Factors affecting the clinical use of non-invasive prenatal testing: a mixed methods systematic review

Non-invasive prenatal testing has been in clinical use for a decade; however, there is evidence that this technology will be more widely applied within the next few years. Guidance is therefore required to ensure that the procedure is offered in a way that is evidence based and ethically and clinically acceptable. We conducted a systematic review of the current relevant literature to ascertain the factors that should be considered when offering non-invasive prenatal testing in a clinical setting. We undertook a systematic search of relevant databases, journals and reference lists, and from an initial list of 298 potential papers, identified 11 that were directly relevant to the study. Original data were extracted and presented in a table, and the content of all papers was analysed and presented in narrative form. Four main themes emerged: perceived attributes of the test, regulation and ethical issues, non-invasive prenatal testing in practice and economic considerations. However, there was a basic difference in the approach of actual or potential service users, who were very positive about the benefits of the technology, compared with other research participants, who were concerned with the potential moral and ethical outcomes of using this testing method. Recommendations for the appropriate use of non-invasive prenatal testing are made. © 2013 John Wiley & Sons, Ltd.     

Increased nuchal translucency in euploid fetuses—what should we be telling the parents?

Nuchal translucency (NT) measurement between 11 and 14 weeks' gestation is an undisputed marker for aneuploidies. When conventional karyotyping is normal, enlarged NT is a strong marker for adverse pregnancy outcome, associated with miscarriage, intrauterine death, congenital heart defects, and numerous other structural defects and genetic syndromes. The risk of adverse outcome is proportional to the degree of NT enlargement. Although the majority of structural anomalies are amenable to ultrasound detection, unspecified genetic syndromes involving developmental delay may only emerge after birth. Concern over these prenatally undetectable conditions is a heavy burden for parents. However, following detection of enlarged NT the majority of babies with normal detailed ultrasound examination and echocardiography will have an uneventful outcome with no increased risk for developmental delay when compared to the general population. Counseling should emphasize this to help parents restore hope in normal pregnancy outcome and infant development. Copyright © 2010 John Wiley & Sons, Ltd.     

Identifying pathways to visions of future land use in Europe

Regional Environmental Change - Plausible scenarios of future land use derived from model projections may differ substantially from what is actually desired by society, and identifying such...     

A fiber-optic redox sensor for the iron(III)–iron(II) transition

A phenosafranine-containing Nafion film attached to the distal end of a fiber-optic probe forms a functional redox-sensitive optical sensor. The synthetic cationic photoactive dye phenosafranine, 3,7-diamino-5-phenylphenazinium chloride, responds with changes in light absorbance between its oxidized and reduced forms. This optical property persists when phenosafranine is sorbed into Nafion, a perfluorosulfonate anionic film. Optical properties of the sensor are similar to those seen by others in solution. At high redox conditions, such as an open nitrogen-purged aqueous pH 6.5 solution, optical absorbance of phenosafranine is high, while at low redox conditions, such as an aqueous pH 6.5 iron(II) solution, optical absorbance of phenosafranine is low. Titration of a closed pH 6.5 aqueous solution with a standard iron(II) solution lowers redox potential in a predictable manner and can be followed by the optical redox sensor in parallel with a commercial redox potential electrode.     

Early signs of recovery of Acropora palmata in St. John,US Virgin Islands

Since the 1980s, diseases have caused significant declines in the population of the threatened Caribbean coral Acropora palmata. Yet it is largely unknown whether the population densities have recovered from these declines and whether there have been any recent shifts in size-frequency distributions toward large colonies. It is also unknown whether colony size influences the risk of disease infection, the most common stressor affecting this species. To address these unknowns, we examined A. palmata colonies at ten sites around St. John, US Virgin Islands, in 2004 and 2010. The prevalence of white-pox disease was highly variable among sites, ranging from 0 to 53 %, and this disease preferentially targeted large colonies. We found that colony density did not significantly change over the 6-year period, although six out of ten sites showed higher densities through time. The size-frequency distributions of coral colonies at all sites were positively skewed in both 2004 and 2010, however, most sites showed a temporal shift toward more large-sized colonies. This increase in large-sized colonies occurred despite the presence of white-pox disease, a severe bleaching event, and several storms. This study provides evidence of slow recovery of the A. palmata population around St. John despite the persistence of several stressors.     

Dealing with uncertainty in collaborative planning: developing adaptive strategies for the IJsselmeer

Adaptive strategies to deal with uncertainty in water management are often collaboratively developed. So far, however, little attention has been paid to the influence of collaboration on handling uncertainty through adaptive planning. In this paper, we study how collaboration has influenced the handling of uncertainty through adaptive planning for water management strategies for the IJsselmeer area in the Netherlands. We show how a fixation on certainty, different perspectives among actors and unclear responsibilities between arenas affect the handling of uncertainty, and found that it is adversely affected by collaboration. The use of adaptive planning challenged current water uses and system functions, creating resistance from actors. We conclude that developing a shared problem perception, creating a common understanding of uncertainties and ensuring a clear demarcation between the water system, its societal functions and water usage, are necessary to make adaptive planning successful in handling uncertainty.