The value and limitations of using predetermined criteria in decision making for maternal-fetal interventions

Maternal-fetal interventions—such as prenatal fetal myelomeningocele (MMC) repair—are at the forefront of clinical innovation within maternal-fetal medicine, pediatric surgery, and neonatology. Many centers determine eligibility for innovative procedures using pre-determined inclusion and exclusion criteria based on seminal studies, for example, the “Management of Myelomeningocele Study” for prenatal MMC repair. What if a person's clinical presentation does not conform to predetermined criteria for maternal-fetal intervention? Does changing criteria on a case-by-case basis (i.e., ad hoc) constitute an innovation in practice and flexible personalized care or transgression of commonly held standards with potential negative consequences? We outline principle-based, bioethically justified answers to these questions using fetal MMC repair as an example. We pay special attention to the historical origins of inclusion and exclusion criteria, risks and benefits to the pregnant person and the fetus, and team dynamics. We include recommendations for maternal-fetal centers facing these questions.     

Study of controlled migration of cadmium and lead into foods from plastic utensils for children

Lead (Pb) is a highly neurotoxic chemical element known for reducing intelligence quotient (IQ) and promoting antisocial behavior in children and adolescents, while cadmium (Cd) is a carcinogenic bioaccumulative element. Both these metals are included in the priority pollutant list of the United States Environmental Protection Agency and in the WHO List of Chemicals of Major Public Health Concern, where contaminated foods and beverages are the most common pathways of exposure. The objective of this study was to determine total Cd and Pb levels in colored plastic utensils (cups, mugs, bowls, feeding bottles, and plates) for use by children and to measure the specific migration of these elements into beverages and foods. Total contaminant levels were determined using a handheld X-ray fluorescence analyzer. Specific migration tests were conducted using the simulant solutions acetic acid 3% (m/v) and water. Migration levels were determined by ICP-MS. Specific migration tests for Pb were also performed on commercially available samples (cola soft drink, orange juice, vinegar, and milk), with levels determined by graphite-furnace atomic absorption spectrometry (GF-AAS). A total of 674 utensils were analyzed in loco at major commercial centers in Greater São Paulo, of which 87 were purchased for containing Cd and Pb concentrations above permitted limits. Mean concentrations of the metals detected in the purchased utensils were 1110 ppm for Pb and 338 ppm for Cd. For specific migration assays, Pb levels were 187, 13, and 380 times above the permitted limit (0.01 mg.kg -1) for acetic acid, water, and orange juice, respectively. Cd levels were 50 and 2.4 times above the maximum permitted limit (0.005 mg.kg -1) for acetic acid and water, respectively. The districts where the utensils were purchased were grouped according to their social vulnerability index and compared using ANOVA. Pb levels were different between low and medium/high social vulnerability groups (p?=?0.006). The findings corroborate the initial hypothesis that these utensils constitute a major source of exposure to PTEs such as Cd and Pb, pointing to the need for stricter regulation and inspection by the Brazilian regulatory agencies.

     

The Wreck of Amtrak's Sunset Limited: News Coverage of a Mass Transport Disaster

Using the 1993 crash of Amtrak's Sunset Limited in Mobile, Alabama, this study examines the safety education provided by seven newspapers. A total of 117 news stories were analysed for five primary themes: overall story category, passenger safety theme, train personnel safety theme, train safety theme and rescue safety. Sixty-three per cent were found to contain at least one safety theme paragraph within the larger story. A total of 631 paragraphs were identified as safety theme paragraphs, 32 per cent of which were passenger safety themes, 8 per cent were train personnel safety, 31 per cent were train safety and 29 per cent were rescue safety themes. As in previous research, safety themes rarely appeared alone; more often than not, a story contained a mixture of all themes. Some safety themes appeared more frequently than others, but overall, the safety themes present a complete view of the safety issues surrounding the crash.
Safety themes are embedded within a story framework which reflects the three stages of disaster news work. Images of normalcy tragically disrupted by the crash abound as do images of passengers escaping and aiding others. Disaster relief personnel and aviation officials are shown working to restore order and solve the mystery of the crash. Within this framework we can learn what to expect when a train crashes and what we might have to do in a similar situation.     

Prey dynamics affect foraging by a pelagic predator (Stenella longirostris) over a range of spatial and temporal scales

Studies have shown that pelagic predators do not overlap with their prey at small scales. However, we hypothesized that spinner dolphin foraging would be affected by the spatio-temporal dynamics of their prey at both small and large scales. A modified echosounder was used to simultaneously measure the abundance of dolphins and their prey as a function of space and time off three Hawaiian islands. Spinner dolphin abundance closely matched the abundance patterns in the boundary community both horizontally and vertically. As hypothesized, spinner dolphins followed the diel horizontal migration of their prey, rather than feeding offshore the entire night. Spinner dolphins also followed the vertical migrations of their prey and exploited the vertical areas within the boundary layer that had the highest prey density. Cooperative foraging by pairs of dolphins within large groups was evident. The geometric and density characteristics of prey patches containing dolphins indicate that dolphins may alter the characteristics of prey patches through this cooperative foraging. The overlap of Hawaiian spinner dolphins and their prey at many temporal and spatial scales, ranging from several minutes to an entire night and 20 m to several kilometers, indicates that the availability of truly synoptic data may fundamentally alter our conclusions about pelagic predator-prey interactions.     

Quantifying Florida Bay Habitat Suitability for Fishes and Invertebrates Under Climate Change Scenarios

The Florida Bay ecosystem supports a number of economically important ecosystem services, including several recreational fisheries, which may be affected by changing salinity and temperature due to climate change. In this paper, we use a combination of physical models and habitat suitability index models to quantify the effects of potential climate change scenarios on a variety of juvenile fish and lobster species in Florida Bay. The climate scenarios include alterations in sea level, evaporation and precipitation rates, coastal runoff, and water temperature. We find that the changes in habitat suitability vary in both magnitude and direction across the scenarios and species, but are on average small. Only one of the seven species we investigate (Lagodon rhomboides, i.e., pinfish) sees a sizable decrease in optimal habitat under any of the scenarios. This suggests that the estuarine fauna of Florida Bay may not be as vulnerable to climate change as other components of the ecosystem, such as those in the marine/terrestrial ecotone. However, these models are relatively simplistic, looking only at single species effects of physical drivers without considering the many interspecific interactions that may play a key role in the adjustment of the ecosystem as a whole. More complex models that capture the mechanistic links between physics and biology, as well as the complex dynamics of the estuarine food web, may be necessary to further understand the potential effects of climate change on the Florida Bay ecosystem.