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211.
    

Background

Tests in pregnancy such as chromosomal microarray analysis and exome sequencing are increasing diagnostic yield for fetal structural anomalies, but have greater potential to result in uncertain findings. This systematic review investigated the experiences of prospective parents about receiving uncertain results from these tests.

Methods

A systematic search of three electronic databases was conducted. Data extraction was performed for studies that met the eligibility and quality criteria. Results were synthesised following the principles of thematic analysis.

Results

Fourteen studies (10 qualitative, 4 quantitative) were included. Findings were grouped into three overarching themes. Sources of uncertainty included the testing procedure, the diagnosis and prognosis, and health professionals' own uncertainty. The clinical impact of the uncertainty included parents struggling to make clinical decisions with the information available, the emotional impact included decisional-regret, shock, worry and feeling overwhelmed. To manage the uncertainty, parents sought support from healthcare professionals, friends, family, the internet and other parents as well as remaining hopeful.

Conclusions

Prospective parents experience a myriad of uncertainties in the prenatal setting, which must be handled sensitively. Future research should explore optimal ways of managing uncertainty to minimise harm. Recommendations are made for discussing uncertainty during pre- and post-test counseling.  相似文献   
212.
Although broiler (chicken, Gallus gallus domesticus) litter has long been used as a fertilizer, estimating the rate required to supply a desired amount of plant-available N is still hampered by the lack of rapid methods to estimate potentially mineralizable nitrogen (PMN). Previous research has suggested that near infrared reflectance spectroscopy (NIRS) and certain poultry litter characteristics, such as water-soluble organic nitrogen (WSON), may be useful for estimating PMN. The objectives of this study were to evaluate NIRS and WSON as tools to estimate PMN in broiler litter. Sixty sieved (2 mm) and freeze-dried broiler litter samples were mixed with Cowarts sandy loam soil (fine-loamy, kaolinitic, thermic Typic Kanhapludult) and incubated at 25 degrees C for 112 d. Cumulative net N mineralized with time was fitted to a single-pool exponential model to determine PMN for each broiler litter sample. The PMN values obtained were regressed against NIRS (780 to 2500 nm) and WSON measurements. We found strong relationships between measured- and NIRS-predicted PMN (R2 = 0.82), and between measured PMN and WSON (R2 = 0.87). These results demonstrate the feasibility of using either of these two methods to estimate PMN in broiler litter. Future work should further test both methods for their ability to estimate mineralizable N in whole, moist broiler litter under field conditions.  相似文献   
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2267 singleton fetuses who had one ultrasound examination between 15 and 21 weeks' gestation were prospectively evaluated for echogenic small bowel. Thirty-two cases of echogenic small bowel were detected—a prevalence of 1·4 per cent. Echogenic fetal small bowel was divided into two grades: grade 1, where the small bowel was more echogenic than the liver; and grade 2, where the small bowel had the echogenicity of bone. In contrast to 19/23 fetuses with grade 1 small bowel echogenicity, only 2/9 fetuses with grade 2 echogenic bowel had a normal pregnancy outcome (Fisher's exact test; P⩽0·01). Complications associated with second-trimester echogenic small bowel included in utero cytomegalovirus infection, second-trimester growth restriction, intrauterine fetal demise, and chromosomal abnormalities. Second-trimester fetal echogenic small bowel is associated with an increased risk of an adverse outcome. The prevalence of perinatal and neonatal complications is significantly greater when small bowel echogenicity approaches that of bone.  相似文献   
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217.
    
EOS, or emulsified oil substrate, was used to stimulate anaerobic biodegradation of trichloroethene (TCE) and tetrachloroethene (PCE) at a former Army‐owned manufacturing facility located in the Piedmont area of North Carolina. Previous use of chlorinated solvents at the facility resulted in soil and groundwater impacts. Ten years of active remediation utilizing soil vacuum extraction and air sparging (SVE/AS) were largely ineffective in reducing the TCE/PCE plume. In 2002, the Army authorized preparation of an amended Remedial Action Plan (RAP) to evaluate in situ bioremediation methods to remediate TCE in groundwater. The RAP evaluated eight groundwater remediation technologies and recommended EOS as the preferred bioremediation alternative for the site. Eight wells were drilled within the 100 × 100 feet area believed to be the primary source area for the TCE plume. In a first injection phase, dilute EOS emulsion was injected into half of the wells. Distribution of the carbon substrate through the treatment zone was enhanced by pumping the four wells that were not injected and recirculating the extracted water through the injection wells. The process was repeated in a second phase that reversed the injection/extraction well pairs. Overall, 18,480 pounds of EOS were injected and 163,000 gallons of water were recirculated through the source area. Anaerobic groundwater conditions were observed shortly after injection with a corresponding decrease in both PCE and TCE concentrations. Dissolved oxygen, oxidation‐reduction potential, and sulfate concentrations also decreased after injection, while TCE‐degradation products, ferrous iron, and methane concentrations increased. The reduction in TCE allowed the Army to meet the groundwater remediation goals for the site. Approximately 18 months after injection, eight wells were innoculated with a commercially prepared dechlorinating culture (KB‐1) in an attempt to address lingering cis‐1,2‐dichloroethene (cis‐DCE) and vinyl chloride (VC) that continued to be observed in some wells. Dehalococcoides populations increased slightly post‐bioaugmentation. Both cis‐DCE and VC continue to slowly decrease. © 2007 Wiley Periodicals, Inc.  相似文献   
218.
Using one- and two-dimensional homogeneous simulations, this paper addresses challenges associated with sensitivity analysis and parameter estimation for virus transport simulated using sorptive-reactive processes. Head, flow, and conservative- and virus-transport observations are considered. The paper examines the use of (1) observed-value weighting, (2) breakthrough-curve temporal moment observations, and (3) the significance of changes in the transport time-step size. The results suggest that (1) sensitivities using observed-value weighting are more susceptible to numerical solution variability, (2) temporal moments of the breakthrough curve are a more robust measure of sensitivity than individual conservative-transport observations, and (3) the transport-simulation time step size is more important than the inactivation rate in solution and about as important as at least two other parameters, reflecting the ease with which results can be influenced by numerical issues. The approach presented allows more accurate evaluation of the information provided by observations for estimation of parameters and generally improves the potential for reasonable parameter-estimation results.  相似文献   
219.
Modelling calculations have been performed to predict the radiological impact of the sea to land transfer pathway to members of the public in North Wales from 1952 to 2004. The radionuclides of interest were (99)Tc, (137)Cs, (239,240)Pu and (241)Am and the exposure routes considered were food consumption, external and inhalation. The consumption of locally grown terrestrial food in the early to mid 1980s was the most significant source of exposure to all of the groups considered, with (239,240)Pu being the radionuclide contributing most to the dose. A maximum dose of 1.46muSvy(-1) was calculated for adult members of the critical consumption group in 1985, with doses for 2004 reducing to 0.59muSvy(-1). Despite the conservative approach of the dose calculations, the dose rate values are very low, less than 0.15% of the annual limit of 1000muSvy(-1) for the UK public from controlled radiation sources (excluding medical).  相似文献   
220.
A ‘roadmap’ has been devised for a progressive greening of the Australian chemical industry over the next two decades. The roadmap is based on a set of interactive principles broadly termed ‘economic’, ‘social’, ‘technological’, ‘environmental’ and ‘political’, which collectively form the ‘drivers of change’ in chemical industry strategy/business/policy planning—leading to greater efficiency and economic sustainability of this industry. The proposed roadmap pre-supposes that real economic, societal and environmental benefits can be obtained through greater use of existing and emerging green chemical technology. It can play an important role in developing a sustainable chemical industry in Australia. Primarily, the proposed roadmap involves a paradigm shift of the business operating plan and a significant mindset change of management.  相似文献   
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