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The field of fetal therapy has so far escaped from formal accreditation and quality control. Despite that, current published evidence shows that outcomes of interventions in younger fetal therapy centers are similar to what is achieved in more experienced centers and outcomes of interventions have improved over time. The question however remains what is not being published and what should be the standard of care, given the lack of level 1 evidence from randomized controlled trials for many interventions. Formal collaborative networks such as NAFTnet and others allow for anonymized benchmarking of center outcomes, without publicly shaming (and financially punishing) underperforming centers. Large registries also allow for tracking of rare complications and may result in improved patient outcomes over time. Core outcome sets, which could serve as a basis for outcome reporting, are available for some conditions, but certainly not for all, resulting in communication difficulties between centers. Formal accreditation, quality control, and outcome reporting are hard to implement, expensive, and may result in decreasing access to care by pushing smaller centers out of the market. Despite the existing difficulties, international societies have committed to quality improvement, and fetal therapy programs are strongly recommended to participate in voluntary outcome tracking. 相似文献
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Natasha Henschke Jason D. Everett Martina A. Doblin Kylie A. Pitt Anthony J. Richardson Iain M. Suthers 《Marine Biology》2014,161(1):149-163
Swarms of the pelagic tunicate, Thalia democratica, form during spring, but the causes of the large interannual variability in the magnitude of salp swarms are unclear. Changes in asexual reproduction (buds per chain) of T. democratica populations in the coastal waters of south-east Australia (32–35°S) were observed in three austral springs (October 2008–2010). T. democratica abundance was significantly higher in 2008 (1,312 individuals m?3) than 2009 and 2010 (210 and 92 individuals m?3, respectively). There was a significant negative relationship (linear regression, r 2 = 0.61, F 1,22 = 33.83, P < 0.001) between abundance and asexual reproduction. Similarly, relative growth rates declined with decreasing abundance. Generalised additive mixed modelling showed that T. democratica abundance was significantly positively related to preferred food >2 μm in size (P < 0.05) and negatively related to the proportion of non-salp zooplankton (P < 0.001). Salp swarm magnitude, growth, and asexual reproduction may depend on the abundance of larger phytoplankton (prymnesiophytes and diatoms) and competition with other zooplankton. 相似文献
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Anthony Galea Manel Grifoll Federico Roman Marc Mestres Vincenzo Armenio Agustin Sanchez-Arcilla Louis Zammit Mangion 《Environmental Fluid Mechanics》2014,14(6):1405-1425
In the present paper, we use numerical simulation to investigate currents, mixing and water renewal in Barcelona harbour under typical conditions of wind forcing for the winter season. This site is of particular importance due to the interplay between touristic and commercial activities, requiring detailed and high-definition studies of water quality within the harbour. We use Large Eddy Simulation (LES) which directly resolves the anisotropic and energetic large scales of motion and parametrizes the small, dissipative, ones. Small-scale turbulence is modelled by the anisotropic Smagorinsky model (ASM) to be employed in presence of large cell anisotropy. The complexity of the harbour is modelled using a combination of curvilinear, structured, non-staggered grid and the immersed boundary method. Boundary conditions for wind and currents at the inlets of the port are obtained from in-situ measurements. Analysis of the numerical results is carried out based on both instantaneous and time-averaged velocity fields. First- and second-order statistics, such as turbulent kinetic energy and horizontal and vertical eddy viscosities, are calculated and their spatial distribution is discussed. The study shows the presence of intense current in the narrow and elongated part of the harbour together with sub-surface along-shore elongated rolling structures (with a time scale of a few hours), and they contribute to the vertical water mixing. Time-averaged velocity field reveals intense upwelling and downwelling zones along the walls of the harbour. The analysis of second-order statistics shows strong inhomogeneity of turbulent kinetic energy and horizontal and vertical eddy viscosities in the horizontal plane, with larger values in the regions characterized by stronger currents. The water renewal within the port is quantified for particular sub-domain regions, showing that the complexity of the harbour is such that certain in-harbour basins have a water renewal of over five days, including the yacht marina area. The LES solution compares favourably with available current-meter data. The LES solution is also compared with a RANS solution obtained in literature for the same site under the same forcing conditions, the comparison demonstrating a large sensitivity of properties to model resolution and frictional parametrization. 相似文献
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为探究湛江近海域海洋沉积物中类二噁英多氯联苯(dioxin-like polychlorinated biphenyls,Dl PCBs)的生物学毒性效应,选取湛江近海域2个地点(近工业区TS和近生活区JSW)采集沉积物样品,制备近海域沉积物Dl PCBs提取物,将斑马鱼胚胎暴露于不同浓度的Dl PCBs提取物,测定斑马鱼胚胎7-乙氧基异吩恶唑脱乙基酶(ethoxyresorufin-O-deethylase,EROD)活性和cyp1a m RNA相对表达量。结果发现,JSW采样点Dl PCBs提取物染毒组EROD酶活性变化与TS采样点Dl PCBs提取物一致,在各染毒浓度下,斑马鱼仔鱼EROD酶活性为对照组的1.1~1.8倍。TS和JSW采样点不同浓度Dl PCBs提取物暴露斑马鱼胚胎96 h后,使斑马鱼仔鱼cyp1a m RNA相对表达量是对照组的3.36~19.45倍。说明一定浓度的近海沉积物Dl PCBs能诱导斑马鱼仔鱼EROD酶活性和cyp1a m RNA表达量升高,且呈现浓度-效应关系。 相似文献
679.
van Putten E. Ingrid Pinkard Elizabeth O’Grady Anthony Schmidt Rebecca K. Cresswell Ian Raoult Vincent Taylor Matt D. 《The Environmentalist》2021,41(4):541-555
Environment Systems and Decisions - Globally we are experiencing a decline in aggregate natural capital. Many primary industries and enterprises are highly dependent on renewable and non-renewable... 相似文献
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The benthic ecological structure of the Tan-Shui estuary, Taiwan is changed due to long term effects of dumping of urban wastewater and of engineering actions. to monitor these changes, we sampled and analyzed benthos and sediment from 12 stations on the estuary. The composition of the dominant species of benthos varied seasonally, with molluscan and crustacean species having greater numbers and higher frequencies of occurrence than other species. the dominant taxa during winter were Nassarius sp. and Maldanidae at two stations. Analysis using Simpson's index and Shannon's index showed the benthic community varied more in coastal areas than in offshore areas. Physicochemical analysis showed that most of the Tan-Shui estuary consisted of sandy sediment. the variations in concentrations of organic carbon and total nitrogen at each station were small. Although the concentrations of chlorophyll-a and carotenoid at all stations were generally low, the two stations had the highest concentrations, and we concluded that the concentration of pigments in these sediments was related to the abundance of benthos. the community structure of the benthos reflected the characteristics of the sediments, and benthic species exhibited selection of and adaptation to specific sedimentary environments. 相似文献