Anatomy and resilience of the global production ecosystem.

Much of the Earth's biosphere has been appropriated for the production of harvestable biomass in the form of food, fuel and fibre. Here we show that the simplification and intensification of these systems and their growing connection to international markets has yielded a global production ecosystem that is homogenous, highly connected and characterized by weakened internal feedbacks. We argue that these features converge to yield high and predictable supplies of biomass in the short term, but create conditions for novel and pervasive risks to emerge and interact in the longer term. Steering the global production ecosystem towards a sustainable trajectory will require the redirection of finance, increased transparency and traceability in supply chains, and the participation of a multitude of players, including integrated 'keystone actors' such as multinational corporations.

Inflammatory bowel disease meta-evidence and its challenges: is it time to restructure surgical research?

AIM: The aim of this study was to compare the methodological quality and input paper characteristics of systematic reviews and meta-analyses reported in the medical and surgical literature by performing a systematic 'overview of reviews'. Ulcerative colitis (UC) and Crohn's disease (CD) were used as the framework for this comparison as they are relatively common serious conditions, with both medical and surgical options for therapy. METHOD: Medline, Embase, CINHAL and the Cochrane Database were searched to November 2013. Eligible papers were systematic reviews or meta-analyses that considered a question of therapy in CD or UC. Two independent reviewers selected the papers, extracted the data and scored their methodology using the AMSTAR scoring system. The papers were categorized into medical therapy (M), surgical therapy (S) or medical and surgical therapy (MS) groups. Following retrieval of the sample of meta-evidence papers, the original input studies used in their creation were identified and a search of Medline, Embase, CINHAL and the Cochrane Database was performed. A team of researchers then examined the collection of papers for bibliographic and financial information. RESULTS: Five hundred papers were identified in the meta-evidence search, of which 118 were deemed eligible. There was a difference in the AMSTAR-rated average quality of the papers between the S and M group (S 7.36 vs M 8.75, P = 0.01). On average S papers were published in journals with a lower impact factor (S 3.26, M 5.04, MS 5.30, P < 0.001). S papers also showed more heterogeneity (I(2) ; S 37%, M 24%, MS 10%, P < 0.001). Some 25% of S meta-analyses used data-sets with significant heterogeneity (I(2) > 75%), compared with 8% of M meta-analyses and 3% of the MS meta-analyses. Some 5% of S papers were done on data sets that had I(2) values > 90%. There was no difference in the average number of papers assessed in each group, the average number of patients per meta-paper, the average time covered by the reviews, the average number of papers considered within each meta-analysis, or the average number of patients considered within each meta-analysis. Considering the conclusions of each meta-analysis, S meta-evidence was 50% more likely than M meta-evidence to be unable to make recommendations for practice. A total of 1499 original input papers were identified, of which 283 were used in more than one review. Within the non-repeated papers (n = 1023) the average impact factor within the S group was lower than that of the M and the MS groups (3.720 vs 11.230 vs 7.563, respectively; ANOVAP < 0.001). M papers had higher rates of pharmaceutical sponsorship than S papers (M 56% vs S 1%) and twice the level of government support (M 16% vs S 8%). Of note, 21% of M papers had corporate sponsorship but did not list any conflict of interest. CONCLUSION: Compared with M meta-analyses, S meta-analyses in the UC and CD domain are more likely to be of poorer methodological quality, are of a greater degree of heterogeneity and less often offer a positive conclusion. The papers used to generate meta-evidence in M papers have a greater degree of corporate and government sponsorship, and are more likely to come from journals with higher impact factors.

Influenza A(H1N1)pdm09 vaccination policies and coverage in Europe.

In August 2010 the Vaccine European New Integrated Collaboration Effort (VENICE) project conducted a survey to collect information on influenza A(H1N1)pdm09 vaccination policies and vaccination coverage in the European Union (EU), Norway and Iceland. Of 29 responding countries, 26 organised national pandemic influenza vaccination and one country had recommendations for vaccination but did not have a specific programme. Of the 27 countries with vaccine recommendations, all recommended it for healthcare workers and pregnant women. Twelve countries recommended vaccine for all ages. Six and three countries had recommendations for specific age groups in children and in adults, countries for specific adult age groups. Most countries recommended vaccine for those in new risk groups identified early in the pandemic such as morbid obese and people with neurologic diseases. Two thirds of countries started their vaccination campaigns within a four week period after week 40/2009. The reported vaccination coverage varied between countries from 0.4% to 59% for the entire population (22 countries); 3% to 68% for healthcare workers (13 countries); 0% to 58% for pregnant women (12 countries); 0.2% to 74% for children (12 countries). Most countries identified similar target groups for pandemic vaccine, but substantial variability in vaccination coverage was seen. The recommendations were in accordance with policy advice from the EU Health Security Committee and the World Health Organization.

Flow cytometric assessment of chicken T cell-mediated immune responses after Newcastle disease virus vaccination and challenge.

The objective of this study was to use flow cytometry to assess chicken T cell-mediated immune responses. In this study two inbred genetic chicken lines (L130 and L133) were subjected to two times vaccination against Newcastle disease (ND) and a subsequent challenge by ND virus (NDV) infection. Despite a delayed NDV-specific antibody response to vaccination, L133 appeared to be better protected than L130 in the subsequent infection challenge as determined by the presence of viral genomes. Peripheral blood was analyzed by flow cytometry and responses in vaccinated/challenged birds were studied by 5-color immunophenotyping as well as by measuring the proliferative capacity of NDV-specific T cells after recall stimulation. Immunophenotyping identified L133 as having a significantly lower CD4/CD8 ratio and a lower frequency of gammadelta T cells than L130 in the peripheral T cell compartment. Furthermore, peripheral lymphocytes from L133 exhibited a significantly higher expression of CD44 and CD45 throughout the experiment. Interestingly, also vaccine-induced differences were observed in L133 as immune chickens had a significantly higher CD45 expression on their lymphocytes than the naïve controls. Immune chickens from both lines had a significantly higher frequency of circulating gammadelta T cells than the naïve controls both after vaccination and challenge. Finally, the proliferative capacity of peripheral CD4+ and CD8+ cells specific for NDV was addressed 3 weeks after vaccination and 1 week after infection and found to be significantly higher in L133 than in L130 at both sampling times. In conclusion, we found the applied flow cytometric methods very useful for the study of chicken T cell biology.

Implementing the water framework directive in Bulgaria: Integrated river basin management on the Black Sea coast.

EC member states and candidate countries are in the process of implementing the requirements of the EC Water Framework Directive 2000/60, which came into force on 22 December 2000. At the core of the Directive is an integrated approach for sustainable water management in river basin districts. The overall objective is to reach good water status for all waters by the year 2015. The challenges for countries implementing the Directive are substantial not least for the River Basin Management Authorities who will be the implementing unit at the regional level. The Black Sea River Basin Directorate in Varna is one of four Directorates established in Bulgaria in 2002 in accordance with the Bulgarian Water Act and is the regional operational unit under the Ministry of Environment and Water for the Black Sea Basin catchment area. The catchment area covers 20% of Bulgaria and 100% of the Bulgarian Black Sea coast. Current implementation activities in the Black Sea Basin Directorate and also at the national level are supported by the Danish EPA through its DANCEE programme in collaboration with the Ministry of Environment and Water. This paper highlights the main activities and outputs of the technical and institutional undertakings in the Black Sea Basin Directorate focusing on the preparation of the River Basin Overview by Dec. 2004.

Setting-up a cost recovery system for the largest wastewater treatment plant in South-East Asia.

A tariff system has been set up for the largest wastewater treatment plant in South-East Asia, the Samut Prakarn Wastewater Treatment Plant south of Bangkok, which is currently under completion. Fully functional the plant will have a design capacity for 500,000 m3 per day and will service a combined residential and industrial area with approximately 600,000 residents and 2,300 factories. The tariff system, which includes a tariff model, is based on water consumption and BOD load. As background for setting the tariffs a comprehensive monitoring system including an industrial permitting system has been developed. The paper presents the background and rationale for setting up the system as well as the objective, scope and content of the tariff system and the industrial permit system. Further, the feasibility of introducing cost recovery systems, which is widely accepted in developing economies on the conceptual level and to some extent implemented at the legal and regulatory level, but has yet to be implemented at large, is discussed.

Psychological distress as a predictor of frequent attendance in family practice: a cohort study.

In cross-sectional studies, psychological distress has been associated with frequent health care utilization. However, there is a need for prospective studies to confirm these findings. This cohort study evaluated whether psychological distress predicted frequent attendance in family practice. In 1990, 185 consecutive adults who consulted their primary care physician (PCP) about an illness were rated on two psychometric scales (Hopkins Symptom Check List [SCL-8] and Whiteley-7), and their annual number of face-to-face contacts with a family practice was followed until 1996. Frequent attenders (FAs) were defined as the top 10%. A logistic regression analysis showed a significantly increased risk of becoming an FA with an increase of 1 point (odds ratio [OR] 1.17 [1.03-1.33]) on SCL and 1.28 (1.06-1.53) on Whiteley). An association was found between score and number of years as an FA (OR 1.16 [0.99-1.36] for SCL and OR 1.31 [1.05-1.65] for Whiteley). Psychological distress involved an increased risk of future frequent attendance among adult patients consulting family practice in the daytime about an illness.

[What is evidence-based medicine?]. / Hvad er evidensbaseret medicin?

Evidence-based medicine is based on the best results from clinical and epidemiological research, which is combined with clinical experience and patient preferences. Questions of prognosis and harm are often best elucidated in large cohort studies. For other clinical questions the best evidence is usually found by systematic review of randomised trials, if possible in the form of meta-analyses. To make a diagnosis is, for example, not an aim in itself but a way to arrive at a prognosis and to suggest a treatment, provided this leads to a better prognosis. The most relevant, albeit rarely seen, test of a diagnostic method is a randomised trial. Evidence-based medicine will provide the best basis for evaluations of which interventions should be abandoned and which are effective and economically feasible. The use of evidence-based clinical guidelines will lead to more cost-effective treatments. It should be a national strategy that health care should be evidence-based.

Assessment of dementia in nursing home residents by nurses and assistants: criteria validity and determinants.

OBJECTIVES: To describe the criterion validity of nursing home staff's assessment of organic disorder compared with ICD-10 criteria, and to identify determinants of staff assessment of organic disorder. METHOD: Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. Nursing staff members were interviewed about the residents' activities of Daily Living, behavioural problems, orientation in surroundings and communication skills, and asked if the resident had an organic disorder. Multiple logistic regression was used to select the items that most strongly determined staff assessment of organic disorder. RESULTS: Sixty-two per cent of the residents were diagnosed by GMS-AGECAT as having organic disorder, 78% of these were correctly identified by the staff. Whether analysed among residents with or without organic disorder, or in the total group of residents, the staff assessment of the presence of organic disorder depended on a limited set of behavioural characteristics of the resident, namely 'going to the toilet in inappropriate places', 'saying things that do not make sense' and impairment in orientation. CONCLUSIONS: Staff comprehension of organic disorder resulted in over- as well as under-labelling of residents, a tendency that will affect communication with medical personnel and may lead to inadequate or wrong medical treatment and to negative performance as well as negative role expectations in everyday life in nursing homes.

Experimental assessment of the pathogenicity of two avian influenza A H5 viruses in ostrich chicks (Struthio camelus) and chickens.

Virus excretion, immune response, and, for chickens, deaths were recorded in 3-week-old ostriches and chickens inoculated by either the intramuscular or intranasal route with one of two influenza A viruses of subtype H5. One of the viruses, A/turkey/England/50-92/91 (H5N1) (50/92), was highly pathogenic for chickens causing 5/5 deaths by each route of inoculation. The other virus, A/ostrich/Denmark-Q/72420/96 (H5N2) (72420/96), isolated from ostriches in quarantine in Denmark during 1996, was of low pathogenicity for chickens, causing no clinical signs by either route of inoculation. No significant clinical signs were seen in any of the ostriches infected with either of the viruses by either route of infection. Both viruses were recoverable from both species up to 12 days post-infection, and low serological responses were detected in surviving infected ostriches and chickens at 21 days after inoculation.

[Patient assessment in ambulatory surgery. A questionnaire study]. / Patientevaluering af sammedagskirurgi. En enqueteundersøgelse.

In our department, from the beginning of December 1994 to the end of February 1995, we operated upon a selected group of 199 patients, hospitalized as day surgery patients. Each patient was given a questionnaire to fill in after discharge. We asked them to evaluate day surgery from the consumer's point of view. We did not record any data which could identify the single patient. We received 158 questionnaires (79%) of which 151 were accepted. One hundred and seven patients (71%) found day surgery acceptable and a good alternative to conventional hospitalization, 82% preferred having the same doctor and primary nursing during the treatment. One hundred and sixteen patients were discharged as planned (77%). There were no serious complications. Provided that patients are carefully selected, we find day surgery a highly satisfactory method of management which is safe and efficient.

Influence of subclinical virus infections and other factors on broiler flock performance.

1. The influence of subclinical infections with infectious bursal disease virus, adenoviruses, REO viruses and chicken anaemia virus and of various production variables on broiler flock performance was investigated. 2. A significant effect could not be demonstrated of any of the viral infections either alone or in combination. 3. The production results were profoundly influenced by several other factors, that is, breed, diet, stock density and contents of whole wheat grain in the food. 4. The incidence of horizontally-transmitted subclinical chicken anaemia virus infection in Danish broilers has decreased significantly during the period 1988-89 to 1992-93, probably because of improved hygiene and management. The incidence of adeno- and REO virus infections did not change during the same period. 5. It is concluded that factors other than subclinical viral infections presently have an economic impact on performance observed in the Danish broiler production.

[Parasuicide in Sør-Trøndelag 1989-92. Rates and sociodemographic characteristics]. / Parasuicid i Sør-Trøndelag 1989-92. Rater og sosiodemografiske karakteristika.

A total of 1,740 events of parasuicide (1,329 persons; female/male ratio 1.4) were registered in the county of Sør-Trøndelag from 1 October 1988 to 31 December 1992. The information was collected by means of monitoring forms completed in hospitals, by general practitioners, and at local health centres. Person-based rates were highest amongst 25-44 year-olds (both sexes). While male rates remained relatively stable, female rates seemed to decline, owing to reduced rates amongst 25-34 year-olds and 45-54 year-olds. For both sexes rates were highest in the urban area of Trondheim. For males and females alike, the lowest rates were found in coastal municipalities. Self-poisoning was involved in 84% of the male and in 92% of the female cases. Rates for divorced and separated males and females (per 100,000) were lower than demonstrated earlier in the catchment area. The largest proportion of female parasuicides were either employed or in receipt of a disability pension; the two largest male groups were unemployed and employed. Low education was characteristic for both sexes. Almost half of each sex reported earlier attempt(s), and the annual rate of repetition varied between 10-21% for females and 11-18% for males.

[Assessment of risk in patients admitted for observation for suspected acute myocardial infarction based on a sensitive immunoanalysis of serum creatine kinase isoenzyme MB]. / Risikovurdering af patienter indlagt til observation for akut myokardieinfarkt baseret på en sensitiv immunoanalyse for serumkreatinkinase isoenzym MB.

We evaluated a new sensitive creatine kinase (CK) isoenzyme MB immunoassay with regard to clinical applicability and clinical outcome in 156 patients admitted consecutively to the Coronary Care Unit and suspected of having acute myocardial infarction (AMI). Sixty-five patients (42%) had AMI based on WHO criteria; 65 (42%) had ischemic heart disease (IHD) without AMI, and 26 (16%) had non-IHD. The 65 IHD-patients without AMI could be subdivided into a group of 24 patients with significant changes in serum CK MB levels and 41 patients with stable serum CK MB levels as compared to the non-IHD group. The cumulative cardiac survival after 2 1/2 year (i.e. not suffering cardiac death) was 95 +/- 3% for patients with stable CK MB levels; for those with changes in CK MB levels it was 66 +/- 10% (p < 0.003). It was 52 +/- 6% for the patients with AMI, similar to patients with changes in CK MB levels (p = 0.15). We conclude, that this new CK MB assay can, in patients with IHD without AMI, detect a sub-group, representing one-third of the patients in this group, which is not diagnosed using routine diagnostic procedures. These patients are characterized by a poor clinical outcome, similar to patients with definite AMI.

A programme for assigning target values for external quality assessment schemes in countries with no authorized reference laboratories. Annex. Experiences with deviating results on Ektachem 700 XR.

The use of consensus values in external quality assessment schemes (EQAS) involves several problems and should preferably be replaced with target values obtained by methods of high metrological level. However, such values are difficult to obtain. In the present study we transferred values from the NIST (former NBS) certified reference serum SRM 909 to lyophilized and frozen test sera for various inorganic components using flame absorption or flame emission spectrometry. Enzyme values were assigned by laboratories of members of the former Scandinavian Enzyme Committee. The assignment was based on 2-4 determinations each day through 3 days of experiment. A total of 10 laboratories participated in the work. The results were utilized in a Danish EQAS. One practical concern is the fairly long time (9 months) which was needed for production, collection and compiling all data. To get an impression of how much dry chemistry analysers, e.g, could influence consensus values a Kodak Ektachem 700 XR was studied using lyophilized and frozen sera. The results are reported in the annex. On NIST SRM 909 the values found for sodium(I) were 6% too high even though the findings on frozen human sera were accurate. For aspartate aminotransferase a result three times the target values was found on a human lyophilized serum, while the values on the frozen sera only were slightly too high.

A comparative study of test methods for assessment of the biodegradability of chemicals in seawater--screening tests and simulation tests.

A comparative study has been performed on test methods for assessing the biodegradability of chemicals in seawater environments. A simple shake flask die-away test with natural seawater and 14C-labeled chemicals added in microgram/liter concentrations is proposed as a "simulation" test. The analytical parameter used in this test is residual dissolved 14C activity. The performance of the simulation test has been compared with the performance of similar screening tests with dissolved organic carbon analysis and test compounds added in mg/liter concentrations to nutrient-enriched seawater. All chemicals investigated that passed the screening tests were also degradable in the simulation test and some results with simulation tests were positive; even screening tests were negative, while some compounds, including maleinhydrazide, known to be degradable in soil, remained undegraded in either type of test. Disappearance times after the ended lag time were smaller in screening tests than in simulation tests, but the rates of biodegradation cannot be meaningfully compared, as zero-order kinetics in combination with an exponentially growing population of degraders prevail in screening tests, while first-order kinetics and frequently a constant activity of degraders (cooxidation) prevail in simulation tests where the test material is a secondary substrate only. In screening tests, lag times are sometimes excessively long and highly variable. Whether the lag times could be decreased and their variability narrowed by supplementation with a cosubstrate (yeast extract) or by inoculation with seawater that had been preadapted to the test material was investigated. In most experiments such test modifications had no significant effect but in one experiment with 4-nitrophenol, inoculation with 1% preadapted seawater decreased the lag phase from greater than 35 to 9 days.