Fetoscopic myelomeningocoele closure: Is the scientific evidence enough to challenge the gold standard for prenatal surgery?

Since the completion of the Management of Myelomeningocoele Study, maternal-fetal surgery for spina bifida has become a valid option for expecting parents. More recently, multiple groups are exploring a minimally invasive approach and recent outcomes have addressed many of the initial concerns with this approach. Based on a previously published framework, we attempt to delineate the developmental stage of the surgical techniques. Furthermore, we discuss the barriers of performing randomized controlled trials comparing two surgical interventions and suggest that data collection through registries is an alternative method to gather high-grade evidence.     

Fungal flora in indoor and outdoor air of different residential houses in Tekirdag City (Turkey): Seasonal distribution and relationship with climatic factors

This study was investigated the density and monthly distribution of indoor and outdoor microfungi in six different residential houses in Tekirdag City through the exposure of Petri dishes containing Rose-Bengal Streptomycin Agar media. Samples were collected in 1-month intervals over a period of 12 months between March, 2001, and February, 2002. We used 432 Petri dishes and counted a total of 4,205 microfungi colonies, 1,790 from indoor air and 2,415 from outdoor air. As a result, 42 species belonging to 12 genera were identified. The most frequent fungal genera were Penicillium (28.61%), Cladosporium (16.08%) and Alternaria (15.98%). While Penicillium (40.61%) and Cladosporium (15.92%) were the dominant genera of indoor air, Alternaria (20.62%) and Penicillium (19.71%) were isolated most frequently from outdoor air (Table 3). Alternaria citri (10.15%) and Penicillium brevicompactum (10.15%) were found to be the most frequent among the 42 identified species. While P. brevicompactum (19.55%) and Aspergillus niger (6.37%) were the most frequent indoor species, A. citri (13.37%) and Cladosporium cladosporioides (8.20%) were the most frequent outdoor species. Linear Regression Analysis was applied to determine whether or not there was a relationship between the number of colonies of isolated fungal genera and meteorological factors during the research period. Correlations between the presence of Aspergillus and temperature, relative humidity, duration of sunny periods and agents of air pollution such as SO(2) and PM were statistically significant. No significant correlations, however, were found between other fungal genera and environmental variables.     

Airborne Alternaria and Cladosporium species and relationship with meteorological conditions in Eskisehir City, Turkey

Alternaria and Cladosporium, known as the most allergenic spores were first collected by means of Durham gravimetric sampler from Eskisehir atmosphere from January 1, 2000 to December 31, 2001. The daily, monthly and annual variations in spores/cm(2) of Cladosporium and Alternaria were recorded. During this period, a total of 10.231 spores belonging to Cladosporium and Alternaria genera were recorded. Of these spores, 5,103 were identified in 2000 and 5,128 in 2001. While 63.09% of the total spores were those of Cladosporium, 36.91% were of Alternaria. Relationships between airborne fungal spore presence and meteorological conditions were statistically investigated. A Shapiro-Wilk test revealed that the airborne Cladosporium and Alternaria spores differed from a normal distribution. Thus, a Friedmann test was performed followed by a Pearson Correlation Analysis. The effects of rainfall, temperature and wind speed on Cladosporium and Alternaria numbers were non-significant according to the sites and months (p > 0.05), but the effects of relative humidity on Cladosporium and Alternaria numbers were significant (p < 0.01). Spore concentrations reached to their highest levels in May 2001.     

Experimental and numerical analysis of metal leaching from fly ash-amended highway bases

A study was conducted to evaluate the leaching potential of unpaved road materials (URM) mixed with lime activated high carbon fly ashes and to evaluate groundwater impacts of barium, boron, copper, and zinc leaching. This objective was met by a combination of batch water leach tests, column leach tests, and computer modeling. The laboratory tests were conducted on soil alone, fly ash alone, and URM-fly ash-lime kiln dust mixtures. The results indicated that an increase in fly ash and lime content has significant effects on leaching behavior of heavy metals from URM-fly ash mixture. An increase in fly ash content and a decrease in lime content promoted leaching of Ba, B and Cu whereas Zn leaching was primarily affected by the fly ash content. Numerically predicted field metal concentrations were significantly lower than the peak metal concentrations obtained in laboratory column leach tests, and field concentrations decreased with time and distance due to dispersion in soil vadose zone.     

The Influence of a Coal-Fired Power Plant in Turkey on the Chemical Composition of Rain Water in a Certain Region

In this study, the chemical composition of the rainwater in Yatağan, which is a region surrounding a coal power plant was investigated from February to April 2002. Rainwater samples were obtained from Yatağan, located northwest of Muğla City in Turkey. pH values and concentrations of major ions (Ca²⁺, Na⁺, K⁺, , , ) in the rainwater samples were analyzed. The pH varied from 5.1 to 7.9 with an average of 6.7 which was in alkaline range considering 5.6 as the neutral pH of cloud water in equilibrium with atmospheric CO₂. In the total of 30 rain events, only three events were observed with water in the acidic range (<5.6), which occurred after continuous rains. The equivalent concentration of components followed the order: Ca²⁺ > > Na⁺ > > > K⁺ > H⁺. The anion and cation concentrations in the rainwater samples showed a high sulphate concentration (131 μEq/l), as well as high sodium (40 μEq/l) and calcium (298 μEq/l) concentrations. These values indicate that one probable source of the high sodium concentration is fly ash, after the coal burning process and the power plant can be effective on level concentrations in rainwater. In addition, the dust-rich local and surrounding limestone environment might have caused the high concentration of Ca²⁺ in rainwater of the Yatağan Basin. Due to a large contribution of these cations to the sulphate neutralization action, the rainwater of this region displays only a moderate acidity, which does not cause significant environmental impact.     

Sorption of alpha and beta hydrophobic endosulfan in a Vertisol from southeast region of Turkey

Endosulfan has been applied to control numerous insects in a variety of food and non-food crops. Limited information is available on dynamics of this pesticide in the soil. The objective of this research was to determine the adsorption–desorption behavior of the alpha (α) and beta (β) endosulfan in a Vertisol from the southeast region of Turkey, where cotton is the main crop in the large irrigated lowlands. The α and β endosulfan were adsorbed considerably and Freundlich adsorption–desorption isotherms fitted the α and β endosulfan data (R² > 0.98). Freundlich adsorption coefficients (K_f) for the α endosulfan ranged between 21.63 and 16.33 while for the β endosulfan they were between 14.01 and 17.98 for the Ap and Bw2 horizons. The difference of K_f values of α and β endosulfan for two horizons were explained with the slight difference in the amount of organic matter and clay, but considerable difference in Fe contents of the two horizons. Alpha and β endosulfan K_fd values were 118.03 and 45.81 for the Ap and 48.08 and 68.71 for the Bw2 horizons. Higher adsorption and desorption behavior of the endosulfan isomers for the same horizon was attributed to poor physical bonding between the endosulfan molecule and the surfaces of fundamental soil particles. This fact is thought to increase the effective use of endosulfan in agriculture with a possibility of its movement to the surface and groundwater in the Vertisol studied.     

Assessment of natural radiation exposure levels and mass attenuation coefficients of lime and gypsum samples used in Turkey

The activity concentrations of ²²⁶Ra, ²³²Th, and ⁴⁰K in lime and gypsum samples used as building materials in Turkey were measured using gamma spectrometry. The mean activity concentrations of ²²⁶Ra, ²³²Th, and ⁴⁰K were found to be 38 ± 16, 20 ± 9, and 156 ± 54 Bq kg^???1 for lime and found to be 17 ± 6, 13 ± 5, and 429 ± 24 Bq kg^???1 for gypsum, respectively. The radiological hazards due to the natural radioactivity in the samples were inferred from calculations of radium equivalent activities (Ra_eq), indoor absorbed dose rate in the air, the annual effective dose, and gamma and alpha indices. These radiological parameters were evaluated and compared with the internationally recommended limits. The experimental mass attenuation coefficients (μ/ρ) of the samples were determined in the energy range 81–1,332 keV. The experimental mass attenuation coefficients were compared with theoretical values obtained using XCOM. It is found that the calculated values and the experimental results are in good agreement.     

Fetoscopic tracheal occlusion for treatment of non-isolated congenital diaphragmatic hernia

Fetoscopic endotracheal occlusion (FETO) is a prenatal treatment that may increase survival in severe congenital diaphragmatic hernia (CDH). In the USA, FETO is offered for isolated severe left-sided CDH in the context of an FDA-approved feasibility study. FETO in non-isolated cases of severe CDH is only performed with a compassionate use exemption from US regulatory bodies. Anomalies frequently associated with CDH include congenital cystic lesions of the lung and cardiac defects. We describe two cases of non-isolated severe left-sided CDH that underwent prenatal FETO, survived after birth and underwent postnatal surgical repair. The potential benefit of FETO in this setting is discussed. © 2017 John Wiley & Sons, Ltd.     

A numerical study on the effects of EGR and spark timing to combustion characteristics and NOx emission of a GDI engine

EGR is one of the most significant strategies for reducing especially nitrogen oxides (NO_x) emissions from internal combustion engines. The thermal efficiency of spark ignition engines is lower than compression ignition engines because of its lower compression ratio. If the compression ratio is increased to obtain higher thermal efficiency, there may be a knocking tendency in spark ignition engines. EGR can be used in order to reduce NO_x emissions and avoid knocking phenomena at higher compression ratios. In-cylinder temperature at the end of combustion is decreased and heat capacity of fresh charge is increased when EGR applied. Besides EGR, spark timing is another significant parameter for reducing exhaust emissions such as nitrogen oxides, and unburned hydrocarbon (UHC). In this study the effects of EGR and spark timing on spark ignition engine were investigated numerically. KIVA codes were used in order to model combustion process. The combustion process has been modeled for a single cylinder, four stroke and gasoline direct injection (GDI) spark ignition engine. The results showed that in-cylinder pressure and heat release rate decrease as EGR ratio increase. In-cylinder pressure increases with the advancing of spark timing. Advancing spark timing increases the heat release rate and in-cylinder temperature. The simulation results also showed that EGR reduced exhaust gas temperature and NO_x emissions.     

Developing of a pricing model for Turkish lignite used in thermal plants

The objective of this paper is to develop a general pricing model for Turkish Lignite, which is mainly sold to thermal plants. This model will contribute to the development of coal mining within the scope of privatization efforts of the Turkish energy market. The paper consists of two stages. First, data of 10 thermal plants have been evaluated by using hedonic pricing analysis to determine influential price parameters. The results of hedonic regression analysis indicate the effect and importance of calorific value and electricity price on lignite prices. Second, a general coal-pricing model has been developed by taking into account the results of hedonic analysis. Comparison of the coal prices estimated by the developed pricing model and the coal prices obtained from thermal plants indicates an acceptable relation.