline3QHCR did not further improve the prediction accuracy.     

Utilization of publicly owned treatment works to promote pollution prevention

Industrial production processes contribute the most diverse group of emissions to air, water, and land pollution. These forms of pollution were the initial focus of environmental regulations requiring control efforts. Under optimum conditions, industrial waste streams pass through some type of treatment to minimize toxicity prior to being released into the environment. Business, government, and interest groups have previously assumed that industrial productivity and environmental quality were diametrically opposed. In other words, enhanced industrial productivity resulted in environmental damage and, conversely, environmental protection resulted in costs to business. However, companies that have implemented pollution prevention (P2) strategies to address their environmental problems have usually found that their facility's productivity can improve, while at the same time waste and pollution can be reduced. Where previous environmental strategies focused on end-of-pipe control efforts, P2 strategies are implemented at the design or process phase. While there are many examples of individual companies successfully implementing P2, consensus shows P2 adoption by the business community advancing at a rate far slower than expected. Most government agencies that currently promote P2 are not typically viewed as credible sources of innovation by industry. Publicly Owned Treatment Works (POTWs), however, may be able to capitalize on their dual status as respected members of the local community as well as experts in waste management thus serving as credible proponents of P2. The paper discusses how POTWs are working with industrial users to promote P2, as well as their interest in doing so and their requirements for technical assistance. Survey results are provided that describe how POTW personnel in the State of Illinois believe they could best promote P2.     

Water management decision makers' evaluations of uncertainty in a decision support system: the case of WaterSim in the Decision Theater

Model-based decision support systems are increasingly used to link knowledge to action for environmental decision making. How stakeholders perceive uncertainty in models and visualisations affects their perceptions of credibility, relevance and usability of these tools. This paper presents a case study of water decision makers’ evaluations of WaterSim, a dynamic water simulation model presented in an immersive decision theatre environment. Results reveal that decision makers’ understandings of uncertainty in their evaluations of decision support systems reflect both scientific and political discourse. We conclude with recommendations for design and evaluation of decision support systems that incorporate decision makers' views.