Methodologies to measure access to care post-discharge in adults with serious injury-related disability: a scoping review.

PURPOSE: This scoping review examined the methodologies used to measure access to care in serious injury-related disability populations, for whom access to care post-discharge has significant implications for patient outcomes and rehabilitation trajectories. METHODS: Four electronic databases were searched for literature published between 1 January 2000 and 15 February 2022. Relevant articles needed to relate to access to care in adult community-dwelling trauma and rehabilitation populations. RESULTS: The initial search identified 679 articles. Following de-duplication, the title/abstract screening was completed on 533 articles, and 56 full-text articles were reviewed. Thirty-eight articles met the eligibility criteria and were included in this review. Of the 38 studies included, there was large heterogeneity in the methodologies used to measure access to care. Two articles used multidimensional measures of access to care. CONCLUSIONS: There is an urgent need to establish the use of multidimensional measures as standard practice in access-to-care research. Failure to account for the multidimensional nature of access to care limits the full realisation of access for people with serious injury-related disability and prevents the implementation of processes that could improve access to health, rehabilitation, and support services and enhance the quality of care for individuals with a serious injury-related disability.

A consistently comprehensive approach to rehabilitation research will provide clearer insight into users' experiences and how to optimise their engagement with services.Multidimensional measures of access to care need to be developed, validated, and used to capture the complexity of access to rehabilitation care and what is important to users.More comprehensive evidence can strengthen consensus on the gold standard of what must be included in the measurement of access to rehabilitation care, to improve service reach and relevance.

Short-Term Effects of the Anti-sea Lice Therapeutant Emamectin Benzoate on Clam Worms (Nereis virens).

The polychaete Nereis virens occurs commonly in marine sediments, is widely distributed, and is a popular bait species, as well as a potential replacement for wild-caught fish in commercial fish feed preparations. It is being considered as a potential co-extractive species for culture in integrated multi-trophic aquaculture operations. However, it is not known whether pesticides or drugs used to treat sea lice on farmed salmon, such as emamectin benzoate (EB), would adversely affect cultured or wild worms, because these compounds may persist in the environment. To determine the potential effects of EB to N. virens, bioassays were performed wherein worms were exposed in sand for 30 days to a concentration of 400 µg/kg dw (nominal). While no treatment-related mortality occurred, significant decreases in worm mass and marked behavioral changes (lack of burrowing) were observed in EB-treated sand compared with controls. These lab-based observations suggest a potential hazard to worms at sites where EB treatments have occurred.

Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus.

AIMS: To evaluate the impact of an integrated model of care for patients with complex Type 2 diabetes mellitus on potentially preventable hospitalizations. METHODS: A prospective controlled trial was conducted comparing a multidisciplinary, community-based, integrated primary-secondary care diabetes service with usual care at a hospital diabetes outpatient clinic. Study and hospital admissions data were linked for the period from 12 months before to 24 months after commencement of the trial. The primary outcome was the number of potentially preventable hospitalizations with diabetes-related principal diagnoses. Length of stay once hospitalized was also reported. RESULTS: Of 327 adult participants, 206 were hospitalized and accounted for 667 admissions during the study period. Compared with the usual care group, patients in the integrated model of care group were nearly half as likely to be hospitalized for a potentially preventable diabetes-related principal diagnosis in the 24 months after study commencement (incidence rate ratio 0.53, 95% CI 0.29, 0.96; P = 0.04). The magnitude of the result remained similar after adjusting for age, sex, education and baseline HbA1c concentration (incidence rate ratio 0.54, 95% CI 0.29, 1.01; P = 0.05).When hospitalized, patients in the integrated care group had a similar length of stay compared with those in the usual care group (median difference -2 days, 95% CI -6.5, 2.3; P = 0.33). CONCLUSIONS: Patients receiving the integrated model of care had a reduction in the number of hospitalizations when the principal diagnosis for admission was a diabetes-related complication. Integrated models of care for people with complex diabetes can reduce hospitalizations and help attempts to curtail increasing demand on finite health services.

Sublethal exposure to azamethiphos causes neurotoxicity, altered energy allocation and high mortality during simulated live transport in American lobster.

In the Bay of Fundy, New Brunswick, sea lice outbreaks in caged salmon are treated with pesticides including Salmosan(®), applied as bath treatments and then released into the surrounding seawater. The effect of chronic exposure to low concentrations of this pesticide on neighboring lobster populations is a concern. Adult male lobsters were exposed to 61 ngL(-1) of azamethiphos (a.i. in Salmosan(®) formulation) continuously for 10 days. In addition to the direct effects of pesticide exposure, effects on the ability to cope with shipping conditions and the persistence of the effects after a 24h depuration period in clean seawater were assessed. Indicators of stress and hypoxia (serum total proteins, hemocyanin and lactate), oxidative damage (protein carbonyls in gills and serum) and altered energy allocation (hepatosomatic and gonadosomatic indices, hepatopancreas lipids) were assessed in addition to neurotoxicity (chlolinesterase activity in muscle). Directly after exposure, azamethiphos-treated lobsters had inhibition of muscle cholinesterase, reduced gonadosomatic index and enhanced hepatosomatic index and hepatopancreas lipid content. All these responses persisted after 24-h depuration, increasing the risk of cumulative impacts with further exposure to chemical or non-chemical stressors. In both control and treated lobsters exposed to simulated shipment conditions, concentrations of protein and lactate in serum, and protein carbonyls in gills increased. However, mortality rate was higher in azamethiphos-treated lobsters (33 ± 14%) than in controls (2.6 ± 4%). Shipment and azamethiphos had cumulative impacts on serum proteins. Both direct effects on neurological function and energy allocation and indirect effect on ability to cope with shipping stress could have significant impacts on lobster population and/or fisheries.

The influence of water temperature on induced liver EROD activity in Atlantic cod (Gadus morhua) exposed to crude oil and oil dispersants.

Juvenile Atlantic cod were exposed to either the water-accommodated fraction (WAF) or the chemically enhanced water-accommodated fraction (CEWAF) of Mediterranean South American (MESA), a medium grade crude oil at three different temperatures. Two concentrations of each mixture were tested, 0.2% and 1.0% (v/v) at 2, 7 and 10°C. Corexit 9500 was the chemical dispersant tested. The liver enzyme ethoxyresorufin-O-deethylase (EROD) was measured during a 72-h exposure. The WAF of oil had significant (P<0.05) effect on enzyme activity compared to controls at only one sampling time: 48 h at 10°C. Exposure of CEWAF of oil resulted in significantly (P<0.05) elevated EROD activity compared to controls. The level of EROD induction was temperature related with higher induction being observed in cod exposed to CEWAF at higher temperatures. Total polycyclic aromatic hydrocarbon (PAH) concentrations in exposure water were significantly higher in chemically dispersed mixtures. While PAH concentrations were lower in the 2°C water compared to 7 or 10°C (8.7 vs 11.9 µg mL(-1)), the level of EROD induction was approximately 9 and 12 times lower at 2°C compared to 7 or 10°C, respectively, suggesting the metabolic rate of the cod plays a role in the enzyme response. These data suggest the risk of negative impacts associated with exposure to chemically dispersed oil may be affected by water temperature and that risk assessment of potential effects of WAF or CEWAF should consider the effects of water temperature on the physiology of the fish as well as the effectiveness of dispersants.

The effect of repeated exposure to azamethiphos on survival and spawning in the American lobster (Homarus americanus).

The azamethiphos formulation Salmosan has been used to control sea lice on Atlantic salmon. To determine the effect of this pesticide on spawning in the American lobster, pre-ovigerous females acclimated to 13 degrees C were given biweekly 1-h exposures to Salmosan at concentrations of 1.25-10 microg/L azamethiphos. In March and April, four exposures to 1.25, 2.5, or 5.0 microg/L had no significant effect on survival or spawning incidence, while three or four exposures to 10 microg/L caused high mortality (43-100%). Spawning incidence in the surviving lobsters in the 10 microg/L groups was significantly reduced in the group given four treatments, but not in the group given three treatments. In December and January, four exposures to 10 microg/L azamethiphos had no significant effect on either survival or spawning incidence. The results demonstrate that repeated 1-h biweekly exposures to azamethiphos can have a negative effect on survival and spawning in female American lobsters. The response to this pesticide appears to be influenced by time of year, as well as concentration and number of exposures.

Relationship between dose of emamectin benzoate and molting response of ovigerous American lobsters (Homarus americanus).

A widely-prescribed treatment to control sea lice on cultured salmon is the administration of feed medicated with SLICE (active ingredient emamectin benzoate (EMB)). High doses of EMB can disrupt the molt cycle of ovigerous American lobsters, causing them to enter proecdysis prematurely and lose their attached eggs when the shell is cast. To determine the dose response to EMB, lobsters were forced to ingest doses that ranged from 0.05 to 0.39 microg g(-1). A significant proportion of lobsters given doses of 0.39 and 0.22 microg g(-1) (37% and 23%, respectively) molted prematurely, almost a year earlier than the control group. All the lobsters in the 0.05 and 0.12 microg g(-1) groups molted at the normal time and the mean time of molt was similar to that of the control group. Thus, the no-observed-effect level (NOEL) and lowest-observed-effect level (LOEL) of EMB on the molt cycle were 0.12 and 0.22 microg EMB g(-1) lobster, respectively. To acquire the LOEL, a 500-g lobster would have to consume 22 g of salmon feed medicated with SLICE at a level of 5 microg EMB g(-1) feed.

Seasonal lethality of the organophosphate pesticide, azamethiphos to female American lobster (Homarus americanus).

The organophosphate pesticide azamethiphos is the active ingredient in Salmosan, a product formerly registered in Canada for the treatment of cultured Atlantic salmon against infestations of the ectoparasite Lepeophtheirus salmonis. The 48-h LC50 of azamethiphos to female American lobsters was determined bimonthly for 2 years to determine whether the sensitivity of lobsters to azamethiphos varied with time of year, molt stage, or reproductive stage. The LC50's ranged from 0.61 to 3.24 microg/L. The lobsters were most sensitive to azamethiphos during the spawning and molting seasons which occur in the summer and early fall when seawater temperatures are highest. Testing of compounds on this species for regulatory purposes should take into account that there may be variations in sensitivity during the molt and reproductive cycles.

Effects of water-borne 4-nonylphenol and 17beta-estradiol exposures during parr-smolt transformation on growth and plasma IGF-I of Atlantic salmon (Salmo salar L.).

4-Nonylphenol (4-NP) is an endocrine disrupting substance (EDS) capable of mimicking the action of 17beta-estradiol (E2). It has been hypothesized that 4-NP in a pesticide formulation is linked to historical declines in Canadian Atlantic salmon (Salmo salar L.) populations, with effects being related to exposure during parr-smolt transformation (PST). To test this hypothesis, Atlantic salmon smolts were exposed to pulse-doses of water-borne 4-NP (20 ug/l), sustained doses of water-borne E2 (100 ng/l) (positive control), or ethanol vehicle (negative control) in mid-May during the final stages of PST. Individually tagged smolts were then sampled at three times (June, July and October) to monitor subsequent growth in sea water and plasma insulin-like growth factor I (IGF-I) concentrations. Smolt weights and plasma IGF-I concentrations were both affected by E2 and 4-NP. The effects of E2 and 4-NP on mean smolt weights were most prominent in July and October [E2 (*98.1 +/- 2.8, *242.3 +/- 10.6 g), 4-NP (*102.1 +/- 3.1, 255.7 +/- 9.5 g), controls (112.5 +/- 2.8, 282.3 +/- 8.8 g)] (P < 0.05), while their effects on mean plasma IGF-I concentrations were most prominent in June and October [E2 (15.0 +/- 1.9, 28.4 +/- 1.8 ng/ml), 4-NP (*14.8 +/- 1.9, *21.6 +/- 1.7 ng/ml), controls (20.0 +/- 1.1, 31.1 +/- 2.0 ng/ml)] (P < 0.05). Additionally, results suggest that the mechanisms of action of E2 and 4-NP involve disruption in the GH/IGF-I axis, and that they may be different from each other. The effects of E2 and 4-NP on growth and plasma IGF-I concentrations observed in this study are ecologically significant because they evoke concerns for successful growth and survival of wild salmon smolts exposed to low levels of estrogenic substances that may occur from current discharges into rivers supporting sea-run salmon stocks.

Aquaculture-related trace metals in sediments and lobsters and relevance to environmental monitoring program ratings for near-field effects.

The study was undertaken to assess the marine environmental effects from feed and waste associated with aquaculture activities. Metal compositions of sediment, lobster, and feed were used to evaluate the extent of detectable effects at 0 m (under the cage) and 50 m distance. Sediments that were collected under the cages and were characterised as hypoxic or anoxic, showed elevated levels of Cu, Zn, organic carbon, and % <63 microm particles, and low Mn and Fe. At 50 m there was a major reduction in waste chemical impact. Using lobster, a bioindicator species, as a tool for detecting near-field impacts, showed accumulations of high Cu associated with active aquaculture sites. Chemical compositions and metal ratios normalised with organic carbon, were used to assess the sediment conditions associated with environmental monitoring program ratings (EMP--normal, hypoxic, and anoxic). Principal component analysis (PCA) was used to explore chemical data at all sites for differentiating normal, hypoxic and anoxic sediment conditions. Selected variables (Cu, Zn, Fe, Mn, organic carbon, and particles <63 microm) were sufficient for the PCA approach with >90% explainable variance of first two components. The groupings based on PCA and cluster analysis were similar to EMP classifications with some exceptions of mis-identification by EMP. The sediment chemistry components were valid indicators for evaluating marine environmental conditions and for assessing aquaculture operating sites. The developed techniques, using chemical variables in combination with EMP and the statistical approach should be useful to predict the effects of aquaculture practices and the suitability of aquaculture operations.

The lethality of Salmosan (Azamethiphos) to American lobster (Homarus americanus) larvae, postlarvae, and adults.

The pesticide formulation Salmosan (47.5% w/w azamethiphos) is currently registered for use, in Canada, to treat salmonids for infestations of the copepod parasites, Lepeophtheirus salmonis and Caligus elongatus (sea lice). Determination was made of the acute lethality of this product to the three larval stages, the first postlarval stage, and the adult of the American lobster (Homarus americanus), a species of significant economic importance in Eastern Canada. The 48-h LC50 (as azamethiphos) is 3.57 microg/liter for Stage I, 1.03 microg/liter for Stage II, 2.29 microg/liter for Stage III, 2.12 microg/liter for Stage IV (the first postlarval stage), and 1.39 microg/liter for adults. These concentrations are not significantly different from each other, although the variability in response is greater in the larval stages than in the postlarvae or adults. These data when interpreted in conjunction with known physical oceanographic data and chemical dispersion studies indicate that single anti-louse treatments are unlikely to result in mortality among lobsters in the vicinity of salmon farms. However, the sublethal effects of this product and the effects of repeated exposures have yet to be determined.

Distinct but overlapping expression patterns of two vertebrate slit homologs implies functional roles in CNS development and organogenesis.

The Drosophila slit gene (sli) encodes a secreted leucine-rich repeat-containing protein (slit) expressed by the midline glial cells and required for normal neural development. A putative human sli homolog, SLIT1, has previously been identified by EST database scanning. We have isolated a second human sli homolog, SLIT2, and its murine homolog Slit2. Both SLIT1 and SLIT2 proteins show approximately 40% amino acid identity to slit and 60% identity to each other. In mice, both genes are expressed during CNS development in the floor plate, roof plate and developing motor neurons. As floor plate represents the vertebrate equivalent to the midline glial cells, we predict a conservation of function for these vertebrate homologs. Each gene shows additional but distinct sites of expression outside the CNS suggesting a variety of functions for these proteins.

Lethality of pyrethrins to larvae and postlarvae of the American lobster (Homarus americanus).

Pesticide formulations containing pyrethrins are being used to treat salmonids for infestations of the copepod parasites Lepeophtherius salmonis and Caligus elongatus (sea lice). The acute lethality of one such formulation to four larval stages of the American lobster (Homarus americanus), a species of significant economic importance in eastern Canada, was determined. The formulation tested contained 0.06% pyrethrins and 0.6% piperonyl butoxide (a synergist). Stage I larvae (48-h LC50 = 4.42 microg/liter) were significantly less sensitive than stage II, III, or IV larvae. Stage II larvae (48-h LC50 = 2.72 microg/liter) were significantly less sensitive than Stage III or IV larvae. Stage III and IV larvae were not significantly different in their response to the pyrethrins formulation (48-h LC50 = 1.39 and 0.73 microg/liter, respectively). Most published studies using lobster larvae have reported that the earliest larval stage was the most sensitive to chemicals. The results described here indicate that the earliest larval stage is the least sensitive to the pyrethrins formulation.

Challenging the traditional view of preoperative visiting.

Anxiety is a product of helplessness. Admission to hospital precipitates this by disturbing patients' integrity with their life-context. Anxiety is relative to the patient's sense of control, yet preoperative visiting which is meant to be caring may be perceived by the surgical patient as being controlled. The visit is influenced by personalized contact, the structure of the visit and the philosophy behind the preoperative visiting programme. The building of a quality relationship lays a foundation for quality caring, and challenges the visiting nurse to be less directive and more reciprocal, responding appropriately as the patient steers the course of the visit.