Is there a role for fetal interventions in gastroschisis management? – An updated comprehensive review

We conducted a comprehensive evidence-based review on the epidemiology and current standard of care of gastroschisis management as well as the pathophysiology, rationale and feasibility of fetal therapy as a viable alternative. Gastroschisis is a periumbilical abdominal wall defect characterized by abdominal viscera herniation in utero. It affects 4 in 10 000 live births, but the prevalence has steadily increased in recent years. Gastroschisis is typically diagnosed on routine second-trimester ultrasound. The overall prognosis is favorable, but complex gastroschisis, which accounts for about 10% to 15% of cases, is associated with a higher mortality, significant disease burden and higher healthcare costs due to long- and short-term complications. The current standard of care has yet to be established but generally involves continued fetal surveillance and multidisciplinary perinatal care. Postnatal surgical repair is achieved with primary closure, staged silo closure or sutureless repair. Experimental animal studies have demonstrated the feasibility of in utero closure, antiinflammatory therapy and prenatal regenerative therapy. However, reports of early preterm delivery and amnioinfusion trials have failed to show any benefit in humans. Further experimental studies and human trials are necessary to demonstrate the potential benefit of fetal therapy in gastroschisis.     

Spatiotemporal Associations of Reservoir Nutrient Characteristics and the Invasive,Harmful Alga Prymnesium parvum in West Texas

Golden alga (Prymnesium parvum) is a harmful alga that has caused ecological and economic harm in freshwater and marine systems worldwide. In inland systems of North America, toxic blooms have nearly eliminated fish populations in some systems. Modifying nutrient profiles through alterations to land or water use may be a viable alternative for golden alga control in reservoirs. The main objective of this study was to improve our understanding of the nutrient dynamics that influence golden alga bloom formation and toxicity in west Texas reservoirs. We examined eight sites in the Upper Colorado River basin, Texas: three impacted reservoirs that have experienced repeated golden alga blooms; two reference reservoirs where golden alga is present but nontoxic; and three confluence sites downstream of the impacted and reference sites. Total, inorganic, and organic nitrogen and phosphorus and their ratios were quantified monthly along with golden alga abundance and ichthyotoxicity between December 2010 and July 2011. Blooms persisted for several months at the impacted sites, which were characterized by high organic nitrogen and low inorganic nitrogen. At impacted sites, abundance was positively associated with inorganic phosphorus and bloom termination coincided with increases in inorganic nitrogen and decreases in inorganic phosphorus in late spring. Management of both inorganic and organic forms of nutrients may create conditions in reservoirs unfavorable to golden alga.     

Applications of life cycle assessment and cost analysis in health care waste management

The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$ 0.12 kg^?1 for the waste treated with microwaves, US$ 1.10 kg^?1 for the waste treated by the autoclave and US$ 1.53 kg^?1 for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible alternative to subsidize the formulation of the policy for small generators of HCW.     

Ambivalence and conservation behaviour: An exploratory study on the recycling of metal cans

As resource conservation is an imperative for sustainable development, it is crucial to achieve a deeper understanding of the factors involved in people's decisions to recycle. This is even more so because the level of environmental concern is usually higher than the level of ecological behaviours. In this paper we take this fact as indicating that decision-making regarding conservation behaviours happens in the context of an internal debate where contradictory ideas are weighed up and the possibility of ambivalence arises. The main aim of this paper is therefore to explore how contradiction and ambivalence impact upon the attitudes, intentions and pro-ecological behaviours of the private sphere. The paper focuses specifically on the separation and deposition of metal cans, and compares the predictive capacity of beliefs, attitudes and intentions for two groups of respondents – one with a high and another with a low level of ambivalence, as assessed with a direct measure. The role of personal identity and the influence of structural constraints are also explored. Results demonstrate a clear moderating effect of experienced ambivalence, and show how beliefs, particularly negative ones, present a higher predictive capacity of the attitude in the high-ambivalence group, and personal identity plays a relevant role in predicting behaviour in both groups. We discuss the importance of pursuing the study of ambivalence when analysing decision-making in the conservation area.