Blue carbon sinks in South Africa and the need for restoration to enhance carbon sequestration.

Blue carbon ecosystems (mangroves, salt marshes, and seagrasses) contribute towards climate change mitigation because they are efficient at sequestering atmospheric CO2 into long-term total ecosystem carbon stocks. Destruction or disturbance therefore reduces sink capacity and leads to significant CO2 emissions. This study reports the first national estimates of: 1) total carbon storage, 2) CO2 emissions from anthropogenic activities, 3) the potential for restoration to enhance carbon sequestration for blue carbon ecosystems in South Africa. Mangrove ecosystems have the greatest carbon storage per unit area (253-534 Mg C ha-1), followed by salt marshes (100-199 Mg C ha-1) and seagrasses (45-144 Mg C ha-1). Salt marshes are the most extensive and contribute 67 % to the national carbon stock of 4000 Gg C. Since 1930, 6500 ha has been lost across all blue carbon ecosystems (26 % of the natural extent), equivalent to losing 1086 Gg C from the national carbon stock. Historic CO2 emissions were estimated at an average rate of 30,266 t CO2e yr-1. Despite losses, a total of 3998 ha could be restored to increase carbon sequestration and CO2 removals of 14,845 tCO2e.yr-1. Extractive activities have declined rapidly in recent decades, but abiotic pressures on estuarine ecosystems (flow modification, reduced water quality, and artificial breaching) have been increasing. There is an urgent need to quantify the potential impact of these pressures and include them in estuarine management and restoration plans. Blue carbon ecosystems cover a relatively small area in South Africa, but they are valued for their multiple ecosystem services that contribute towards climate change adaptation and biodiversity co-benefits. These ecosystems need to be included in national policies driving climate change response in the Agriculture, Forestry and Other Land-Use (AFOLU) sector, such as incorporating them into the wetland subcategory of the national GHG inventory.

Healthcare provided by a homeopath as an adjunct to usual care for Fibromyalgia (FMS): results of a pilot Randomised Controlled Trial.

OBJECTIVES: To assess the feasibility of a Randomised Controlled Trial (RCT) design of usual care compared with usual care plus adjunctive care by a homeopath for patients with Fibromyalgia syndrome (FMS). METHODS: In a pragmatic parallel group RCT design, adults with a diagnosis of FMS (ACR criteria) were randomly allocated to usual care or usual care plus adjunctive care by a homeopath. Adjunctive care consisted of five in depth interviews and individualised homeopathic medicines. The primary outcome measure was the difference in Fibromyalgia Impact Questionnaire (FIQ) total score at 22 weeks. RESULTS: 47 patients were recruited. Drop out rate in the usual care group was higher than the homeopath care group (8/24 vs 3/23). Adjusted for baseline, there was a significantly greater mean reduction in the FIQ total score (function) in the homeopath care group than the usual care group (-7.62 vs 3.63). There were significantly greater reductions in the homeopath care group in the McGill pain score, FIQ fatigue and tiredness upon waking scores. We found a small effect on pain score (0.21, 95% CI -1.42 to 1.84); but a large effect on function (0.81, 95% CI -8.17 to 9.79). There were no reported adverse events. CONCLUSIONS: Given the acceptability of the treatment and the clinically relevant effect on function, there is a need for a definitive study to assess the clinical and cost effectiveness of adjunctive healthcare by a homeopath for patients with FMS.

Using endoscopic procedures for AN-DRG (Australian National Diagnosis Related Groups) assignment: Australia leads the way.

The study reported in this article sought to develop Australian National Diagnosis Related Groups (AN-DRGs) using endoscopic procedures in Major Diagnostic Category (MDC) 6 (Digestive System) and MDC 7 (Hepatobiliary System and Pancreas) through statistical analysis of the Australian Casemix Clinical Committee's recommendations. Five ANOVA were undertaken on final recommendations for gastroscopy and colonoscopy in MDC 6. The Reduction in Variance (RIV) for the AN-DRGs in version 3 relative to version 2 increased by up to 14.6%, representing RIV of between 25.28% to 32.30%. For all ANOVAs, F > 100, alpha < .0001, Coefficient of Variation (CV) was generally lower in version 3 by between 0.4% to 22.9%, except for AN-DRGs for other gastroscopy for major gastro-intestinal disease, which increased by 8.7%. Two ANOVA for Endoscopic Retrograde Cholangio-pancreatography Procedures (ERCP) recommendations resulted in RIV of up to 18.67%, F > 100, alpha < .0001 and CV up to 0.8091. MDC 6, in AN-DRG versions 3 and 3.1, has 11 AN-DRGs following the surgical hierarchy involving gastroscopy and colonoscopy. Patients assigned will not have an operating room procedure; they will have a non-operating room procedure that is either a complex therapeutic or other (diagnostic or therapeutic) procedure. Similar AN-DRGs are in MDC 7 for ERCP. Version 3.1 has expanded the definition of Common Bile Duct Exploration (CDE) to include ERCP. There is no separate AN-DRG for laparoscopy cholecystectomy.

Health workforce planning: an analysis of employer demand pertaining to the Victorian medical record administration & diagnostic coding workforces.

In 1990, LaTrobe University introduced the world's first Post-Graduate Diploma in Nosology, in response to unmet demand for diagnostic coders in Victoria. After the first graduates entered employment, a two-part study was undertaken. The composition, employment levels and projected institutional demand for the coding workforce (comprising medical record administrator coders, Nosologists and "unqualified" coders) were ascertained. In parallel, the current employment levels and projected demand for the institutional medical record administrator workforce also were investigated. The institutional variables of major health care role, annual inpatient discharges and operating sector were found to impact upon employment levels and demand for both workforces by current, prospective and non-employers. The study identified a minimal projected demand for nosologists, the reasons for which are postulated, and negligible projected demand for nonqualified coding personnel. The results highlight a health current and projected employer demand for both medical record administrators and medical record administrator coders.