Imaging the prenatal brain in congenital heart defects

Prenatal detection of congenital heart defects has been known to decrease mortality and morbidity in children born with such defects. This thesis describes the increase of prenatal detection of two outflow-tract anomalies, by adding an additional mandatory plane to the national screening program. The second part of this thesis, studies the development of the fetal brain in children affected by congenital heart defects. These children are known to have worse neurodevelopmental outcome than their healthy counterparts. There is some evidence describing a prenatal origin of the delay in neurodevelopment. In the studies that were described in part two of this thesis, we have used a deep-learning algorithm that can assess the maturation (or development) of the fetal brain. We have found small delays in brain maturation as compared to healthy control fetuses. The clinical significance of these outcomes however, remains unclear. A multifactorial cause of brain damage in children with CHD is much more likely. Whatever the exact cause of the long-term neurodevelopmental delay in children with congenital heart defects is, the correlation is undeniable. And thus, expecting parents must be informed of this matter. Afdeling verloskunde LUMC, Chipsoft, Stichting Oranjekliniek, Bridea Medical, Canon Medical SystemsLUMC / Geneeskund

ACTION FOR BETTER GOVERNMENT: A ROLE FOR DONORS

Summary This article describes calls for more participation and accountability to bring better government in countries receiving aid and suggests how donors could help. These calls are made because people are more educated, better informed, disillusioned with bad government, and moved by news of changes elsewhere and by the concerns of donors. Better government requires a balance between economic, social and political goals, and the political determination to act against corruption. Aid programmes need participatory and accountable management with project appraisals that value social and political, as well as economic, benefits. The article concludes with a portfolio of project proposals to help political leaders, give people voice, transfer resources from public to private sectors, act against corruption, support law and order, strengthen civil society, and provide training to develop attitudes as well as skills. Résumé Cet article décrit les appels pour une augmentation de la participation et de la responsabilité financière afin d'instaurer de meilleures pratiques de gouvernement dans les pays donataires d'aide, et suggère certains moyens par lesquels les donateurs pourraient faciliter à ce processus. Ces demandes se font entendre parce que les peuples sont plus éduqués, mieux informés, désillusionnés par le mauvais gouvernement, et poussés à la fois par les nouvelles des changements intervenus ailleurs et par les inquitétudes des pays donateurs. L'amélioration de la pratique gouvernamentale exige un équilibre entre les aspirations économiques, sociales et politiques, et la volonté politique d'intervenir contre la corruption. Les programmes d'aide exigent la mise en place de moyens de gestion à la fois participatifs et capables de répondre d'eux mêmes, offrant en particulier des moyens d'évaluation des projets qui tiendraient compte des avantages sociaux et politiques en plus des bénéfices économiques. L'article présente en conclusion un portefeuille de projets proposés afin d'aider les dirigeants politiques; de faire entendre la voix des peuples; de transférer les ressources du secteur public au secteur privé; d'intervenir contre la corruption; d'appuyer l'ordre public; de renforcer la société civile; et de mettre en place des programmes de formation susceptibles de développer à la fois les attitudes et les aptitudes. Resumen Este artículo describe los llamamientos a más participación y responsabilidad para alcanzar mejor gobierno en los países que reciben ayuda, y sugiere cómo los donantes pueden ayudar. Se hacen estos llamamientos porque la gente está hoy más educada, mejor informada, y desilusionada con los malos gobiernos, y conmovida con las noticias de cambios en otros sitios, así como por el interés de los donantes. Un mejor gobierno requiere un equilibrio entre los objetivos económicos, sociales y políticos, y la determinación de actuar contra la corrupción. Los programas de ayuda necesitan una administración participatoria y responsable con evaluaciones que midan no sólo los beneficios económicos, sino también los sociales y los políticos. El artículo concluye con un paquete de propuestas para ayudar a los líderes políticos, dar voz al pueblo, transferir recursos del sector público al privado, apoyar la lucha contra la corrupción, asegurar el respeto a las leyes, fortalecer la sociedad civil, y proveer entrenamiento para desarrollar tanto actitudes como habilidades

Ethnographic Vignettes: Social Change and Social Encounters in Solwezi, Northwestern Zambia

What is social change, and where is it coming from? How can we see it when it happens, and is there ever any moment of time where there is no change? Societies never stagnate, of course, but is there something like accelerated change or the beginning of social change? What are the conditions for it? And how can we not only recognise it when it happens but also relate it to a readership? These questions shaped our discussions during two terms in the seminar rooms of the Chair of Social Anthropology, University of Basel and - albeit in the background - during six weeks of guided field research in Solwezi town in Northwestern Zambia. In this Basel Paper issue, master students in Social Anthropology and African Studies present the results of this enquiry. The issue's contribution is threefold: First, it engages with the question of how to present social change with the help of vignettes, second, it offers a diverse tapestry of insights into a central region of today's capitalist world and, third, it attempts a refine- ment of the ethnographic method of participant observation

Serial neurosonography in fetuses with congenital heart defects shows mild delays in cortical development

Introduction Neurodevelopmental delay is more common in children born with congenital heart defects (CHD), even with optimal perinatal and peri-operative care. It is hypothesized that fetuses with CHD are prone to neurological impairment in utero due to their cardiac defect, possibly leading to delayed cortical development. Methods Cerebral cortical maturation was assessed with advanced neurosonographic examinations every 4 weeks in fetuses with CHD and compared to control fetuses. Five different primary fissures and four areas were scored (ranging 0-5) by blinded examiners using a cortical maturation scheme. Results Cortical staging was assessed in 574 ultrasound examinations in 85 CHD fetuses and 61 controls. Small differences in grading were seen in Sylvian and cingulate fissures. (Sylvian fissure: -0.12 grade, 95% CI (-0.23; -0.01) p = 0.05, cingulate fissure: -0.24 grade, 95% CI (-0.38; -0.10) p = <0.001. Other cortical areas showed normal maturation as compared to control fetuses. Conclusion Small differences were seen in three of the nine analyzed cortical areas in CHD fetuses, in contrast to previous reports on progressive third-trimester delay. The clinical implications of the small differences however, remain unknown.Research into fetal development and medicin

The association between flow and oxygenation and cortical development in fetuses with congenital heart defects using a brain-age prediction algorithm.

OBJECTIVES: Presumably, changes in fetal circulation contribute to the delay in maturation of the cortex in fetuses with congenital heart defect (CHD). The aim of the current study is to analyze fetal brain development based on hemodynamic differences, using novel brain-age prediction software. METHODS: We have performed detailed neurosonography, including acquiring 3D volumes, prospectively in cases with isolated CHD from 20 weeks onwards. An algorithm that assesses the degree of fetal brain-age automatically was used to compare CHD cases to controls. We stratified CHD cases according to flow and oxygenation profiles by lesion physiology and performed subgroup analyses. RESULTS: A total of 616 ultrasound volumes of 162 CHD cases and 75 controls were analyzed. Significant differences in maturation of the cortex were observed in cases with normal blood flow toward the brain (-3.8 days, 95%CI [-5.5; -2.0], P = <.001) and low (-4.0 days, 95% CI [-6.7; -1.2] P = <.05; hypoplastic left heart syndrome[HLHS]) and mixed (-4.4 days, 95%CI [-6.4; -2.5] p = <.001) oxygen saturation in the ascending aorta (TGA) and in cardiac mixing (eg, Fallot) cases. CONCLUSION: The current study shows significant delay in brain-age in TGA and Fallot cases as compared to control cases. However, the small differences found in this study questions the clinical relevance

The association between flow and oxygenation and cortical development in fetuses with congenital heart defects using a brain-age prediction algorithm.

OBJECTIVES: Presumably, changes in fetal circulation contribute to the delay in maturation of the cortex in fetuses with congenital heart defect (CHD). The aim of the current study is to analyze fetal brain development based on hemodynamic differences, using novel brain-age prediction software. METHODS: We have performed detailed neurosonography, including acquiring 3D volumes, prospectively in cases with isolated CHD from 20 weeks onwards. An algorithm that assesses the degree of fetal brain-age automatically was used to compare CHD cases to controls. We stratified CHD cases according to flow and oxygenation profiles by lesion physiology and performed subgroup analyses. RESULTS: A total of 616 ultrasound volumes of 162 CHD cases and 75 controls were analyzed. Significant differences in maturation of the cortex were observed in cases with normal blood flow toward the brain (-3.8 days, 95%CI [-5.5; -2.0], P = <.001) and low (-4.0 days, 95% CI [-6.7; -1.2] P = <.05; hypoplastic left heart syndrome[HLHS]) and mixed (-4.4 days, 95%CI [-6.4; -2.5] p = <.001) oxygen saturation in the ascending aorta (TGA) and in cardiac mixing (eg, Fallot) cases. CONCLUSION: The current study shows significant delay in brain-age in TGA and Fallot cases as compared to control cases. However, the small differences found in this study questions the clinical relevance