Kelp and sea urchin settlement mediated by biotic interactions with benthic coralline algal species.

Species interactions can influence key ecological processes that support community assembly and composition. For example, coralline algae encompass extensive diversity and may play a major role in regime shifts from kelp forests to urchin-dominated barrens through their role in inducing invertebrate larval metamorphosis and influencing kelp spore settlement. In a series of laboratory experiments, we tested the hypothesis that different coralline communities facilitate the maintenance of either ecosystem state by either promoting or inhibiting early recruitment of kelps or urchins. Coralline algae significantly increased red urchin metamorphosis compared with a control, while they had varying effects on kelp settlement. Urchin metamorphosis and density of juvenile canopy kelps did not differ significantly across coralline species abundant in both kelp forests and urchin barrens, suggesting that recruitment of urchin and canopy kelps does not depend on specific corallines. Non-calcified fleshy red algal crusts promoted the highest mean urchin metamorphosis percentage and showed some of the lowest canopy kelp settlement. In contrast, settlement of one subcanopy kelp species was reduced on crustose corallines, but elevated on articulated corallines, suggesting that articulated corallines, typically absent in urchin barrens, may need to recover before this subcanopy kelp could return. Coralline species differed in surface bacterial microbiome composition; however, urchin metamorphosis was not significantly different when microbiomes were removed with antibiotics. Our results clarify the role played by coralline algal species in kelp forest community assembly and could have important implications for kelp forest recovery.

Impacts of Seawater pH Buffering on the Larval Microbiome and Carry-Over Effects on Later-Life Disease Susceptibility in Pacific Oysters.

Ocean acidification upwelling events and the resulting lowered aragonite saturation state of seawater have been linked to high mortality of marine bivalve larvae in hatcheries. Major oyster seed producers along North America's west coast have mitigated impacts via seawater pH buffering (e.g., addition of soda ash). However, little consideration has been given to whether such practice may impact the larval microbiome, with potential carry-over effects on immune competency and disease susceptibility in later-life stages. To investigate possible impacts, Pacific oysters (Crassostrea gigas) were reared under soda ash pH buffered or ambient pH seawater conditions for the first 24 h of development. Both treatment groups were then reared under ambient pH conditions for the remainder of the developmental period. Larval microbiome, immune status (via gene expression), growth, and survival were assessed throughout the developmental period. Juveniles and adults arising from the larval run were then subjected to laboratory-based disease challenges to investigate carry-over effects. Larvae reared under buffered conditions showed an altered microbiome, which was still evident in juvenile animals. Moreover, reduced survival was observed in both juveniles and adults of the buffered group under a simulated marine heatwave and Vibrio exposure compared with those reared under ambient conditions. Results suggest that soda ash pH buffering during early development may compromise later-life stages under stressor conditions, and illustrate the importance of a long-view approach with regard to hatchery husbandry practices and climate change mitigation. IMPORTANCE Shellfish industries are threatened worldwide by recurrent summer mortality events. Such incidences are often associated with Vibrio disease outbreaks, and thus, it is critical that animals are able to mount sufficient immune responses. The oyster immune system is linked to the microbiome which is laid down during early developmental stages. Consequently, shellfish hatcheries play a key role with regard to shaping the immune competency of later-life stages. This study represents the first in-depth examination of whether the adoption of seawater pH buffering practice by hatcheries for mitigation of ocean acidification may alter the larval microbiome, and thus, have repercussions for adult susceptibility to summer mortality events. Findings demonstrate that even minimal buffering results in a changed microbiome which is paralleled by increased mortality of later-life stages under Vibrio and temperature stressors, highlighting the importance of the hatchery environment with regard to shaping resilience to summer mortality events.

Ethical questions must be considered for electronic health records.

National electronic health record initiatives are in progress in many countries around the world but the debate about the ethical issues and how they are to be addressed remains overshadowed by other issues. The discourse to which all others are answerable is a technical discourse, even where matters of privacy and consent are concerned. Yet a focus on technical issues and a failure to think about ethics are cited as factors in the failure of the UK health record system. In this paper, while the prime concern is the Australian Personally Controlled Electronic Health Record (PCEHR), the discussion is relevant to and informed by the international context. The authors draw attention to ethical and conceptual issues that have implications for the success or failure of electronic health records systems. Important ethical issues to consider as Australia moves towards a PCEHR system include: issues of equity that arise in the context of personal control, who benefits and who should pay, what are the legitimate uses of PCEHRs, and how we should implement privacy. The authors identify specific questions that need addressing.

Depuration of anthropogenic particles by Pacific oysters (Crassostrea gigas): Feasibility and efficacy.

Anthropogenic particles (APs) generated from both natural and synthetic materials are widespread in the aquatic environment and contaminate seafood products, including shellfish. Depuration, involving the placement of filter-feeding shellfish in clean water for a period of time, often several days, is used to reduce contaminant concentrations, but the practicality of its use by the shellfish industry for APs has not yet been examined. In the present study, cultured adult Pacific oysters (Crassostrea gigas) were depurated for 10 days in a facility with limited airflow and filtered seawater. On average, there was a 73 % reduction in oyster AP concentration after 5 days, but no further reduction at 10 days, potentially due to the difficulty in depurating some particles or to re-contamination from the experimental environment. Long-term feasibility for industry will depend on future guidelines for safe AP consumption levels and the practicality and financial feasibility of creating and running clean facilities.

Using clinical trial data and linked administrative health data to reduce the risk of adverse events associated with the uptake of newly released drugs by older Australians: a model process.

BACKGROUND: The study was undertaken to evaluate the contribution of a process which uses clinical trial data plus linked de-identified administrative health data to forecast potential risk of adverse events associated with the use of newly released drugs by older Australian patients. METHODS: The study uses publicly available data from the clinical trials of a newly released drug to ascertain which patient age groups, gender, comorbidities and co-medications were excluded in the trials. It then uses linked de-identified hospital morbidity and medications dispensing data to investigate the comorbidities and co-medications of patients who suffer from the target morbidity of the new drug and who are the likely target population for the drug. The clinical trial information and the linked morbidity and medication data are compared to assess which patient groups could potentially be at risk of an adverse event associated with use of the new drug. RESULTS: Applying the model in a retrospective real-world scenario identified that the majority of the sample group of Australian patients aged 65 years and over with the target morbidity of the newly released COX-2-selective NSAID rofecoxib also suffered from a major morbidity excluded in the trials of that drug, indicating a substantial potential risk of adverse events amongst those patients. This risk was borne out in post-release morbidity and mortality associated with use of that drug. CONCLUSIONS: Clinical trial data and linked administrative health data can together support a prospective assessment of patient groups who could be at risk of an adverse event if they are prescribed a newly released drug in the context of their age, gender, comorbidities and/or co-medications. Communication of this independent risk information to prescribers has the potential to reduce adverse events in the period after the release of the new drug, which is when the risk is greatest.Note: The terms 'adverse drug reaction' and 'adverse drug event' have come to be used interchangeably in the current literature. For consistency, the authors have chosen to use the wider term 'adverse drug event' (ADE).

Size and shape matter: A preliminary analysis of microplastic sampling technique in seawater studies with implications for ecological risk assessment.

Microplastic particles (MPs) are widely distributed in seawater. Fibrous MPs (microfibres) are often reported as the most commonly encountered shape of particle. To estimate MP concentrations in seawater, samples are often collected using towed nets (generally 300-350-µm mesh) and may underestimate the amount of microfibres present, which may pass through the mesh due to their narrow width. We compared the potential microplastic particle (PMP) concentration estimates provided by two different seawater sampling methods conducted at three commercial shellfish farms and three unfarmed sites in Baynes Sound, British Columbia, Canada. The methods were: 10-L bucket samples sieved through 63-µm mesh in situ and subsequently filtered through an 8-µm polycarbonate membrane; and 1-L bulk samples collected in jars and subsequently filtered to 8 µm. The jar samples yielded PMP concentrations averaging approximately 8.5 times higher than the bucket samples per L of water (at the site level), largely driven by differences in the number of microfibres. There was no significant difference in PNP concentration between shellfish farms and unfarmed sites. An analysis of MP concentrations and mesh sizes reported in the literature suggests that using a 300-350-µm mesh may underestimate total MP concentrations by one to four orders of magnitude compared with samples that are filtered through much smaller mesh sizes (e.g. <100 µm), despite the effect of sample volume. Particles <300 µm in diameter make up a large component of MPs commonly found in fish and invertebrates. As such, common sampling practices fail to adequately measure a biologically relevant class of MPs, thereby undermining the ability to quantify ecological risk. We suggest that seawater sampling methods be designed to filter to <10 µm (the approximate width of many microfibres), either using pressurized pumps for large-volume samples, or by using sufficient replication of small-volume discrete samples.

Using Patient Flow Information to Determine Risk of Hospital Presentation: Protocol for a Proof-of-Concept Study.

BACKGROUND: Every day, patients are admitted to the hospital with conditions that could have been effectively managed in the primary care sector. These admissions are expensive and in many cases are possible to avoid if early intervention occurs. General practitioners are in the best position to identify those at risk of imminent hospital presentation and admission; however, it is not always possible for all the factors to be considered. A lack of shared information contributes significantly to the challenge of understanding a patient's full medical history. Some health care systems around the world use algorithms to analyze patient data in order to predict events such as emergency presentation; however, those responsible for the design and use of such systems readily admit that the algorithms can only be used to assess the populations used to design the algorithm in the first place. The United Kingdom health care system has contributed data toward algorithm development, which is possible through the unified health care system in place there. The lack of unified patient records in Australia has made building an algorithm for local use a significant challenge. OBJECTIVE: Our objective is to use linked patient records to track patient flow through primary and secondary health care in order to develop a tool that can be applied in real time at the general practice level. This algorithm will allow the generation of reports for general practitioners that indicate the relative risk of patients presenting to an emergency department. METHODS: A previously designed tool was used to deidentify the general practice and hospital records of approximately 100,000 patients. Records were pooled for patients who had attended emergency departments within the Eastern Health Network of hospitals and general practices within the Eastern Health Network catchment. The next phase will involve development of a model using a predictive analytic machine learning algorithm. The model will be developed iteratively, testing the combination of variables that will provide the best predictive model. RESULTS: Records of approximately 97,000 patients who have attended both a general practice and an emergency department have been identified within the database. These records are currently being used to develop the predictive model. CONCLUSIONS: Records from general practice and emergency department visits have been identified and pooled for development of the algorithm. The next phase in the project will see validation and live testing of the algorithm in a practice setting. The algorithm will underpin a clinical decision support tool for general practitioners which will be tested for face validity in this initial study into its efficacy.

The role of phytoplankton in the modulation of dissolved and oyster cadmium concentrations in Deep Bay, British Columbia, Canada.

We previously identified dissolved cadmium (Cd(diss)) as the main source of this metal in cultured Pacific oysters, Crassostrea gigas, in Deep Bay, British Columbia, Canada (Lekhi et al., 2008). Total suspended particulate Cd (Cd(part)) was not found to be a significant source of oyster Cd (Cd(oys)), with Cd(part) >20 µm negatively correlated with Cd(oys) concentration. High phytoplankton abundance in spring and summer was hypothesized to reduce Cd(oys) indirectly by drawing down Cd(diss) and increasing oyster growth. In the present study we expanded on these results by examining specifically how the phytoplankton community composition modulates both Cd(diss) and Cd(oys) concentrations in Deep Bay. Based on calculations of nutrients and Cd(diss) drawdown, phytoplankton accounted for approximately 90% of the overall summer reduction in Cd(diss) in the bay. Diatoms were the dominant phytoplankton group, being correlated negatively with Cd(oys) and positively with Cd(part). This suggests that diatom growth mediates the transfer of Cd from the dissolved to the particulate phase, resulting in lower Cd(oys). Spring blooms and sporadic harmful algal blooms may mediate a large flux of Cd(part) to the sediments. Thus, phytoplankton act as a sink, rather than a source, of Cd to oysters in Deep Bay and have a crucial role in the seasonality of Cd(oys) by reducing the concentration of Cd(diss) during the summer. Based on environmental variables, two descriptive models for annual Cd(oys) concentrations were developed using multiple linear regression. The first model (R(2)=0.870) was created to explain the maximum variability in Cd(oys) concentrations throughout the year, while the second (R(2)=0.806) was based on parameters that could be measured easily under farm conditions. Oyster age heavily affected both models, with the first model being secondarily affected by temperature and the second one being more sensitive to changes in salinity.

Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence.

OBJECTIVES: To review the literature on different models of clinical governance and to explore their relevance to Australian primary health care, and their potential contributions on quality and safety. DATA SOURCES: 25 electronic databases, scanning reference lists of articles and consultation with experts in the field. We searched publications in English after 1999, but a search of the German language literature for a specific model type was also undertaken. The grey literature was explored through a hand search of the medical trade press and websites of relevant national and international clearing houses and professional or industry bodies. 11 software packages commonly used in Australian general practice were reviewed for any potential contribution to clinical governance. STUDY SELECTION: 19 high-quality studies that assessed outcomes were included. DATA EXTRACTION: All abstracts were screened by one researcher, and 10% were screened by a second researcher to crosscheck screening quality. Studies were reviewed and coded by four reviewers, with all studies being rated using standard critical appraisal tools such as the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Two researchers reviewed the Australian general practice software. Interviews were conducted with 16 informants representing service, regional primary health care, national and international perspectives. DATA SYNTHESIS: Most evidence supports governance models which use targeted, peer-led feedback on the clinician's own practice. Strategies most used in clinical governance models were audit, performance against indicators, and peer-led reflection on evidence or performance. CONCLUSIONS: The evidence base for clinical governance is fragmented, and focuses mainly on process rather than outcomes. Few publications address models that enhance safety, efficiency, sustainability and the economics of primary health care. Locally relevant clinical indicators, the use of computerised medical record systems, regional primary health care organisations that have the capacity to support the uptake of clinical governance at the practice level, and learning from the Aboriginal community-controlled sector will help integrate clinical governance into primary care.

What supports effective research links between Divisions of General Practice and universities?

OBJECTIVE: To find out what supports effective links between Divisions of General Practice and universities. DESIGN: Qualitative study based on semi-structured interviews during October 2004, from which a framework for effective linking was constructed and its validity assessed by discussion with researchers and Division staff and members at four interactive workshops held between 9 November 2004 and 5 November 2005 . PARTICIPANTS: 21 participants from Divisions of General Practice and universities in Australia. RESULTS: Qualities conceptualised as "opportunity" and "fair relationships" were critical factors in establishing successful links between the two sectors. The relationship between these two factors describes the types of interactions that currently occur. CONCLUSIONS: To develop effective links requires an environment that promotes adequate opportunities, and in which mutual trust can grow. This will require commitment and system change from all parties.

Doctors' perceptions and attitudes to prescribing within the Authority Prescribing System.

OBJECTIVE: To examine doctors' perceptions and attitudes to prescribing within the Authority Prescribing System (APS). DESIGN AND SETTING: Questionnaire survey of Australian doctors' responses to a number of statements and factorial vignettes, conducted between 1 May and 30 June 2001. PARTICIPANTS: A national random sample of 1200 doctors, stratified according to specialist/generalist, rural/urban and high/low prescriber: 669 (56%) responded. MAIN OUTCOME MEASURES: Self-reported perceptions of the APS and attitudes to prescribing within the APS. RESULTS: 72% of doctors agreed that the APS makes effective medications available to the socioeconomically disadvantaged members of the Australian public and 50% agreed that it compromises patient privacy. Fewer agreed that authority indicators were based on the highest quality of evidence quality (40%) or medication safety (12%). Doctors placed more emphasis on the doctor-patient relationship than on the criteria for authority prescribing in their decisions about prescribing APS medications. Doctors who used computers to prescribe were more likely to agree that computers can improve the authority prescribing process. CONCLUSIONS: This study suggests that authority-required prescribing is not achieving the stated aims of the National Medicines Policy in reducing variability in prescribing. Strategies to improve the quality of prescribing must consider the professional and ethical conundrum associated with prescribing outside of PBS/APS approved use for clinical and patient-centred reasons.