Detrimental effects of ocean acidification on the economically important Mediterranean red coral (Corallium rubrum).

The mean predicted decrease of 0.3-0.4 pH units in the global surface ocean by the end of the century has prompted urgent research to assess the potential effects of ocean acidification on the marine environment, with strong emphasis on calcifying organisms. Among them, the Mediterranean red coral (Corallium rubrum) is expected to be particularly susceptible to acidification effects, due to the elevated solubility of its Mg-calcite skeleton. This, together with the large overexploitation of this species, depicts a bleak future for this organism over the next decades. In this study, we evaluated the effects of low pH on the species from aquaria experiments. Several colonies of C. rubrum were long-term maintained for 314 days in aquaria at two different pH levels (8.10 and 7.81, pHT ). Calcification rate, spicule morphology, major biochemical constituents (protein, carbohydrates and lipids) and fatty acids composition were measured periodically. Exposure to lower pH conditions caused a significant decrease in the skeletal growth rate in comparison with the control treatment. Similarly, the spicule morphology clearly differed between both treatments at the end of the experiment, with aberrant shapes being observed only under the acidified conditions. On the other hand, while total organic matter was significantly higher under low pH conditions, no significant differences were detected between treatments regarding total carbohydrate, lipid, protein and fatty acid composition. However, the lower variability found among samples maintained in acidified conditions relative to controls, suggests a possible effect of pH decrease on the metabolism of the colonies. Our results show, for the first time, evidence of detrimental ocean acidification effects on this valuable and endangered coral species.

Diet in phenylketonuria: a snapshot of special dietary costs and reimbursement systems in 10 international centers.

BACKGROUND AND AIMS: To gather exploratory data on the costs and reimbursement of special dietary foods used in the management of phenylketonuria (PKU) from ten international specialist PKU centers. METHODS: Experts from each center provided data on retail costs of the three most frequently used phenylalanine-free protein substitutes and low-protein foods at their center; reimbursement of protein substitutes and low-protein foods; and state monetary benefits provided to PKU patients. RESULTS: The mean annual cost of protein substitutes across 4 age groups (2 y, 8 y, 15 y and adults) ranged from €4273 to €21,590 per patient. The cost of low-protein products also differed; the mean cost of low-protein bread varied from €0.04 to €1.60 per 100 kcal. All protein substitutes were either fully reimbursed or covered by health insurance. However, reimbursement for low-protein products varied and state benefits differed between centers. CONCLUSIONS: The variation in the cost and reimbursement of diet therapy and the level of additional state benefits for PKU patients demonstrates the large difference in expenditure on and access to PKU dietary products. This highlights the inequality between healthcare systems and access to special dietary products for people with PKU, ultimately leading to patients in some countries receiving better care than others.

[Doctor, I come from emergency service!]. / Doctor, vengo de urgencias!

OBJECTIVE: To identify the risk factors responsible for the high demand for care from patients coming via casualty to the general medicine and paediatrics clinics at our health centre. DESIGN: Observational study. SETTING: Primary care. Panaderas II Health Centre, Madrid. PATIENTS: All the patients attending the paediatrics and/or general medicine clinic via casualty in October 1996 were included (636). At random, 209 patients were selected from those who attended on demand. MEASUREMENTS AND MAIN RESULTS: For each patient the following variables were gathered: emergency/appointment, age, sex, room assigned, whether they asked for appointment, hour of call, type of emergency, clinic where seen, delay in appointment, assigned to which doctor's list, paediatrician/general practitioner. Being a girl was a significant risk factor in paediatrics casualty. In general practice, belonging to clinics with longer waits for an appointment and more patients per doctor (OR > 2) brought a higher risk, though not significantly, of attendance for consultation via casualty. Young people attended more frequently via casualty (chi 2 = 6.55, p = 0.01). CONCLUSIONS: The increase in each doctor's patient list generates attendance overload and anomalous paths for consultation. Limiting accessibility of the population does not control demand and increases the route via casualty. The doctor should assess personally those urgent requests not controlled by the clerical staff. Special attention to the young is probably needed to find the causes of the increase in emergency consultations among this population group.