First-trimester diagnosis of Meckel–Gruber syndrome by transabdominal sonography in a low-risk case

Meckel–Gruber syndrome is a rare autosomal recessive disorder often resulting in neonatal death within a few hours of life. The condition is usually diagnosed ultrasonographically in the second trimester and earlier diagnosis has been mainly confined to high recurrence risk pregnancies. We describe the earliest non-invasive diagnosis of this condition at 12⁺² weeks' gestation in a patient with no previous history using transabdominal ultrasound. Pregnancy termination was declined. Subsequent development of anhydramnios in the mid-trimester resulted in poor fetal visualization. We propose that first-trimester diagnosis of this condition is not only possible but preferable, as normal liquor volume facilitates visualization of fetal anatomy.     

Prenatal diagnosis of Pallister–Killian syndrome: Resolution of cytogenetic ambiguity by use of fluorescent in situ hybridization

We report a case of Pallister-Killian syndrome initially diagnosed prenatally as tetrasomy 21. A 33-year-old primiparous woman was noted at 24 weeks' gestation to have moderate polyhydramnios. Ultrasonography showed diminished fetal stomach filling, hydronephrosis, and prominence of the cisterna magna. Cytogenetic analysis of cultured amniocytes was initially interpreted as mosaic tetrasomy 21: 46,XX/47,XX,+i(21q). The patient was then referred to our centre for genetic counselling. At 34 weeks' gestation, a dysmorphic infant was delivered and died within 30 min. Physical features were consistent with the Pallister-Killian syndrome. Renal, gastrointestinal, and central nervous system anomalies were found at post-mortem examination. Analysis of peripheral lymphocytes revealed 5 per cent of cells with a marker chromosome, while 92 per cent of cultured fibroblasts had this same marker. Fluorescent in situ hybridization (FISH) using an alpha-satellite probe for chromosomes 13 and 21 failed to hybridize to the marker, while a chromosome 12 centromeric probe unequivocally identified it as an i(12p). Use of FISH can provide rapid, specific prenatal diagnosis of ambiguous marker chromosomes and improve prenatal counselling.     

Meckel–Gruber syndrome: Ultrasonographic diagnosis at 13 weeks' gestational age in an at-risk case

A case of early diagnosis at 13 weeks' gestational age of Meckel–Gruber syndrome by ultrasound is reported in a patient with a 25 percent recurrence risk. The usefulness of genetic counselling and aimed echographic examination is discussed.     

Bicycle helmet effectiveness is not overstated

Objective: The objective of this study was to discuss the challenges in estimating bicycle helmet effectiveness from case–control studies of injured cyclists and to estimate helmet effectiveness from cases and available exposure data.

Methods: Data were extracted from studies of cyclists in Seattle; Victoria and New South Wales, Australia; and The Netherlands. Estimates of helmet use were used as exposure to compute relative risks for Seattle and Victorian data. Cycling distance data are routinely collected in The Netherlands; however, these data cannot be disaggregated by helmet use, which makes it unsuitable for estimating helmet effectiveness. Alternative controls were identified from larger cohorts for the Seattle and New South Wales cases.

Results: Estimates of helmet effectiveness were similar from odds ratios (ORs) using hospital controls or from relative risks (RRs) using helmet use estimates (Seattle: OR = 0.339, RR = 0.444; Victoria: OR = 0.500, RR = 0.353). Additionally, the odds ratios using hospital controls were similar when controls were taken from a larger cohort for head injury of any severity (Seattle: OR = 0.250, alt OR = 0.257; NSW: OR = 0.446, alt OR = 0.411) and for serious head injury (Seattle: OR = 0.135, alt OR = 0.139; NSW: OR = 0.335, alt OR = 0.308). Although relevant exposure data were unavailable for The Netherlands, the odds ratio for helmet effectiveness of those using racing, mountain, or hybrid bikes was similar to other estimates (OR = 0.371).

Conclusions: Despite potential weaknesses with case–control study designs, the best available evidence suggests that helmet use is an effective measure of reducing cycling head injury.     

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.     

‘It's off to work we go!’ Person–environment fit and turnover intentions in managerial and administrative mining personnel

Purpose. Person–environment fit asserts that incompatibility between an employee and aspects of their work environment is more likely to lead to occupational stress. The aim of this study was to investigate the impact that varying levels of person–environment fit had on key criterion outcomes including work engagement, work-related wellbeing and turnover intentions in a unique sample of managerial and administrative mining personnel. Method. An online self-report survey was distributed to an Australian mining organization by the company’s Chief Executive Officer. Anonymous survey links were sent to staff, of which 118 participants responded. The survey consisted of previously validated measures. Results. Hierarchical multiple regression analyses revealed significant relationships between abilities–demand fit, needs–supply fit and work engagement. Additionally, work-related wellbeing was significantly associated with increased person–organization fit and needs–supply fit. However, only needs–supply fit had a significant negative relationship with turnover intentions. Needs–supply fit significantly predicted all criterion variables. Conclusions. This study found that personal need fulfilment through work-related activities had the most significant impact on work-related wellbeing and work engagement. Personal need fulfilment through work also produced the most significant negative relationship with turnover intentions.     

Hand-arm vibration disorder among grass-cutter workers in Malaysia

Introduction. Prolonged exposure to hand-transmitted vibration from grass-cutting machines has been associated with increasing occurrences of symptoms and signs of occupational diseases related to hand–arm vibration syndrome (HAVS). Methods. A cross-sectional study was carried out using an adopted HAVS questionnaire on hand–arm vibration exposure and symptoms distributed to 168 male workers from the grass and turf maintenance industry who use hand-held grass-cutting machines as part of their work. The prevalence ratio and symptom correlation to HAVS between high and low–moderate exposure risk groups were evaluated. Results. There were positive HAVS symptoms relationships between the low–moderate exposure group and the high exposure group among hand-held grass-cutting workers. The prevalence ratio was considered high because there were indicators that fingers turned white and felt numb, 3.63, 95% CI [1.41, 9.39] and 4.24, 95% CI [2.18, 8.27], respectively. Less than 14.3% of workers stated that they were aware of the occupational hand–arm vibration, and it seemed to be related to the finger blanching and numbness. Conclusion. The results suggest that HAVS is under-diagnosed in Malaysia, especially in the agricultural sectors. More information related to safety and health awareness programmes for HAVS exposure is required among hand-held grass-cutting workers.     

Understanding traffic crash under-reporting: Linking police and medical records to individual and crash characteristics

Objective: This study aligns to the body of research dedicated to estimating the underreporting of road crash injuries and adds the perspective of understanding individual and crash factors contributing to the decision to report a crash to the police, the hospital, or both.

Method: This study focuses on road crash injuries that occurred in the province of Funen, Denmark, between 2003 and 2007 and were registered in the police, the hospital, or both authorities. Underreporting rates are computed with the capture–recapture method, and the probability for road crash injuries in police records to appear in hospital records (and vice versa) is estimated with joint binary logit models.

Results: The capture–recapture analysis shows high underreporting rates of road crash injuries in Denmark and the growth of underreporting not only with the decrease in injury severity but also with the involvement of cyclists (reporting rates of about 14% for serious injuries and 7% for slight injuries) and motorcyclists (reporting rates of about 35% for serious injuries and 10% for slight injuries). Model estimates show that the likelihood of appearing in both data sets is positively related to helmet and seat belt use, number of motor vehicles involved, alcohol involvement, higher speed limit, and females being injured.

Conclusions: This study adds significantly to the literature about underreporting by recognizing that understanding the heterogeneity in the reporting rate of road crashes may lead to devising policy measures aimed at increasing the reporting rate by targeting specific road user groups (e.g., males, young road users) or specific situational factors (e.g., slight injuries, arm injuries, leg injuries, weekend).     

Ecological knowledge and North Sea environmental policies

In an analysis of North Sea eutrophication science and policies, focusing on the period 1980–2005, it was investigated how scientific information was used in policy-making. The analysis focused on the central assumptions of the rational policy-making model, i.e. that scientific information can be used to formulate decisions, based upon objective scientific information (rational decision-making), and secondly, can support implementing these decisions (rational management). In general terms, the following was concluded:

• •More knowledge has increased rather than reduced uncertainty;
• •In order to handle the problem of dealing with complexity and uncertainty at the political level, a simplification of facts has occurred, in this case focusing on nutrients as the main cause of the problem, at the same time excluding other possible causes;
• •Both the limited scientific view (i.e. the nutrient view) and the exaggeration of the seriousness of the problem (impacts, scope) have been used as an authoritative basis for the justification of political decisions. Both were not supported by the majority of the scientific community;
• •New scientific knowledge, not in support of existing policies, has been excluded from the policy process;
• •The science–policy interface, mainly consisting of “civil-servant scientists”, that emerged and increased its influence over the period of investigation, has been the central element in the simplification and exclusion process.

The main lesson learned is that work at the interface of science and policy must be subject to democratic principles, i.e. be transparent and involving all parties with a stake in the issue under consideration.     

Hybridization,agency discretion,and implementation of the U.S. Endangered Species Act

The U.S. Endangered Species Act (ESA) requires that the “best available scientific and commercial data” be used to protect imperiled species from extinction and preserve biodiversity. However, it does not provide specific guidance on how to apply this mandate. Scientific data can be uncertain and controversial, particularly regarding species delineation and hybridization issues. The U.S. Fish and Wildlife Service (FWS) had an evolving hybrid policy to guide protection decisions for individuals of hybrid origin. Currently, this policy is in limbo because it resulted in several controversial conservation decisions in the past. Biologists from FWS must interpret and apply the best available science to their recommendations and likely use considerable discretion in making recommendations for what species to list, how to define those species, and how to recover them. We used semistructured interviews to collect data on FWS biologists’ use of discretion to make recommendations for listed species with hybridization issues. These biologists had a large amount of discretion to determine the best available science and how to interpret it but generally deferred to the scientific consensus on the taxonomic status of an organism. Respondents viewed hybridization primarily as a problem in the context of the ESA, although biologists who had experience with hybridization issues were more likely to describe it in more nuanced terms. Many interviewees expressed a desire to continue the current case‐by‐case approach for handling hybridization issues, but some wanted more guidance on procedures (i.e., a “flexible” hybrid policy). Field‐level information can provide critical insight into which policies are working (or not working) and why. The FWS biologists’ we interviewed had a high level of discretion, which greatly influenced ESA implementation, particularly in the context of hybridization.