Intrauterine manometry: Technique and application to fetal pathology

A technique is described for measuring pressure within the amniotic cavity and within fetal vessels and/or body compartments. Two saline-filled catheters were connected at one end to needles inserted during indicated invasive procedures and at the other to silicon strain gauge transducers. In 36 pregnancies with normal liquor volume, stable intra-amniotic pressure (IAP, range 1–14 mmHg) increased with gestation (r=0·48, p<0·01). In pregnancies complicated by severe oligohydramnios, IAP was ≤ 1 mm Hg and rose to normal levels with saline amnioinfusion. Raised IAP (range 17–26 mm Hg), found in pregnancies with gross polyhydramnios, fell with drainage of amniotic fluid. Subtraction manometry was used to determine supra-amniotic pressure within the intervillus space, umbilical vein, umbilical artery, abdominal and thoracic cavities, and the urinary tract in normal and/or pathological fetuses. Low intravesical and intrapelvicalyceal pressures (median 6·5, range 2–10 mmHg) were noted in fetuses with obstructive uropathies. Intrauterine subtraction manometry appears to be a useful tool in the understanding of fetal pathophysiology and may be of clinical benefit in the therapeutic drainage and infusion of amniotic fluid and in the assessment of certain fetal disease states.     

MATERNAL SERUM ALPHA-FETOPROTEIN SCREENING FOR OPEN NEURAL TUBE DEFECTS IN TWIN PREGNANCIES

Data on maternal serum alpha-fetoprotein (AFP) levels at 13–24 weeks' gestation in 46 twin pregnancies with open neural tube defects (22 with anencephaly, 24 with open spina bifida) and 169 unaffected twins were used to estimate the detection and false-positive rates associated with different cut-off levels. Using the conventional cut-off level of 2·5 multiples of the median (MoM) for unaffected singleton pregnancies of the same gestation and laboratory, the detection rate in twins was 99 per cent for anencephaly and 89 per cent for open spina bifida, with a false-positive rate of 30 per cent. Using a 5·0 MoM cut-off level to maintain a similar false-positive rate to that found among singleton pregnancies at 16–18 weeks' gestation (about 3 per cent), the detection rate was 83 per cent for anencephaly and 39 per cent for open spina bifida. Estimates are provided of the odds of having an affected twin pregnancy given a positive AFP result as well as the odds for individual women with a raised AFP level.     

Is maternal alpha-fetoprotein screening still of value in a low-risk area for neural tube defects?

Estimation of maternal serum alpha-fetoprotein (AFP) was used as a screening method for the detection of neural tube defects (NTDs) in 6344 women over three years. Of 88 (1.4 per cent) who had one or more serum AFP levels equal to, or greater than, 2.5 multiples of the median (MoM) for the relevant gestational age, 43 (0.68 per cent) underwent amniocentesis. There were eight NTDs. Four of these were screened by serum AFP, and all cases of spina bifida had serum AFP levels greater than 3.0 MoM, including one small open defect which was not seen on ultrasound. The other four cases of NTD, which were not screened, were identified by ultrasound. Of 64 singleton pregnancies 32 (50 per cent) had serum AFP levels between 2.5 and 3.0 MoM, and low birthweight (⪕2500 g) occurred in 29 per cent. Because of improvements in ultrasound techniques and the apparent falling incidence of NTD, the role of serum AFP as the primary screening procedure should be regularly reviewed. Effective screening is dependent on mothers booking early.     

Serum PAPP-A measurements in first-trimester screening for Down syndrome

Serum PAPP-A measurements taken from 254 women in the first trimester are reported. Eleven chromosomal abnormalities were detected. The mean serum PAPP-A levels in cases of Down syndrome were 0.44 MOM at 9 weeks gestation, 0.15 MOM at 10 weeks, and 0.29 MOM at 11 weeks. The PAPP-A level at 10 weeks was below those of pregnancies which aborted spontaneously. At 11 weeks, the pregnancies with Down syndrome recorded the lowest PAPP-A levels at that gestation. On this small sample, offering chorionic villus sampling to women with singleton pregnancies and a PAPP-A level below 0.3 MOM (approximately 6.5 per cent of this at-risk group) would have detected all the Down syndrome fetuses at 10 weeks and 50 per cent at 11 weeks without selecting those cases destined to abort. This suggests that serum PAPP-A should continue to be investigated as a potential first-trimester screening test for Down syndrome.     

Cost-effective selection of sampling frequencies for regulatory water quality monitoring

A dynamic programming code was formulated for the purpose of assigning sampling frequencies throughout a regulatory water quality monitoring network in order to optimize the statistical performance of the network while operating within a fixed budgetary constraint. The statistical objective is to achieve the greatest possible station to station uniformity in confidence interval widths about annual geometric means of the measured water quality variables and to keep the average confidence width reasonably small. The objective function is the sum (over several selected variables and all stations) of the normalized positive deviations of the predicted confidence interval widths from preselected design confidence interval widths. The code was designed to account for the effects of deterministic seasonal variation and serial correlation of the water quality observations by incorporating the results of the time series analysis of historical quality data. The economic constraint ensures that the annual operating cost of the system, including direct costs of travel and laboratory analysis, will not exceed the allowable budget. As an example situation, the dynamic programming code was used to assign sampling frequencies to the nine stations in Illinois from which historical quality data had been obtained and analyzed. Using five design quality constituents and representative travel and laboratory costs, an “optimal” design was produced. The optimal design achieved a 10% improvement in uniformity (standard deviation) of confidence interval widths when compared to a more traditional design based on the same budget and using identical sampling frequencies at every station.     

ECONOMIC COSTS AND BENEFITS OF INSTREAM FLOW PROTECTION FOR ENDANGERED SPECIES IN AN INTERNATIONAL BASIN1

ABSTRACT: The U.S. Endangered Species Act (ESA) restricts federal agencies from carrying out actions that jeopardize the continued existence of any endangered species. The U.S. Supreme Court has emphasized that the language of the ESA and its amendments permits few exceptions to the requirement to give endangered species the highest priority. This paper estimates economic costs associated with one measure for increasing instream flows to meet critical habitat requirements of the endangered Rio Grande silvery minnow. Impacts are derived from an integrated regional model of the hydrology, economics, and institutions of the upper Rio Grande Basin in Colorado, New Mexico, Texas, and Mexico. One proposal for providing minimum streamflows to protect the silvery minnow from extinction would provide guaranteed year round streamflows of at least 50 cubic feet per second in the San Acacia reach of the upper Rio Grande. These added flows can be accomplished through reduced surface diversions by New Mexico water users in dry years when flows would otherwise be reduced below the critical level required by the minnow. Based on a 44‐year simulation of future inflows to the basin, we find that some agricultural users suffer damages, but New Mexico water users as a whole do not incur damages from a policy that reduces stream depletions sufficiently to provide habitat for the minnow. The same policy actually benefits downstream users, producing average annual benefits of over $200,000 per year for west Texas agriculture, and over $1 million for El Paso municipal and industrial water users, respectively. Economic impacts of instream flow deliveries for the minnow are highest in drought years.     

In-situ sparging: Mass transfer mechanisms

In-situ sparging has been accepted as a method to rapidly remediate groundwater at considerably lower costs compared to remedies based on groundwater recovery alone. The success of in-situ sparging depends on effective mass transfer between air and contaminated media in the subsurface. Factors affecting mass transfer include advective airflow, diffusive transport, interphase chemical partitioning, and chemical and biological reaction rates between sparged gases and subsurface contaminants, minerals, and naturally occurring organic compounds. Understanding these factors can increase the design efficiency of in-situ sparging and assist in developing sparging systems that use gases other than air (i.e., oxygen, ozone, and methane).     

Impact of water control projects on fisheries resources in Bangladesh

Bangladesh is a very flat delta built up by the Ganges—Brahmaputra—Meghna/Barak river systems. Because of its geographical location, floods cause huge destruction of lives and properties almost every year. Water control programs have been undertaken to enhance development through mitigating the threat of disasters. This structural approach to flood hazard has severely affected floodplain fisheries that supply the major share of protein to rural Bangladesh, as exemplified by the Chandpur Irrigation Project. Although the regulated environment of the Chandpur project has become favorable for closed-water cultured fish farming, the natural open-water fishery loss has been substantial. Results from research show that fish yields were better under preproject conditions. Under project conditions per capita fish consumption has dropped significantly, and the price of fish has risen beyond the means of the poor people, so that fish protein in the diet of poor people is gradually declining. Bangladesh is planning to expand water control facilities to the remaining flood-prone areas in the next 15–20 years. This will cause further loss of floodplain fisheries. If prices for closed-water fish remain beyond the buying power of the poor, alternative sources of cheap protein will be required.