Prenatal incision of ureterocele causing bladder outlet obstruction: a multicenter case series

We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four fetal therapy centers. Inclusion criteria were (1) ureterocele confirmed on detailed fetal ultrasound examination, (2) absence of additional fetal malformations, and (3) fetal intervention to decompress the ureterocele with local institutional review boards' approval. Data on sonographic follow-up, obstetrical, neonatal outcome, and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described. Six cases benefited from a fetoscopy for laser incision and decompression, two cases had an ultrasound guided puncture before resorting to a fetoscopy with laser incision, one case had a balloon catheterization under ultrasound guidance, and one case had an ultrasound-guided opening of the ureterocele with a laser fiber passed through a 20-gauge needle. Mean gestational age at diagnosis was 21.6 GW. Two cases underwent termination of pregnancy. The remaining eight cases recovered normal amniotic fluid volume and delivered a liveborn child at a mean gestational age of 38.6 GW with normal creatinine levels during the first week of life. Prenatal incision provided complete treatment of severely obstructive ureteroceles in 80% of the cases and allowed improvement of urinary electrolytes, renal size and echogenicity, bladder filling in all survivors, and recollection of normal amniotic fluid volume, in case of oligoanhydramnios. © 2017 John Wiley & Sons, Ltd.     

Integration of standardized environmental and quality management systems audits

In the last few years, many organizations have chosen to implement standardized Management Systems (MSs), such as the ones based on ISO 14001 and ISO 9001. However, few studies exist on how firms carry out the process of auditing these MSs.Our goal is to study how companies with more than one standardized MSs conduct the audits and to which extent they integrate the audit elements in order to benefit from the advantages of having a sole, integrated audit system.We provide four case studies and confirm the idea that firms with more than one MS integrate their audits. However, the degree and specific characteristics of this integration vary in the different companies analyzed.This paper contains one of the first qualitative empirical studies regarding the integration of MSs audits. The study provides an original contribution to the understanding of whether and how the four case study organizations have integrated certain aspects of the audit systems, for instance, the human resources, time, and audit inputs and outputs.     

Nested vulnerability: exploring cross-scale linkages and vulnerability teleconnections in Mexican and Vietnamese coffee systems

Analyses of the vulnerability of farm populations and food systems to exogenous change, whether in relation to climatic extremes, market shocks, epidemics or other concerns, have typically been approached through a focus on the place of food production or the specific sub-sector exposed to stress. Relatively little attention has been paid to the ways in which national institutions, history and social expectations transform the same signals of global change into very different outcomes in distinct geographic contexts. The channels that convey signals of change from the global to the local may also work in reverse, connecting the responses and choices of households in one geographic context to outcomes and choices of other households in quite distant places. We draw from recent case studies of farm-level vulnerability and livelihood security in Mexico and Vietnam to demonstrate that coffee smallholders’ independent responses to the risks and opportunities associated with global scale economic and environmental change, are teleconnected and thus can create feedbacks which in turn affect the present and future vulnerabilities of other smallholders around the globe.     

Optimisation of adjusted barrier management to improve glass eel migration at an estuarine barrier

Estuarine barriers may significantly reduce the upstream migration of diadromous fish species like the European eel (Anguilla anguilla L.). Previous research showed that limited barrier opening during tidal rise was a cost-efficient and effective mitigation option to improve upstream glass eel migration, without significant intrusion of sea water. This paper aims to optimise this adjusted barrier management to improve eel passage at a tidal barrier complex at the mouth of the River Yser, Flanders, Belgium, one of the most important migration routes for glass eel in Flanders. Specifically, three hypotheses were tested. The first hypothesis analysed the impact of the number of barriers opened on the upstream glass eel migration. The second hypothesis evaluated the relation between the size of the barrier opening and glass eel migration. Finally, we tested whether the suggested adjusted barrier management may lead to a significant increase in conductivity in the River Yser. Increased opening of one barrier appeared more efficient than opening several barriers slightly. Conductivity increased during periods of extreme drought and at base flow, but decreased within 24 h after the first peak flow. This indicates that adjusted barrier management does not entail salt intrusion in the Yser basin, as long as this management is not applied in extremely dry periods. Since the adjusted barrier management is easily implemented and could be applied on numerous tidal barriers, the presented results may contribute to restoration of eel populations worldwide and be of interest to a wide range of river managers and stakeholders.