Prenatal ultrasound diagnosis of a case of Pfeiffer syndrome without cloverleaf skull and review of the literature

Pfeiffer syndrome is characterized by bilateral coronal craniosynostosis, midface hypoplasia, beaked nasal tip, broad and medially deviated thumbs and great toes. Originally, it was described in eight persons from three generations in a pedigree consistent with an autosomal dominant transmission. Since then, several reports have documented its high clinical and genetic heterogeneity. The condition is usually detected in the newborn period or later, and very few prenatal ultrasound diagnoses have been reported. We present a case of Pfeiffer syndrome prenatally diagnosed at 20 weeks' gestation, in which the sonographic features of craniosynostosis, hypertelorism associated with an extreme proptosis, and broad thumb led to the diagnosis, confirmed after termination of pregnancy by dysmorphological, pathological and radiological evaluation. DNA analysis of the fibroblast growth factor receptor 2 (FGFR2) showed a missense mutation consisting in a transversion G → C at nucleotide 870. This led to a Trp290Cys amino acidic substitution. We discuss the relevant findings of our and previously published cases. Our report demonstrates that a careful sonographic examination can lead to an early prenatal diagnosis of Pfeiffer syndrome also in cases without cloverleaf skull. Copyright © 2004 John Wiley & Sons, Ltd.     

Prenatal ultrasound diagnosis of cloacal exstrophy associated with myelocystocele complex by the ‘elephant trunk–like’ image and review of the literature

A case of cloacal exstrophy (CE) was detected by ultrasound as early as 22 weeks of gestation in association with myelocystocele complex, an unusual form of occult spinal dysraphism often associated with such a disease. The ultrasonographic diagnosis was made through the detection of a wavy cord-like segment of soft tissue protruding from the anterior abdominal wall, just below the umbilical cord insertion, strongly resembling the trunk of an elephant. Our article enforces the suggestion that the ultrasound elephant trunk–like image should be added to the existing major criteria for making prenatal diagnosis of CE. Copyright © 2005 John Wiley & Sons, Ltd.     

The combined benefits of motorcycle antilock braking systems (ABS) in preventing crashes and reducing crash severity

Objective: Several studies have reported the benefits of motorcycle antilock braking systems (ABS) in reducing injury crashes, due to improved stability and braking performance. Both aspects may prevent crashes but may also reduce the crash severity when a collision occurs. However, it is still unknown to what extent the reductions in injury crashes with ABS may be due to a combination of these mechanisms.

Methods: Swedish hospital and police reports (2003–2012) were used. The risk for permanent medical impairment (RPMI) was calculated, showing the risk of at least 1 or 10% permanent medical impairment. In total, 165 crashes involving ABS-equipped motorcycles were compared with 500 crashes with similar motorcycles without ABS.

The analysis was performed in 3 steps. First, the reduction in emergency care visits with ABS was calculated using an induced exposure approach. Secondly, the injury mitigating effects of ABS were investigated. The mean RPMI 1+ and RPMI 10+ were analyzed for different crash types. The distributions of impairing injuries (PMI 1+) and severely impairing injuries (PMI 10+) were also analyzed. In the third step, the total reduction of PMI 1+ and PMI 10+ injured motorcyclists was calculated by combining the reductions found in the previous steps. An additional analysis of combined braking systems (CBS) together with ABS was also performed.

Results: The results showed that emergency care visits were reduced by 47% with ABS. In the second step, it was found that the mean RPMI 1+ and RPMI 10+ with ABS were 15 and 37% lower, respectively. Finally, the third step showed that the total reductions in terms of crash avoidance and mitigation of PMI 1+ and PMI 10+ injured motorcyclists with ABS were 67 and 55%, respectively. However, PMI 1+ and PMI 10+ leg injuries were not reduced by ABS to the same extent. Indications were found suggesting that the benefits of ABS together with CBS may be greater than ABS alone.

Conclusions: This article indicated that motorcycle ABS reduced impairing injuries, mostly due to fewer emergency care visits but also due to a reduction in crash severity. This may seem reasonable as the improved stability and braking performance provided by ABS could prevent some crashes but would also decrease crash severity if a collision still occurs. As suggested by previous studies, however, the lower extremities would be more exposed in a crash with ABS. It is recommended that future research should follow up these results with additional data.     

The effectiveness of lane departure warning systems—A reduction in real-world passenger car injury crashes

Objective: The objective of this study was to estimate the safety benefits of in vehicle lane departure warning (LDW) and lane keeping aid (LKA) systems in reducing relevant real-world passenger car injury crashes.

Methods: The study used an induced exposure method, where LDW/LKA-sensitive and nonsensitive crashes were compared for Volvo passenger cars equipped with and without LDW/LKA systems. These crashes were matched by car make, model, model year, and technical equipment; that is, low-speed autonomous emergency braking (AEB) called City Safety (CS). The data were extracted from the Swedish Traffic Accident Data Acquisition database (STRADA) and consisted of 1,853 driver injury crashes that involved 146 LDW-equipped cars, 11 LKA-equipped cars, and 1,696 cars without LDW/LKA systems.

Results: The analysis showed a positive effect of the LDW/LKA systems in reducing lane departure crashes. The LDW/LKA systems were estimated to reduce head-on and single-vehicle injury crashes on Swedish roads with speed limits between 70 and 120 km/h and with dry or wet road surfaces (i.e., not covered by ice or snow) by 53% with a lower limit of 11% (95% confidence interval [CI]). This reduction corresponded to a reduction of 30% with a lower limit of 6% (95% CI) for all head-on and single-vehicle driver injury crashes (including all speed limits and all road surface conditions).

Conclusions: LDW/LKA systems were estimated to lower the driver injury risk in crash types that the systems are designed to prevent; that is, head-on and single-vehicle crashes. Though these are important findings, they were based on a small data set. Therefore, further research is desirable to evaluate the effectiveness of LDW/LKA systems under real-world conditions and to differentiate the effectiveness between technical solutions (i.e., LDW and LKA) proposed by different manufacturers.     

Preparation and Properties of Green Composites Based on Tapioca Starch and Differently Recycled Paper Cellulose Fibers

Green composites obtained from biodegradable renewable resources have gained much attention due to environmental problems resulting from conventionally synthetic plastics and a global increasing demand for alternatives to fossil resources. In this work we used different cellulose fibers from used office paper and newspaper as reinforcement for thermoplastic starch (TPS) in order to improve their poor mechanical, thermal and water resistance properties. These composites were prepared by using tapioca starch plasticized by glycerol (30 % wt/wt of glycerol to starch) as matrix reinforced by the extracted cellulose fibers with the contents ranging from 0 to 8 % (wt/wt of fibers to matrix). Properties of composites were determined by mechanical tensile tests, differential scanning calorimetry, thermogravimetric analysis, water absorption measurements, scanning electron microscopy, and soil burial tests. The results showed that the introduction of either office paper or newspaper cellulose fibers caused the improvement of tensile strength and elastic modulus, thermal stability, and water resistance for composites when compared to the non-reinforced TPS. Scanning electron microscopy showed a good adhesion between matrix and fibers. Moreover, the composites biological degraded completely after 8 weeks but required a longer time compared to the non-reinforced TPS. The results indicated that these green composites could be utilized as commodity plastics being strong, inexpensive, plentiful and recyclable.     

Assessing coastal vulnerability to climate change: comparing segmentation at global and regional scales

Recent concerns about potential climate-change effects on coastal systems require the application of vulnerability assessment tools in order to define suitable adaptation strategies and improve coastal zone management effectiveness. In fact, while various research efforts were devoted to evaluate coastal vulnerability to climate change on a national to global level, fewer applications were carried out so far to develop more comprehensive and site-specific vulnerability assessments suitable to plan possible adaptation measures at the regional scale. In this respect, specific indicators are needed to address climate-change-related issues for coastal zones and to identify vulnerable areas at the regional level. Two sets of coastal vulnerability indicators were selected, one for regional and one for global studies, respectively, concerning the same features of coastal systems, including topography and slope, geomorphological characteristics, presence and distribution of wetlands and vegetation cover, density of coastal population and number of coastal inhabitants. The proposed set of indicators for the regional scale was chosen taking into account the availability of environmental and territorial data for the whole coastal area of the Veneto region and was based on site-specific datasets characterized by a spatial resolution appropriate for a regional analysis. Moreover, a GIS-based segmentation procedure was applied to divide the coastline into linear segments, homogeneous in terms of vulnerability to climate change and sea-level rise at the regional scale. This approach allowed to divide the Veneto shoreline into 140 segments with an average length of about 1 km, while the global scale approach identified four coastal segments with an average length of about 66 km. The performed comparison indicated how the more detailed approach adopted at the regional scale is essential to understand and manage the complexities of the specific study area. In fact, the 25-m DEM employed at the regional scale provided a more accurate differentiation of the coastal area's elevation and thus of coastal susceptibility to the inundation risks, compared to the 1-km DEM used at the global level. Moreover, at the regional level the use of a 1:20,000 geomorphological map allowed to differentiate the unique landform class detected at the global level (e.g., fluvial plain) in a variety of more detailed coastal typologies (e.g., open coast eroding sandy shores backed by bedrock) characterized by a different sensitivity to climate change and sea-level rise. Accordingly, the information provided by regional indicators can support decision-makers in improving the management of coastal resources by considering the potential impacts of climate change and in the definition of appropriate actions to reduce inundation risks, to avoid the potential loss of valuable wetlands and vegetation and to plan the nourishment of sandy beaches subject to erosion processes.     

Understanding the interacting factors that influence social vulnerability: a case study of the 2016 central Italy earthquake

This paper seeks to identify those areas that proved socially vulnerable to the earthquake that struck central Italy on 24 August 2016. The study involved four key steps. First, six relevant social vulnerability indicators were selected, based on previous conclusions in the literature. Second, the indicators were mapped using the inverse distance weighted interpolation method. Third, social vulnerability was assessed according to a spatial combination of the indicators. Fourth, in order to build a heterogeneity map, another approach was employed to represent the spatial variability of social vulnerability and to provide additional information on the synergistic contributions of the indicators. The results indicate that age and accessibility indicators affect the entire region under review, with highly vulnerable zones being close to small historical centres. These findings will be useful to governments, policymakers, and stakeholders with regard to implementing vulnerability mitigation strategies in Italian territories that are highly susceptible to earthquake hazards.     

Handling of dioxin measurement data in the presence of non-detectable values: overview of available methods and their application in the Seveso chloracne study

Exposure measurements of concentrations that are non-detectable or near the detection limit (DL) are common in environmental research. Proper statistical treatment of non-detects is critical to avoid bias and unnecessary loss of information. In the present work, we present an overview of possible statistical strategies for handling non-detectable values, including deletion, simple substitution, distributional methods, and distribution-based imputation. Simple substitution methods (e.g., substituting 0, DL/2, DL/ radical2, or DL for the non-detects) are the most commonly applied, even though the EPA Guidance for Data Quality Assessment discouraged their use when the percentage of non-detects is >15%. Distribution-based multiple imputation methods, also known as robust or "fill-in" procedures, may produce dependable results even when 50-70% of the observations are non-detects and can be performed using commonly available statistical software. Any statistical analysis can be conducted on the imputed datasets. Results properly reflect the presence of non-detectable values and produce valid statistical inference. We describe the use of distribution-based multiple imputation in a recent investigation conducted on subjects from the Seveso population exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), in which 55.6% of plasma TCDD measurements were non-detects. We suggest that distribution-based multiple imputation be the preferred method to analyze environmental data when substantial proportions of observations are non-detects.