Identifying ecological production functions for use in ecosystem services-based environmental risk assessment of chemicals.

There is increasing research interest in the application of the ecosystem services (ES) concept in the environmental risk assessment of chemicals to support formulating and operationalising regulatory environmental protection goals and making environmental risk assessment more policy- and value-relevant. This requires connecting ecosystem structure and processes to ecosystem function and henceforth to provision of ecosystem goods and services and their economic valuation. Ecological production functions (EPFs) may help to quantify these connections in a transparent manner and to predict ES provision based on function-related descriptors for service providing species, communities, ecosystems or habitats. We review scientific literature for EPFs to evaluate availability across provisioning and regulation and maintenance services (CICES v5.1 classification). We found quantitative production functions for nearly all ES, often complemented with economic valuation of physical or monetary flows. We studied the service providing units in these EPFs to evaluate the potential for extrapolation of toxicity data for test species obtained from standardised testing to ES provision. A broad taxonomic representation of service providers was established, but quantitative models directly linking standard test species to ES provision were extremely scarce. A pragmatic way to deal with this data gap would be the use of proxies for related taxa and stepwise functional extrapolation to ES provision and valuation, which we conclude possible for most ES. We suggest that EPFs may be used in defining specific protection goals (SPGs), and illustrate, using pollination as an example, the availability of information for the ecological entity and attribute dimensions of SPGs. Twenty-five pollination EPFs were compiled from the literature for biological entities ranging from 'colony' to 'habitat', with 75% referring to 'functional group'. With about equal representation of the attributes 'function', 'abundance' and 'diversity', SPGs for pollination therefore would seem best substantiated by EPFs at the level of functional group.

The daily direct costs of isolating patients identified with highly resistant micro-organisms in a non-outbreak setting.

BACKGROUND: Isolation precautions are recommended when caring for patients identified with highly resistant micro-organisms (HRMOs). However, the direct costs of patients in isolation are largely unknown. AIM: To obtain detailed information on the daily direct costs associated with isolating patients identified with HRMOs. METHODS: This study was performed from November until December 2017 on a 12-bed surgical ward. This ward contained solely isolation rooms with anterooms. The daily direct costs of isolation were based on three cost items: (1) additional personal protective equipment (PPE), measured by counting the consumption of empty packaging materials; (2) cleaning and disinfection of the isolation room, based on the costs of an outsourced cleaning company; and (3) additional workload for healthcare workers, based on literature and multiplied by the average gross hourly salary of nurses. A distinction was made between the costs for strict isolation, contact-plus isolation, and contact isolation. FINDINGS: During the study period, 26 patients were nursed in isolation because of HRMO carriage. Time for donning and doffing of PPE was 31 min per day. The average daily direct costs of isolation were the least expensive for contact isolation (gown, gloves), €28/$31, and the most expensive for strict isolation (surgical mask, gloves, gown, cap), €41/$47. CONCLUSION: Using a novel, easy method to estimate consumption of PPE, we conclude that the daily direct costs of isolating a patient differ per type of isolation. Insight into the direct costs of isolation is of utmost importance when developing or updating infection prevention policies.

Assessment of the AAV-mediated expression of channelrhodopsin-2 and halorhodopsin in brainstem neurons mediating auditory signaling.

The physiology and circuitry associated with dorsal cochlear nucleus neurons (DCN) have been well described. The ability to remotely manipulate neuronal activity in these neurons would represent a step forward in the ability to understand the specific function of DCN neurons in hearing. Although, optogenetics has been used to study the function of pathways in other systems for several years, in the auditory system only neurons in the auditory cortex have been studied using this technique. Adeno-associated viral vectors with either channelrhodopsin-2 fused with GFP (ChR2-GFP) or halorhodopsin fused with mCherry (HaloR-mCherry), capable of expressing light sensitive cation channels or chloride pumps, respectively, were delivered into the dorsal cochlear nucleus (DCN). One to 18 months later, expression of ChR2 and HaloR was observed throughout the DCN. Rhodopsin distribution within the DCN was determined to be within several cell types identified based on morphology and location within the DCN. Expression of ChR2-GFP and HaloR-mCherry was found at both the injection site as well as in regions receiving projections from the site. Wavelength appropriate optical stimulation in vivo resulted in neuronal activity that was significantly increased over pre-stimulation levels with no return to baseline levels during the time of the light exposure. We also examined the effects of optically driven neuronal activity on subsequent tone driven responses in the DCN. In the DCN 75% of the 16 electrode sites showed decreased neuronal activity in response to a tone immediately following light stimulation while six percent were decreased following tone stimulation and 19% of the electrode sites showed no change. This is in contrast to tone driven neuronal activity prior to the light exposure in which the majority of electrode sites showed increased neuronal activity. Our results indicate that expression and activation of rhodopsin within neurons involved in auditory processing does not appear to have deleterious effects on hearing even 18 months following expression. In addition, virally targeted rhodopsins may be useful as tract tracers to delineate as well as modulate the activity of pathways and specific neurons. In the future rhodopsins can be targeted to specific subpopulations of auditory neurons. Ultimately, photostimulation may provide a physiologically relevant method for modulating the function of auditory neurons and affecting hearing outcomes. This article is part of a Special Issue entitled Optogenetics (7th BRES).

Predictive performance of Acute Physiological and Chronic Health Evaluation releases II to IV: a single New Zealand centre experience.

There is debate in Australia and New Zealand around the appropriate use of illness severity scoring systems in Australasian intensive care units. The international benchmark is the Acute Physiological and Chronic Health Evaluation (APACHE) system. In order to compare the performance of recent APACHE releases, we audited 2080 sequential patients admitted between 1 January 2006 and 31 March 2008 to the Middlemore Hospital intensive care unit, Auckland, New Zealand. We compared the predictive performance of the proprietary APACHE II, IIIh, IIIj and IV releases, and the performance of a 'localised' version of APACHE II containing re-estimated coefficients derived from a legacy dataset (7703 sequential patients admitted between 1 January 1997 and 31 December 2005). Discrimination assessed by receiver operating characteristic curves was highest with the APACHE III and IV releases, and significantly better than the APACHE II releases. Calibration assessed by the Hosmer-Lemeshow statistic was poor with all releases, although it was best with APACHE IV and 'localised' version of the APACHE II release. Overall accuracy assessed by the Brier Mean Probability score and Shapiro's R statistic was best with APACHE IV. Our study suggests the possibility of improved prediction in moving to APACHE IV from older releases, although broader multicentre study within the Australian and New Zealand critical care community is warranted. Our study also suggests localisation of the APACHE system offers further opportunity to improve prediction, although these improvements may not be major without ground-up development of a new risk prediction model within our local critical care setting.

Patient indicators of a pulmonary exacerbation: preliminary reports from school aged children map onto those of adults.

BACKGROUND: Despite the importance of identifying and managing a pulmonary exacerbation, and its use as an outcome measure in interventions, there is no standardised definition in cystic fibrosis. In achieving standardised criteria it is important to identify patient-reported indicators. METHODS: Interviews were undertaken with 35 school aged children. They reported symptoms experienced during a pulmonary exacerbation in two ways: the first symptoms they become aware of, and how they recognised when they were improving. Interviews were taped, transcribed verbatim and the data analysed thematically. RESULTS: For many children, the onset of an exacerbation was characterised by 'cold' symptoms, tiredness, and changes in cough. For those with moderate or severe disease, sleep disruption, activity induced breathlessness, changes in mood, sputum volume and lack of appetite were common. When describing improvement children focused initially on activities they were now able to perform accompanied by improvements in tiredness and cough. Those with moderate or severe disease also reported improvements in sleep and mood, breathlessness, sputum volume and colour. CONCLUSIONS: Child-reported indicators of a pulmonary exacerbation tend to map onto those reported by adults. These results provide the rationale for the development of a single scale for school age children and adults that could be sensitive to progressive stages of CF disease.

An assessment of the barriers to accessing food among food-insecure people in Cobourg, Ontario.

INTRODUCTION: Low-income people are most vulnerable to food insecurity; many turn to community and/or charitable food programs to receive free or low-cost food. This needs assessment aims to collect information on the barriers to accessing food programs, the opportunities for improving food access, the barriers to eating fresh vegetables and fruit, and the opportunities to increasing their consumption among food-insecure people in Cobourg, Ontario. METHODS: We interviewed food program clients using structured individual interviews consisting of mostly opened-ended questions. RESULTS: Food program clients identified barriers to using food programs as lack of transportation and the food programs having insufficient quantities of food or inconvenient operating hours. They also stated a lack of available vegetables and fruit at home, and income as barriers to eating more vegetables and fruit, but suggested a local fresh fruit and vegetable bulk-buying program called "Good Food Box" and community gardens as opportunities to help increase their vegetable and fruit intake. DISCUSSION: Many of the barriers and opportunities identified can be addressed by working with community partners to help low-income individuals become more food secure.

Recent advances in the management of viral hepatitis.

While viral hepatitis is a global problem its prevalence in the UK is often underestimated. Chronic infection with the hepatitis B and/or C virus causes significant morbidity and mortality. New treatments that attenuate viral replication or induce immunity against infection have transformed the management of these conditions, but their effectiveness comes at some cost - both in financial terms and in the side-effect profile associated with treatment. Viral resistance promises to be an ongoing problem, particularly in patients who have an inadequate response to antiviral therapy or are non-adherent with treatment protocols. This article explores new developments in the treatment of chronic hepatitis B and C infection, and describes current protocols for managing patients with these conditions.

Organ donor index: a benchmark for comparing hospital organ donor rates.

OBJECTIVE: To develop organ donor indices to assess donor rates of individual hospitals. DESIGN: Data from hospital databases were retrospectively reviewed for patient separation ICD-9-CM codes (i.e., diagnostic codes from the International classification of diseases, 9th revision, clinical modification) to identify and categories actual and potential organ donors. Organ donor indices for groups of codes and for individual hospitals were determined by dividing the number of actual donors by the total number of patients who died with the same separation ICD-9-CM codes. SETTING: The three South Australian adult tertiary hospitals in 1988-1995. PATIENTS: The 154 actual organ donors, and all patients aged less than 71 years who died with the same groups of ICD-9-CM codes as the organ donors. RESULTS: Organ donors could be classified by three groups of ICD-9-CM codes specifying diseases or pathological processes that could result in brain death. These groups were head injury (44.2% of donors), cerebrovascular accident (CVA) (42.2%), and eight "other" codes (13.6%). Differences between the head injury donor indices for the three hospitals were not significant (Hospital A, 19.1%; Hospital B, 24%; Hospital C, 21%), but there were significant interhospital differences in donor indices for the CVA group (A, 11.2%; B, 5.7%; C, 5.1%; P < 0.05) and the "other" group (A, 3.6%; B, 0.7%; C, 0.3%; P < 0.001). CONCLUSIONS: ICD-9-CM codes can be used to describe organ donors and hospital populations from which potential organ donors may be found. The casemix-controlled organ donor indices can be used to compare the organ donor rates of individual hospitals and to examine reasons for low rates (other than purely casemix variation).

Intensive care costing methodology: cost benefit analysis of mask continuous positive airway pressure for severe cardiogenic pulmonary oedema.

Costing data for intensive care admissions is important, not only for unit funding, but also for cost outcome analysis of new therapies. This paper presents an intensive care episode costing methodology using the example of a cost-benefit analysis of mask CPAP for severe cardiogenic pulmonary oedema (CPO). This analysis examines the intervention of admitting all patients with severe CPO to the intensive care unit for mask CPAP, compared with the previous practice of admitting only patients failing conventional non-CPAP treatment and requiring mechanical ventilation. The episode costs were determined from a prospective study which showed mask CPAP reduced the need for mechanical ventilation from 35% to 0%. The mean cost of a mask CPAP episode was $1,156, with a mean stay of 1.2 days, compared with ventilated patients, $5,055 and 4.2 days. The major contributors to cost in both groups were nursing and medical salaries, and hospital overheads. The cost of previous estimated yearly caseload of 35 ventilated patients ($176,925) was greater than the cost associated with an increased caseload of 100 mask CPAP patients ($115,600). We conclude that, despite an increase in admissions, mask CPAP for severe CPO is cost-effective.

The merger that wasn't: lessons for senior administrators.

A turbulent health care environment has prompted some hospitals to consider integrating services and in some cases merge entirely. Fundamental lessons may be learned by studying how an attempted merger between Women's College Hospital and The Toronto Hospital in Toronto failed--despite board and senior executive support. Clarity of purpose, involvement of essential external and internal stakeholders, rational analysis, ideological fit and political expediency are a few key elements to consider. Once initiated, changes of this magnitude may take on a life of their own with often unpredictable results.

The health network: an alternative form of care delivery.

The Health Network, a community and social service organization of volunteers and a small staff aims to serve three suburban and rural communities west of Ottawa. In June 1991, the Health Network approached Ontario's Ministry of Health for funding of community-based health services for these municipalities. In light of decreasing resources in hospitals, this article reviews how the Health Network became organized and summarizes a community needs assessment complete in September 1989.

Assessment of protein reserves (cellular mass) in Aboriginal children.

The body protein reserves, assessed indirectly by the measurement of intracellular water, was determined in free-living Aboriginal children and adolescents located in Central and Northwestern Australia. Fifty one individuals were studied--31 males and 20 females. Significant reductions were observed in intracellular water or cell mass relative to the cube of body length for Aboriginal females when compared to a control female group. Only marginal or borderline differences for the same parameters were observed when Aboriginal males were compared with controls. Comparison of Aboriginal females with Aboriginal males demonstrated significant reductions in cell mass (intracellular water) relative to body length cubed in the female. This finding in the Aboriginal female is of concern because many become pregnant in the early teenage years. Evidence was found during the course of this study that plasma zinc concentrations were frequently low. This led to a concomitant study on serum and plasma trace metals in two Aboriginal settlements (364 individuals) to be published in a subsequent paper.