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411.
The field of fetal therapy has so far escaped from formal accreditation and quality control. Despite that, current published evidence shows that outcomes of interventions in younger fetal therapy centers are similar to what is achieved in more experienced centers and outcomes of interventions have improved over time. The question however remains what is not being published and what should be the standard of care, given the lack of level 1 evidence from randomized controlled trials for many interventions. Formal collaborative networks such as NAFTnet and others allow for anonymized benchmarking of center outcomes, without publicly shaming (and financially punishing) underperforming centers. Large registries also allow for tracking of rare complications and may result in improved patient outcomes over time. Core outcome sets, which could serve as a basis for outcome reporting, are available for some conditions, but certainly not for all, resulting in communication difficulties between centers. Formal accreditation, quality control, and outcome reporting are hard to implement, expensive, and may result in decreasing access to care by pushing smaller centers out of the market. Despite the existing difficulties, international societies have committed to quality improvement, and fetal therapy programs are strongly recommended to participate in voluntary outcome tracking. 相似文献
412.
Jan Deprest Marc Van Ranst Lore Lannoo Emma Bredaki Greg Ryan Anna David Jute Richter Tim Van Mieghem 《黑龙江环境通报》2020,40(13):1755-1758
Even though the global COVID-19 pandemic may affect how medical care is delivered in general, most countries try to maintain steady access for women to routine pregnancy care, including fetal anomaly screening. This means that, also during this pandemic, fetal anomalies will be detected, and that discussions regarding invasive genetic testing and possibly fetal therapy will need to take place. For patients, concerns about Severe Acute Respiratory Syndrome-Corona Virus 2 will add to the anxiety caused by the diagnosis of a serious fetal anomaly. Yet, also for fetal medicine teams the situation gets more complex as they must weigh up the risks and benefits to the fetus as well as the mother, while managing a changing evidence base and logistic challenges in their healthcare system. 相似文献
413.
Lara Gotha Vagisha Pruthi Nimrah Abbasi Abhaya V. Kulkarni Paige Church James M. Drake Jose C.A. Carvalho Yenge Diambomba Varsha Thakur Greg Ryan Tim Van Mieghem 《黑龙江环境通报》2020,40(12):1499-1507
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. 相似文献
414.
Tim Marshall 《Journal of Environmental Planning and Management》1998,41(4):421-443
The first round of regional planning strategies in England in the 1990s only made tentative attempts to incorporate environmental priorities. More recent work is giving sustainability a higher profile and other factors, including the establishment of more co-ordinated government regional offices in 1994 and of the Environment Agency (with new regional boundaries) in 1996, are also raising questions about the future focus on economic and environmental planning at the regional level. Regional planning in Germany has incorporated environmental considerations to a greater degree and for longer. The paper examines experience in Lower Saxony (Niedersachsen) in the 1990s, when the Land has been ruled first by a Social Democrat-Green Party coalition and then by the Social Democrats on their own, but with still some environmental emphasis. Particular attention is paid to policies in the energy, water and waste sectors. Although any direct transfer to experience in England is clearly not possible, it is argued that there are implications for possible directions for regional planning. This is the case whether the new British government initiates major changes or whether there is only gradual building on the foundations laid since 1990. 相似文献
415.
A flexible spatio-temporal model for air pollution with spatial and spatio-temporal covariates 总被引:1,自引:0,他引:1
Johan Lindström Adam A. Szpiro Paul D. Sampson Assaf P. Oron Mark Richards Tim V. Larson Lianne Sheppard 《Environmental and Ecological Statistics》2014,21(3):411-433
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. 相似文献
416.
Daniel Andres Tim H. Clutton-Brock Loeske E. B. Kruuk Josephine M. Pemberton Katie V. Stopher Kathreen E. Ruckstuhl 《Behavioral ecology and sociobiology》2013,67(8):1249-1258
In several primates, the presence of mothers affects the growth, survival and reproduction of their offspring, but similar effects have not yet been demonstrated in ungulates. Here, we investigate the effects of the mother’s presence in a population of red deer (Cervus elaphus) on the Isle of Rum, Scotland, which is the subject of a long-term, individual-based study. We compared measures of performance including antler growth in young males and age at first reproduction in females and survival of deer with mothers still alive against those that have lost their mothers (orphans). We show that orphaning both before and after weaning increases the risk of a natural death for both sexes. For males, no maternal benefit was detectable past 24 months of age while, for females, post-weaning benefits continued throughout life. Orphaning resulted in compromised male physical condition as measured by a reduced probability of growing antlers by 16 months of age while no evidence for compromised reproduction was found in females. These results support assertions that post-weaning maternal associations affect the development and survival of offspring. 相似文献
417.
The cost of reproduction can generate covariation between demographic rates that can potentially influence demography and population dynamics in long-lived iteroparous species. However, there has been relatively little work linking the survival cost of reproduction and population dynamics. The apparent scarcity of information on this important link is potentially due to covariation between vital rates, which can substantially influence fluctuations in population size. In this paper we examine the opportunity for survival costs of reproduction to leave a dynamic signature using a simulation model based broadly on an ungulate life history. We find that an increase in the cost delays the onset of reproduction and reduces reproductive rates of young, but not of prime-age, females. Accordingly, the number of offspring produced declines and the interval between reproductive events increases among young females experiencing high cost. These effects are translated to an age structure skewed toward young ages and reduced population density. These results suggest that, by delaying reproduction when conditions deteriorate, females protect their survival during the critical first three years of life, after which the negative effect of reproduction on survival declines. Unless conditions for reproduction are severe, it is not profitable to delay reproduction beyond age 3 years due to the high risk of death before having a chance to reproduce. We also demonstrate that lack of adjustment of reproductive strategies to elevated levels of the cost of reproduction, for example due to rapid changes in environmental conditions, results in lower average density and longevity compared to females that have sufficient time to adjust to changes in the cost. This suggests that even moderate costs of reproduction may have a major negative effect on population dynamics of ungulates. 相似文献
418.
Sorption of iron-cyanide complexes on goethite in the presence of sulfate and desorption with phosphate and chloride 总被引:1,自引:0,他引:1
Soils are contaminated with potentially toxic iron-cyanide complexes by some industrial activities. The influence of sulfate on the sorption of the iron-cyanide complexes ferricyanide, [Fe(CN)6]3-, and ferrocyanide, [Fe(CN)6]4-, on goethite was investigated in batch experiments. The experiments were conducted as influenced by pH and varying sulfate/iron-cyanide complex concentration ratios. Furthermore, the desorption of iron-cyanide complexes sorbed on goethite was studied using phosphate and chloride solutions as influenced by pH and anion concentration. Over the whole pH range (pH 3.5 to 8), ferricyanide and sulfate showed similar affinities for the goethite surface. The extent of ferricyanide sorption strongly depended on sulfate concentrations and vice versa. In contrast, ferrocyanide sorption was only decreased (approximately 12%) by sulfate additions at pH 3.5. Ferricyanide was completely desorbed by 1 M chloride, ferrocyanide not at all. Unbuffered phosphate solutions (pH 8.3) desorbed both iron-cyanide complexes completely. Even in 70-fold excess, pH-adjusted phosphate solutions could not desorb ferrocyanide completely at pH 3.5. For ferricyanide we propose a sorption mechanism that is similar to the sulfate sorption mechanism, including outer-sphere and weak inner-sphere surface complexes on goethite. Ferrocyanide appears to form inner-sphere surface complexes. Additionally, we assume that ferrocyanide precipitates probably as a Berlin Blue-like phase at pH 3.5. Hence, ferrocyanide should be less mobile in the soil environment than ferricyanide or sulfate. 相似文献
419.
A technical and economic comparison of biofiltration and wet chemical oxidation (scrubbing) for odor control at wastewater treatment plants 总被引:2,自引:0,他引:2
Li Gao Tim C. Keener Lian Zhuang Kaniz F. Siddiqui 《Environmental Engineering and Policy》2001,2(4):203-212
An economic and technical comparison of two odor control systems, a biofilter and a chemical wet scrubber, was conducted over a 1-year time period at a large municipal wastewater treatment plant. The biofilter system was designed to remove hydrogen sulfide gas and other oxidizable sewage odors from four covered gravity sludge thickeners, a gravity sludge thickener effluent channel and an influent splitter box for the gravity sludge thickeners. The sodium hypochlorite/sodium hydroxide wet scrubber was designed to control hydrogen sulfide gas and other oxidizable sewage odors from the covered primary settling tanks, influent distribution channels and effluent channel, and the mixing tank effluent channel. The technical comparison comprised their overall removal rates and efficiencies based on inlet H2S concentrations and other operating variables. The economic comparison was designed to provide the cost per cubic meter of H2S removed for each system. Influent and effluent gas samples were collected on a weekly basis. H2S concentration levels were determined through the use of gas chromatography with a flame photometric detector. The results showed that the H2S inlet gas concentration has a seasonal change with a maximum value occurring in August and September. The effluent H2S concentration was lower than 2 ppmv for both systems for most of the samples. The efficiency for both the biofilter and wet scrubber was above 95%, and was related to the operating and ambient conditions. The economic comparison revealed that the actual unit cost for the biofilter was higher than for the wet scrubber (U.S.160 /m < SUP > 3 < /SUP > H < SUB > 2 < /SUB > S removed versus U.S.160 /m3 H2S removed versus U.S.131 /m3 H2S removed). For both the biofilter and the wet scrubber, the investment costs are affected by the size/scale of the system, the design flow and other factors. For these systems, the mulch change costs, chemical usage costs, maintenance costs and power usage costs were mainly dependent on the actual odor gas loadings which showed substantial seasonal fluctuations as a function of the seasonal temperature. The worst case conditions reported here indicate that the H2S concentrations generated during the summer months should be used to determine the design load. 相似文献
420.