Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years

BACKGROUND: Over the last two decades, improvements in medical care have been associated with a significant increase and better outcome of very preterm (VP, < 32 completed gestational weeks) and very low birth weight (VLBW, < 1500 g) infants. Only a few publications analyse changes of their short-term outcome in a geographically defined area over more than 10 years. We therefore aimed to investigate the net change of VP- and VLBW infants leaving the hospital without major complications. METHODS: Our population-based observational cohort study used the Minimal Neonatal Data Set, a database maintained by the Swiss Society of Neonatology including information of all VP- and VLBW infants. Perinatal characteristics, mortality and morbidity rates and the survival free of major complications were analysed and their temporal trends evaluated. RESULTS: In 1996, 2000, 2004, and 2008, a total number of 3090 infants were enrolled in the Network Database. At the same time the rate of VP- and VLBW neonates increased significantly from 0.87% in 1996 to 1.10% in 2008 (p < 0.001). The overall mortality remained stable by 13%, but the survival free of major complications increased from 66.9% to 71.7% (p < 0.01). The percentage of infants getting a full course of antenatal corticosteroids increased from 67.7% in 1996 to 91.4% in 2008 (p < 0.001). Surfactant was given more frequently (24.8% in 1996 compared to 40.1% in 2008, p < 0.001) and the frequency of mechanical ventilation remained stable by about 43%. However, the use of CPAP therapy increased considerably from 43% to 73.2% (p < 0.001). Some of the typical neonatal pathologies like bronchopulmonary dysplasia, necrotising enterocolitis and intraventricular haemorrhage decreased significantly (p ≤ 0.02) whereas others like patent ductus arteriosus and respiratory distress syndrome increased (p < 0.001). CONCLUSIONS: Over the 12-year observation period, the number of VP- and VLBW infants increased significantly. An unchanged overall mortality rate and an increase of survivors free of major complication resulted in a considerable net gain in infants with potentially good outcome

The greenhouse gas emissions and mitigation options for materials used in UK construction

The UK construction industry faces the daunting task of replacing and extending a significant proportion of UK infrastructure, meeting a growing housing shortage and retrofitting millions of homes whilst achieving greenhouse gas (GHG) emission reductions compatible with the UK's legally binding target of an 80% reduction by 2050. This paper presents a detailed time series of embodied GHG emissions from the construction sector for 1997–2011. This data is used to demonstrate that strategies which focus solely on improving operational performance of buildings and the production efficiencies of domestic material producers will be insufficient to meet sector emission reduction targets. Reductions in the order of 80% will require a substantial decline in the use of materials with carbon-intensive supply chains. A variety of alternative materials, technologies and practices are available and the common barriers to their use are presented based upon an extensive literature survey. Key gaps in qualitative research, data and modelling approaches are also identified. Subsequent discussion highlights the lack of client and regulatory drivers for uptake of alternatives and the ineffective allocation of responsibility for emissions reduction within the industry. Only by addressing and overcoming all these challenges in combination can the construction sector achieve drastic emissions reduction

Annual report 2000

SIGLEAvailable from British Library Document Supply Centre-DSC:1364.240(2000) / BLDSC - British Library Document Supply CentreGBUnited Kingdo