Issues associated with possible implementation of Non-Invasive Prenatal Testing (NIPT) in first-tier screening: A rapid scoping review

In recent years, as the implementation and use of Non-Invasive Prenatal Testing (NIPT) have increased, the cost of the test has been decreasing. The cost of NIPT is expected to fall further in the upcoming years. As a result of the decreasing cost of NIPT, many jurisdictions may change their prenatal screening policies toward abandoning serum-based screening and instead, implement and support NIPT as the first-tier screening for all women. There are several concerns in replacing first-trimester screening with NIPT. In this scoping review, we aimed to map the existing knowledge about possible issues in the systematic implementation of NIPT as the primary method of first-tier screening and to assess if any jurisdiction has altered its policy and discontinued serum-based prenatal screening in exchange for NIPT. The Medline database (Ovid) and Google Scholar was searched and all the studies discussing, investigating, or reporting on the systematic implementation of NIPT as the primary method of first-tier screening were included. All the studies went through a two-stage screening process and included full-text articles were reviewed. We did not find any articles indicating a country or region that replaced traditional prenatal screening by NIPT. The included articles were charted, and the data about the possible issues in the systematic implementation of NIPT as the primary method of first-tier screening are summarized narratively and presented in tables in four categories. The findings of this scoping review may be informative for stakeholders and policymakers regarding recent changes in NIPT implementation policies around the world and may aid with developing policy for NIPT implementation with a broader perspective.     

Reasons for Child Passenger Nonrestraint in Motor Vehicles

Objective: Although child passenger restraint use in motor vehicles has increased, there is an important minority of children who remain unrestrained. The goal of this study was to identify the frequency of and under what circumstances parents keep their children unrestrained.

Methods: A cross-sectional, online survey was distributed to parents and caregivers of children 10 years old and younger. Survey participants were asked about child restraint practices, including frequency of and reasons for nonuse of restraints. Parents were specifically asked how acceptable it would be to keep their child unrestrained in certain situations.

Results: One thousand two hundred eighty-five parents and guardians responded to the survey and 1,002 completed it; 23.8% (95% confidence interval [CI], 21.3–26.6%) of respondents said they had driven with their child not fully restrained on at least one occasion. Approximately 1 in 5 parents strongly or somewhat agreed that it would be acceptable to keep their child unrestrained in certain situations, including a short drive, in a rush, an inadequate number of restraints, riding in a taxi, if somebody was holding the child, and as a reward for a child. Parents were more likely to agree that it was acceptable to keep their child unrestrained under nearly all circumstances listed if they were male, ages 18–29, with a graduate school education, in the $100,000+ income bracket, or Latino.

Conclusions: There are certain situations for which parents find it acceptable to leave their children unrestrained. This has implications for targeted child passenger safety efforts designed to maximize consistent restraint use.     

Efficient management capacity evaluation of tourism in protected areas

Despite the increasing number of protected areas around the world and their importance in the conservation of species and ecosystems, protected areas management capacity remains difficult to evaluate. A standard is needed to help policy makers compare the goals with the results obtained. This empirical research builds a tool to analyze the management efficiency and predicts the new touristic outcomes in case of a policy change. Using as example the state parks agencies in the USA, this paper develops a technological frontier using data envelopment analysis based on the Protected Areas Management Approach. After that, a prediction of the outcomes is analyzed with a budget change for any state park agency. Data suggest that many of them need to improve their performance to be more efficient. Another result obtained shows how budget changes will affect each agency's performance in different degrees and, therefore, budget reductions should be modeled separately.     

Engaging stakeholders in an adaptation process: governance and institutional arrangements in heat-health policy development in Adelaide, Australia

Record breaking heat waves have been recorded in Adelaide, Australia in recent years and climate change would likely increase the frequency, duration and severity of heat waves. This paper describes the governance and institutional arrangements during the development of an adaptation strategy (herein referred to as heat-health policy) for heat waves in Adelaide, Australia. In-depth, semi-structured interviews were conducted between June and August 2011 among 18 stakeholders who were involved in the participatory process during the development of the heat-health policy. Informed consent was obtained and interviews were recorded, transcribed verbatim and the data analysed using framework analysis. Interview data were supplemented by data gathered through a review of documents associated with the process. The results found that the process of developing the heat-health policy was initiated by the state government and comprised of stakeholders from both the state and non-state sectors. There was a high level of leadership and political commitment demonstrated during the process, given that the different players wanted a policy to be in place before any future heat wave. A Steering Committee was established that provided coordination and oversight in addition to the Emergency Management Act within the state which provided the legislative framework during the heat-health policy development process. Although the decision-making authority was controlled by a controlled by a public institution, to a larger extent, there was collaborative decision-making by virtue of the context in which the heat-health policy was developed. An assurance mechanism established during the process was among the factors that ensured accountability during the participatory process. Overall, the development of the heat-health policy in Adelaide was largely successful, attributed to the extent of political commitment from the state government and the sound institutional and legislative framework that facilitated the process. Good governance and institutional arrangements provide the enabling environment, the structures, systems and resources that would facilitate the development of adaptation strategies such as heat-health policies.     

Book reviews

Making Cities Work: the role of local government in the urban environment. Richard Gilbert, Don Stevenson, Herbert Girardet &; Richard Stren, 1996, London, Earthscan, 203pp. ISBN 1 85383 354 1, £13.95 pbk

Environmental Policy in an International Context, Vols 1–3: Perspectives, Conflicts and Prospects. P. Glasbergen &; A. Blowers (Series Eds) London, Arnold

Rhetoric and Reality in Environmental Policy. M. Wintle &; R. Reeve (Eds), 1994, Aldershot, Avebury Studies in Green Research, 154 pp. ISBN 1 85628 927 3

FutureNatural: Nature, Science, Culture. G. Roberston et al. (Eds) 1996, London, Routledge, ISBN 0415 070139, £40.00 hbk

Environmental Policy with Political Integration: the European Union and the United States. New horizons in environmental economics. John B. Braden, Henk Folmer &; Thomas S. Ulen (Eds), 1996, Cheltenham, Elgar Publishing, 477 pp. ISBN 1 85898 217 0     

Identifying Key Factors in Homeowner’s Adoption of Water Quality Best Management Practices

The recognition of the significance of the residential environment in contributing to non-point source (NPS) pollution and the inherently dispersed nature of NPS pollution itself that presents significant challenges to effective regulation has led to the creation and dissemination of best management practices (BMPs) that can reduce the impacts of NPS pollution (Environmental Protection Agency US, Protecting water quality from urban runoff, http://www.epa.gov/npdes/pubs/nps_urban-facts_final.pdf, 2003). However, very few studies have examined the factors that influence the adoption of BMPs by residential homeowners, despite the fact that residential environments have been identified as one of the most significant contributors to NPS pollution. Given this need, the purpose of this project was to explore how demographic and knowledge-based factors predict adoption of residential BMPs in an urbanizing watershed in Northern Illinois using statistical analyses of survey data collected as part of a watershed planning process. The findings indicate that broad knowledge of BMPs is the strongest predictor of use for a specific BMP. Knowledge of BMPs is strongly correlated with their use, which reinforces the need for educational programs, even among those assumed to be knowledgeable about BMPs.     

Gorlin syndrome (naevoid basal cell carcinoma syndrome): Prenatal detection in a fetus with macrocephaly and ventriculomegaly

The Gorlin (naevoid basal cell carcinoma) syndrome is an autosomal dominant disorder consisting principally of naevoid basal cell carcinomas, odontogenic keratocysts, skeletal abnormalities, and intracranial calcification. We report the prenatal detection of the Gorlin syndrome by ultrasonography in a fetus with macrocephaly and mild ventriculomegaly.     

Prenatal diagnosis of cytomegalovirus (CMV) infection: A preliminary report

Eight patients were referred for prenatal diagnosis for suspected fetal cytomegalovirus infection (CMV): six for documented first-trimester infection and two for abnormal ultrasound evaluation suggestive of fetal infection. Three methods of diagnosis were employed: (1) amniotic fluid viral cultures and CMV-specific IgM in fetal serum; (2) amniotic fluid cultures and detection by polymerase chain reaction amplification of CMV-specific DNA in chorionic villi; and (3) detection of CMV-specific DNA in villus samples only. Amniotic fluid cultures detected all cases of infection, but CMV-specific IgM was not a reliable indicator of infection in any case. DNA analysis correlated well with both culture results and clinical outcome.     

Census Peek: Collaboration in the New York City Catskill/Delaware Watershed: Case Study 1990–2000

Because watershed collaborations connect economic and environmental concerns, they are of interest to students of sustainable economic development. The economic outcomes of such collaborations are difficult to study because socio-economic data collection areas do not generally correspond to collaboration boundaries and also because of the simultaneity of economic stimuli and restrictions in collaborative arrangements. This case study of New York City’s Watershed Collaboration in its Catskill Delaware Watershed used a mapping program to create a database of Watershed residents from the 1990 and 2000 census. It provides a heretofore unavailable socioeconomic portrait of the Watershed and trends in indicators relevant to Collaboration effectiveness such as age, demographic pressures, and economic welfare. Through the use of national, state, regional and rural controls, the study also explores the impact of the agreement on the Watershed. Results do not provide evidence of a net negative impact and are consistent with a net positive impact. Several trends which work against agreement effectiveness are identified.