Perioperative fetal hemodynamic changes in twin-twin transfusion syndrome and neurodevelopmental outcome at two years of age

Objective

To investigate whether perioperative fetal hemodynamic changes in twin-to-twin transfusion syndrome (TTTS) are associated with neurodevelopmental impairment (NDI) at two years.

Methods

Doppler parameters of three sonograms (day before, first day after and 1 week after laser surgery for TTTS) were assessed for correlation with neurodevelopmental outcome at two years (2008-2016). NDI was defined as: cerebral palsy, deafness, blindness, and/or a Bayley-III cognitive/motor developmental test-score > 2SD below the mean.

Results

Long-term outcome was assessed in 492 TTTS survivors. NDI was present in 5% (24/492). After adjustment for severe cerebral injury (present in 4%), associated with NDI were: middle cerebral artery peak systolic velocity (MCA-PSV) >1.5 multiples of the median (MoM) 1 day after surgery (odds ratio [OR] 4.96; 95% confidence interval [CI]: 1.17-21.05, P = .03), a change from normal umbilical artery pulsatility index (UA-PI) presurgery to UA-PI >p95 postsurgery (OR 4.19; 95% CI: 1.04-16.87, P = .04), a change from normal to MCA-PSV >1.5MoM (OR 4.75; 95% CI: 1.43-15.77, P = .01).

Conclusion

Perioperative fetal hemodynamic changes in TTTS pregnancies treated with laser are associated with poor neurodevelopmental outcome. Prospective research on the cerebrovascular response to altered hemodynamic conditions is necessary to further understand the cerebral autoregulatory capacity of the fetus in relation to neurodevelopmental outcome.     

Microbial response to heavy metal-polluted soils: community analysis from phospholipid-linked fatty acids and ester-linked fatty acids extracts

Heavy metal pollution of soil is of concern for human health and ecosystem function. The soil microbial community should be a sensitive indicator of metal contamination effects on bioavailability and biogeochemical processes. Simple methods are needed to determine the degree of in situ pollution and effectiveness of remediating metal-contaminated soils. Currently, phospholipid-linked fatty acids (PLFAs) are preferred for microbial profiling but this method is time consuming, whereas direct soil extraction and transesterification of total ester-linked fatty acids (ELFAs) is attractive because of its simplicity. The 1998 mining acid-metal spill of >4000 ha in the Guadiamar watershed (southwestern Spain) provided a unique opportunity to study these two microbial lipid profiling methods. Replicated treatments were set up as nonpolluted, heavy metal polluted and reclaimed, and polluted soils. Inferences from whole community-diversity analysis and correlations of individual fatty acids with metals suggested Cu, Cd, and Zn were the most important in affecting microbial community structure, along with pH. The microbial stress marker, monounsaturated fatty acids, was significantly lower for reclaimed and polluted soil over nonpolluted soils for both PLFA and ELFA extraction. Another stress marker, the monounsaturated to saturated fatty acids ratio, only showed this for the PLFA. The general fungal marker (18:2omega6c), the arbuscule mycorrhizae marker (16:1omega5c), and iso- and anteiso-branched PLFAs (gram positive bacteria) were suppressed with increasing pollution whereas 17:0cy (gram negative bacteria) increased with metal pollution. For both extraction methods, richness and diversity were greater in nonpolluted soils and lowest in polluted soils. The ELFA method was sensitive for reflecting metal pollution on microbial communities and could be suitable for routine use in ecological monitoring and risk assessment programs because of its simplicity and reproducibility.     

Ten years later: The progress and future of integrating sustainable principles,practices, and metrics into remediation projects

In 2009, the Sustainable Remediation Forum released a white paper entitled “Integrating sustainable principles, practices, and metrics into remediation projects” (Ellis & Hadley, 2009, Remediation, 19, pp. 5–114). Sustainable remediation was a relatively new concept, and the white paper explored a range of approaches on how sustainability could be integrated into traditional remediation projects. This paper revisits the 2009 white paper, providing an overview of the early days of the evolving sustainable remediation practice and an assessment of the progress of sustainable remediation over the last 10 years with a primary focus on the United States. The current state of the sustainable remediation practice includes published literature, current practices and resources, applications, room for improvement, international progress, the virtuous cycle that applying sustainable remediation creates, and the status of the objectives cited in the 2009 white paper. Over the last decade, several sustainable remediation frontiers have emerged that will likely be a focus in advancing the practice. These frontiers include climate change and resiliency, weighting and valuation to help better consolidate different sustainable remediation metrics, programmatic implementation, and better integration of the societal impacts of sustainable remediation. Finally, as was the case for the 2009 white paper, this paper explores how sustainable remediation may evolve over the next 10 years and focuses on the events and drivers that can be significant in the pace of further development of the practice. The events and drivers include transformation impacts, societal influences, and the continued development of new technologies, approaches, and tools by remediation practitioners. The remediation industry has made significant progress in developing the practice of sustainable remediation and has implemented it successfully into hundreds of projects. While progress has been significant, an opportunity exists to implement the tenets of sustainable remediation on many more projects and explore new frontiers to help improve the communication, integration, and derived benefits from implementing sustainable remediation into future remediation projects.     

A social identity perspective on leadership and employee creativity

This research uses a social identity analysis to predict employee creativity. We hypothesized that team identification leads to greater employee creative performance, mediated by the individual's creative effort. We hypothesized that leader inspirational motivation as well as leader team prototypicality would moderate the relationship between identification and creative effort. Consistent with these predictions, data based on 115 matched pairs of employee‐leader ratings in a research and development context showed an indirect relationship between team identification and creative performance mediated by creative effort. The analyses also confirmed the expected moderated relationships. Leader inspirational motivation enhanced the positive association between identification and creative effort, especially when leader prototypicality was high. We discuss the value of social identity analyses of employee creativity and of the integration of social identity and transformational leadership analyses. Copyright © 2009 John Wiley & Sons, Ltd.     

Confronting environmental pressure,environmental quality and human health impact indicators of priority air emissions

This paper evaluates the ranking of 21 priority air pollutants with three indicator schemes: environmental pressure indicator (EPI), environmental quality indicator (EQI), and human health effect indicator (HEI). The EPI and EQI compare the emissions and concentrations with the target emissions and target concentrations, respectively. The HEI comprehends the steps from cause (i.e. national emissions) to effect (i.e. human health effects), and is the total human health burden, expressed in Disability Adjusted Life Years per year of exposure (DALYs year^?1). We estimated a health burden in the Netherlands of 41 × 10³ DALYs year^?1 caused by Dutch air emissions of PM10 and its precursors in the year 2003. The burden due to 17 carcinogenic substances emitted to air, was much lower (140 DALYs year^?1). In contrast, when the same substances were evaluated regarding environmental pressure and environmental quality, carbon tetrachloride (pressure) and benzo[a]pyrene (quality) were of highest importance, whereas the importance of PM10 was substantially lower. This result is remarkable, because for the majority of substances evaluated, the target concentrations and target emissions are based on preventing human health damage. The differences in relevance are explained by the different weighting of interests in the indicators. The HEI is based on concentration–response relations, whereas the EPI and EQI also depend on other, policy-based, principles and on technical feasibility. Therefore, to effectively prioritize emission reduction measures in policy-making, substances should not only be evaluated as to whether emission targets and environmental quality targets are reached, but they should be evaluated regarding their human health impact as well. In this context, the HEI is a suitable indicator to evaluate the human health impact.     

Grassland Plant Composition Alters Vehicular Disturbance Effects in Kansas,USA

Many “natural” areas are exposed to military or recreational off-road vehicles. The interactive effects of different types of vehicular disturbance on vegetation have rarely been examined, and it has been proposed that some vegetation types are less susceptible to vehicular disturbance than others. At Fort Riley, Kansas, we experimentally tested how different plant community types changed after disturbance from an M1A1 Abrams tank driven at different speeds and turning angles during different seasons. The greatest vegetation change was observed because of driving in the spring in wet soils and the interaction of turning while driving fast (vegetation change was measured with Bray-Curtis dissimilarity). We found that less vegetation change occurred in communities with high amounts of native prairie vegetation than in communities with high amounts of introduced C₃ grasses, which is the first experimental evidence we are aware of that suggests plant communities dominated by introduced C₃ grasses changed more because of vehicular disturbance than communities dominated by native prairie grasses. We also found that vegetation changed linearly with vehicular disturbance intensity, suggesting that at least initially there was no catastrophic shift in vegetation beyond a certain disturbance intensity threshold. Overall, the intensity of vehicular disturbance appeared to play the greatest role in vegetation change, but the plant community type also played a strong role and this should be considered in land use planning. The reasons for greater vegetation change in introduced C₃ grass dominated areas deserve further study.     

Prenatal interventions for fetal lung lesions

The widespread availability of high resolution ultrasound equipment and almost universal routine anatomy scanning in all pregnant women in the developed world has lead to increased detection of abnormalities in the fetal thorax. Already in the 1980s, large pleural effusions and significant macrocystic lesions in the fetus were easily detected on ultrasound. However, smaller lung tumours were often missed. Nowadays, fetal medicine centres receive many referrals for evaluation of fetal lung lesions, of which the most common are congenital cystic adenomatoid malformation and bronchopulmonary sequestration. Almost invariably, both the parents and the referring physicians experience anxiety after detection of large lung masses in the fetus. However, the vast majority of the currently detected fetal lung lesions have an excellent prognosis without the need for prenatal intervention. In the small group of fetuses in which the prognosis is poor, almost exclusively those with concomitant fetal hydrops and cardiac failure, several options for fetal therapy exist, often with a more than 50% survival rate. Indications, techniques, complications and outcomes of these interventions will be described in this review. Copyright © 2011 John Wiley & Sons, Ltd.     

Parvovirus B19 infection in pregnancy: new insights and management

In this article, we review the virology, pathology, epidemiology and clinical spectrum of intrauterine human parvovirus B19 (B19V) infection, including intrauterine fetal death, non-immune hydrops fetalis, thrombocytopenia and neurological manifestations such as pediatric stroke and perivascular calcifications. In addition, we discuss the new insights into the neurodevelopmental outcome of intrauterine B19V infection. Current diagnosis and management of B19V infection is summarized, including a diagnostic and follow-up flowchart for practical clinical use. Copyright © 2011 John Wiley & Sons, Ltd.