Save the Mekong Delta from drowning.

Policy must address drivers, not just symptoms, of subsidence.

Author Correction: Mapping the world's free-flowing rivers.

An Amendment to this paper has been published and can be accessed via a link at the top of the paper.

Mapping the world's free-flowing rivers.

Free-flowing rivers (FFRs) support diverse, complex and dynamic ecosystems globally, providing important societal and economic services. Infrastructure development threatens the ecosystem processes, biodiversity and services that these rivers support. Here we assess the connectivity status of 12 million kilometres of rivers globally and identify those that remain free-flowing in their entire length. Only 37 per cent of rivers longer than 1,000 kilometres remain free-flowing over their entire length and 23 per cent flow uninterrupted to the ocean. Very long FFRs are largely restricted to remote regions of the Arctic and of the Amazon and Congo basins. In densely populated areas only few very long rivers remain free-flowing, such as the Irrawaddy and Salween. Dams and reservoirs and their up- and downstream propagation of fragmentation and flow regulation are the leading contributors to the loss of river connectivity. By applying a new method to quantify riverine connectivity and map FFRs, we provide a foundation for concerted global and national strategies to maintain or restore them.

Content validity of the SOS-WRIST questionnaire for timely identification of wrist overuse in young athletes.

Objectives: Young athletes do not always seek medical help for overuse wrist injuries, risking invalidating long-term consequences resulting from late diagnosis. This study aimed to develop a questionnaire to identify overuse wrist injuries in young athletes. Methods: According to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria, items were collected from literature and 6 focus groups of sports physicians and of young athletes with (previous) overuse wrist injuries. An expert panel and 40 Delphi study participants performed item reduction. Young athletes evaluated comprehensiveness during interviews and English translation was performed according to linguistic validation guidelines. Results: In total 323 items were generated and 110 were marked important by focus group participants. The resulting questionnaire consists of 18 multiple-choice questions about wrist pain during sports (e.g. pain during training, skipping training sessions/elements) and daily life activities (e.g. writing, turning a key), and other symptoms (e.g. reduced strength, swelling). Conclusion: The SOS-WRIST questionnaire for identification of overuse wrist injuries in young athletes has good content validity. It can be used to promote awareness and timely treatment of overuse wrist injuries in young athletes.

Planning dam portfolios for low sediment trapping shows limits for sustainable hydropower in the Mekong.

The transboundary Mekong Basin has been dubbed the "Battery of Southeast Asia" for its large hydropower potential. Development of hydropower dams in the six riparian countries proceeds without strategic analyses of dam impacts, e.g., reduced sediment delivery to the lower Mekong. This will impact some of the world's largest freshwater fisheries and endangers the resilience of the delta, which supports 17 million livelihoods, against rising sea levels. To highlight alternatives, we contribute an optimization-based framework for strategic sequencing of dam development. We quantify lost opportunities from past development and identify remaining opportunities for better tradeoffs between sediment and hydropower. We find that limited opportunities remain for less impactful hydropower in the lower basin, where most development is currently planned, while better trade-offs could be reached with dams in the upper Mekong in China. Our results offer a strategic vision for hydropower in the Mekong, introduce a globally applicable framework to optimize dam sequences in space and time, and highlight the importance of strategic planning on multiple scales to minimize hydropower impacts on rivers.

Giant maxillary gingival fibromatosis.

We present a case of both unusual pathology and severity - giant maxillary gingival fibromatosis - and discuss the disease and its management, accompanied by clinical imaging. This represents an overlap between maxillofacial and oral surgery, and may present as demonstrated in this case.

Electronic medical record reduces HIV medication refill response time and emergency refills in a Latino community clinic.

In May 2006, our community clinic, serving mainly indigent HIV+ Latinos, initiated an electronic medical record (EMR) system that transmitted refill requests and responses between the pharmacy's software to and from the EMR. Prior to this time, refill requests had been perceived as delayed at times due to system problems and pharmacies had responded by issuing emergency refills of antiretrovirals to prevent possible medication resistance and morbidity as may result from missed doses. The EMR service appeared to reduce response time and errors. HealthMatics EMR and the Internet service SureScripts, in cooperation with two MOMS pharmacies, were utilized. We compared the following data from before EMR initiation and after 10 months of use: number of emergency refills/28 days, response times of the clinic to refill requests and opinions of the pharmacists. The average refill response time decreased from 1.57 to 1.04 days (P < 0.004) from 2006 (n = 115) to 2007 (n = 217). Variance decreased from 3.53 to 1.73, respectively, between two same 28-day periods. Before EMR, one pharmacy felt the response times were worse than other clinics, but both perceived general improvement with EMR. The numbers of emergency refills per period were 88 and <1 respectively. In conclusion, with the utilization of EMR for medication refill requests, (1) there was a statistically significant decrease in emergency refill utilization, (2) there was a statistically significant improvement in the response time to a refill request, and (3) pharmacists perceived improvement in response times.

Long-term follow-up of autologous stem cell transplantation for refractory juvenile idiopathic arthritis.

Since 1997, autologous stem cell transplantation (ASCT) had been applied to more than 40 children with polyarticular or systemic juvenile idiopathic arthritis (JIA). For this review, results of the follow-up are available from 25 children with systemic JIA and six with polyarticular JIA that were reported in detail from eight different pediatric European transplant centers. Before ASCT all children had progressive disease despite the use of corticosteroids, methotrexate (MTX) up to 1 mg/kg/week, cyclosporin (2.5 mg/kg/day) and/or anti-TNFalpha therapy. The clinical follow-up of these children ranges from 8 to 60 months (median 33 months).

Automating the medication system: yesterday's impossibilities are today's realities.

Automating previously manual functions helps reduce the potential for medical errors by introducing objective standards and procedures into the system.

Biologic response to chronic blockade of vasopressin receptors in Sprague-Dawley rats.

The renal tubular arginine vasopressin receptor antagonist, d-(CH2)5-D-Tyr(Et)VAVP, is a potent inhibitor of the vasopressin-induced stimulation of adenylate cyclase in rat renal medullary homogenates in vitro. In acute experiments in vivo, this antagonist increased urine volume and decreased urine osmolality after i.v. or s.c. administration in normally hydrated or dehydrated Sprague-Dawley rats. It did not show any effects in water-loaded rats. The duration of action of the antagonist was between 3 to 4 hr. Chronic i.v. infusion or repeated s.c. injections did not result in a persistent diabetes insipidus. A transient rise in water excretion was followed by a progressive normalization. The marked initial water loss was fully compensated for by an increased water intake so that plasma volume and extracellular fluid volume remained unchanged. After 1 week of treatment with the antagonist, glomerular filtration rate and plasma renin activity were not significantly different from base-line values. Only small functional deficits in renal concentrating capacity became manifest when drinking water was withheld. It is possible that the activation of endogenous compensatory mechanisms restored water balance during chronic arginine vasopressin receptor blockade. An intrinsic agonism of this antagonist, which was not detectable in acute experiments, might have contributed to the normalization of water balance by limiting the maximum anti-antidiuretic effects of renal tubular arginine vasopressin receptor blockade.

Chronic blockade of vasopressin receptors in rats.

Chronic i.v. administration of a competitive antagonist of arginine-vasopressin (AVP), d(CH2)5-D-Tyr(Et)-VAVP, in Sprague-Dawley rats induced only a transient diabetes insipidus (DI)-like state. Water excretion and intake were markedly increased on the first day of administration but subsequently reverted to normal. A similar response to the antagonist was observed upon continuous i.v. infusion in Brattleboro rats, homozygous for hereditary hypothalamic DI, which had been substituted with exogenous AVP. This excludes the possibility that increased secretion of endogenous AVP had overcome the blocking effect of the competitive antagonist in Sprague-Dawley rats. However, when AVP was withdrawn from chronically AVP-treated DI rats, water intake increased to values higher than those observed after the antagonist. Subsequently, water intake also decreased but remained elevated compared to that of AVP-substituted rats receiving the antagonist. This suggests that the antagonist might have AVP-like agonistic properties that limit its efficacy and allow compensatory mechanisms to restore normal water balance despite continuous blockade of AVP receptors. The agonistic properties of d(CH2)5-D-Tyr(Et)VAVP were verified upon chronic i.v. administration in nonpretreated DI rats. Thus, the normalization of water balance in Sprague-Dawley rats chronically receiving d(CH2)5-D-Tyr(Et)VAVP is probably due to the activation of compensatory mechanisms and to the agonistic effects of d(CH2)5-D-Tyr(Et)VAVP.

Contribution of vascular and tubular effects of arginine-vasopressin to the development of deoxycorticosterone acetate (DOCA)-salt hypertension in rats.

The role of arginine-vasopressin (AVP) in the pathogenesis of deoxycorticosterone acetate (DOCA) salt hypertension in rats was studied with AVP receptor antagonists for its tubular (V2) and/or vascular (V1) actions. When chronic (six weeks) infusion of the antagonists was started concomitantly with DOCA-salt treatment the development of hypertension was attenuated by the V1-antagonist and prevented by the V1V2-antagonist. However, the V1V2-antagonist induced severe and persistent hypernatraemia in all rats. When chronic (two weeks) infusion of the antagonists was started in rats with established hypertension after five weeks of DOCA-salt treatment blood pressure was not influenced by the V1-antagonist. The rats which received the V1V2-antagonist died from hypernatraemia within four days. These results suggest that in DOCA-salt treated rats AVP is essential for the prevention of severe and life-threatening hypernatraemia. AVP appears to contribute significantly to the development of this form of hypertension through both its vascular and tubular effects.

[The relationship between bacterial sputum analysis and infection]. / Verwantskap fussen bakteriële sputumontleding en infeksie.

Sputum specimens were examined microscopically for the presence of squamous epithelial cell (SECs) and leucoctyes. Where less than 10 SECs and more than 25 leucocytes per low-power field were present, pathogenic organisms were isolated from 84% of patients with pulmonary infections. Sputum specimens which did not comply with these requirements showed a weaker correlation and more non-pathogenic organisms of the buccal cavity were isolated. The bacteriological isolates in sputum specimens and the clinical conditions with which they were associated in this series, are described.