Studio longitudinale della funzione cardiaca materna nelle gravidanze gemellari

Obiettivo: studio longitudinale di una coorte di gravidanze gemellari e valutazione di eventuali correlazioni tra specifici parametri cardiaci materni ed esito sfavorevole della gravidanza. Metodi: Sono state arruolate in modo prospettico donne con gravidanze gemellari, sottoposte a controlli seriati della funzione cardiaca materna ( 20-23 settimane; 26-29 settimane e 30-33 settimane). Le pazienti in cui il parto si è verificato prima della 34°settimana compiuta di gestazione sono state escluse a priori dallo studio. Specifici parametri cardiaci campionati sono stati confrontati tra il gruppo di gravidanze con esito positivo ed il gruppo di pazienti che hanno sviluppato complicanze nel corso della gravidanza quali: preeclampsia o ipertensione gestazionale, basso peso alla nascita ( SGA: peso neonatale di uno o entrambi i feti < 5° centile per l’epoca di gestazione). Risultati: sono state incluse nello studio 28 gravidanze gemellari,di cui 8 complicate. Durante ogni visita abbiamo osservato un aumento significativo della gittata cardiaca ( CO ) e sistolica ( SV ) ed una caduta delle resistenze vascolari totali ( TVR ) nelle gravidanze gemellari normali vs complicate. Inoltre, CO, pressione arteriosa (BP), frequenza cardiaca ( HR ) e TVR son rimaste invariate nel corso dei controlli ambulatoriali per le gravidanze con esiti sfavorevole, mentre mostravano modificazioni significative ( CO, HR e BDP in aumento; TVR in diminuzione ) nel gruppo di pazienti con esito favorevole della gravidanza. Conclusioni: La valutazione longitudinale della funzione cardiaca materna sembra dimostrare una significativa differenza tra i valori dei parametri cardiaci materni delle gravidanze multiple non complicate, rispetto a quelle complicate da preeclampsia o neonati SGA.

Therapeutic vaccination for chronic hepatitis B in the Trimera mouse model

Therapeutic vaccination for chronic hepatitis B in the Trimera mouse modelrnRaja Vuyyuru and Wulf O. BöcherrnHepatitis B is a liver disease caused by Hepatitis B virus (HBV). It ranges in severity from a mild illness, lasting a few weeks (acute), to a serious long-term (chronic) illness that can lead either to liver disease or liver cancer. Acute infection is self limiting in most adults, resulting in clearance of virus from blood and liver and the development of lasting immunity. However 5% of acutely infected patients do not resolve primary HBV infection, leading to chronic infection with persistent viral replication in the liver. The strength of the initial antiviral immune response elicited to Hepatitis B determines the subsequent clinical outcome. A strong and broad T cell response leads to spontaneous resolution. Conversely, a weak T cell response favours viral persistence and establishment of chronic disease. While treatments using interferon-alpha or nucleos(t)ide analogues can reduce disease progression, they rarely lead to complete recovery. The lack of a suitable small animal model hampered efforts to understand the mechanisms responsible for immune failure in these chronic patients.rnIn current study we used Trimera mice to study the efficacy of potential vaccine candidates using HBV loaded dendritic cells in HBV chronic infection in vivo. The Trimera mouse model is based on Balb/c mice implanted with SCID mouse bone marrow and human peripheral blood mononuclear cells (PBMC) from HBV patients, and thus contains the immune system of the donor including their HBV associated T cell defect.rnIn our present study, strong HBV specific CD4+ and CD8+ T cell responses were enhanced by therapeutic vaccination in chronic HBV patients. These T cell responses occurred independently of either the course of the disease or the strength of their underlying HBV specific T cell failure. These findings indicate that the Trimera mouse model represents a novel experimental tool for evaluating potential anti-HBV immunotherapeutic agents. This in vivo data indicated that both the HBV specific CD4+ cell and CD8+ responses were elicited in the periphery. These HBV specific T cells proliferated and secreted cytokines upon restimulation in Trimera mice. The observation that these HBV specific T cells are not detectable directly ex vivo indicates that they must be immune tolerant or present at a very low frequency in situ. HBV specific T cell responses were suppressed in Trimera mice under viremic conditions, suggesting that viral factors might be directly involved in tolerizing or silencing antiviral T cell responses. Thus, combination of an effective vaccine with antiviral treatment to reduce viremia might be a more effective therapeutic strategy for the future. Such approaches should be tested in Trimera mice generated in HBV or HBs expressing transgenic mice before conducting clinical trials.rn

Physical coronary arteriogenesis: a human "model" of collateral growth promotion

In patients with coronary artery disease, the size of myocardial infarction mainly determines the subsequent clinical outcome. Accordingly, it is the primary strategy to decrease cardiovascular mortality by minimizing infarct size. Promotion of collateral artery growth (arteriogenesis) is an appealing option of reducing infarct size. It has been demonstrated in experimental models that tangential fluid shear stress is the major trigger of arterial remodeling and, thus, of collateral growth. Lower-leg, high-pressure external counterpulsation triggered to occur during diastole induces a flow velocity signal and thus tangential endothelial shear stress in addition to the flow signal caused by cardiac stroke volume. We here present two cases of cardiac transplant recipients as human "models" of physical coronary arteriogenesis, providing an example of progressing and regressing clinical arteriogenesis, and review available evidence from clinical studies on other feasible forms of physical arteriogenesis.

Clinical outcomes after PCI for acute coronary syndrome in unprotected left main coronary artery disease: insights from the Swiss Acute Left Main Coronary Vessel Percutaneous Management (SALVage) study

Unprotected left main (ULM) coronary artery disease is encountered in 3%-10% of coronary angiograms and is associated with high mortality. The survival of patients with ULM disease presenting with acute coronary syndromes (ACS) depends on different variables and is lowest in those with cardiogenic shock (CS). The aim of the present study was to estimate the impact of baseline characteristics on the subsequent clinical outcome in patients treated by percutaneous coronary intervention (PCI) of ULM for ACS.

Anti-inflammatory and immunosuppressive drugs and reproduction

Rheumatic diseases in women of childbearing years may necessitate drug treatment during a pregnancy, to control maternal disease activity and to ensure a successful pregnancy outcome. This survey is based on a consensus workshop of international experts discussing effects of anti-inflammatory, immunosuppressive and biological drugs during pregnancy and lactation. In addition, effects of these drugs on male and female fertility and possible long-term effects on infants exposed to drugs antenatally are discussed where data were available. Recommendations for drug treatment during pregnancy and lactation are given.

C-reactive protein production in term human placental tissue

OBJECTIVE: C-reactive protein (CRP) is a marker of systemic inflammation. Recently, it has been shown that CRP is present in amniotic fluid and fetal urine, and that elevated levels are associated with adverse pregnancy outcome. However, the precise source of amniotic fluid CRP, its regulation, and function during pregnancy is still a matter of debate. The present in vivo and in vitro studies were designed to investigate the production of CRP in human placental tissues. MATERIAL AND METHODS: Ten paired blood samples from peripheral maternal vein (MV), umbilical cord artery (UA) and umbilical vein (UV) were collected from women with elective caesarean sections at term. The placental protein accumulation capacity of hCG, hPL, leptin and CRP was compared with the dual in vitro perfusion method of an isolated cotyledon of human term placentae and quantified by ELISA. Values for accumulation (release) were calculated as total accumulation of maternal and fetal circuits normalized for tissue weight and duration of perfusion. For gene expression, RNA was extracted from placental tissue and reverse transcribed. RT-PCR and real-time PCR were performed using specific primers. RESULTS: The median (range) CRP level was significantly different between UA and UV [50.1 ng/ml (12.1-684.6) vs. 61 ng/ml (16.9-708.1)]. The median (range) difference between UV and UA was 9.3 ng/ml (2.2-31.6). A significant correlation was found between MV CRP and both UA and UV CRP levels. Median (range) MV CRP levels [2649 ng/ml (260.1-8299)] were 61.2 (6.5-96.8) fold higher than in the fetus. In vitro, the total accumulation rates (mean+/-SD) were 31+/-13 (mU/g/min, hCG), 1.16+/-0.19 (microg/g/min, hPL), 4.71+/-1.91 (ng/g/min, CRP), and 259+/-118 (pg/g/min, leptin). mRNA for hCG, hPL and leptin was detectable using conventional RT-PCR, while CRP mRNA could only be demonstrated by applying real-time RT-PCR. In the perfused tissue the transcript levels for the four proteins were comparable to those detected in the native control tissue. CONCLUSIONS: Our results demonstrate that the human placenta produces and releases CRP mainly into the maternal circulation similarly to other analyzed placental proteins under in vitro conditions. Further studies are needed to explore the exact role of placental CRP during pregnancy.

The vaginal microflora in relation to gingivitis

BACKGROUND: Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty. METHODS: Vaginal samples were collected from 180 women (mean age 29.4 years, SD +/- 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at >or= 20% of tooth sites. RESULTS: A Nugent score of 0-3 (normal vaginal microflora) was found in 83 women (46.1%), and a score of > 7 (BV) in 49 women (27.2%). Gingivitis was diagnosed in 114 women (63.3%). Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01). Independent of gingival conditions, vaginal bacterial counts were higher (p < 0.001) for 38/74 species in BV+ in comparison to BV- women. Counts of four lactobacilli species were higher in BV- women (p < 0.001). Independent of BV diagnosis, women with gingivitis had higher counts of Prevotella bivia (p < 0.001), and Prevotella disiens (p < 0.001). P. bivia, P. disiens, M. curtisii and M. mulieris (all at the p < 0.01 level) were found at higher levels in the BV+/G+ group than in the BV+/G- group. The sum of bacterial load (74 species) was higher in the BV+/G+ group than in the BV+/G- group (p < 0.05). The highest odds ratio for the presence of bacteria in vaginal samples (> 1.0 x 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5-5.7, p < 0.001) and 3.6 for P. disiens (95%CI: 1.8-7.5, p < 0.001), and a diagnosis of BV for P. bivia (odds ratio: 5.3, 95%CI: 2.6 to 10.4, p < 0.001) and P. disiens (odds ratio: 4.4, 95% CI: 2.2 to 8.8, p < 0.001). CONCLUSION: Higher vaginal bacterial counts can be found in women with BV and gingivitis in comparison to women with BV but not gingivitis. P. bivia and P. disiens may be of specific significance in a relationship between vaginal and gingival infections.

Patterns of care and outcomes for pregnant inmates and their infants in Texas state prisons: Epidemiologic and ethnographic analyses

Female inmates make up the fastest growing segment in our criminal justice system today. The rapidly increasing trend for female prisoners calls for enhanced efforts to strategically plan the correctional facilities that address the needs of this growing population, and to work with communities to prevent crime in women. The incarcerated women in the U.S. have an estimated 145,000 minor children who are predisposed to unique psychosocial problems as a result of parental incarceration.^ This study examined the patterns of care and outcomes for pregnant inmates and their infants in Texas state prisons between 1994 and 1996. The study population consists of 202 pregnant inmates who delivered in a 2-year period, and a randomly sampled comparison cohort of 804 women from general Texas population, matched on race and educational levels. Both quantitative and qualitative data were used to elucidate the inmates' risk-factor profile, delivery/birth outcomes, and the patterns of care during pregnancy. The continuity-of-care issues for this population were also explored.^ Epidemiologic data were derived from multiple record systems to establish the comparison between two cohorts. A significantly great proportion of the inmates have prior lifestyle risk-factors (smoking, alcohol, and illicit drug abuse), poorer health status, and worse medical history. However, most of these existing risk-factors seem to show little manifestation in their current pregnancy. On the basis of maternal labor/delivery outcome and a number of neonatal indicators, this study found some evidence of a better pregnancy outcome for the inmate cohort when compared to the comparison group. Some possible explanations of this paradox were discussed. Seventeen percent of inmates gave birth to infants with suspected congenital syphilis. The placement patterns for the infants' care immediately after birth were elucidated.^ In addition to the quantitative data, an ethnographic approach was used to collect qualitative data from a subset of the inmate cohort (n = 20) and 12 care providers. The qualitative data were analyzed for their contents and themes, giving rise to a detailed description of the inmates' pregnancy experience. Eleven themes emerged from the study's thematic analysis, which provides the context for interpreting the epidemiologic data.^ Meaningful findings in this study were presented in a three-dimensional matrix to shed light on the apparent relationship between outcome indicators and their potential determinants. The suspected "linkages" between the outcome and their determinants can be used to generate hypotheses for future studies. ^

Continuous milking of dairy cows disrupts timing of peak IgG concentration appearance in mammary secretions

The length of the dry period in commercial dairy production is under close scrutiny. While the main concern is the composition and volume of milk produced, the evaluation of colostrum quality under these new paradigms has suggested a decline in IgG concentrations, while some reports indicate no change. Colostrum quality has been defined as an adequate concentration (>50 mg/ml) of immunoglobulin in the secretions to provide the newborn with maximal disease resistance. We investigated the appearance of IgG in mammary pre- and post partum secretions in cows without a dry period (continuously milked, Dry0) and compared the secretions with cows that experienced a dry period of 60 d (Dry60). Blood was collected during the experimental period and plasma analysed for progesterone (P4) and prolactin (Prl). Approximately -6 d relative to parturition, the Dry0 animals exhibited increased concentration of IgG in their secretions to an average of ∼35 mg/ml that remained rather constant through subsequent pregnancy and following parturition. Dry0 cows were producing an average IgG concentration in parturition colostrum of 44·2±17·6 mg/ml that was not different than that of controls (66·86±16·8 mg/ml). However, Dry0 cows exhibited high variation, different peak times (day) of IgG concentration including times that occurred both pre and post parturition. IgG mass of the Dry0 cows remained rather constant pre- and post partum and did not show the same declining mass following parturition that was shown for the Dry60 cows. The change in plasma P4 and Prl were shown to have no timing effect on colostrum IgG concentration.

Postnatal retention in HIV care: insight from the Swiss HIV Cohort Study over a 15-year observational period.

OBJECTIVES The aim of this study was to quantify loss to follow-up (LTFU) in HIV care after delivery and to identify risk factors for LTFU, and implications for HIV disease progression and subsequent pregnancies. METHODS We used data on pregnancies within the Swiss HIV Cohort Study from 1996 to 2011. A delayed clinical visit was defined as > 180 days and LTFU as no visit for > 365 days after delivery. Logistic regression analysis was used to identify risk factors for LTFU. RESULTS A total of 695 pregnancies in 580 women were included in the study, of which 115 (17%) were subsequent pregnancies. Median maternal age was 32 years (IQR 28-36 years) and 104 (15%) women reported any history of injecting drug use (IDU). Overall, 233 of 695 (34%) women had a delayed visit in the year after delivery and 84 (12%) women were lost to follow-up. Being lost to follow-up was significantly associated with a history of IDU [adjusted odds ratio (aOR) 2.79; 95% confidence interval (CI) 1.32-5.88; P = 0.007] and not achieving an undetectable HIV viral load (VL) at delivery (aOR 2.42; 95% CI 1.21-4.85; P = 0.017) after adjusting for maternal age, ethnicity and being on antiretroviral therapy (ART) at conception. Forty-three of 84 (55%) women returned to care after LTFU. Half of them (20 of 41) with available CD4 had a CD4 count < 350 cells/μL and 15% (six of 41) a CD4 count < 200 cells/μL at their return. CONCLUSIONS A history of IDU and detectable HIV VL at delivery were associated with LTFU. Effective strategies are warranted to retain women in care beyond pregnancy and to avoid CD4 cell count decline. ART continuation should be advised especially if a subsequent pregnancy is planned.

Effect of Multiple Freezing of Stallion Semen on Sperm Quality and Fertility

To increase the efficiency of equine semen, it could be useful to split the artificial insemination dose and refreeze the redundant spermatozoa. In experiment I, semen of 10 sires of the Hanoverian breed, with poor and good semen freezability, was collected by artificial vagina, centrifuged, extended in INRA82 at 400 × 106 sperm/mL, and automatically frozen. After this first routinely applied freezing program, semen from each stallion was thawed, resuspended in INRA82 at 40 × 106 sperm/mL, filled in 0.5-mL straws, and refrozen. These steps were repeated, and sperm concentration was adjusted to 20 × 106 sperm/mL after a third freezing cycle. Regardless of stallion freezability group, sperm motility and sperm membrane integrity (FITC/PNA-Syto-PI-stain) decreased stepwise after first, second, and third freezing (62.3% ± 9.35, 24.0% ± 15.4, 3.3% ± 4.34, P ≤ .05; 29.6% ± 8.64, 14.9% ± 6.38, 8.3% ± 3.24, P ≤ .05), whereas the percentage of acrosome-reacted cells increased (19.5% ± 7.59, 23.9% ± 8.51, 29.2% ± 6.58, P ≤ .05). Sperm chromatin integrity was unaffected after multiple freeze/thaw cycles (DFI value: 18.6% ± 6.6, 17.2% ± 6.84, 17.1% ± 7.21, P > .05). In experiment II estrous, Hanoverian warmblood mares were inseminated with a total of 200 × 106 spermatozoa of two stallions with either good or poor semen freezability originating from the first, second, and third freeze/thaw cycle. First-cycle pregnancy rates were 4/10, 40%; 1/10, 10%; and 0/10, 0%. In conclusion, as expected, sperm viability of stallion spermatozoa significantly decreases as a consequence of multiple freezing. However, sperm chromatin integrity was not affected. Pregnancy rates after insemination of mares with refrozen semen are reduced.

Improving the health and well-being of women at risk for neural tube defect recurrence

There is growing interest in providing women with internatal care, a package of healthcare and ancillary services that can improve their health during the period after the termination of one pregnancy but before the conception of the next pregnancy. Women who have had a pregnancy affected by a neural tube defect can especially benefit from internatal care because they are at increased risk for recurrence and improvements to their health during the inter-pregnancy period can prevent future negative birth outcomes. The dissertation provides three papers that inform the content of internatal care for women at risk for recurrence by examining descriptive epidemiology to develop an accurate risk profile of the population, assessing whether women at risk for recurrence would benefit from a psychosocial intervention, and determining how to improve health promotion efforts targeting folic acid use.^ Paper one identifies information relevant for developing risk profiles and conducting risk assessments. A number of investigations have found that the risk for neural tube defects differs between non-Hispanic Whites and Hispanics. To understand the risk difference, the descriptive epidemiology of spina bifida and anencephaly was examined for Hispanics and non-Hispanic Whites based on data from the Texas Birth Defects Registry for the years 1999 through 2004. Crude and adjusted birth prevalence ratios and corresponding 95% confidence intervals were calculated between descriptive epidemiologic characteristics and anencephaly and spina bifida for non-Hispanic Whites and for Hispanics. In both race/ethnic groups, anencephaly expressed an inverse relationship with maternal age and a positive linear relationship with parity. Both relationships were stronger in non-Hispanic Whites. Female infants had a higher risk for anencephaly in non-Hispanic Whites. Lower maternal education was associated with increased risk for spina bifida in Hispanics.^ Paper two assesses the need for a psychosocial intervention. For mothers who have children with spina bifida, the transition to motherhood can be stressful. This qualitative study explored the process of becoming a mother to a child with spina bifida focusing particularly on stress and coping in the immediate postnatal environment. Semi-structured interviews were conducted with six mothers who have children with spina bifida. Mothers were asked about their initial emotional and problem-based coping efforts, the quality and kind of support provided by health providers, and the characteristics of their meaning-based coping efforts; questions matched Transactional Model of Stress and Coping (TMSC) constructs. Analysis of the responses revealed a number of modifiable stress and coping transactions, the most salient being: health providers are in a position to address beliefs about self-causality and prevent mothers from experiencing the repercussions that stem from maintaining these beliefs. ^ Paper three identifies considerations when creating health promotion materials targeting folic acid use. A brochure was designed using concepts from the Precaution Adoption Process Model (PAPM). Three focus groups comprising 26 mothers of children with spina bifida evaluated the brochure. One focus group was conducted in Spanish-only, the other two focus groups were conducted in English and Spanish combined. Qualitative analysis of coded transcripts revealed that a brochure is a helpful adjunct. Questions about folic acid support the inclusion of an insert with basic information. There may be a need to develop different educational material for Hispanics so the importance of folic acid is provided in a situational context. Some participants blamed themselves for their pregnancy outcome which may affect their receptivity to messages in the brochure. The women's desire for photographs that affect their perception of threat and their identification with the second role model indicate they belong to PAPM Stage 2 and 3. Participants preferred colorful envelopes, high quality paper, intimidating photographs, simple words, conversational style sentences, and positive messages.^ These papers develop the content of risk assessment, psychosocial intervention, and health promotion components of internatal care as they apply to women at risk for recurrence. The findings provided evidence for considering parity and maternal age when assessing nutritional risk. The two dissimilarities between the two race/ethnic groups, infant sex and maternal education lent support to creating separate risk profiles. Interviews with mothers of children with spina bifida revealed the existence of unmet needs-suggesting that a psychosocial intervention provided as part of internatal care can strengthen and support women's well-being. Segmenting the audience according to race/ethnicity and PAPM stage can improve the relevance of print materials promoting folic acid use.^

AMERICAN TRYPANOSOMIASIS (CHAGAS') DISEASE - A STUDY OF FETO-MATERNAL MORBIDITY AND MORTALITY

The possibility of a relationship between American Trypanosomiasis (Chagas') disease and pregnancy outcome was analyzed measuring feto-maternal morbidity and mortality in a sample of 604 pregnant women and their offspring seen at the Hospital Universitario de Maternidad y Neonatologia in Cordoba, Argentina during 1979.^ A cross-sectional, "case-comparison" investigation was employed to determine the degree of risk between having a reactive chagasic serologic test and a negative pregnancy outcome as determined by abortion, stillbirth, and infant death prior to one week of age. Patients were selected using a dichotomous, 0-1 scale with either the presence or the absence of a reactive Machado-Guerreiro complement fixation serologic blood test result.^ The data obtained were analyzed using appropriate statistical techniques for measuring the comparisons between the case and control groups under various demographic and socioeconomic variables such as, age, marital status, educational attainment, and residence. Similarly, additional biological variables of birth order, maternal and fetal complications, and prematurity were examined.^ From the analysis of the data obtained in this investigation, no definite conclusions can be reached regarding the risk of having an unsuccessful pregnancy outcome in the presence of a reactive serologic finding because the study design was a cross-sectional one and the number of events were too few for an adequate analysis. Notwithstanding these limitations, the results obtained, after statistical adjustments were employed, demonstrated that women with a reactive test result were older, were of a higher parity, and were less educated. Marital status and residence were not significant variables. The risk of pregnancy wastage, however, was almost twice as frequent in the reactive group as in the non-reactive group of women. Statistically significant differences in maternal morbidity involved two complications, polyhydramnios and varicosities of the lower extremities and vulva; while in the newborn, infection was higher in infants whose mothers exhibited a reactive serologic test result.^ In summary, what this research study has shown is the need for engaging in a larger, longitudinal study for an in-depth exploration of feto-maternal morbidity and mortality--an investigation that would corraborate or refute the findings of this study.^

The effects of adequacy and content of prenatal care on birth outcomes in a high -risk Missouri population

The purpose of this observational study was investigation of the relationship between quantitative adequacy of prenatal care, specific prenatal care content and pregnancy outcome in a high risk Missouri population. A sample of 1484 women from three Missouri regions known to have high rates of low birth weight, infant mortality, and inadequate prenatal care rates participated in structured post-partum interviews. Approximately one-half of the sample had received adequate prenatal care and the other half inadequate prenatal care as determined by an index utilized by the Missouri Department of Health.^ Prenatal care content was assessed by reports of prenatal education in six different areas: Diet, smoking, alcohol, drug, preterm labor counseling, and advice on when to call the health provider if preterm labor was suspected by the woman. Low birth weight, in both term and preterm infants, were the two birth outcomes examined. A variety of maternal socio-demographic variables were also considered.^ The results of this study suggest that specific educational content, delivered during prenatal care, may have lessen the risk of giving birth to a preterm-low birth weight infant. Prenatal education for recognition of preterm labor, and advice on when to call the health provider if preterm labor was suspected were found to be associated with a decreased risk of preterm delivery. Specific educational content was not, however, associated with risk of term-low weight birth nor was quantitative adequacy of care associated with the risk of either term- or preterm-low birth weight.^ These findings reinforce a body of literature which stresses the importance of appropriate prenatal care in preventing preterm low birth weight. Additionally, the findings suggest interventions that may be specifically effective for prematurity prevention. ^

An Intercomparison of Modelling Approaches for Simulating the Atmospheric Dispersion of Ammonia Emitted by Agricultural Sources

RESUMEN La dispersión del amoniaco (NH3) emitido por fuentes agrícolas en medias distancias, y su posterior deposición en el suelo y la vegetación, pueden llevar a la degradación de ecosistemas vulnerables y a la acidificación de los suelos. La deposición de NH3 suele ser mayor junto a la fuente emisora, por lo que los impactos negativos de dichas emisiones son generalmente mayores en esas zonas. Bajo la legislación comunitaria, varios estados miembros emplean modelos de dispersión inversa para estimar los impactos de las emisiones en las proximidades de las zonas naturales de especial conservación. Una revisión reciente de métodos para evaluar impactos de NH3 en distancias medias recomendaba la comparación de diferentes modelos para identificar diferencias importantes entre los métodos empleados por los distintos países de la UE. En base a esta recomendación, esta tesis doctoral compara y evalúa las predicciones de las concentraciones atmosféricas de NH3 de varios modelos bajo condiciones, tanto reales como hipotéticas, que plantean un potencial impacto sobre ecosistemas (incluidos aquellos bajo condiciones de clima Mediterráneo). En este sentido, se procedió además a la comparación y evaluación de varias técnicas de modelización inversa para inferir emisiones de NH3. Finalmente, se ha desarrollado un modelo matemático simple para calcular las concentraciones de NH3 y la velocidad de deposición de NH3 en ecosistemas vulnerables cercanos a una fuente emisora. La comparativa de modelos supuso la evaluación de cuatro modelos de dispersión (ADMS 4.1; AERMOD v07026; OPS-st v3.0.3 y LADD v2010) en un amplio rango de casos hipotéticos (dispersión de NH3 procedente de distintos tipos de fuentes agrícolas de emisión). La menor diferencia entre las concentraciones medias estimadas por los distintos modelos se obtuvo para escenarios simples. La convergencia entre las predicciones de los modelos fue mínima para el escenario relativo a la dispersión de NH3 procedente de un establo ventilado mecánicamente. En este caso, el modelo ADMS predijo concentraciones significativamente menores que los otros modelos. Una explicación de estas diferencias podríamos encontrarla en la interacción de diferentes “penachos” y “capas límite” durante el proceso de parametrización. Los cuatro modelos de dispersión fueron empleados para dos casos reales de dispersión de NH3: una granja de cerdos en Falster (Dinamarca) y otra en Carolina del Norte (EEUU). Las concentraciones medias anuales estimadas por los modelos fueron similares para el caso americano (emisión de granjas ventiladas de forma natural y balsa de purines). La comparación de las predicciones de los modelos con concentraciones medias anuales medidas in situ, así como la aplicación de los criterios establecidos para la aceptación estadística de los modelos, permitió concluir que los cuatro modelos se comportaron aceptablemente para este escenario. No ocurrió lo mismo en el caso danés (nave ventilada mecánicamente), en donde el modelo LADD no dio buenos resultados debido a la ausencia de procesos de “sobreelevacion de penacho” (plume-rise). Los modelos de dispersión dan a menudo pobres resultados en condiciones de baja velocidad de viento debido a que la teoría de dispersión en la que se basan no es aplicable en estas condiciones. En situaciones de frecuente descenso en la velocidad del viento, la actual guía de modelización propone usar un modelo que sea eficaz bajo dichas condiciones, máxime cuando se realice una valoración que tenga como objeto establecer una política de regularización. Esto puede no ser siempre posible debido a datos meteorológicos insuficientes, en cuyo caso la única opción sería utilizar un modelo más común, como la versión avanzada de los modelos Gausianos ADMS o AERMOD. Con el objetivo de evaluar la idoneidad de estos modelos para condiciones de bajas velocidades de viento, ambos modelos fueron utilizados en un caso con condiciones Mediterráneas. Lo que supone sucesivos periodos de baja velocidad del viento. El estudio se centró en la dispersión de NH3 procedente de una granja de cerdos en Segovia (España central). Para ello la concentración de NH3 media mensual fue medida en 21 localizaciones en torno a la granja. Se realizaron también medidas de concentración de alta resolución en una única localización durante una campaña de una semana. En este caso, se evaluaron dos estrategias para mejorar la respuesta del modelo ante bajas velocidades del viento. La primera se basó en “no zero wind” (NZW), que sustituyó periodos de calma con el mínimo límite de velocidad del viento y “accumulated calm emissions” (ACE), que forzaban al modelo a calcular las emisiones totales en un periodo de calma y la siguiente hora de no-calma. Debido a las importantes incertidumbres en los datos de entrada del modelo (inputs) (tasa de emisión de NH3, velocidad de salida de la fuente, parámetros de la capa límite, etc.), se utilizó el mismo caso para evaluar la incertidumbre en la predicción del modelo y valorar como dicha incertidumbre puede ser considerada en evaluaciones del modelo. Un modelo dinámico de emisión, modificado para el caso de clima Mediterráneo, fue empleado para estimar la variabilidad temporal en las emisiones de NH3. Así mismo, se realizó una comparativa utilizando las emisiones dinámicas y la tasa constante de emisión. La incertidumbre predicha asociada a la incertidumbre de los inputs fue de 67-98% del valor medio para el modelo ADMS y entre 53-83% del valor medio para AERMOD. La mayoría de esta incertidumbre se debió a la incertidumbre del ratio de emisión en la fuente (50%), seguida por la de las condiciones meteorológicas (10-20%) y aquella asociada a las velocidades de salida (5-10%). El modelo AERMOD predijo mayores concentraciones que ADMS y existieron más simulaciones que alcanzaron los criterios de aceptabilidad cuando se compararon las predicciones con las concentraciones medias anuales medidas. Sin embargo, las predicciones del modelo ADMS se correlacionaron espacialmente mejor con las mediciones. El uso de valores dinámicos de emisión estimados mejoró el comportamiento de ADMS, haciendo empeorar el de AERMOD. La aplicación de estrategias destinadas a mejorar el comportamiento de este último tuvo efectos contradictorios similares. Con el objeto de comparar distintas técnicas de modelización inversa, varios modelos (ADMS, LADD y WindTrax) fueron empleados para un caso no agrícola, una colonia de pingüinos en la Antártida. Este caso fue empleado para el estudio debido a que suponía la oportunidad de obtener el primer factor de emisión experimental para una colonia de pingüinos antárticos. Además las condiciones eran propicias desde el punto de vista de la casi total ausencia de concentraciones ambiente (background). Tras el trabajo de modelización existió una concordancia suficiente entre las estimaciones obtenidas por los tres modelos. De este modo se pudo definir un factor de emisión de para la colonia de 1.23 g NH3 por pareja criadora por día (con un rango de incertidumbre de 0.8-2.54 g NH3 por pareja criadora por día). Posteriores aplicaciones de técnicas de modelización inversa para casos agrícolas mostraron también un buen compromiso estadístico entre las emisiones estimadas por los distintos modelos. Con todo ello, es posible concluir que la modelización inversa es una técnica robusta para estimar tasas de emisión de NH3. Modelos de selección (screening) permiten obtener una rápida y aproximada estimación de los impactos medioambientales, siendo una herramienta útil para evaluaciones de impactos en tanto que permite eliminar casos que presentan un riesgo potencial de daño bajo. De esta forma, lo recursos del modelo pueden Resumen (Castellano) destinarse a casos en donde la posibilidad de daño es mayor. El modelo de Cálculo Simple de los Límites de Impacto de Amoniaco (SCAIL) se desarrolló para obtener una estimación de la concentración media de NH3 y de la tasa de deposición seca asociadas a una fuente agrícola. Está técnica de selección, basada en el modelo LADD, fue evaluada y calibrada con diferentes bases de datos y, finalmente, validada utilizando medidas independientes de concentraciones realizadas cerca de las fuentes. En general SCAIL dio buenos resultados de acuerdo a los criterios estadísticos establecidos. Este trabajo ha permitido definir situaciones en las que las concentraciones predichas por modelos de dispersión son similares, frente a otras en las que las predicciones difieren notablemente entre modelos. Algunos modelos nos están diseñados para simular determinados escenarios en tanto que no incluyen procesos relevantes o están más allá de los límites de su aplicabilidad. Un ejemplo es el modelo LADD que no es aplicable en fuentes con velocidad de salida significativa debido a que no incluye una parametrización de sobreelevacion del penacho. La evaluación de un esquema simple combinando la sobreelevacion del penacho y una turbulencia aumentada en la fuente mejoró el comportamiento del modelo. Sin embargo más pruebas son necesarias para avanzar en este sentido. Incluso modelos que son aplicables y que incluyen los procesos relevantes no siempre dan similares predicciones. Siendo las razones de esto aún desconocidas. Por ejemplo, AERMOD predice mayores concentraciones que ADMS para dispersión de NH3 procedente de naves de ganado ventiladas mecánicamente. Existe evidencia que sugiere que el modelo ADMS infraestima concentraciones en estas situaciones debido a un elevado límite de velocidad de viento. Por el contrario, existen evidencias de que AERMOD sobreestima concentraciones debido a sobreestimaciones a bajas Resumen (Castellano) velocidades de viento. Sin embrago, una modificación simple del pre-procesador meteorológico parece mejorar notablemente el comportamiento del modelo. Es de gran importancia que estas diferencias entre las predicciones de los modelos sean consideradas en los procesos de evaluación regulada por los organismos competentes. Esto puede ser realizado mediante la aplicación del modelo más útil para cada caso o, mejor aún, mediante modelos múltiples o híbridos. ABSTRACT Short-range atmospheric dispersion of ammonia (NH3) emitted by agricultural sources and its subsequent deposition to soil and vegetation can lead to the degradation of sensitive ecosystems and acidification of the soil. Atmospheric concentrations and dry deposition rates of NH3 are generally highest near the emission source and so environmental impacts to sensitive ecosystems are often largest at these locations. Under European legislation, several member states use short-range atmospheric dispersion models to estimate the impact of ammonia emissions on nearby designated nature conservation sites. A recent review of assessment methods for short-range impacts of NH3 recommended an intercomparison of the different models to identify whether there are notable differences to the assessment approaches used in different European countries. Based on this recommendation, this thesis compares and evaluates the atmospheric concentration predictions of several models used in these impact assessments for various real and hypothetical scenarios, including Mediterranean meteorological conditions. In addition, various inverse dispersion modelling techniques for the estimation of NH3 emissions rates are also compared and evaluated and a simple screening model to calculate the NH3 concentration and dry deposition rate at a sensitive ecosystem located close to an NH3 source was developed. The model intercomparison evaluated four atmospheric dispersion models (ADMS 4.1; AERMOD v07026; OPS-st v3.0.3 and LADD v2010) for a range of hypothetical case studies representing the atmospheric dispersion from several agricultural NH3 source types. The best agreement between the mean annual concentration predictions of the models was found for simple scenarios with area and volume sources. The agreement between the predictions of the models was worst for the scenario representing the dispersion from a mechanically ventilated livestock house, for which ADMS predicted significantly smaller concentrations than the other models. The reason for these differences appears to be due to the interaction of different plume-rise and boundary layer parameterisations. All four dispersion models were applied to two real case studies of dispersion of NH3 from pig farms in Falster (Denmark) and North Carolina (USA). The mean annual concentration predictions of the models were similar for the USA case study (emissions from naturally ventilated pig houses and a slurry lagoon). The comparison of model predictions with mean annual measured concentrations and the application of established statistical model acceptability criteria concluded that all four models performed acceptably for this case study. This was not the case for the Danish case study (mechanically ventilated pig house) for which the LADD model did not perform acceptably due to the lack of plume-rise processes in the model. Regulatory dispersion models often perform poorly in low wind speed conditions due to the model dispersion theory being inapplicable at low wind speeds. For situations with frequent low wind speed periods, current modelling guidance for regulatory assessments is to use a model that can handle these conditions in an acceptable way. This may not always be possible due to insufficient meteorological data and so the only option may be to carry out the assessment using a more common regulatory model, such as the advanced Gaussian models ADMS or AERMOD. In order to assess the suitability of these models for low wind conditions, they were applied to a Mediterranean case study that included many periods of low wind speed. The case study was the dispersion of NH3 emitted by a pig farm in Segovia, Central Spain, for which mean monthly atmospheric NH3 concentration measurements were made at 21 locations surrounding the farm as well as high-temporal-resolution concentration measurements at one location during a one-week campaign. Two strategies to improve the model performance for low wind speed conditions were tested. These were ‘no zero wind’ (NZW), which replaced calm periods with the minimum threshold wind speed of the model and ‘accumulated calm emissions’ (ACE), which forced the model to emit the total emissions during a calm period during the first subsequent non-calm hour. Due to large uncertainties in the model input data (NH3 emission rates, source exit velocities, boundary layer parameters), the case study was also used to assess model prediction uncertainty and assess how this uncertainty can be taken into account in model evaluations. A dynamic emission model modified for the Mediterranean climate was used to estimate the temporal variability in NH3 emission rates and a comparison was made between the simulations using the dynamic emissions and a constant emission rate. Prediction uncertainty due to model input uncertainty was 67-98% of the mean value for ADMS and between 53-83% of the mean value for AERMOD. Most of this uncertainty was due to source emission rate uncertainty (~50%), followed by uncertainty in the meteorological conditions (~10-20%) and uncertainty in exit velocities (~5-10%). AERMOD predicted higher concentrations than ADMS and more of the simulations met the model acceptability criteria when compared with the annual mean measured concentrations. However, the ADMS predictions were better correlated spatially with the measurements. The use of dynamic emission estimates improved the performance of ADMS but worsened the performance of AERMOD and the application of strategies to improved model performance had similar contradictory effects. In order to compare different inverse modelling techniques, several models (ADMS, LADD and WindTrax) were applied to a non-agricultural case study of a penguin colony in Antarctica. This case study was used since it gave the opportunity to provide the first experimentally-derived emission factor for an Antarctic penguin colony and also had the advantage of negligible background concentrations. There was sufficient agreement between the emission estimates obtained from the three models to define an emission factor for the penguin colony (1.23 g NH3 per breeding pair per day with an uncertainty range of 0.8-2.54 g NH3 per breeding pair per day). This emission estimate compared favourably to the value obtained using a simple micrometeorological technique (aerodynamic gradient) of 0.98 g ammonia per breeding pair per day (95% confidence interval: 0.2-2.4 g ammonia per breeding pair per day). Further application of the inverse modelling techniques for a range of agricultural case studies also demonstrated good agreement between the emission estimates. It is concluded, therefore, that inverse dispersion modelling is a robust technique for estimating NH3 emission rates. Screening models that can provide a quick and approximate estimate of environmental impacts are a useful tool for impact assessments because they can be used to filter out cases that potentially have a minimal environmental impact allowing resources to be focussed on more potentially damaging cases. The Simple Calculation of Ammonia Impact Limits (SCAIL) model was developed as a screening model to provide an estimate of the mean NH3 concentration and dry deposition rate downwind of an agricultural source. This screening tool, based on the LADD model, was evaluated and calibrated with several experimental datasets and then validated using independent concentration measurements made near sources. Overall SCAIL performed acceptably according to established statistical criteria. This work has identified situations where the concentration predictions of dispersion models are similar and other situations where the predictions are significantly different. Some models are simply not designed to simulate certain scenarios since they do not include the relevant processes or are beyond the limits of their applicability. An example is the LADD model that is not applicable to sources with significant exit velocity since the model does not include a plume-rise parameterisation. The testing of a simple scheme combining a momentum-driven plume rise and increased turbulence at the source improved model performance, but more testing is required. Even models that are applicable and include the relevant process do not always give similar predictions and the reasons for this need to be investigated. AERMOD for example predicts higher concentrations than ADMS for dispersion from mechanically ventilated livestock housing. There is evidence to suggest that ADMS underestimates concentrations in these situations due to a high wind speed threshold. Conversely, there is also evidence that AERMOD overestimates concentrations in these situations due to overestimation at low wind speeds. However, a simple modification to the meteorological pre-processor appears to improve the performance of the model. It is important that these differences between the predictions of these models are taken into account in regulatory assessments. This can be done by applying the most suitable model for the assessment in question or, better still, using multiple or hybrid models.