UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development

It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional DSD team acts as the first point of contact. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents are as fully informed as possible and have access to specialist psychological support. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration. © 2011 Blackwell Publishing Ltd.

Widening engineering horizons: Addressing the complexity of sustainable development

The complex, fragmented and diverse aspects of a sustainable development perspective are translated into an eight-point framework that defines a problem boundary larger than that traditionally adopted by civil engineers. This leads to practical questions intended to inform engineers who ask 'am I being sustainable?' during project implementation. The value of the questions is tested against a case history of a wastewater treatment project. This demonstrates the relevance of the questions to successive project delivery phases of defining the problem, choosing a solution and implementing that solution through design, construction and operation. The case history highlights that answers to several of the additional questions raised by considering this wider problem space are currently buried within government and clients' policies, regulations and standard practice; these answers may not be accessible to the professional engineer.