Prenatal diagnosis of cleft lip and/or palate: What do we tell prospective parents?

Cleft lip and/or palate (CL/CP) is the most common congenital craniofacial anomaly and parents often ask, “how did this happen?” Patients and families may benefit from access to a multidisciplinary team (MDT) from prenatal diagnosis into early adulthood. Multiple factors can contribute to the development of a cleft. We discuss the epidemiology and risk factors that increase the likelihood of having a newborn with a cleft. The purpose of this article is to review the prenatal investigations involved in the diagnosis and workup of these patients in addition to postpartum treatment, prognostic factors, and counseling families regarding future recurrence risk.     

Development of a Standardised Approach to River Habitat Assessment in Australia

Despite the demonstrated utility of the Australian River Assessment Scheme (AUSRIVAS) to provide national-scale information on the biological condition of rivers, there is no commensurate scheme that can provide standardised information on physical habitat. Existing habitat assessment methods are not suitable for implementation on a national scale, so we present a new habitat assessment protocol that incorporates favorable elements of existing methods. Habitat Predictive Modelling forms the basis for the protocol because it can predict the occurrence of local-scale features from large-scale data, uses the reference condition concept, can be modified to incorporate a range of biologically and geomorphologically relevant variables, and employs a rapid survey approach. However, the protocol has been augmented with geomorphological variables and incorporates principles of hierarchy and geomorphological river zonation. There are four sequential components to the implementation of the protocol: reference site selection, data collection, predictive model construction and assessment of test sites using the predictive models. Once implemented, the habitat assessment protocol will provide a standardised tool for the assessment of river habitat condition at a variety of governance levels.     

Accumulation of heavy metals in native Andean plants: potential tools for soil phytoremediation in Ancash (Peru)

Metal contamination is a recurring problem in Peru, caused mainly by mine tailings from a past active mining activity. The Ancash region has the largest number of environmental liabilities, which mobilizes high levels of metals and acid drainages into soils and freshwater sources, posing a standing risk on human and environmental health. Native plant species spontaneously growing on naturally acidified soils and acid mine tailings show a unique tolerance to high metal concentrations and are thus potential candidates for soil phytoremediation. However, little is known about their propagation capacity and metal accumulation under controlled conditions. In this study, we aimed at characterizing nine native plant species, previously identified as potential hyperaccumulators, from areas impacted by mine tailings in the Ancash region. Plants were grown on mine soils under greenhouse conditions during 5 months, after which the concentration of Cd, Cu, Ni, Pb, and Zn was analyzed in roots, shoots, and soils. The bioaccumulation (BAF) and translocation factor (TF) were calculated to determine the amount of each metal accumulated in the roots and shoots and to identify which species could be better suited for phytoremediation purposes. Soil samples contained high Cd (6.50–49.80 mg/kg), Cu (159.50–1187.00 mg/kg), Ni (3.50–8.70 mg/kg), Pb (1707.00–4243.00 mg/kg), and Zn (909.00–7100.00 mg/kg) concentrations exceeding national environmental quality standards. After exposure to mine tailings, concentrations of metals in shoots were highest in Werneria nubigena (Cd, 16.68 mg/kg; Cu, 41.36 mg/kg; Ni, 26.85 mg/kg; Zn, 1691.03 mg/kg), Pennisetum clandestinum (Pb, 236.86 mg/kg), and Medicago lupulina (Zn, 1078.10 mg/kg). Metal concentrations in the roots were highest in Juncus bufonius (Cd, 34.34 mg/kg; Cu, 251.07 mg/kg; Ni, 6.60 mg/kg; Pb, 718.44 mg/kg) and M. lupulina (Zn, 2415.73 mg/kg). The greatest BAF was calculated for W. nubigena (Cd, 1.92; Cu, 1.20; Ni, 6.50; Zn, 3.50) and J. bufonius (Ni, 3.02; Zn, 1.30); BCF for Calamagrostis recta (Cd, 1.09; Cu, 1.80; Ni, 1.09), J. bufonius (Cd, 3.91; Cu, 1.79; Ni, 18.36), and Achyrocline alata (Ni, 137; Zn, 1.85); and TF for W. nubigena (Cd, 2.36; Cu, 1.70; Ni, 2.42; Pb, 1.17; Zn, 1.43), A. alata (Cd, 1.14; Pb, 1.94), J. bufonius (Ni, 2.72; Zn, 1.63), and P. clandestinum (Zn, 1.14). Our results suggest that these plant species have a great potential for soil phytoremediation, given their capability to accumulate and transfer metals and their tolerance to highly metal-polluted environments in the Andean region.     

Ten years later: The progress and future of integrating sustainable principles,practices, and metrics into remediation projects

In 2009, the Sustainable Remediation Forum released a white paper entitled “Integrating sustainable principles, practices, and metrics into remediation projects” (Ellis & Hadley, 2009, Remediation, 19, pp. 5–114). Sustainable remediation was a relatively new concept, and the white paper explored a range of approaches on how sustainability could be integrated into traditional remediation projects. This paper revisits the 2009 white paper, providing an overview of the early days of the evolving sustainable remediation practice and an assessment of the progress of sustainable remediation over the last 10 years with a primary focus on the United States. The current state of the sustainable remediation practice includes published literature, current practices and resources, applications, room for improvement, international progress, the virtuous cycle that applying sustainable remediation creates, and the status of the objectives cited in the 2009 white paper. Over the last decade, several sustainable remediation frontiers have emerged that will likely be a focus in advancing the practice. These frontiers include climate change and resiliency, weighting and valuation to help better consolidate different sustainable remediation metrics, programmatic implementation, and better integration of the societal impacts of sustainable remediation. Finally, as was the case for the 2009 white paper, this paper explores how sustainable remediation may evolve over the next 10 years and focuses on the events and drivers that can be significant in the pace of further development of the practice. The events and drivers include transformation impacts, societal influences, and the continued development of new technologies, approaches, and tools by remediation practitioners. The remediation industry has made significant progress in developing the practice of sustainable remediation and has implemented it successfully into hundreds of projects. While progress has been significant, an opportunity exists to implement the tenets of sustainable remediation on many more projects and explore new frontiers to help improve the communication, integration, and derived benefits from implementing sustainable remediation into future remediation projects.     

Portable ladder assessment tool development and validation – Quantifying best practices in the field

Many causes for falls from ladders in construction are related to the user’s activities; however, the extent to which users comply with ladder use best practices is unknown and has not been well quantified before. We developed and tested an audit tool that assesses compliance with best practices guidelines for portable-ladder-use designed for applications in the construction industry. Implemented on a hand-held computer, the assessment tool consisted of a series of check-lists categorized in four groups; ladder condition, setup, moving on a ladder, and completing tasks from a ladder. For these four observational categories, the resulting tool contained 31 and 33 questions for step and extension ladders, respectively. Three individuals trained to use the tool scored a set of photographs and videos depicting 25 ladder conditions, 20 ladder setups, 10 users moving on ladders, and 13 users completing tasks from a ladder for a total of 78 observations. The assessment tool had good agreement across and within raters. For the three raters, agreement ranged from 79% to 97% across the questions. Within one subject, kappa coefficients for the intra-rater reliability ranged from 0.67 to 0.91. The tool offers a practical method to quantify best practices associated with ladder use that can ultimately inform targeted intervention efforts.     

Validity of police-reported alcohol involvement in fatal motor carrier crashes in the United States between 1982 and 2005

Objective

To examine the validity of police-reported alcohol data for drivers involved in fatal motor carrier crashes.

Material and Methods

We determined the availability of blood alcohol concentration (BAC) and police-reported alcohol data on 157,702 drivers involved in fatal motor carrier crashes between 1982 - 2005 using Fatality Analysis and Reporting System (FARS) data. Drivers were categorized as motor carrier drivers if they operated a vehicle with a gross vehicle weight rating of greater than 26,000 pounds. Otherwise, they were classified as non motor carrier drivers. The sensitivity and specificity of police-reported alcohol involvement were estimated for both driver types.

Results

Of the 157,702 drivers, 18% had no alcohol information, 15% had BAC results, 42% had police-reported alcohol data, and 25% had both. Alcohol information varied significantly by driver, crash, and vehicle characteristics. For example, motor carrier drivers were significantly more likely (51%) to have BAC testing results compared to non motor carrier drivers (31%) (p < 0.001). The sensitivity of police-reported alcohol involvement for a BAC level ≥ 0.08 was 83% (95% CI 79%, 86%) for motor carrier drivers and 90% (95% CI 89%, 90%) for non motor carrier drivers. The specificity rates were 96% (95% CI 95%, 96%) and 91% (95% CI 90%, 91%), respectively.

Conclusions

The sensitivity and specificity of police-reported alcohol involvement are reasonably high for drivers involved in fatal motor carrier crashes. Further research is needed to determine the extent to which the accuracy of police-reported alcohol involvement may be overestimated because of verification bias.

Impact on the Industry

Based on the results of this study, the federal government should continue to work with states to strengthen their strategies to increase chemical testing of all drivers involved in fatal crashes.