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.     

Complex cardiac defect with hypoplastic right ventricle in a fetus with valproate exposure

We describe a fetus with a hypoplastic right ventricle detected by prenatal ultrasound examination. A possible causal relationship with prenatal valproate exposure is discussed. Copyright © 2005 John Wiley & Sons, Ltd.     

Accelerating the deployment of carbon capture and storage technologies by strengthening the innovation system

In order to take up the twin challenge of reducing carbon dioxide (CO₂) emissions, while meeting a growing energy demand, the potential deployment of carbon dioxide capture and storage (CCS) technologies is attracting a growing interest of policy makers around the world. In this study we evaluate and compare national approaches towards the development of CCS in the United States, Canada, Norway, the Netherlands, and Australia. The analysis is done by applying the functions of innovation systems approach. This approach posits that new technology is developed, demonstrated and deployed in the context of a technological innovation system. The performance assessment of the CCS innovation system shows that the extensive knowledge base and knowledge networks, which have been accumulated over the past years, have not yet been utilized by entrepreneurs to explore the market for integrated CCS concepts linked to power generation. This indicates that the build-up of the innovation system has entered a critical phase that is decisive for a further thriving development of CCS. In order to move the CCS innovation system through this present difficult episode and deploy more advanced CCS concepts at a larger scale; it is necessary to direct policy initiatives at the identified weak system functions, i.e. entrepreneurial activity, market creation and the mobilization of resources. Moreover, in some specific countries it is needed to provide more regulatory guidance and improve the legitimacy for the technology. We discuss how policy makers and technology managers can use these insights to develop a coherent policy strategy that would accelerate the deployment of CCS.     

Midnight at the oasis: does restoration change the rigs-to-reefs debate in the North Sea?

ABSTRACT

In the North Sea, many oil and gas fields will reach the end of their productivity and their associated structures will be decommissioned. OSPAR decision 98/3 prescribes removal of all disused offshore structures as the only acceptable decommissioning option. This policy is the legacy of the 1995 Brent Spar incident, which resulted in the current dominant discourse of ‘Hands off the Oceans,’ ruling out the conversion of oil and gas rigs into artificial reefs (Rigs-to-Reefs (RtR)). The shift from a conservation to a restoration paradigm could open up the RtR debate. In this paper, a discourse analysis is carried out to discern whether and how ideas about RtR and ecosystem restoration are articulated to challenge the dominant ‘Hands off the Oceans’ discourse and thereby bring about change in North Sea decommissioning policy. A discourse analytic framework is applied to elucidate whether an ‘RtR as Restoration’ discourse can be distinguished and how competing claims are presented in the various storylines. Our analysis shows an ‘RtR as Restoration’ discourse, consisting of four different storylines. Given the fragmented nature of this discourse, the ‘RtR as Restoration’ discourse will not overcome the dominant ‘Hands off the Oceans’ discourse.     

EFFECT OF SIMULATED CLIMATE CHANGE ON SNOWMELT RUNOFF MODELING IN SELECTED BASINS1

ABSTRACT: The projected increase in the concentration of CO₂ and other greenhouse gases in the atmosphere is likely to result in a global temperature increase. This paper reports on the probable effects of a temperature increase and changes in transpiration on basin discharge in two different mountain snowmelt regions of the western United States. The hydrological effects of the climate changes are modeled with a relatively simple conceptual, semi-distributed snowmelt runoff model. Based on the model results, it may be concluded that increased air temperatures will result in a shift of snowmelt runoff to earlier in the snowmelt season. Furthermore, it is shown that it is very important to include the expected change in climate-related basin conditions resulting from the modeled temperature increase in the runoff simulation. The effect of adapting the model parameters to reflect the changed basin conditions resulted in a further shift of streamflow to April and an even more significant decrease of snowmelt runoff in June and July. If the air temperatures increase by approximately 5°C and precipitation and accumulated snow amounts remain about the same, runoff in April and May, averaged for the two basins, is expected to increase by 185 percent and 26 percent, respectively. The runoff in June and July will decrease by about 60 percent each month. Overall, the total seasonal runoff decreases by about 6 percent. If increased CO₂ concentrations further change basin conditions by reducing transpiration by the maximum amounts reported in the literature, then, combined with the 5°C temperature increase, the April, May, June, and July changes would average +230 percent, +40 percent, ?55 percent, and ?45 percent, respectively. The total seasonal runoff change would be +11 percent.     

Combining theory and wisdom in pragmatic,scenario-based decision support for sustainable development

Researchers have increasingly acknowledged the relative strength of ‘hybrid’ approaches to scenario analysis for exploring the futures of coupled human-nature systems. In this paper, we explain, demonstrate, and provisionally evaluate the usefulness of a simple analytical framework, based on five categories of capital assets, as part of a protocol for overcoming the conversion problem in hybrid scenario analysis. Based on a preliminary application of the framework to a case study in South Africa, we suggest that the five capitals framework has the potential to improve expedience and counter the bias against ‘soft’ drivers in hybrid approaches to scenario analysis. However, in light of the methodological trade-off between rigour and expedience, we suggest that future research needs to compare the available protocols for hybrid scenario analysis by weighing up the relative gain in scenario quality versus the relative cost of scenario construction.