Increased nuchal translucency after low-risk noninvasive prenatal testing: What should we tell prospective parents?

Three decades ago, the observation that first trimester fetuses with excess fluid accumulation at the back of the neck were more likely to be aneuploid, gave rise to a new era of prenatal screening. The nuchal translucency (NT) measurement in combination with serum biomarkers and maternal age, resulted in the first trimester combined screening (FTCS) program. The introduction of noninvasive prenatal testing (NIPT) over the past decade has introduced the option for parents to receive highly sensitive and specific screening information for common trisomy from as early as 10 weeks gestation, altering the traditional pathway FTCS pathway. The retention of the 11–13-week NT ultrasound remains important in the detection of structural anomalies; however, the optimal management of pregnancies with a low-risk NIPT result and an isolated increased NT measurement in an era of advanced genomic testing options is a new dilemma for clinicians. For parents, the prolonged period between the initial diagnosis in first trimester, and prognostic information at each successive stage of investigations up to 22–24 weeks, can be emotionally challenging. This article addresses the common questions from parents and clinicians as they navigate the uncertainty of having a fetus diagnosed with an increased NT after a low-risk NIPT result and presents suggested approaches to management.     

Older women drivers: fatal crashes in good conditions

PROBLEM: By 2030, there will be approximately 70 million older people (65+) in the United States, more than twice their number in 2000. This increase also represents an increased percentage of older licensed drivers. Thus, it is important to understand the special circumstances of how they may be involved in traffic crashes. METHOD: This study used the Fatality Analysis Reporting System (FARS), which is a census of all fatal crashes occurring in the United States over the last two decades maintained by the National Highway Traffic Safety Administration (NHTSA), to study the special characteristics of fatal crashes involving females older than 70 years. RESULTS: The results indicate that senior women are overrepresented in crashes that occur under the "safest" conditions, on roads with low speed limits, in daylight, when traffic is low (not at rush hour), when the weather is good, and when the roads are dry.     

Identifying Determinants of Nations' Wetland Management Programs Using Structural Equation Modeling: An Exploratory Analysis

Integrated management and policy models suggest that solutions to environmental issues may be linked to the socioeconomic and political characteristics of a nation. In this study, we empirically explore these suggestions by applying them to the wetland management activities of nations. Structural equation modeling was used to evaluate a model of national wetland management effort and one of national wetland protection. Using five predictor variables of social capital, economic capital, environmental and political characteristics, and land-use pressure, the multivariate models were able to explain 60% of the variation in nations' wetland protection efforts based on data from 90 nations, as defined by level of participation in the international wetland convention. Social capital had the largest direct effect on wetland protection efforts, suggesting that increased social development may eventually lead to better wetland protection. In contrast, increasing economic development had a negative linear relationship with wetland protection efforts, suggesting the need for explicit wetland protection programs as nations continue to focus on economic development. Government, environmental characteristics, and land-use pressure also had a positive direct effect on wetland protection, and mediated the effect of social capital on wetland protection. Explicit wetland protection policies, combined with a focus on social development, would lead to better wetland protection at the national level.     

Size-fractionated plutonium isotopes in a coastal environment

We have examined the distribution of individual Pu isotopes (239Pu, 240Pu, and 241Pu) in seawater from the Gulf of Maine (GOM). Samples were size-fractionated with a 1 kD cross-flow ultrafiltration (CFF) membrane. Subfractioned samples were radiochemically purified and Pu isotopes were analyzed using a three-stage thermal ionization mass spectrometer (TIMS). To our knowledge, this is the first time that both size class and Pu isotopic data have been obtained for seawater samples. Within measurement uncertainties a single 240Pu/239Pu atom ratio of 0.18 was found for all sample collection depths and sample size fractions. This signifies a current, single Pu source in GOM waters, namely global fallout, and suggests that no measurable isotopic fractionation occurred during CFF processing. The majority of Pu was found in the low molecular weight fraction (< 1 kD). Colloidal Pu varied from 8% of the total in surface waters to < 1% in the deepest (250 m) seawater sample. Evidence suggests that the vertical distribution of Pu in GOM is primarily controlled by conservative mixing processes. The high Pu fraction found in the low molecular size fraction implies that most of the Pu is in the non-particle-reactive oxidized fraction, and is consistent with the conservative Pu behavior. The activity levels are in agreement with other studies which show a slow decrease in Pu with time due to continued mixing and relatively slow particle removal.