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Background: Hypospadias is a common male birth defect that has shown widespread variation in reported prevalence estimates. Many countries have reported increasing trends over recent decades.Objective: To analyze the prevalence and trends of hypospadias for 27 international programs over a 31-yr period.Design, setting, and participants: The study population included live births, stillbirths, and elective terminations of pregnancy diagnosed with hypospadias during 1980-2010 from 27 surveillance programs around the world.Outcome measurements and statistical analysis: We used joinpoint regression to analyze changes over time in international total prevalence of hypospadias across programs, prevalence for each specific program, and prevalence across different degrees of severity of hypospadias.Results and limitations: The international total prevalence of hypospadias for all years was 20.9 (95% confidence interval: 19.2-22.6) per 10 000 births. The prevalence for each program ranged from 2.1 to 39.1 per 10 000 births. The international total prevalence increased 1.6 times during the study period, by 0.25 cases per 10 000 births per year (p Conclusions: Although there have been changes in clinical practice and registry ascertainment over time in some countries, the consistency in the observed increasing trends across many programs and by degrees of severity suggests that the total prevalence of hypospadias may be increasing in many countries. This observation is contrary to some previous reports that suggested that the total prevalence of hypospadias was no longer increasing in recent decades.Patient summary: We report on the prevalence and trends of hypospadias among 27 birth defect surveillance systems, which indicate that the prevalence of hypospadias continues to increase internationally. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Sorption enhanced gasification (SEG) is a promising technology for producing gas derived from renewable feedstock to be used in biofuel synthesis processes. As a response to the growing need for renewable fuels, an SEG reactor design was developed for industrial-scale dimethyl ether (DME) production. A 100 MW th scale SEG reactor concept for wood pellets as a feedstock was created by a model-based approach. Thus, a 1D modeling tool for the coupled circulating fluidized beds was developed. The model was used to investigate the dual fluidized bed system’s operation in the gasifier temperature range of 730–790°C. In this range, the optimal producer gas composition without external hydrogen for the downstream DME synthesis was achieved at gasifier temperature 730°C: 63 % v o l , d b H 2 , 11 % v o l , d b CO , 13 % v o l , d b CO 2 . The model prediction was successfully compared against experimental data and modeling results from the literature. The developed 1D model enables the investigation of the composition and yield of the producer gas with different operating parameters, such as the part-load operation. This advanced capability can be used to develop new control strategies for the SEG system and investigate the impact of various operating parameters on the producer gas composition and yield.

Sorption-enhanced gasification (SEG) is a promising technology for producing renewable feedstock gas to be used in biofuel synthesis processes, especially in dimethyl ether (DME) synthesis. To adopt the technology on a commercial scale, it is necessary to acquire knowledge about the related operational characteristics. The SEG process is carried out at lower temperatures than those employed in conventional gasifiers. A typical operating range is from 600 ◦C to 800 ◦C. Fuel decomposition experiments have shown distribution of the decomposition products to vary by the process temperature in this operating range, and thus, it is important to adapt this phenomenon for modelling the SEG process. To model the temperature dependence of the decomposition products, a fuel model was developed. Fuel decomposition experiments were conducted to obtain the boundary conditions for the fuel model. The developed fuel model was implemented to an SEG model frame, and the model prediction was compared against data from a 200 kWth dual fluidised bed facility. The model gave satisfactory predictions for producer composition and temperature trends. Furthermore, the main balances of the model were in agreement with typical trends of the SEG process. The conducted simulations improved our understanding of material balances in SEG reactors. Knowledge from physical operations governing the process is of value in further development of the technology.

Objective Monthly variation in the total prevalence of the univentricular heart (UVH) and dextro-transposition of the great arteries (d-TGA) at gestational age 7 + 0 weeks was assessed to determine potential environmental factors, such as viral or bacterial infections, underlying the variation. Study design The nationwide retrospective ten-year population-based cohort consisted of 592 733 births and 2764 terminated pregnancies due to fetal anomaly. The pre- or postnatally diagnosed cases of UVH (n = 440) and simple d-TGA (n = 127) from five national registers included live births, stillbirths, and pregnancy terminations due to fetal anomaly. We evaluated the variation in the monthly total prevalence of UVH and d-TGA at gestational age 7 + 0 weeks. The monthly variation of UVH and d-TGA was also compared with monthly variation in reported viral and bacterial infections. Results In the UVH and d-TGA, we observed significant monthly variation in total prevalence. However, we observed no correlations in the studied viral or bacterial infections and the number of cases. Conclusions Assessing monthly variation in total prevalence at early pregnancy, including pregnancy terminations and stillbirths, and using first-trimester timing provides the most accurate information on the variation. The reasons for monthly variation remain unclear, but we observed no associations with specific viral or bacterial infections.

Introduction Newborn infants with transposition of the great arteries (d-TGA) need immediate care for an optimal outcome. This study comprised a nationwide 11-year population-based cohort of d-TGA infants, and assessed whether the implementation of a nationwide systematic fetal screening program, or other perinatal, or perioperative factors, are associated with mortality or an increased need for hospital care. Material and methods The national cohort consisted of all live-born infants with simple d-TGA (TGA +/- small ventricular septal defect, n = 127) born in Finland during 2004-2014. Data were collected from six national registries. Prenatal diagnosis and perinatal and perioperative factors associated with mortality and length of hospitalization were evaluated. Results Preoperative mortality was 7.9%, and the total mortality was 8.7%. The prenatal detection rate increased after introducing systematic fetal anomaly screening from 5.0% to 37.7% during the study period (P

Distraction osteogenesis (DO) has become increasingly popular to correct craniosynostosis. Disadvantages of DO include the secondary operation needed for device removal and titanium screw related dura injury. To reduce invasiveness of the secondary device removal operation and to overcome titanium-related problems, fixation of the cranial distractor with resorbable materials is a potential alternative. New resorbable fixation methods, such as ultrasound-activated pins (UAPs) or heat-activated pins (HAPs), allow faster attachment on thinner bone than conventional resorbable screws (CRSs) since tapping is not required. However, resorbable materials are designed to be attached with a resorbable plate, not with a titanium distractor. We evaluated the suitability of CRSs, HAPs and UAPs for the cranial distractor fixation in a laboratory setting with a mechanical testing machine. Fracture tests were conducted in two directions with respect to the longitudinal axis; vertical i.e. axial pull-out strength, and horizontal i.e. shear strength. Mean maximum pull-out strength for CRS, HAP and UAP was 48.9 N, 32.5 N and 14.7 N, respectively. Mean maximum shear strength for CRS, HAP and UAP was 40.8 N, 77.9 N and 38.9 N, respectively. According to our in vitro tests, the cranial distractor attachment with four CRSs or six HAPs per footplate would provide sufficient fixation stability. (C) 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The primary goal when designing a CFB boiler is to ensure its high energy efficiency. Additional constraints come from environmental regulations, which are constantly becoming more difficult to assess, and require improvements in the boiler design process. Local on-site measurements are often restricted to short distances inward from the furnace wall, leaving most of the core unmeasured. Computer simulations are practically the only feasible tools to investigate the combustion processes and to support the design of CFB units. Three-dimensional steady-state semi-empirical CFB furnace models predict adequate results within reasonable times but these models require tuning to existing objects, which obviously excludes their application for new object design. The present study represents a step toward using the hybrid Euler–Lagrange (HEL) technique to model flow variables in order to replace the measured data. The information collected using the HEL model for an arbitrary furnace can be used to tune a semi-empirical model. To validate the HEL model, measurements of a 235 MWe CFB were used. The simulations show good agreement between the numerical and experimental results, indicating that the presented idea is worth investigating in the future.

Systemic complications are common in status epilepticus. We have no tools to evaluate total burden of complications and its effect on the outcome of status epilepticus. For Complication Burden Index (CBI) a patient is assessed for 13 complication categories: respiratory, cardiovascular, nervous, renal, hepatic, coagulation, gastrointestinal and musculoskeletal systems, electrolyte/acid-base balance, infection, hypo-/hyperglycemia, skin/allergic reactions, and mental condition. Maximum CBI is 13. CBI was internally validated in a retrospective cohort of 70 consecutive adult patients with generalized convulsive status epilepticus (GCSE) treated in a tertiary hospital over a period of 2 years. Functional outcome at discharge was defined Poor for Glascow Outcome Scale (GOS) 1-3 or worse-than-baseline condition and Good for GOS >3 or return to baseline condition. Relative risks (RRs) and receiver-operating characteristic (ROC) -curves were calculated to obtain optimal cutoff. Functional outcome was poor in 40% and worse-than-baseline in 59%. In-hospital mortality was 7%. Average CBI was 3.8 (range 0-10, median 3). Cutoff value predicting poor functional outcome was a CBI >3 (GOS 1-3 RR 1.84, P = .045, 95% confidence interval [CI 1.01-3.33; ROC-AUC [area under the curve] 0.687, P = .008, sensitivity 64%, specificity 61%; worse-than-baseline condition RR 1.52, P = .04, 95% CI 1.02-2.26; ROC-AUC 0.662, P = .022, sensitivity 56%, specificity 69%). CBI with cutoff >3 and as a continuous variable was associated with GOS1-3 (P = .046, P = .002) and with worse-than-baseline condition (P = .041, P = .004). CBI is a novel tool for comprehensive assessment of status epilepticus complications predicting poor/worse-than-baseline functional outcome with cutoff >3.

INTRODUCTION Congenital diaphragmatic hernia (CDH) has a well-known risk of congenital heart defects with poor prognosis. This study was conducted to determine the national total prevalence and prenatal detection rates of CDH with heart defects and its association with major extra-cardiac malformations and to further evaluate the impact of the heart defect severity on survival. MATERIAL AND METHODS A 10-year national cohort was derived from four national registries, including live births, stillbirths, and terminations of pregnancy for fetal anomalies. The study cohort was sorted according to cardiac defect severity. RESULTS The total prevalence of CDH with heart defects was 0.6/10 000 births and live birth prevalence 0.3/10 000 live births. Of 145 cases with CDH, 37 (26%) had a concurrent heart defect. The overall prenatal detection rate of heart defects was 41%. The total prevalence (483/10 000) and live birth prevalence (500/10 000) of hypoplastic left heart syndrome were 124 and 250 times higher than in the general population in Finland, respectively. Additional major extra-cardiac malformations were found in 68% of cases. The survival rate for CDH with major heart defects was 11 and 38% with minor heart defects. CONCLUSIONS The total prevalence of hypoplastic left heart syndrome was significantly higher in CDH patients than in the general population in Finland. Prenatal detection rate for heart defects in CDH patients was 41%. Major extra-cardiac malformations were more common than previously reported. The prognosis of CDH with major heart defects remained poor.

Posterior calvarial vault osteodistraction (PCVO) has become increasingly popular in the correction of craniosynostosis. When compared to cranioplasty, PCVO offers a shorter, less invasive operation, greater intracranial volume advancement and a lower rate of relapse. In general, distraction protocols are based primarily on clinical observations rather than systematic research. Faster distraction protocols may reduce complications. However, distraction protocols producing higher forces can increase complications. Thus, we need to understand these forces in order to improve distraction protocols and devices. We developed a force measurement method that can be used on PCVO devices. Here, we present preliminary data about the forces developed during PCVO. We measured the forces in four bicoronal craniosynostosis patients during PCVO. We observed a linear-like trend between the force increase and the distraction distance within distraction sessions. We also observed a step-wise force increase between distraction sessions and found that the distraction force relaxed rapidly shortly after the distraction session. The mean maximum pre distraction force for one distracter was 20.4 N, while the mean maximum end-distraction force for one distracter was 57.6 N. Our data suggests that current treatment protocols might be re-evaluated favouring shorter distraction distances and more frequent distraction sessions. (C) 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Background: Status epilepticus (SE) is a life-threatening neurologic emergency, which requires prompt medical treatment. Little is known of the long-term survival of SE. The aim of this study was to investigate which factors influence 90 days and 1-year mortality after SE. Materials and methods: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with generalized convulsive SE (GCSE) in Helsinki University Central Hospital (HUCH) emergency department (ED) over 2 years. We defined specific factors including patient demographics, GCSE characteristics, treatment, complications, delays in treatment, and outcome at hospital discharge and determined their relation to 90 days and 1-year mortality after GCSE by using logistic regression models. Survival analyses at 1 year after GCSE were performed with Cox proportional hazards regression analysis. Results: In-hospital mortality was 7.1%. Mortality rate was 14.3% at 90 days and 24.3% at 1 year after GCSE. In the univariate logistic regression analysis, Status Epilepticus Severity Score > 4 (STESS) (ODDS = 7.30, p = 0.012), worse-than-baseline condition at hospital discharge (ODDS = 3.5, p = 0.006), long delays in attaining seizure freedom (ODDS = 2.2, p = 0.041), and consciousness (ODDS = 3.4, p = 0.014) were risk factors for mortality at 90 days whereas epilepsy (ODDS = 0.2, p = 0.014) and Glasgow Outcome Scale (GOS) > 3 at hospital discharge (ODDS = 0.05, p = 0.006) were protective factors. Risk factors for mortality at 1 year were STESS >4 (ODDS = 5.1, p = 0.028), use of vasopressors (ODDS = 8.2, p = 0.049), and worse-than-baseline condition at discharge (ODDS = 7.8, p = 0.010) while GOS >3 (ODDS = 0.2, p = 0.005) was protective. The univariate survival analysis at 1 year confirmed the significant findings regarding parameters STESS >4 (Hazard ratio (HR) = 4.1, p = 0.009), worse-than-baseline condition (HR = 6.2, p = 0.015), GOS >3 (HR = 0.2, p = 0.004) at hospital discharge and epilepsy (HR = 0.4, p = 0.044). Additionally, diagnostic delay over 6 h (HR = 3.8, p = 0.022) and Complication Burden Index (CBI) as an ordinal variable (0-2, 3-6, >6) (HR = 2.7, p = 0.027) were predictive for mortality. In the multivariate survival analysis, STESS > 4 ( HR = 5.1, p = 0.007), CBI (HR = 3.2, p = 0.025, ordinal variable), diagnostic delay over 6 h (HR = 7.2, p = 0.003), and worse-than-baseline condition at hospital discharge (HR = 5.8, p = 0.027) were all independent risk factors for mortality at 1 year. Conclusions: Severe form of SE, delayed recognition of GCSE, high number of complications during treatment period, and poor condition at hospital discharge are all independent predictors of long-term mortality. Most of these factors are also associated with mortality at 90 days, though at that point, delays in treatment seem to have a greater impact on prognosis than at 1 year. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures (c) 2019 Elsevier Inc. All rights reserved.

Sorption enhanced gasification (SEG) is a promising technology for production of a renewable feedstock gas for biofuel synthesis processes. The technology has been previously demonstrated at pilot scale. Scaling of the technology to an industrial size requires knowledge from governing phenomena. One-dimensional bubbling fluidized bed (BFB) reactor model was developed and validated against experimental data from 200kWth dual fluidized bed facility. Sub-models for biomass gasification, reactive bed material and fluidized bed hydrodynamics were incorporated into the model frame. The model gave satisfactory predictions for bed material conversion, temperature profiles and gas composition of the producer gas. The conducted validation improved understanding of bed material conversion, water–gas shift reaction and hydrodynamics and their role in SEG reactors. Further refinement and comprehensive validation of the model with additional data from the pilot is required. The knowledge from the comprehensive validation can be utilized in simulation of an industrial size reactor. Post-print / Final draft

OBJECTIVE To evaluate whether a nationwide prenatal anomaly screening programme improves detection rates of univentricular heart (UVH) and transposition of great arteries (TGA), and whether maternal risk factors for severe fetal heart disease affect prenatal detection. DESIGN Population-based cohort study. SETTING Nationwide data from Finnish registries 2004-14. POPULATION A total of 642 456 parturients and 3449 terminated pregnancies due to severe fetal anomaly. METHODS Prenatal detection rates were calculated in three time periods (prescreening, transition and screening phase). The effect of maternal risk factors (obesity, in vitro fertilisation, pregestational diabetes and smoking) was evaluated. MAIN OUTCOME MEASURES Change in detection rates and impact of maternal risk factors on screening programme efficacy. RESULTS In total, 483 cases of UVH and 184 of TGA were detected. The prenatal detection rate of UVH increased from 50.4% to 82.8% and of TGA from 12.3% to 41.0% (P < 0.0001). Maternal risk factors did not affect prenatal detection rate, but detection rate differed substantially by region. CONCLUSIONS A nationwide screening programme improved overall UVH and TGA detection rates, but regional differences were observed. Obesity or other maternal risk factors did not affect the screening programme efficacy. The establishment of structured guidelines and recommendations is essential when implementing the screening programme. In addition, a prospective screening register is highly recommended to ensure high quality of screening. TWEETABLE ABSTRACT Implementation of a nationwide prenatal anomaly screening improved detection rates of UVH and TGA.

In modeling of large-scale circulating fluidized bed (CFB) furnaces, semi-empirical 3D process models are used in furnace analysis, design and optimization as their accuracy versus computational times make them more favorable than high resolution computational fluid dynamics (CFD) in many engineering type of studies. One of the key aspects in determining the furnace performance and efficiency is the correct modeling of the fuel flow as it determines where the thermochemical reactions take place in the furnace, affecting the temperature and gaseous species distributions. In modeling, this requires the suitable approximation of the momentum exchange between the fuel and the gas phase as well as the fuel and the bed material. To model the momentum exchange with current models presented in the literature, information on the material properties, namely the fuel particle size has to be given. The determination of particle size is affected by the particle shape and for irregular, non-spherical material, such as biomass, currently there are no readily applicable methods to determine the effective momentum exchange based on the particle geometry. In this work, a new gas–fuel momentum exchange model is developed for the fuel flow, which acknowledges the effect of physical properties of the fuel, namely the shape and size. Due to impracticality of determining a representative fuel particle size, characterization data is utilized to directly obtain information on the gas–fuel momentum exchange and the particles are classified based on their elutriation behavior, rather than particle size. The new momentum exchange model is utilized with an existing semi-empirical 3D process model and applied in simulation of a utility-scale CFB furnace firing biomass. The simulation results are compared with measurements and are found to be in good agreement, which demonstrates the applicability of the modeling approach. The presented method improves the modeling of fuel flow with CFB process models, especially with irregular, non-spherical fuels such as biomass. The improved modeling of fuel flow within large-scale CFB furnaces enables faster and more reliable design and analysis of CFB furnaces.

Offspring of cancer survivors (CS) may be at risk for congenital anomalies due to the mutagenic therapies received by their parents. Our population-based cohort study aimed to investigate the risk for congenital anomalies in offspring of CS compared to offspring of their siblings. Using the Finnish Cancer Registry, Central Population Register, and Hospital Discharge Register, we identified hospital contacts due to congenital anomalies in 6,862 offspring of CS (early-onset cancer between 1953 and 2004) and 35,690 offspring of siblings. Associations between congenital anomalies and cancer were evaluated using generalized linear regression modelling. The ratio of congenital anomalies in offspring of CS (3.2%) was slightly, but non-significantly, elevated compared to that in offspring of siblings (2.7%) [prevalence ratio (PR) 1.07, 95% confidence interval (CI) 0.91-1.25]. When offspring of childhood and adolescent survivors (0-19 years at cancer diagnosis) were compared to siblings' offspring, the risk for congenital anomalies was non-significantly increased (PR 1.17, 95% CI 0.92-1.49). No such increase existed for offspring of young adult survivors (20-34 years at cancer diagnosis) (PR 1.01, 95% CI 0.83-1.23). The risks for congenital anomalies were elevated among offspring of CS diagnosed with cancer in the earlier decades (1955-1964: PR 2.77, 95% C I 1.26-6.11; and 1965-1974: PR 1.55, 95% C I 0.94-2.56). In our study, we did not detect an overall elevated risk for congenital anomalies in offspring of survivors diagnosed in young adulthood. An association between cancer exposure of the parent and congenital anomalies in the offspring appeared only for those CS who were diagnosed in the earlier decades.

Background Fetal alcohol syndrome (FAS) is a well-known consequence of prenatal alcohol exposure. However, women tend to deny or underreport their alcohol use during pregnancy. The aim of this study was to explore the usability of various alcohol biomarkers for FAS screening in a data set without information on self-reported alcohol use. Methods A nationwide register study with a case–control design was conducted. The target population consisted of all live births in Finland from 1987 to 2005. FAS cases (n = 565) were identified from the Finnish Register of Congenital Malformations. Mothers of FAS cases and their controls were selected in a ratio of 1 to 2 from the Finnish Maternity Cohort (FMC). Background information was obtained from the Finnish Medical Birth Register. Serum samples, collected at the mother's first visit to the maternity care, were obtained from the national FMC biobank. Biomarkers of alcohol consumption, gamma-glutamyltransferase (GGT), carbohydrate-deficient transferrin (%CDT), combination of GGT and CDT (GGT-CDT), and ethylglucuronide (EtG) were analyzed from mothers of FAS cases (n = 385) and their controls (n = 745). Results Median levels of all biomarkers were significantly higher among the mothers of FAS children than in control mothers. Using previously validated cutoffs for EtG, GGT, %CDT, and GGT-CDT, nearly half (46%) of the mothers with affected offspring could be identified. The predictive association was highest for GGT-CDT combination and significant also for all the other biomarkers. Conclusions In this explorative case–control study, we demonstrate that the FMC biobank can be used to screen alcohol biomarkers for epidemiological research purposes. According to our results, the use of alcohol biomarkers during the first trimester may help to identify the high-risk pregnancies for FAS. A more systematic use of alcohol biomarkers at maternity care may open new possibilities for screening and intervention of alcohol use among pregnant mothers.

Background and Aims:There are no population-based studies about hospital admissions and need for surgical treatment of congenital lower-limb deficiencies. The aim is to assess the impact children with lower-limb deficiencies pose to national hospital level health-care system.Materials and Methods:A population-based study was conducted using the national Register of Congenital Malformations and Care Register for Health Care. All 185 live births with lower-limb deficiency (1993–2008) were included. Data on hospital care were collected until 31 December 2009 and compared to data on the whole pediatric population (0.9 million) live born in 1993−2008.Results:The whole pediatric population had annually on average 0.10 hospital admissions and the mean length of in-patient care of 0.3 days per child. The respective figures were 1.5 and 5.6 in terminal lower-limb amputations (n = 7), 1.1 and 3.9 in long-bone deficiencies (n = 53), 0.6 and 1.9 in foot deficiencies (n = 26) and 0.4 and 2.6 in toe deficiencies (n = 101). Orthopedic surgery was performed in 72% (5/7) of patients with terminal amputations, in 62% (33/53) of patients with long bone, in 58% (14/24) of patients with foot and in 25% (25/101) of patients in toe deficiencies. Half (54%) of all procedures were orthopedic operations.Conclusion:In congenital lower-limb deficiencies the need of hospital care and the number of orthopedic procedures is multiple-fold compared to whole pediatric population. The burden to the patient and to the families is markedly increased, especially in children with terminal amputations and long-bone deficiencies of lower limbs.

Oxyfuel combustion is one of the leading technologies considered for capturing CO2 from power plants with CCS. This involves the process of burning the fuel with nearly pure oxygen instead of air. In order to control the flame temperature, some part of the flue gas are recycled back into the furnace/boiler. Since the publication of the Special Report on CO2 Capture and Storage by the International Panel for Climate Change (IPCC, 2005), the development of oxyfuel combustion technology has progressed significantly and could be considered at par in terms of technology maturity as compared to other leading CO2 capture technologies. This paper presents an overview to the current state-of-the-art technology on the development of oxyfuel combustion applied to (a) PC and CFB coal fired power plants and (b) gas turbine based power plant. It should be noted that it is not the intention of this paper to provide a comprehensive review but to present what have been achieved in the past 10 years of RD&D efforts. For coal fired power plant using oxyfuel combustion, this paper primarily presents the different development aspects of the burners and boilers (combustion and heat transfer), emissions, operation of the plant (i.e. start-up and turndown) and its integration to the ASU and CPU. For gas turbine based power plant using oxyfuel combustion, the different GT cycles are described, looking at the different aspects in combustion, emissions, cycle efficiency and development of the turbomachineries. Also presented in this paper is a snapshot to what we have learned from the operation of the different large-scale pilot plants and development of large scale demonstration projects worldwide. The paper concludes by presenting the potential of this technology and highlighting the importance of realizing large scale demonstration plant as a necessary step to achieve its ultimate goal of technology commercialization.

Solid fuel combustion via chemical looping with oxygen uncoupling (CLOU) represents a novel route for CO 2 capture with minimal energy penalty. An essential part of the viability of a CLOU system is based on the behaviour of the fuel reactor. This paper presents a one-dimensional fluidized bed model capable of describing the operation of the fuel reactor involved in CLOU. The model considers physical phenomena relevant to CLOU, such as oxygen carrier decomposition, combustion of coal with molecular oxygen, fluidized bed hydrodynamics, and transfer of heat within the reactor. The performance of a CLOU fuel reactor fed with bituminous coal and a TiO 2 -supported CuO oxygen carrier was evaluated by means of modelling. A reference case was first defined and simulated, after which the effect of various process parameters on the results was assessed by parameter variation. For the reference case conditions with a temperature of 960 °C and solids inventory of 400 kg/MWf in the reactor and without utilization of a carbon separation system, a CO 2 capture efficiency of approximately 90% was predicted. A CO 2 capture efficiency of 95% could be reached by optimizing the operating conditions. It was found that when using low-reactive coals, a carbon stripper is required to obtain a feasible CO 2 capture rate. Overall, the model predictions appeared to be in agreement with results presented in the literature.

A Eulerian multiphase model was used to study the hydrodynamics of the gas–solids flow in a circulating fluidized bed (CFB) furnace. Alternative modeling approaches were tried to evaluate their effects on the predicted solids distribution in the furnace. Due to high computational costs, large scale calculations are commonly performed by using a coarse mesh, which leads to too uniform solids flow field and an overestimated gas–solid drag force. Thus, a suitable form of correction of the gas–solid drag is needed for coarse mesh simulations. This study presents fluid dynamics simulations of a 235 MWe CFB furnace by two sets of interphase momentum exchange coefficients: the model based on the homogeneous flow condition and the model based on the energy-minimization multi-scale (EMMS) approach. The calculations with one solid phase included studies with two mesh resolutions and different particle sizes. Additional simulations were performed using two solid phases and four solid phases to analyze the effect of polydispersity of particles. The model results were compared with the measured vertical pressure profile of the furnace and the locally measured solid concentration and velocity profiles. The results show that with a homogeneous model, the model matches better with measurements if the mesh resolution is finer. The EMMS approach can be used to improve the calculations in a coarse mesh if the average particle size can be determined correctly for the model. With multiple solid phases, the vertical and horizontal segregation could be simulated. However, increasing the number of solid phases did not change the total solid concentration and pressure profiles if the Sauter mean diameter of the total system was constant. The results indicate that with a coarse mesh, similar drag corrections would be necessary between the solid phases that have been developed for gas–solid drag.

Bladder exstrophy (BE) is a complex congenital anomaly characterized by a defect in the closure of the lower abdominal wall and bladder. We aimed to provide an overview of the literature and conduct an epidemiologic study to describe the prevalence, and maternal and case characteristics of BE. We used data from 22 participating member programs of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). All cases were reviewed and classified as isolated, syndrome, and multiple congenital anomalies. We estimated the total prevalence of BE and calculated the frequency and odds ratios for various maternal and case characteristics. A total of 546 cases with BE were identified among 26,355,094 births. The total prevalence of BE was 2.07 per 100,000 births (95% CI: 1.90-2.25) and varied between 0.52 and 4.63 among surveillance programs participating in the study. BE was nearly twice as common among male as among female cases. The proportion of isolated cases was 71%. Prevalence appeared to increase with increasing categories of maternal age, particularly among isolated cases. The total prevalence of BE showed some variations by geographical region, which is most likely attributable to differences in registration of cases. The higher total prevalence among male cases and older mothers, especially among isolated cases, warrants further attention. (C) 2011 Wiley Periodicals, Inc.

This study describes the epidemiology of congenital amelia (absence of limb/s), using the largest series of cases known to date. Data were gathered by 20 surveillance programs on congenital anomalies, all International Clearinghouse for Birth Defects Surveillance and Research members, from all continents but Africa, from 1968 to 2006, depending on the program. Reported clinical information on cases was thoroughly reviewed to identify those strictly meeting the definition of amelia. Those with amniotic bands or limb-body wall complex were excluded. The primary epidemiological analyses focused on isolated cases and those with multiple congenital anomalies (MCA). A total of 326 amelia cases were ascertained among 23,110,591 live births, stillbirths and (for some programs) elective terminations of pregnancy for fetal anomalies. The overall total prevalence was 1.41 per 100,000 (95% confidence interval: 1.26-1.57). Only China Beijing and Mexico RYVEMCE had total prevalences, which were significantly higher than this overall total prevalence. Some under-registration could influence the total prevalence in some programs. Liveborn cases represented 54.6% of total. Among monomelic cases (representing 65.2% of nonsyndromic amelia cases), both sides were equally involved, and the upper limbs (53.9%) were slightly more frequently affected. One of the most interesting findings was a higher prevalence of amelia among offspring of mothers younger than 20 years. Sixty-nine percent of the cases had MCA or syndromes. The most frequent defects associated with amelia were other types of musculoskeletal defects, intestinal, some renal and genital defects, oral clefts, defects of cardiac septa, and anencephaly. (C) 2011 Wiley Periodicals, Inc.

BACKGROUND: The aim of this study was to examine trends of Down syndrome (DS) in relation to maternal age and termination of pregnancies (ToP) in 20 registries of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). METHODS: Trends of births with DS (live-born and stillborn), ToP with DS, and maternal age (percentage of mothers older than 35 years) were examined by year over a 12-year period (1993-2004). The total mean number of births covered was 1550,000 annually. RESULTS: The mean percentage of mothers older than 35 years of age increased from 10.9% in 1993 to 18.8% in 2004. However, a variation among the different registers from 4-8% to 20-25% of mothers >35 years of age was found. The total mean prevalence of DS (still births, live births, and ToP) increased from 13.1 to 18.2/10,000 births between 1993 and 2004. The total mean prevalence of DS births remained stable at 8.3/10,000 births, balanced by a great increase of ToP. In the registers from France, Italy, and the Czech Republic, a decrease of DS births and a great increase of ToP was observed. The number of DS births remained high or even increased in Canada Alberta, and Norway during the study period. CONCLUSIONS: Although an increase in older mothers was observed in most registers, the prevalence of DS births remained stable in most registers as a result of increasing use of prenatal diagnostic procedures and ToP with DS. Birth Defects Research (Part A) 88:474-479, 2010. (C) 2010 Wiley-Liss, Inc.

ObjectiveTo validate the estimates of Global Burden of Disease (GBD) due to congenital anomaly for Europe by comparing infant mortality data collected by EUROCAT registries with the WHO Mortality Database, and by assessing the significance of stillbirths and terminations of pregnancy for fetal anomaly (TOPFA) in the interpretation of infant mortality statistics.Design, setting and outcome measuresEUROCAT is a network of congenital anomaly registries collecting data on live births, fetal deaths from 20 weeks’ gestation and TOPFA. Data from 29 registries in 19 countries were analysed for 2005–2009, and infant mortality (deaths of live births at age ResultsAccording to WHO, 17%–42% of infant mortality was attributed to congenital anomaly. In 11 EUROCAT countries, average infant mortality with congenital anomaly was 1.1 per 1000 births, with higher rates where TOPFA is illegal (Malta 3.0, Ireland 2.1). The rate of stillbirths with congenital anomaly was 0.6 per 1000. The average TOPFA prevalence was 4.6 per 1000, nearly three times more prevalent than stillbirths and infant deaths combined. TOPFA also impacted on the prevalence of postneonatal survivors with non-lethal congenital anomaly.ConclusionsBy excluding TOPFA and stillbirths from GBD years of life lost (YLL) estimates, GBD underestimates the burden of disease due to congenital anomaly, and thus declining YLL over time may obscure lack of progress in primary, secondary and tertiary prevention.

Chemical looping with oxygen uncoupling (CLOU) is a promising concept for efficient combustion of solid fuels with an inherent capture of the greenhouse gas CO 2 . This paper presents a CLOU process scheme with stoichiometric mass, energy, and exergy balances. A CLOU reactor system using medium volatile bituminous coal as fuel and silica-supported CuO as an oxygen carrier is analyzed. The analysis includes the estimation of various design and operational parameters, thermal considerations, and evaluation of the overall performance. The operation of a reactor system of two interacting circulating fluidized beds (CFBs) is greatly influenced by the hydrodynamics. For the CuO oxygen carrier, the hydrodynamic operating range appeared feasible considering the maximum solid circulation rates in current CFB boilers. Depending upon the reactor temperatures, oxygen carrier inventories of 400–680 kg/MW in the system were found necessary for stoichiometric combustion of the fuel. The temperature difference between the reactors should not exceed 50 °C, as otherwise, problems may arise with the heat balance. Exergetic efficiencies in the range of 63–70% were obtained for different combinations of relevant design parameters. It is evident that the possible operating conditions in the system are closely related to the properties of the chosen oxygen carrier. However, the calculation procedure and design criteria presented here are applicable to any oxygen carrier to be used in the process.

To study the mixing and flow of fuel inside commercial scale circulating fluidized bed (CFB) furnaces, a new model was introduced to solve the flow of fuel in an existing semi-empirical, steady state, three-dimensional Eulerian model frame. The fuel flow model is a simplified momentum equation which is based on the momentum balance considering the fuel inertia, gravity, and drag force from gaseous and solid phase. The model improves the prediction capabilities of fuel flow patterns in the existing model frame for conventional and especially renewable fuels, such as biomass. The fuel flow model improves the analysis of CFBs and can be utilized in the design and development of commercial CFB units.

It is important to understand the packing characteristics and behaviour of the randomly packed pebble bed to further analyse the reactor physical and thermal-hydraulic behaviour and to design a safe and economically feasible pebble bed reactor. The objective of this work was to establish methods to model and analyse the pebble packing in detail to provide useful tools and data for further analyses. Discrete element method (DEM) is a well acknowledged method for analysing granular materials, such as the fuel pebbles in a pebble bed reactor. In this work, a DEM computer code was written specifically for pebble bed analyses. Analysis methods were established to extract data at various spatial scales from the pebble beds resulting from the DEM simulations. A comparison with available experimental data was performed to validate the DEM implementation. To test the code implementation in full-scale reactor calculations, DEM packing simulations were done in annular geometry with 450,000 pebbles. Effects of the initial packing configuration, friction and restitution coefficients and pebble size distribution to the resulting pebble bed were investigated. The packing simulations revealed that from the investigated parameters the restitution coefficient had the largest effect on the resulting average packing density while other parameters had smaller effects. Detailed local packing density analysis of pebble beds with different average densities revealed local variations especially strong in the regions near the walls. The implemented DEM code can be used for further analyses of pebble beds and can be customised for particular needs. The results of the packing simulations are useful when determining suitable values to obtain a pebble bed with the desired packing density for subsequent analyses. It is recommended to consider the local packing density variations especially in further coolant flow and heat transfer analyses.

A 1-D dynamic calcium looping model was applied to a large scale calcium looping concept capturing CO 2 from a 250 MWt power plant. Several new features were added to the existing model frame in order to successfully simulate the large scale unit. Models were needed for new material fractions, such as ash and CaSO 4 , sulfur capture and heat transfer in the solid return system. The plant was dimensioned based on the experience from large CFB units and the heat transfer design was evaluated based on initial simulations of the design case. The unit was then simulated in five load scenarios ranging from full load to zero load, no flue gas flow to the carbonator. The scale-up of the process is feasible from the model’s point of view keeping in mind the assumptions and simplifications made in the modeling. The results from the simulations confirmed that successful operation of a large scale calcium looping unit requires good heat transfer design including cooling of the hot solids coming the calciner. Also the recirculation of flue gas in both reactors is necessary to ensure the sufficient fluidization for different flue gas flows from the source combustor. Solid circulation control is also critical because it affects heavily the thermal balance of the system as well as the capture efficiency and the CO 2 balance. Results show that utilizing the experience gained from the large CFB-units coupled with new innovations, the scale-up of this process could be feasible in the near future. The ability to operate flexibly in different modes could give this technology an advantage needed for wide industrial utilization of the process.

Is there a different risk for major congenital anomalies (CAs) in children born after frozen-thawed embryo transfer (FET) compared with children born after fresh embryo transfer (ET)?Children born after FET have a similar risk of developing major CAs as children born after fresh ET.The perinatal outcome in children born after FET is as good as that after fresh ET. Children born as a result of assisted reproductive technology (ART) have an increased risk for CAs when compared with spontaneously conceived children, but the knowledge on the risk for CAs in specific organ systems of children born after FET is limited.This register-based cohort study includes women who have undergone ART treatments with ET leading to singleton births (n = 4772) between the years 1995 and 2006. The women were identified from the registers of the infertility clinics, and the corresponding births were matched with data from the Finnish Medical Birth Register (FMBR). The 10% random sample of women with spontaneous pregnancies from the FMBR served as the reference group (n = 31,243). The study data were linked with the Register of Congenital Malformations using the mothers' and children's personal identification numbers to get information on CAs. Furthermore, the personal identification numbers of the ART women were linked with the Register of Induced Abortions to find their selective terminations of pregnancy for severe foetal anomalies.The study was focused on singleton births and included 1830 children born after FET, 2942 children born after fresh ET and 31 243 children born after spontaneous pregnancies. Only major CAs were analysed in keeping with European Concerted Action on Congenital Anomalies and Twins. The risk estimates for CAs were adjusted for the children's year of birth and maternal age, parity and socioeconomic status. The total prevalence of major CAs was counted, including both births and selective terminations of pregnancy for major fetal anomalies (n = 33).Among singletons at least one major CA was reported in 77 cases (4.2%) in the FET group, 132 cases (4.5%) in the fresh ET group and 994 cases (3.2%) in the reference group. The risk for at least one major CA of the children born after FET was not increased compared with the children born after fresh ET [adjusted odd ratio (aOR) 0.95; 0.71-1.27]. Furthermore, no increased risks according to the organ system affected were found between these two ART groups. When comparing the children born after ART (FET and fresh ET) with the reference group children, the risk of having at least one major CA was moderately increased in the ART group (aOR 1.24; 1.05-1.47).Because of the study design we were neither able to examine the aetiology of infertility nor could we compare the data with a group of subfertile women to account for the effect of infertility per se on CAs.Perinatal outcomes of FET children, including the risks for CAs, are good and comparable with outcomes of other ART children indicating that slow freezing is a safe method to use during ART treatments.University Hospital of Oulu and Helsinki, Finland. THL covered the data linkages and the work of Annukka Ritvanen and Mika Gissler. There are no competing interests to be reported.

Chemical looping combustion (CLC) is an emerging combustion technology with an inherent separation of the greenhouse gas CO2. The feasibility of CLC has been proven in various small-scale units worldwide, but the large-scale realization of theoretical or small-scale units is still lacking due to many technical challenges. Most of the existing CLC installations use a configuration of two interacting fluidized bed reactors, and even though the fluidized bed technology is mature and well-established, a high level of uncertainty is included in the attempts to up-scale the reactor system involved in CLC. For progressive scale-up of the new technology, a preliminary design of a 100 MWth pre-commercial CLC unit for gaseous fuels is presented. A reactor-level model was used to predict the performance of such a system, and as a result, the operation of the system was characterized and valuable information of the parameters affecting the process was received. For cost-effective energy generation with efficient CO2 capture, the power plant-level integration of CLC must be conducted carefully, and different plant configurations need to be investigated to find the most optimal solution. Hence, the integration of the reactor system and steam turbine cycle for power production was studied resulting in a suggested plant layout including a CLC boiler system, a simple heat recovery setup, and an integrated steam cycle with a three pressure level steam turbine. A plant-level model was used to evaluate the viability of the plant, and without the purification and compression of CO2, the net cycle efficiency of 42.8% was obtained. It was also found that a drop of 2% points in the degree of fuel conversion decreases the net cycle efficiency by about 1% point.

The calcium looping process is a fast-developing post-combustion CO 2 capture technology in which combustion flue gases are treated in two interconnected fluidized beds. CO 2 is absorbed from the flue gases with calcium oxide in the carbonator operating at 650 °C. The resulting CaCO 3 product is regenerated into CaO and CO 2 in the calciner producing a pure stream of CO 2 . In order to produce a suitable gas stream for CO 2 compression, oxy-combustion of a fuel, such as coal, is required to keep the temperature of the calciner within the optimal operation range of 880–920 °C. Studies have shown that the calcium looping process CO 2 capture efficiencies are between 70% and 97%. The calciner reactor is a critical component in the calcium looping process. The operation of the calciner determines the purity of gases entering the CO 2 compression. The optimal design of the calciner will lower the expenses of the calcium looping process significantly. Achieving full calcination at the lowest possible temperature reduces the cost of oxygen and fuel consumption. In this work, a 1.7 MW pilot plant calciner was studied with two modeling approaches: 3-D calciner model and 1-D process model. The 3-D model solves fundamental balance equations for a fluidized bed reactor operating under steady-state condition by applying the control volume method. In addition to the balance equations, semi-empirical models are used to describe chemical reactions, solid entrainment and heat transfer to reduce computation effort. The input values of the 3-D-model were adjusted based on the 1-D-model results, in order to model the behavior of the carbonator reactor realistically. Both models indicated that the calcination is very fast in oxy-fuel conditions when the appropriate temperature conditions are met. The 3-D model was used to study the sulfur capture mechanisms in the oxy-fired calciner. As expected, very high sulfur capture efficiency was achieved. After confirming that the 1-D model with simplified descriptions for the sorbent reactions produces similar results to the more detailed 3-D model, the 1-D model was used to simulate calcium looping process with different recirculation ratios to find an optimal area where the fuel consumption is low and the capture efficiency is sufficiently high. It was confirmed that a large fraction of the solids can be recirculated to both reactors to achieve savings in fuel and oxygen consumption before the capture efficiency is affected in the pilot unit. With low recirculation ratios the temperature difference between the reactors becomes too low for the cyclic carbonation and calcination. As a general observation, the small particle size creates high solid fluxes in the calcium looping process that should be taken into account in the design of the system.

The objective of this research is to evaluate the average gas-to-char mass transfer coefficient predicted by a two-dimensional Eulerian multiphase CFD model in the conditions prevailing in a bench and a pilot scale bubbling and circulating fluidised bed combustors. It was found that the Eulerian multiphase CFD model is able to predict the same response of the bed Sherwood number to the fluidisation velocity as shown by the experimental results. The CFD simulations also suggest that the bed Sherwood number drops with increase of reactor width from the bench to the pilot scale. Research highlights that, in the combustion process, the bed Sherwood number is a function of Reynolds number, as well as phase mass transfer, char loading and chemical kinetics.

Aim The birth prevalence of sacrococcygeal teratoma (SCT) has been reported to range from 1:27 000 to 1:40 000. We assessed the population-based prevalence and clinical presentation of SCT over 22 years. Methods We identified all cases of SCT, including live births, stillbirths and terminations of pregnancy (TOPs), in the Finnish Register of Congenital Malformations, covering 1987–2008. Data on prenatal diagnoses, pregnancy outcomes, infant deaths and associated anomalies were collected. Results One hundred and twenty four SCT cases were identified among 1 331 699 pregnancies. There were 89 (72%) live births, 13 (10%) stillbirths and 22 (18%) TOPs. The total prevalence of SCT was 1:10 700. Tumours were detected in utero in 55% of the pregnancies with SCT. The proportion of perinatal deaths among all SCT births was 28%. Thirty percentage of the cases had associated abnormalities (mainly of the urinary tract and various syndromes). Conclusion This nationwide, population-based study on SCT shows that the total and birth prevalence of SCT in Finland is markedly higher than previously reported. This may reflect true differences between populations, but may also be explained by accurate nationwide registration of SCTs. The high perinatal mortality rate has an impact on counselling of families and planning of deliveries.

For the study of gas–solid flows in a circulating fluidized bed (CFB) riser, the model based on the Eulerian description of phases is widely used. Such a description requires the usage of a fine mesh and a short time step in the numerical simulations. Due to the constraint of long calculation times with fine meshes, it becomes practical to simulate the gas–solid flow in a CFB riser with coarse meshes. This work is the continuation of formulating the subgrid-scale models for the space averaged two-fluid model equations which can be used in coarse mesh simulations of gas–solid flows in risers. In this study, the vertical component of the drag force and the convective term are analyzed and their dependence on the averaging size and solid volume fraction with the distance from the wall is presented.

Upper-limb defects with deficiencies of the radial ray have varying etiologies, with a low proportion of true Mendelian disorders. We carried out a population-based study to elucidate the birth prevalence and clinical spectrum of radial ray deficiencies in Finland. We identified all births with radial ray deficiency reported to the Finnish Register of Congenital Malformations in 1993–2005. Altogether 138 cases were identified (123 live births), with a birth prevalence of 1.83 per 10,000 births and a live birth prevalence of 1.64 per 10,000 live births. The proportion of infant deaths was as high as 35%. The majority of the cases were associated with known syndromes or multiple anomalies; only 13% were true isolated radial ray deficiencies. The most common syndrome was trisomy 18, and the most common in multiple anomalies was VACTERL association. In 8.7% of cases an association between radial ray deficiency and heart anomaly was observed. The high proportion of cases with associated major anomalies indicates that radial ray deficiency can be regarded isolated only after thorough assessment of the various organ systems in an affected infant. © 2013 Wiley Periodicals, Inc.

Gastroschisis risk is highest in offspring of young women and is increasing in prevalence, suggesting that exposures that are increasingly common among younger females may be causal. Some infections by viruses in the herpes family are more common in the earlier childbearing years and have been increasing in prevalence over time. Data from the Finnish Maternity Cohort were linked to Finnish malformation and birth registers (1987-2012) for this study, a nested case-control study of mothers of offspring with gastroschisis and age-matched controls. Maternal antibody responses in early pregnancy (mean gestational age = 11.1 weeks) to Epstein Barr virus (EBV), herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), and cytomegalovirus were measured. Conditional logistic regression models were used to estimate odds ratios (and 95% confidence intervals) for high immunoglobulin reactivity. Odds ratios for high immunoglobulin M (IgM) reactivity to EBV-viral capsid antigen and HSV-1 or HSV-2 (as indicators of recent infection) were 2.16 (95% confidence interval (CI): 0.97, 4.79) and 1.94 (95% CI: 0.74, 5.12), respectively. For higher immunoglobulin G (IgG) reactivity to EBV-viral capsid antigen and HSV-2 IgG, odds ratios were 2.16 (95% CI: 0.82, 5.70) and 2.48 (95% CI: 1.50, 4.10), respectively. Reactivities to HSV-1 IgG, cytomegalovirus IgM, or cytomegalovirus IgG did not appear to increase gastroschisis risk. Primary EBV infection was not associated with gastroschisis, but observed associations with both IgM and IgG reactivities to EBV and HSV suggest that reactivations may be risk factors for it.

The underlying research materials for this article can be accessed at http://czvp.szu.cz/support/TDS_samples.htm A total diet study (TDS) is a public health tool for determination of population dietary exposure to chemicals across the entire diet. TDSs have been performed in several countries but the comparability of data produced is limited. Harmonisation of the TDS methodology is therefore desirable and the development of comparable TDS food lists is considered essential to achieve the consistency between countries. The aim of this study is to develop and test the feasibility of a method for establishing harmonised TDS food and sample lists in five European countries with different consumption patterns (Czech Republic, Finland, Germany, Iceland and Portugal). The food lists were intended to be applicable for exposure assessment of wide range of chemical substances in adults (18-64 years) and the elderly (65-74 years). Food consumption data from recent dietary surveys measured on individuals served as the basis for this work. Since the national data from these five countries were not comparable, all foods were linked to the EFSA FoodEx2 classification and description system. The selection of foods for TDS was based on the weight of food consumed and was carried out separately for each FoodEx2 level 1 food group. Individual food approach was respected as much as possible when the TDS samples were defined. TDS food lists developed with this approach represented 94.7-98.7% of the national total diet weights. The overall number of TDS samples varied from 128 in Finland to 246 in Germany. The suggested method was successfully implemented in all five countries. Mapping of data to the EFSA FoodEx2 coding system was recognised as a crucial step in harmonisation of the developed TDS food lists. This research was funded by the European Commission’s Seventh Framework Programme [FP7/2012–2016] as a part of TDS Exposure project [grant agreement number 289108]. The work was also supported by Ministry of Health of Czech Republic – DRO [National Institute of Public Health, IN 75010330]. info:eu-repo/semantics/publishedVersion

Correction of calvarial defects after calvarial vault reconstruction (CVR) is challenging in craniosynostosis patients of advanced age and typically employs autologous bone. Demineralized bone matrix (DBM) is a potential alternative material for autologous bone, but its use has not been extended to correct calvarial defects. CVR patients operated at the Department of Plastic Surgery, Helsinki University Hospital, during 2008-2010 were retrospectively reviewed. Inclusion criteria of the study were CVR patients who received DBM plate, with or without bone dust, on calvarial defects and who had suitable uncovered defect on the contralateral side as control. This study included 17 craniosynostosis and one positional plagiocephaly patient, whose mean age was 6.9 years (range 0.9-19 years). The mean follow-up time was 5.6 years. The fusion degree of all defects was measured from 1 week to 1 year postoperatively using three-dimensional computed tomography (3D CT) images by the OsiriX (R) method. Medical records were reviewed for DBM-related complications. A total of 26 defects were covered with a DBM plate (mean area 11.1 cm(2)) and 26 control defects were identified (mean area 7.8 cm2). The mean fusion degree of the DBM defects was 74% and 54% for the controls (p 30 months) than in younger patients or when used with bone dust. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

High-temperature solid looping processes for CCS (carbon capture and storage) represent a class of promising technologies that enables CO2 capture with relatively low net efficiency penalties. The novel concept of the CLOU (Chemical Looping with Oxygen Uncoupling) process is based on a system of two interconnected fluidized bed reactors that operate at atmospheric pressure. In the fuel reactor, the capability of certain metal oxides to spontaneously release molecular oxygen at high temperatures is exploited to promote the direct conversion of coal in an oxygen-rich atmosphere. As a novel CO2 capture concept, the CLOU process requires the optimization of design and operation parameters, which may substantially influence the total power plant performance. This study approaches this issue by performing joint simulations of CLOU reactors using a 1.5D model and a steam cycle power plant. A sensitivity analysis has been performed to investigate the performance and main technical issues that are related to the integration of a CLOU island in a state-of-the-art USC (ultra-supercritical) power plant. In particular, the effect of the key process parameters has been evaluated. Superior performance has been estimated for the power plant, with electrical efficiencies of approximately 42% and more than 95% CO2 avoided.

Objective. To study perinatal mortality associated with placental abruption. Design. Retrospective population study using the Finnish Hospital Discharge Register and Medical Birth Register data. Setting. Finland, 1987–2005. Population. Pregnancies with placental abruption and all other births without placental abruption. Methods. The national Hospital Discharge Register and Medical Birth Register were used to identify all pregnancies with placental abruption. Demographic data and delivery outcomes were collected retrospectively. Perinatal mortality associated with placental abruption was compared with that in other births. Potential risk factors were analysed. Main outcome measures. Perinatal mortality in placental abruption. Results. The study consisted of 618 735 women with 1.14 million pregnancies, 4336 of whom had placental abruption. Overall perinatal mortality with abruption was 119 per 1000 births. Placental abruption explained 7% of all perinatal deaths. The mortality among singleton births (125 per 1000) was higher than among multiple births (40 per 1000). The majority of deaths (77%) occurred in utero. Singleton perinatal mortality with abruption decreased from 173 per 1000 in 1987–1990 to 98 per 1000 in 2000–2005 (p < 0.001). In singleton births at

Calcium looping is an emerging technology for post-combustion carbon dioxide capture and storage in development. In this study, a 1-dimensional dynamical model for the calcium looping process was developed. The model was tested against a laboratory scale 30 kW test rig at INCAR-CSIC, Spain. The study concentrated on steady-state simulations of the carbonator reactor. Capture efficiency and reactor temperature profile were compared against experimental data. First results showed good agreement between the experimental observations and simulations.

Proper modeling for fluid dynamics is central in understanding any industrial multiphase flow. For the study of gas–solid flow in a circulating fluidized bed (CFB) riser, the model based on the Eulerian description of the phases is widely used. Gas–solid flows in fluidized bed units are heterogeneous, and resolving them in numerical simulations requires a very fine mesh spacing and a short time step size. Such constraints on the mesh and time step size result in very time consuming calculations even for pilot scale fluidized bed studies. A small scale CFB riser 3 m in height and 0.40 m in width was examined in order to study effects of different scales such as mesh and time step size. When using coarse scales, the information about the mesoscale structures is lost illustrating the dependence of results on the discretization scales. The same set of equations is thus not valid for the simulation using coarse meshes. A study on space averaging was done to formulate the correction factor to the drag model with some defined notations. It was found that the correction factor for the drag model was dependent on the location in the flow domain.

Acardia is a severe, complex malformation of monozygotic twinning, but beyond clinical case series, very few epidemiologic data are available. The goals of this study were to assess the epidemiologic characteristics of acardia from birth defect registries in the International Clearinghouse for Birth Defects Surveillance and Research (Clearinghouse), and compare these findings to current literature. The study included 17 surveillance programs of the Clearinghouse representing 23 countries from North and South America, Europe, China, and Australia. Anonymized individual records with clinical and demographic data were reviewed centrally by clinical geneticists. A literature search was performed. A total of 164 cases of acardia were reported from an underlying cohort of 21.2 million births. Of these, 23% were elective pregnancy terminations. Rates did not vary significantly by maternal age. For many cases, information on pregnancy exposures and genetic testing was missing. However, these limited data did not suggest high rates of chronic illnesses (diabetes, seizure disorders) or lifestyle factors such as smoking. One case had trisomy 13. Major malformations were reported in 2.4% of co-twins. With some basic assumptions, the total prevalence of acardia was estimated at 1 in 50,000-70,000 births, and 1 in 200-280 monozygotic twins. In summary, acardia is a dramatic, probably underreported, and incompletely understood malformation. Studies on its epidemiology and etiology are challenging and still rare. An international collaboration of epidemiologists, clinicians, and geneticists is necessary to understand the etiology, pathogenesis, and occurrence of this severe malformation complex. (C) 2011 Wiley Periodicals, Inc.

Cyclopia is characterized by the presence of a single eye, with varying degrees of doubling of the intrinsic ocular structures, located in the middle of the face. It is the severest facial expression of the holoprosencephaly (HPE) spectrum. This study describes the prevalence, associated malformations, and maternal characteristics among cases with cyclopia. Data originated in 20 Clearinghouse (ICBDSR) affiliated birth defect surveillance systems, reported according to a single pre-established protocol. A total of 257 infants with cyclopia were identified. Overall prevalence was 1 in 100,000 births (95% CI: 0.89-1.14), with only one program being out of range. Across sites, there was no correlation between cyclopia prevalence and number of births (r = 0.08; P = 0.75) or proportion of elective termination of pregnancy (r = -0.01; P = 0.97). The higher prevalence of cyclopia among older mothers (older than 34) was not statistically significant. The majority of cases were liveborn (122/200; 61%) and females predominated (male/total: 42%). A substantial proportion of cyclopias (31%) were caused by chromosomal anomalies, mainly trisomy 13. Another 31% of the cases of cyclopias were associated with defects not typically related to HPE, with more hydrocephalus, heterotaxia defects, neural tube defects, and preaxial reduction defects than the chromosomal group, suggesting the presence of ciliopathies or other unrecognized syndromes. Cyclopia is a very rare defect without much variability in prevalence by geographic location. The heterogeneous etiology with a high prevalence of chromosomal abnormalities, and female predominance in HPE, were confirmed, but no effect of increased maternal age or association with twinning was observed. (C) 2011 Wiley Periodicals, Inc.

Conjoined twins (CT) are a very rare developmental accident of uncertain etiology. Prevalence has been previously estimated to be 1 in 50,000 to 1 in 100,000 births. The process by which monozygotic twins do not fully separate but form CT is not well understood. The purpose of the present study was to analyze diverse epidemiological aspects of CT, including the different variables listed in the Introduction Section of this issue of the Journal. The study was made possible using the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) structure. This multicenter worldwide research includes the largest sample of CT ever studied. A total of 383 carefully reviewed sets of CT obtained from 26,138,837 births reported by 21 Clearinghouse Surveillance Programs (SP) were included in the analysis. Total prevalence was 1.47 per 100,000 births (95% CI: 1.32-1.62). Salient findings including an evident variation in prevalence among SPs: a marked variation in the type of pregnancy outcome, a similarity in the proportion of CT types among programs: a significant female predominance in CT: particularly of the thoracopagus type and a significant male predominance in parapagus and parasitic types: significant differences in prevalence by ethnicity and an apparent increasing prevalence trend in South American countries. No genetic, environmental or demographic significant associated factors were identified. Further work in epidemiology and molecular research is necessary to understand the etiology and pathogenesis involved in the development of this fascinating phenomenon of nature. (C) 2011 Wiley Periodicals, Inc.

Epidemiologic data on phocomelia are scarce. This study presents an epidemiologic analysis of the largest series of phocomelia cases known to date. Data were provided by 19 birth defect surveillance programs, all members of the International Clearinghouse for Birth Defects Surveillance and Research. Depending on the program, data corresponded to a period from 1968 through 2006. A total of 22,740,933 live births, stillbirths and, for some programs, elective terminations of pregnancy for fetal anomaly (ETOPFA) were monitored. After a detailed review of clinical data, only true phocomelia cases were included. Descriptive data are presented and additional analyses compared isolated cases with those with multiple congenital anomalies (MCA), excluding syndromes. We also briefly compared congenital anomalies associated with nonsyndromic phocomelia with those presented with amelia, another rare severe congenital limb defect. A total of 141 phocomelia cases registered gave an overall total prevalence of 0.62 per 100,000 births (95% confidence interval: 0.52–0.73). Three programs (Australia Victoria, South America ECLAMC, Italy North East) had significantly different prevalence estimates. Most cases (53.2%) had isolated phocomelia, while 9.9% had syndromes. Most nonsyndromic cases were monomelic (55.9%), with an excess of left (64.9%) and upper limb (64.9%) involvement. Most nonsyndromic cases (66.9%) were live births; most isolated cases (57.9%) weighed more than 2,499 g; most MCA (60.7%) weighed less than 2,500 g, and were more likely stillbirths (30.8%) or ETOPFA (15.4%) than isolated cases. The most common associated defects were musculoskeletal, cardiac, and intestinal. Epidemiological differences between phocomelia and amelia highlighted possible differences in their causes.

Purpose The aim of this population-based nationwide drugs and pregnancy surveillance system was to get basic information on the use of prescribed drugs during pregnancy and to achieve more detailed information on drug exposure–outcome associations with data obtained from the Finnish national health registers. Methods The data are based on information on all pregnancies ending in births (n = 632 629) or termination of pregnancy (TOP) (n = 117 255) in Finland between 1996 and 2006. The data containing information on maternal background factors, chronic diseases and drug purchases during pregnancy, born children, induced abortions, perinatal health and major congenital malformations were obtained from the Finnish national health registers. Information from the different registers was merged through record linkages based on unique personal identification numbers. Statistical analyses were conducted between the exposed and unexposed for individual drugs or Anatomical Therapeutic Chemical (ATC) classification drug groups in multivariate logistic regression including potential confounding factors. Results Nearly half of parturients and almost every third woman with TOP purchased drugs at least once 1 month prior to pregnancy and/or during pregnancy. The most frequent chronic diseases during pregnancy were asthma, hypothyroidism, epilepsy, rheumatoid arthritis and diabetes. Previously known causal connections between maternal chronic diseases and/or medication and perinatal health risks were already seen in the ATC-group-level analysis. Conclusions Comprehensive and detailed information for pharmacoepidemiological research on the effects of drug use during pregnancy in a cohort setting is possible with long-term and cumulative data collection. Copyright © 2011 John Wiley & Sons, Ltd.

This retrospective cohort study was planned to determine whether recommendations to take folic acid have in fact lessened the risk of neural tube defects. Recommendations typically include eating a healthy diet and takingfolic acid supplements when planning pregnancy or throughout the childbearing years. In a few countries, including the United States, flour is fortified so that much of the population will receive at least a small supplemental amount of folic acid. Many governments promote the use of supplements because folic acid is inexpensive, safe, and easy to use. The authors acquired information on more than 13 million births from 13 birth defects registries in Norway that monitored rates of neural tube defects from 1988 to 1998. Cases of anencephaly and spina bifida totaled 8636. Rates of defects were stable during the 10-year monitoring interval in most areas. There were no evident changes in rates of defects after local recommendations were issued. Comparable findings were obtained when analyzing anencephaly and spina bifida separately and combined. Folic acid use in Europe is, in general, low; in Norway, it is approximately 10%. In China, intensive educational efforts and a high rate of planned pregnancies probably are responsible for the effectiveness of a public health campaign to promote the use of folic acid supplements. Rates of folic acid use generally follow economic and educational trends. Fortifying flour with folic acid holds promise for delivering some folic acid to a large part of the population, crossing social and economic barriers. Blood folate levels have increased rapidly where this practice is followed. It is estimated that thousands of neural tube defects occurring since 1992 could have been prevented.

Objectives: The aim of the present study was to examine the effects of aerobic fitness on physiological stress responses experienced by teachers during working hours. Materials and Methods: Twenty six healthy female and male teachers aged 33–62 years, participated in the study. The ratings of perceived stress visual analogue scale (VAS), and the measurement of physiological responses (norepinephrine, epinephrine, cortisol, diastolic and systolic blood pressure, heart rate (HR) and trapezius muscle activity by electromyography (EMG) were determined. Predicted maximal oxygen uptake (VO 2 max) was measured using the submaximal bicycle ergometer test. The predicted VO 2 max was standardized for age using residuals of linear regression analyses. Results: Static EMG activity, HR and VAS were associated with aerobic fitness in teachers. Conclusions: The results suggest that a higher level of aerobic fitness may reduce muscle tension, HR and perceived work stress in teachers.

Introduction. This study was designed to identify the delays and factors related to and predicting the cessation of generalized convulsive SE (GCSE). Methods. This retrospective study includes 70 consecutive patients (>16 years) diagnosed with GCSE and treated in the emergency department of a tertiary hospital over 2 years. We defined cessation of SE stepwise using clinical seizure freedom, achievement of burst-suppression, and return of consciousness as endpoints and calculated delays for these cessation markers. In addition 10 treatment delay parameters and 7 prognostic and GCSE episode related factors were defined. Multiple statistical analyses were performed on their relation to cessation markers. Results. Onset-to-second-stage-medication (p=0.027), onset-to-burst-suppression (p=0.005), and onset-to-clinical-seizure-freedom (p=0.035) delays correlated with the onset-to-consciousness delay. We detected no correlation between age, epilepsy, STESS, prestatus period, type of SE onset, effect of the first medication, and cessation of SE. Conclusion. Our study demonstrates that rapid administration of second-stage medication and early obtainment of clinical seizure freedom and burst-suppression predict early return of consciousness, an unambiguous marker for the end of SE. We propose that delays in treatment chain may be more significant determinants of SE cessation than the previously established outcome predictors. Thus, streamlining the treatment chain is advocated.