Antenatal sonographic diagnosis of arthrogryposis multiplex Congenita

Arthrogryposis Multiplex Congenita (AMC) was suspected on ultrasound examination of a fetus at 30·5 weeks of gestation. The criteria for establishing this prenatal diagnosis as well as the importance of establishing the diagnosis at any gestational age are discussed. The diagnosis of AMC was confirmed at birth in this case.     

Road accident fatality risks for “vulnerable” versus “protected” road users in northern Ghana

Background: Road traffic injuries (RTIs) are a serious epidemic that claims more than a million lives across the globe each year. The burden of RTIs is particularly pronounced in Africa and other low- and middle-income countries. The unfavorable disparity of the burden of road trauma in the world is largely attributable to unsafe vehicles, lack of appropriate road infrastructure, and the predominance of vulnerable road users (VRUs) in developing countries. However, little research exists in northern Ghana to highlight the scale and risk of death among road users.

Objective: The objective of this research was to establish the relative risk of death among road users in northern Ghana.

Methods: Crash data from police reports between 2007 and 2011 were analyzed for the Upper Regions of Ghana. Conditional probabilities and multivariable logistic regression techniques were used to report proportions and adjusted odds ratios (AORs), respectively.

Results: Generally, crashes in northern Ghana were extremely severe; that is, 35% of all injury related collisions were fatal. The proportion of fatal casualties ranged between 21% among victims of sideswipe collisions and 41% among pedestrians and victims of rear-end collisions. Though males were 6 times more likely to die than females overall, females were more likely to die as pedestrians (90% of all female casualty deaths) and males were more likely to die as riders/drivers (78% of all male casualty deaths). Pedestrians were 3 times more likely to die (odds ratio [OR] = 3.1; 95% confidence interval [CI], 2.4 to 4.1) compared with drivers/riders. Compared with drivers, the odds of death among cyclists was about 4 times higher (AOR = 3.6; 95% CI, 2.3 to 5.6) and about 2 times higher among motorcyclists (AOR = 1.6; 95% CI, 1.2 to 2.2). Compared with casualties aged between 30 and 59 years, children under 10 years and those aged 60 years and above were independently 2 times more likely to die in traffic collisions.

Conclusion: Provision of requisite road infrastructure is vital for the safety of VRUs in northern Ghana. Cycle paths and lanes (for cyclists) as well as sidewalks (for pedestrians) in particular will separate VRUs from motorists and improve their safety. Enforcement of traffic laws particularly regarding helmet use, speeding, and alcohol use will be beneficial. Introduction of the demerit points system in the enforcement of traffic regulations may have significant deterrent effects on road users who have the penchant for violating traffic regulations. Road safety education is also required to create responsible road users.     

Evaluation of a responsible beverage service and enforcement program: Effects on bar patron intoxication and potential impaired driving by young adults

Objective: Studies of alcohol-related harm (violence, injury, illness) suggest that the most significant risk factors are the amount of alcohol consumed and whether obviously intoxicated patrons continue to be served. This study's objective was to investigate the effects of a responsible beverage service (RBS)/enhanced alcohol enforcement intervention on bars, bar patrons, and impaired driving.

Method: Two communities—Monroe County, New York, and Cleveland, Ohio—participated in a demonstration program and evaluation. The intervention applied RBS training, targeted enforcement, and corrective actions by law enforcement to a random sample of 10 identified problem bars in each community compared to 10 matched nonintervention problem bars. Data were collected over 3 waves on bar serving practices, bar patron intoxication, drinking and driving, and other alcohol-related harm from intervention and control bars and treatment and comparison communities.

Results: In Monroe County, New York, of the 14 outcome measures analyzed, 7 measures showed statistically significant differences from pre- to postintervention. Six of those measures indicated changes in the desired or positive direction and 2 measures were in the undesired or negative direction. Of note in the positive direction, the percentage of intervention bar patrons who were intoxicated decreased from 44 to 27% and the average blood alcohol concentration of patrons decreased from 0.097 to 0.059 g/dL pre- to postintervention. In Cleveland, Ohio, 6 of the 14 measures showed statistically significant changes pre- to postintervention with 6 in the positive direction and 4 in the negative direction. Of note, the percentage of pseudo-intoxicated patrons denied service in intervention bars increased from 6 to 29%.

Conclusions: Of the 14 outcome measures that were analyzed in each community, most indicated positive changes associated with the intervention, but others showed negative associations. About half of the measures showed no significance, the sample sizes were too small, or the data were unavailable. Therefore, at best, the results of these demonstration programs were mixed. There were, however, some positive indications from the intervention. It appears that when bar managers and owners are aware of the program and its enforcement and when servers are properly trained in RBS, fewer patrons may become intoxicated and greater efforts may be made to deny service to obviously intoxicated patrons. Given that about half of arrested impaired drivers had their last drink at a licensed establishment, widespread implementation of this strategy has the potential to help reduce impaired driving.     

Administrative license suspension: Does length of suspension matter?

Objective: Administrative license revocation (ALR) laws, which provide that the license of a driver with a blood alcohol concentration at or over the illegal limit is subject to an immediate suspension by the state department of motor vehicles, are an example of a traffic law in which the sanction rapidly follows the offense. The power of ALR laws has been attributed to how swiftly the sanction is applied, but does the length of suspension matter? Our objectives were to (a) determine the relationship of the ALR suspension length to the prevalence of drinking drivers relative to sober drivers in fatal crashes and (b) estimate the extent to which the relationship is associated to the general deterrent effect compared to the specific deterrent effect of the law.

Methods: Data comparing the impact of ALR law implementation and ALR law suspension periods were analyzed using structural equation modeling techniques on the ratio of drinking drivers to nondrinking drivers in fatal crashes from the Fatality Analysis Reporting System (FARS).

Results: States with an ALR law with a short suspension period (1–30 days) had a significantly lower drinking driver ratio than states with no ALR law. States with a suspension period of 91–180 days had significantly lower ratios than states with shorter suspension periods, while the three states with suspension lengths of 181 days or longer had significantly lower ratios than states with shorter suspension periods.

Discussion: The implementation of any ALR law was associated with a 13.1% decrease in the drinking/nondrinking driver fatal crash ratio but only a 1.8% decrease in the intoxicated/nonintoxicated fatal crash ratio. The ALR laws and suspension lengths had a significant general deterrent effect, but no specific deterrent effect.

Practical Implications: States might want to keep (or adopt) ALR laws for their general deterrent effects and pursue alternatives for specific deterrent effects. States with short ALR suspension periods should consider lengthening them to 91 days or longer.     

A spectral power analysis of driving behavior changes during the transition from nondistraction to distraction

Objective: This article investigated and compared frequency domain and time domain characteristics of drivers' behaviors before and after the start of distracted driving.

Method: Data from an existing naturalistic driving study were used. Fast Fourier transform (FFT) was applied for the frequency domain analysis to explore drivers' behavior pattern changes between nondistracted (prestarting of visual–manual task) and distracted (poststarting of visual–manual task) driving periods. Average relative spectral power in a low frequency range (0–0.5 Hz) and the standard deviation in a 10-s time window of vehicle control variables (i.e., lane offset, yaw rate, and acceleration) were calculated and further compared. Sensitivity analyses were also applied to examine the reliability of the time and frequency domain analyses.

Results: Results of the mixed model analyses from the time and frequency domain analyses all showed significant degradation in lateral control performance after engaging in visual–manual tasks while driving. Results of the sensitivity analyses suggested that the frequency domain analysis was less sensitive to the frequency bandwidth, whereas the time domain analysis was more sensitive to the time intervals selected for variation calculations. Different time interval selections can result in significantly different standard deviation values, whereas average spectral power analysis on yaw rate in both low and high frequency bandwidths showed consistent results, that higher variation values were observed during distracted driving when compared to nondistracted driving.

Conclusions: This study suggests that driver state detection needs to consider the behavior changes during the prestarting periods, instead of only focusing on periods with physical presence of distraction, such as cell phone use. Lateral control measures can be a better indicator of distraction detection than longitudinal controls. In addition, frequency domain analyses proved to be a more robust and consistent method in assessing driving performance compared to time domain analyses.     

The effects of agricultural cooperatives on smallholder livelihoods and agricultural performance in Cambodia

Cooperatives are increasingly advocated as a means to improve incomes, livelihoods and the sustainability of smallholder farmers. This study analyzes the impact of commercial vegetable cooperative membership on smallholder agricultural performance in Cambodia. Institutional heterogeneities are considered across cooperatives and various econometric techniques are used to control for potential selection bias. The impacts of horticulture on agricultural outcomes are also analyzed. The results indicate that membership of commercial vegetable cooperatives has so far had no effect on agricultural incomes or the value or amounts of agricultural inputs. However, results indicate that membership has affected technology choice, access to credit services and information transmission through technological training. Additionally, there is evidence that horticulture, as a component of overall agricultural diversification, can augment farm income. The results suggest that much of the benefit of cooperative membership stems from the cooperative's provision of services, which might not be easily inferred from measures of member incomes.     

Special section: advancing the role of cities in climate governance – promise,limits, politics

This special issue contributes to scholarly debates about the role of cities in global climate governance, reflecting on the promise, limits, and politics of cities as agents of change. It takes an empirically-informed approach drawing on multiple diverse geographical and political contexts. Overall, the special issue aims to stimulate reflection and debate about where understanding and practice needs improvement to advance the role of cities in global climate governance. Key questions that are addressed in the special issue include: To what extent do real world experiences confirm or disconfirm the high expectations of cities as agents and sites of change in addressing global climate change as expressed in urban climate governance literature? In what ways do internal political dynamics of cities enable or constrain urban climate governance? How is climate governance in cities enabled and constrained by interactions with broader governance levels? In what ways can climate governance in cities be advanced through critical attention to the previous issues?     

Urea Fluctuations in Stream Baseflow across Land Cover Gradients and Seasons in a Coastal Plain River System

Urea‐N is a component of bioavailable dissolved organic nitrogen (DON) that contributes to coastal eutrophication. In this study, we assessed urea‐N in baseflow across land cover gradients and seasons in the Manokin River Basin on the Delmarva Peninsula. From March 2010 to June 2011, we conducted monthly sampling of 11 streams (4 tidal and 7 nontidal), 2 wastewater treatment plants, an agricultural drainage ditch, and groundwater underlying a cropped field. At each site, we measured urea‐N, DON, dissolved organic carbon (DOC), total dissolved nitrogen (TDN), NO₃^?‐N, and NH₄⁺‐N. In general, urea‐N comprised between 1% and 6% of TDN, with the highest urea‐N levels in drainage ditches (0.054 mg N/L) and wetland‐dominated streams (0.035–0.045 mg N/L). While urea‐N did not vary seasonally in tidal rivers, nontidal streams saw distinct urea‐N peaks in summer (0.038 mg N/L) that occurred several months after cropland fertilization in spring. Notably, the proportion of wetlands explained 78% of the variance in baseflow urea‐N levels across the Manokin watershed. In wetland‐dominated basins, we found urea‐N was positively related to water temperature and negatively related to DOC:DON ratios, indicating short‐term urea‐N dynamics at baseflow were more likely influenced by instream and wetland‐driven processes than by recent agricultural urea‐N inputs. Findings demonstrate important controls of wetlands on baseflow urea‐N concentrations in mixed land‐use basins.     

Road Erosion and Delivery Index (READI): A Model for Evaluating Unpaved Road Erosion and Stream Sediment Delivery

The Road Erosion and Delivery Index (READI) is a new geographic information system–based model to assess erosion and delivery of water and sediment from unpaved road networks to streams. READI quantifies the effectiveness of existing road surfacing and drain placements in reducing road sediment delivery and guides upgrades to optimize future reductions. Roads are draped on a digital elevation model and parsed into hydrologically distinct segments. Segments are further divided by engineered drainage structures. For each segment, a kinematic wave approximation generates runoff hydrographs for specified storms, with discharge directly to streams at road–stream crossings and onto overland‐flow plumes at other discharge points. Plumes are attenuated by soil infiltration, which limits their length, with delivery occurring if plumes intersect streams. Sediment production and sediment delivery can be calculated as a relative dimensionless index. READI predicts only a small proportion of new drains and new surfacing results in the majority of sediment delivery reductions. The model illustrates how the spatial relationships between road and stream networks, controlled by topography and network geometries, influence patterns of road–stream connectivity. READI was applied in seven northern California basins. The model was also applied in a recent burn area to examine how reduced hillslope infiltration can result in increased hydrologic connectivity and sediment delivery.     

Further Development of a Specific Conductivity Approach to Measure Groundwater Discharge Area within Lakes

Groundwater exchanges with most lakes are rarely quantified because there are many technical challenges to quantification. We investigated a lakebed mapping approach to infer the relative areas of groundwater exchange in 12 prairie shallow lakes and five Laurentian mixed forest shallow lakes in Minnesota, USA in 2011. We used a relatively common approach (seepage meters) to provide baseline information on the magnitude and direction of flow at four locations in each lake. To expand from point measurements to the whole‐lake scale, we explored use of specific conductivity as a cheaper and more time efficient proxy for groundwater discharge to lakes. We validated the approach at near shore stations in each lake where seepage meter measurements and specific conductivity surveys overlapped. Specific conductivity surveys provided a similar assessment of groundwater discharge compared to seepage meters for 50% of the lake‐sampling period combinations. The lakebed mapping approach, when validated for a lake with a limited number of seepage meter (or alternative methods) measurements, offers the advantages of being more time and labor efficient over the use of a similar number of seepage meter monitoring locations; seepage meters (or piezometers, for example) are costlier in terms of equipment and labor, even for single‐lake studies. We show the combined approach could provide useful baselines for understanding and mapping groundwater exchange in shallow lakes.