How Much Are Floridians Willing to Pay for Protecting Sea Turtles from Sea Level Rise?

Sea level rise (SLR) is posing a great inundation risk to coastal areas. Some coastal nesting species, including sea turtle species, have experienced diminished habitat from SLR. Contingent valuation method (CVM) was used in an effort to assess the economic loss impacts of SLR on sea turtle nesting habitats for Florida coasts; and to elicit values of willingness to pay (WTP) of Central Florida residents to implement certain mitigation strategies, which would protect Florida's east coast sea turtle nesting areas. Using the open-ended and dichotomous choice CVM, we sampled residents of two Florida communities: Cocoa Beach and Oviedo. We estimated the WTP of households from these two cities to protect sea turtle habitat to be between $42 and $57 per year for 5 years. Additionally, we attempted to assess the impact of the both the respondents' demographics and their perception toward various situations on their WTP value. Findings include a negative correlation between the age of a respondent and the probability of an individual willing to pay the hypothetical WTP amount. We found that WTP of an individual was not dependent on prior knowledge of the effects of SLR on sea turtle habitat. The greatest indicators of whether or not an individual was willing to pay to protect sea turtle habitat were the respondents' perception regarding the trustworthiness and efficiency of the party which will implement the conservation measures and their confidence in the conservation methods used. Respondents who perceive sea turtles having an effect on their life were also more likely to pay.

Umbilical vein varix: Importance of ante- and post-natal monitoring by ultrasound.

Foetal intra-abdominal umbilical vein varix is rare. Colour Doppler ultrasonography helps distinguish this vascular anomaly. A detailed anatomic scan must be performed to exclude associated anomalies: forms associated with additional complications are found in 29 to 35% of the cases. Intra-uterine foetal demise (IUFD) is a complication of umbilical vein varix. However, recent studies are more reassuring. When foetal intra-abdominal umbilical vein varix is isolated, there is no reason to change the management of the pregnancy. Foetal sonographic follow-up is recommended, focusing on an increase in the size of the varix and the appearance of a clot. A particular clinical form, connecting the umbilicus to the extra-hepatic portal vein should be known, because of a high risk of thrombosis. On the basis of this finding, postnatal monitoring by ultrasound is necessary.

Diagnosis of fetal urinary tract malformations: prenatal management and postnatal outcome.

OBJECTIVE: To evaluate prenatal management and to define the criteria of gravity for accurate assessment of the renal and overall prognosis of fetuses presenting malformations of the urinary tract. METHODS: We carried out a retrospective study of 127 cases of urinary tract malformation. We carried out descriptive statistical and univariate analyses as a function of severity criteria and the outcome of pregnancy. RESULTS: One-third of fetuses presented associated extrarenal malformations and 10% of the karyotypes were abnormal. There were more abortions in case of decrease in amniotic fluid volume (p < 0.001), extent of renal damage (p < 0.05), presence of associated extrarenal malformations (p < 0.05), early diagnosis of the malformation (p < 0.001) and presence of chromosomal syndrome (p = 0.01). In our study, there was an excellent correlation between prenatal data and pathological findings for the fetus following abortions for medical reasons or obtained during the surveillance of live-born children. Fetal biochemistry made very little contribution. CONCLUSION: In cases of urinary tract malformation, this work confirms the need for regular and frequent ultrasound scans, checking for the echographic factors indicative of gravity and for adapted karyotyping. It also demonstrates that pluridisciplinary management is necessary for the prenatal evaluation of renal and overall fetal prognosis.

[Process management in a radiology department. Impact on the quality system]. / Management en processus d'un département d'imagerie médicale. Impact sur le système qualité

The purpose of this work was the transition from a mode of management combining TQM (Total Quality Management) based on the European model "EFQM", and quality assurance based on the ISO 9001-1994 certification model, to the ISO 9001-2000 certification model which imposes process management and integrates both management and quality assurance. In order to visualize the inter-relation between processes, a processes-map was made. That is to say a representation of the organization in terms of inputs and outputs. Those processes were divided step by step, from general to final processes which were translated into an algorithmic approach. Subsequently, two external auditors were asked to evaluate the new quality system. They used three quality standards (IOS 9001-2000, MFQ and ANAES) in order to determine the adaptation score of the quality system. Finally, the implementation of the department documentation system on an intranet was evaluated by means of two questionnaires: a qualitative one, dealing with staff acceptability, and a quantitative one, dealing with research effectiveness.

[Comparison of accreditation procedures, ISO 9000 certification procedures and total quality management. Personal experiences and application of quality assurance in a department of radiology and medical imaging]. / Comparaison des procédures d'accréditation, de certification ISO 9000 et d'évaluation en qualité totale. Expérience personnelle et application à la gestion de la qualité d'un département de radiologie et imagerie médicale.

Management of quality assurance protocols in a radiology department can be done by using several tools or models. Some are specific like accreditation manuals issued by some organizations, others like the ISO 9000 certification and the Total Quality management are more general and already well known by manufacturers. In order to implement a process of quality improvement, we have reviewed three models of quality assurance: evaluation in total quality based on the European model "EFQM", accreditation based on booklets from French cancer centers and Canadian radiology centers and, finally, accreditation based on the ISO 9002 certification model. Based on results of our comparative study, these three tools of quality management are not contradictory and may be complementary. However, they can be compared in terms of constraints they impose, of their historical background, of the criteria evaluated as well as the role of different teams. In conclusion, we suggest that directors of radiology department interested in implementing a quality assurance program first evaluate their department using the Canadian accreditation model issued in 1993 which is useful to become familiar with this new concept of quality. In a second step, a self assessment using the EFQM has to be done in collaboration with all members of the administration board in order to integrate all parameters and to share this protocol with all decision makers. The last step is to consolidate the organization of the quality assurance protocols by means of the ISO 9002 certification.

[From accreditation to certification. Quality management in a radiology department]. / De la certification à l'accréditation expérience de la gestion de la qualité dans un service de radiologie et d'imagerie médicale.

The leaders of a radiology department started a quality process based on ISO 9001 certification and the total quality management program. The purpose of this work is to match the conformity of this quality system to ANAES recommendations. If the concordance is obvious, the advantages of using quality insurance to get an accreditation are important. In conclusion, a quality process is proposed, it includes a quality insurance manual of ISO 9001 norm, the total quality management in the first point of the norm and the ANAES recommendations spread over the 20 points of the norm.

Central nervous system malformations and early end-stage renal disease in oro-facio-digital syndrome type I: a review.

Intracerebral cysts and porencephaly or arachnoid cysts are rarely but are repeatedly reported in orofaciodigital (OFD) syndrome type 1. We report on 2 families in which OFD syndrome type 1 was observed with central nervous system (CNS) malformations and 3 sporadic cases of OFD with CNS defects, most likely representing fresh mutations for OFD 1. In one case, vermis hypoplasia was present; in another, periventricular heterotopiae were noted. We review the literature on CNS anomalies in OFD syndromes and stress the difficulties in genetic counseling and functional prognosis for children of OFD 1 female carriers prenatally diagnosed with a malformation of the brain. As for CNS malformations, renal cystic disease is an often overlooked complication specific to OFD 1. In 1 family, cystic medullary disease was noted in OFD 1 carriers, leading 1 patient to dialysis by age 35 years and the other to severe renal insufficiency by age 28 years. Longitudinal follow-up of OFD 1 carriers should be performed, and renal function should be assessed in those with cysts because the functional prognosis of this developmental anomaly may be worse than usually reported in the literature.

Prenatal detection of a congenital pancreatic cyst and Beckwith-Wiedemann syndrome.

We report a case of congenital pancreatic cyst detected prenatally by ultrasound in a fetus with evidence for a diagnosis of Beckwith-Wiedemann syndrome (BWS). Neonatal hypoglycaemia was prevented. The cyst was managed by internal drainage. This is the second reported case of BWS associated with pancreatic cystic dysplasia and the first time that this association has been detected prenatally. Differential diagnosis of cystic abdominal lesions occurring in utero should take pancreatic cysts into consideration. This case suggests that pancreatic cysts should be included in the BWS phenotype.

[Spontaneous abortion of male fetuses with incontinentia pigmenti (apropos of a family)]. / L'interruption spontanée des grossesses de foetus mâles atteints dans l'incontinentia pigmenti (a propos d'une famille).

We report a family with incontinentia pigmenti. One affected woman had seven pregnancies, seven miscarriages; a prenatal diagnosis by molecular biology was undertaken in the last four cases (two males, two females). In the last two males, a miscarriage occurred at the beginning of the second trimester with cystic hygroma in a case. In the first two males a miscarriage was observed also at the beginning of the second trimester after chorionic biopsy or amniocentesis. These two miscarriages would not be a complication of prenatal diagnosis but spontaneous abortion of an affected male. The date of the miscarriage of affected males (the beginning of the second trimester) and the role of a cystic hygroma for the diagnosis of incontinentia pigmenti in this mother of a fetus karyotyped 46,XY are discussed.

Fetal ascites and oligohydramnios: prenatal diagnosis of a sialic acid storage disease (index case).

In a 20-year-old primiparous patient, a routine ultrasound scan performed at 28 weeks revealed fetal ascites, bilateral talipes, and oligohydramnios. This woman, married to possibly her first cousin, was at risk for an autosomal recessive disease, a metabolic disorder. At 29 weeks, an amniotic fluid biochemical study revealed the presence of an abnormal band of free sialic acid, leading to a diagnosis of a congenital form of sialic acid storage disease. Termination of pregnancy was performed at 30 weeks. Measurement of free sialic acid in cultured fetal skin fibroblasts confirmed the diagnosis.

Remarks about the prognosis in case of antenatal diagnosis of gastroschisis.

We report our experience of 15 cases of gastroschisis which occurred between 1981 and 1993. All but one were diagnosed antenatally by ultrasound between 16 and 32 weeks of pregnancy. We made a termination of the pregnancy in 3 cases, for multiple malformations in 2 cases and one case of very early premature rupture of the membranes (PROM). When checked (11 cases), the karyotype was normal. We made a cesarean section in 11 cases: the indication was a complication for 6 (fetal distress, PROM, polyhydramnios, large dilatation of the gut). We noted growth retardation in 7 newborns and prematurity in 5/12 (mean gestational age of 36.8 weeks). The preoperative study of the gut noted 5 cases with intestinal damage and one case of complete necrosis of the gut. The global prognosis is not as good as usual, with a perinatal mortality of 41.6% (5/12). We discuss this latter point and examine the literature.

Absent end diastolic flow of umbilical artery Doppler: pregnancy outcome in 62 cases.

We retrospectively studied the outcome of pregnancy in 62 cases of absent end diastolic flow (AEDF) of umbilical artery Doppler flow velocity waveform. The history of pregnancies revealed that nearly all were of high risk. Many cases presented cerebral (65%) or uterine (55.5%) Doppler flow abnormalities, or both (38%). We noted 10 fetal deaths and decided 7 pregnancy terminations. Malformation and chromosomal defect rate was 16%. We noted 44 (71%) live-births, a very high rate of cesarean section (86%), prematurity (75%), small for gestational age (39%). Forty-five percent of the neonates had a 1-min Apgar score under 7, which dropped to 27% at 5 min. Neonate mortality rate was 6.9% and the total mortality rate was 34% (21/62). Morbidity was significant (7 cases with severe morbidity, 2 cases with chromosomal abnormality of poor prognosis). We compared different sub-groups with a view to looking for some prenatal factors which predict poor neonatal outcome in case of AEDF.

[Reflections on 10 years of medically induced abortions in Ille-et-Vilaine]. / Réflexions sur 10 ans d'interruptions médicales de grossesse (IMG) en Ille-et-Vilaine.

The medical files of 532 patients who underwent medically induced abortion over a 10-year period (1982-1991) in the French department of Ille-et-Vilaine were studied in order to evaluate the indications and outcomes. Among the patients, 358 resided in the department (67%). Comparatively with the number of births during the 10-year period, there was a relative increase in the number of medically induced abortions from 3.5/1000 to 5.5/1000. This parameter was taken into consideration for the interpretation of a parallel decrease in the perinatal mortality during the same period, from 5.9/1000 to 5.1/1000. There was a maternal indication in 91 cases which correspond to the former category of therapeutic induced abortions. There was a clear increase in 1991 corresponding to abortions induced because of extremely premature rupture of the membranes which were formerly allowed to continue to dead births. Foetal indications were frequent: 441 cases (83%). Exogenous causes were lower (15.6%), particularly due to the disappearance of indications resulting from maternal irradiation. For indications related to infection, the vaccination against rubella and improved prenatal diagnosis resulted in the disappearance of rubella as an indication during the last three years of the study and a clear decrease in the number of toxoplasmosis indications. There were few indications due to maternal infection by human immunodeficiency virus (4 cases). Chromosomal abnormalities were the main cause of medically induced abortion among the foetal indications (27.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Alloimmune thrombocytopenia: in utero treatment by high doses of intravenous gamma globulins.

The authors report successful in utero treatment by high doses of intravenous gamma globulins in a case of neonatal alloimmune thrombocytopenia. Early diagnosis allows an appropriate management: fetal blood sampling as early as 20 weeks of gestation; in case of fetal thrombocytopenia, treatment by intravenous gamma globulin (1.0 g/kg/b.w.) each week during 8 weeks or more; ultrasound screening of in utero hemorrhage, particularly intracranial hemorrhage; fetal blood sampling before delivery at term and in utero transfusion of platelet antigen negative in case of persistence of fetal thrombocytopenia.

[Therapeutic termination of pregnancy. Diagnosis and protocols. 54 cases]. / Interruption thérapeutique de grossesse. Diagnostics et protocoles à propos de 54 cas.

The authors present 54 cases histories of therapeutic terminations of pregnancy. The mean age of the patients was 28.6 years at the time of diagnosis with the following in indications for the antenatal diagnosis in order of decreasing frequency: clinical history, age of the mother, seropositive for toxoplasmosis or rubella, a high fetal alpha protein level and ultrasound signs. They highlight the usefulness of ultrasound in reaching a decision as to whether pregnancy should be terminated (as it was in 25 cases out of 49) and the predominance of diagnoses of karyotype abnormalities. They also compare the various prostaglandin s used in this study (analogs of PGE1 and PGE2, diniprost). Their results, in accordance with the literature were good for gemeprost and sulprostone with expulsion in 29 out of 32 cases within 24 hours and in 9 cases out of 11 within 20 hours respectively.

[Autoimmune thrombocytopenic purpura and pregnancy: significance of fetal blood punction]. / Purpura thrombopénique auto-immun et grossesse: intérêt de la ponction de sang foetal.

The authors report three cases of percutaneous fetal blood sampling at 38 weeks of pregnancies complicated by immunologic thrombocytopenia. In each case, the purity was perfect which is essential for using the examination with a view to the obstetrical management. The birth is programmed 24 or 48 hours later. In two cases, the neonatal control is in agree with the fetal blood sampling. In the third observation, the fetal platelet count in 142,000/mm3 and the newborn control 55,000/mm3: the only explanation is a very active process as usually state with newborns. There was no accident, and these samplings led to natural births. This approach seems to be the more effective for the evaluation of fetal platelet count and allow the choice of birth management. A cesarean section is decided in case of fetal thrombopenia lower than 50,000/mm3.

[A family with x-linked hydrocephaly followed for 20 years: echographic prenatal diagnosis; elective abortion]. / Une famille d'hydrocéphalie liée à l'X suivie sur 20 années: diagnostic prénatal échographique; interruption sélective de grossesse.

In a Bickers-Adams family followed up for almost 20 years, authors report pregnancies of two propositus' sisters: echographic diagnosis of (normal) girls, of normal or affected boys and selective abortion in a case of dizygotic twin pregnancy with a normal girl and an affected boy.

[Indications for therapeutic interruption of pregnancy in Ille-et-Villaine from 1982 to 1986. Apropos of 222 cases]. / Les indications des interruptions thérapeutiques de grossesse en Ille-et-Vilaine de 1982 à 1986. A propos de 222 cas.

The authors have made the census of all the Medical Terminations of Pregnancy (MTP) which have been carried out in the Department of Ille et Vilaine from 1982 to 1986, i.e. 222 cases, in order to precise the different indications and the diagnosis tools which were used. 132 MTP concern women who live in the Department of Ille et Vilaine. By referring this figure to the total number of pregnancies in this area, one can see that the average incidence is of 1.9%; MTP account for 1% of the total number of Terminations of Pregnancies. Foetal indications are more frequent (188 cases; i.e. 84.7%) than maternal ones (34 cases, 15.3%); these figures remained stable over the 5-year period of study. Chromosomal aberrations and closing defects of the neural tubule are the main causes of MTP (22.9% of foetal indications). Among the 43 chromosomal aberrations, trisomies are the most frequent ones (34.9%) because all women aged 38 or more are proposed a detection. The diagnosis of trisomy was made in 24 cases after tests were programmed either because of the age of the mother or because of family antecedents (amniocentesis: 22 times, punction of foetal blood: once, biopsy of chorion villosities: once), in 6 cases after tests were carried out on the basis of suspect clinical signs amniocentesis: once, punction of foetal blood: 5 times), and in 13 cases after the echography had revealed a major syndrome. Closing defects of the central nervous system mainly concern anencephaly (17.6% of foetal indications) since the echography enables an easy diagnosis. All anencephaly have actually been detected during the reference period of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Selective interruption of pregnancy and embryonic malformations of the limbs]. / Interruption sélective de grossesses et malformations embryonnaires des extrémités.

The authors report 3 cases of fetal malformations consisting of amputation of the limbs. These were found in their cases of selective abortion carried out around the 10th week of amenorrhoea by injection under ultrasonic needle guidance of hypertonic saline into selected sacs. These malformations seem to be associated with either the existence of amniotic bands or with a toxic mechanism (direct contact of the limbs of the embryo with neighbouring hyperosmolar membranes). This technique is to be given up in favour of transcervical aspiration, or direct needling of the fetus. The different techniques for selective abortion have been reviewed as well as the so-called "alternative" techniques (such as follicular aspiration) which are preferable.