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.     

Use of coatings to minimise acid emissions during ceramic tile firing

The manufacture of traditional ceramic products (ceramic tiles, roof tiles, and bricks) is often associated with the emission of F, Cl, and S compounds during the firing stage. According to the literature, fluorine emissions can be reduced by adding CaCO₃ to the raw materials mixture used in fabricating these products. However, data available to the authors indicate that this procedure, which has been successfully applied in manufacturing structural ceramics (roof tiles and bricks), is ineffective in ceramic tile manufacture and modifies tile end properties.This paper examines the possibility of reducing such emissions by applying coatings of alkaline-earth carbonates on to the ceramic tile bottom surface to retain the acid compounds emitted during tile firing. The effectiveness of MgCO₃, CaCO₃, SrCO₃, and BaCO₃ coatings for retaining these acid emissions was studied, using the evolved gas analysis (EGA) technique with a TG-DSC-FTIR-QM instrument.The SrCO₃ coating was found to provide the greatest retention, showing that SO₂ and HCl were retained more efficiently than HF. The presence of fluorides, chlorides, and sulphates of Ca, Sr, and Ba was verified in the respective fired coatings, confirming the existence of chemical reactions between the emitted acid compounds and the coating materials at high temperature.     

A Bayesian assessment of the effect of highway bypasses in Iowa on crashes and crash rate

Introduction

A common contention is that the construction of highway bypasses negatively impacts the economy of local communities by reducing pass-by traffic for businesses. However, as access to specific business' account records is limited, this impact is difficult to quantify. Another common contention is that bypasses contribute to a reduction in overall crashes in the community and in the surrounding areas. Even though a large number of bypasses have been constructed in the State of Iowa over the past several years, their actual impact in terms of traffic safety has not been quantified.

Objectives

This study seeks answers to the following questions: (a) Are bypasses in Iowa associated with a reduction in crash frequencies and crash rates on the bypassed highway? (b) Do bypasses in Iowa introduce a reduction of overall crash frequencies and rates or do they merely shift crashes from the highways through the communities to the bypasses with no significant overall reduction?

Method

We obtained crash information from the Iowa DOT at 19 sites on which a bypass was constructed sometime during the past 23 years. We also obtained the same information at six sites used as comparison sites on which no bypasses were constructed at least until 2005. We them employed a Bayesian approach to estimating the association between the construction of the bypass and crash rates, while also accounting for other factors.

Results

The construction of bypasses in Iowa is associated with a significant increase in traffic safety both on the main road through town and on the combined main road and bypass roadway.     

The impact of the BP Baker report

Introduction

This study examined the impact of the British Petroleum (BP) Baker Panel Report, reviewing the March 2005 BP-Texas City explosion, on the field of process safety.

Method

Three hundred eighty-four subscribers of a process safety listserv responded to a survey two years after the BP Baker Report was published.

Results

Results revealed respondents in the field of process safety are familiar with the BP Baker Report, feel it is important to the future safety of chemical processing, and believe that the findings are generalizable to other plants beyond BP-Texas City. Respondents indicated that few organizations have administered the publicly available BP Process Safety Culture Survey. Our results also showed that perceptions of contractors varied depending on whether respondents were part of processing organizations (internal perspective) or government or consulting agencies (external perspective).

Conclusions

This research provides some insight into the beliefs of chemical processing personnel regarding the transportability and generalizability of lessons learned from one organization to another.

Impact on Industry

This study has implications for both organizational scientists and engineers in that it reveals perceptions about the primary mechanism used to share lessons learned within one industry about one major catastrophe (i.e., investigation reports). This study provides preliminary information about the perceived impact of a report such as this one.     

Implementing falls prevention research into policy and practice in Australia: past, present and future

Introduction

Falls in older Australians are a significant public health issue with one in three older people falling one or more times each year.

Method

Many fall prevention randomized controlled trials have been conducted in Australia as well as across the world.

Results

The findings of these studies now constitute a substantial evidence base that can provide direction for health and lifestyle interventions for preventing falls in older people. This research evidence has contributed to health policy in Australia to some extent, but is yet to be widely implemented into practice. This opinion piece overviews previous policy initiatives and describes a new Partnership research program funded by the Australian National Health and Medical Research Council (NHMRC), which seeks to further influence health policy and address the ongoing research-practice gap.     

Using the RE-AIM framework to translate a research-based falls prevention intervention into a community-based program: lessons learned

Problem

Exercise-based research interventions demonstrate reduced risk and rates of falls for community dwelling older adults; however, little is known about effective mechanisms for the translation, implementation, and maintenance of these interventions in community settings.

Method

The RE-AIM framework was used to assess the translatability of an effective exercise-based research intervention in a community setting. Questions included: Reach — Would the target population attend? Effectiveness — What was the adherence and compliance to the program? Were there individual improvements in falls risk factors? Adoption: Would staff at the center adopt the program and offer it past the funding period? Implementation — What adaptations, including optimal frequency and duration, should be made to meet the community needs, still adhere to core elements and achieve similar outcomes? Maintenance — Would the program be sustained by our community partners?

Discussion

The process of translating a controlled research intervention targeting older adults at risk of falls into a community setting was challenging. Licensed professionals developed the infrastructure to safely and effectively deliver the program. The end product was highly appealing program to our target audience, resulted in improved outcomes and was successfully adopted and maintained by the community partner.

Summary

Partnerships between community and healthcare providers are key to successful implementation of falls prevention interventions. Lessons learned from this experience can be applied to the translation of future exercise-based falls prevention interventions.     

Modelling spills of water-reactive chemicals

This paper describes part of a programme of work undertaken at the Health and Safety Laboratory (HSL) to investigate the behaviour of selected water-reactive chemicals. Following an accidental release, such substances react exothermically with any water present, generating acidic vapours. The STAWaRS (Source Term Assessment of Water Reactive Substances) software was developed for the Health and Safety Executive (HSE) by ESR Technology to model this complex process. The aims of the study described here were to provide experimental validation of the heats of hydrolysis used within STAWaRS, and to perform sensitivity studies on selected STAWaRS input parameters.The heat of hydrolysis of acetyl chloride was measured and showed good correlation with the value used within STAWaRS. Some of the variables that influence the severity of acetyl chloride spills are examined, with reference to predictions made by the STAWaRS model. The heats of hydrolysis of titanium tetrachloride previously measured at HSL are also discussed, and the effect of adopting these experimentally derived values for modelling spills is shown for a hypothetical land use planning case. This study demonstrates the importance of using experimentally validated values for STAWaRS input parameters.     

Effects of significant damage of flame gap surfaces in flameproof electrical apparatus on flame gap efficiency

Electrical apparatus for use in the presence of explosive gas atmospheres has to be specially designed to prevent the apparatus from igniting the gas. Flameproof design is one of several options, and one requirement is then that any holes and slits in the enclosure wall be designed to prevent a possible gas explosion inside the enclosure from being transmitted to an explosive gas cloud outside it. Current standards (IEC) require that joint surfaces have a surface roughness of <6.3 μm. Any damaged joint surface has be restored to this quality. The present investigation has demonstrated that flame gap surfaces in flameproof electrical apparatuses can suffer considerable mechanical and corrosive damage before the flame gaps no longer function satisfactorily. In some cases very significant mechanical surface damage in fact improves the gap performance. This indicates that current high costs of repairing and replacing flameproof electrical apparatus in process plants offshore and onshore can be reduced considerably without any increase of the explosion risk.