Prenatal DNA Sequencing: Clinical,Counseling, and Diagnostic Laboratory Considerations

Clinical diagnostic laboratories are producing next-generation sequencing-based test results that are becoming increasingly incorporated into patient care. Whole genome and exome sequencing on fetal material derived from amniocytes, chorionic villi, or products of conception is starting to be offered clinically in specialized centers, but it has not yet become routine practice. The technical, interpretation, and ethical challenges are greatest in the area of prenatal medicine because the fetus has a limited health history, and the physical examination is only indirectly available via prenatal sonography. Here, we provide an overview of these challenges and highlight the clinical utility, reporting, and counseling issues associated with prenatal DNA sequencing. Future considerations are also discussed. © 2017 John Wiley & Sons, Ltd.     

Fetal magnetocardiography using optically pumped magnetometers: a more adaptable and less expensive alternative?

Fetal magnetocardiography provides the requisite precision for diagnostic measurement of electrophysiological events in the fetal heart. Despite its significant benefits, this technique with current cryogenic based sensors has been limited to few centers, due to high cost of maintenance. In this study, we show that a less expensive non-cryogenic alternative, optically pumped magnetometers, can provide similar electrophysiological and quantitative characteristics when subjected to direct comparison with the current technology. Further research can potentially increase its clinical use for fetal magnetocardiography. © 2016 John Wiley & Sons, Ltd.     

Typical patterns of smallholder vulnerability to weather extremes with regard to food security in the Peruvian Altiplano

Smallholder livelihoods in the Peruvian Altiplano are frequently threatened by weather extremes, including droughts, frosts and heavy rainfall. Given the persistence of significant undernourishment despite regional development efforts, we propose a cluster approach to evaluate smallholders’ vulnerability to weather extremes with regard to food security. We applied this approach to 268 smallholder households using information from two existing regional assessments and from our own household survey. The cluster analysis revealed four vulnerability patterns that depict typical combinations of household attributes, including their harvest failure risk, agricultural resources, education level and non-agricultural income. We validated the identified vulnerability patterns by demonstrating the correlation between them and an independently reported damage: the purchase of food and fodder resulting from exposure to weather extremes. The vulnerability patterns were then ranked according to the different amounts of purchase. A second validation aspect accounted for independently reported mechanisms explaining smallholders’ sensitivity and adaptive capacity. Based on the similarities among the households, our study contributes to the understanding of vulnerability beyond individual cases. In particular, the validation strengthens the credibility and suitability of our findings for decision-making pertaining to the reduction of vulnerability.     

Subjective realities of climate change: how mental maps of impacts deliver socially sensible adaptation options

This paper discusses the perceived impacts of weather-related extreme events on different social groups in New Delhi, India. Using network statistics and scenario analysis with the Fuzzy Cognitive Mapping as part of a vulnerability analysis, the investigation provides quantitative and qualitative measures to compare impacts and adaptation strategies for different social groups. Impacts of rain events and heat waves are considered and differ across groups. Rain events affect the lower income classes more, while heat waves are the bigger burden for higher income classes. Overall, the strength of perceived impacts is larger for lower income classes, directly threatening their daily incomes. Urban managers have no immediate feedback on their livelihood, but often refer to health issues. The strongest effect on ameliorating burdens is investments in schemes to ease traffic, e.g., by improving the sewage and drainage infrastructure paired with other supply side measures to enable transport of goods for lower income classes during rain. During heat events, improving the water supply situation would reduce burden for all, while constant electricity supply is an effective means in reducing burden for the higher income classes in particular. Our analysis suggests that improvements in the water supply and sewage infrastructure would be the most suitable first step to initiate a well-planned adaptation strategy for all social groups.