Estimation of tile drainage contribution to streamflow and nutrient loads at the watershed scale based on continuously monitored data.

Nitrogen losses from artificially drained watersheds degrade water quality at local and regional scales. In this study, we used an end-member mixing analysis (EMMA) together with high temporal resolution water quality and streamflow data collected in the 122 km2 Otter Creek watershed located in northeast Iowa. We estimated the contribution of three end-members (groundwater, tile drainage, and quick flow) to streamflow and nitrogen loads and tested several combinations of possible nitrate concentrations for the end-members. Results indicated that subsurface tile drainage is responsible for at least 50% of the watershed nitrogen load between April 15 and November 1, 2015. Tiles delivered up to 80% of the stream N load while providing only 15-43% of the streamflow, whereas quick flows only marginally contributed to N loading. Data collected offer guidance about areas of the watershed that should be targeted for nitrogen export mitigation strategies.

Genetic diversity of Clostridium perfringens isolated from healthy broiler chickens at a commercial farm.

Clostridium perfringens is an important commensal and bacterial pathogen of many animal species. It has particular significance in poultry, where it may cause necrotic enteritis. Our objective was to characterize the population diversity of C. perfringens colonizing healthy birds, and to observe how diversity changed over time. Isolates were obtained from broiler chicken cecal samples in two barns on a single farm, on days 7, 14, 22, 27, 30 and 34 of a single 42-day rearing cycle. Bacitracin was used as a feed additive in one of the barns and withdrawn from the second barn for the duration of the experiment. Each isolate was typed using pulsed-field gel electrophoresis (PFGE) using SmaI restriction endonuclease. A total of 205 cecal isolates from 49 birds were typed, as well as 93 isolates from the barn environment (bedding, drinking water and feces). Eight major PFGE types and 17 subtypes were found in the 298 total isolates. The results show that an optimal sampling strategy would involve a large number of birds, with only a few isolates sampled per bird. The diversity of C. perfringens in this study appears to be low within a single bird, and increases as the bird matures. There was no significant difference in genetic diversity between the two barns. In addition, isolates from fresh fecal samples appear to represent the cecal C. perfringens population accurately, although this was not proven statistically. Antimicrobial susceptibility testing was performed on selected isolates (n=41) representing a cross-section of PFGE types. Based on minimum inhibitory concentration distributions, 95% of the isolates tested were deemed resistant to bacitracin, with a 16 microg/mL breakpoint. Three new cpb2 (beta2 toxin gene) variants were found in the study.

Testes size and testosterone levels in a model for weightlessness.

The purpose of this study was to test whether the lack of testicular growth found in suspended rats would affect testosterone production in a way that might have consequences on muscle atrophy and function studies. Body and testes weight, food consumption, and testosterone levels in testes and plasma were measured at the beginning of the experiment and after 1, 3 or 8 weeks of suspension. Suspended animals ate more but gained less weight than their pair-fed controls. Testes testosterone concentration (microgram/g tissue) was increased at 3 and 8 weeks, but total tissue testosterone (microgram/testes) was not. Up to 3 weeks of suspension, tissue concentration was dependent on testes size and independent of treatment. Plasma testosterone was increased only after 8 weeks of suspension. At 8 weeks, plasma levels correlated with total testes testosterone. Our results show that use of the Morey-Holton rat tail-suspension model up to 3 weeks did not induce testosterone changes of consequence to a skeletal muscle study. For long term studies consideration should be given to possible hormonal effects as tissue and plasma testosterone levels increase after 8 weeks of suspension.

Massive liver hemorrhage in Ontario broiler chickens.

A massive liver hemorrhage (MLH) recognized in Ontario broiler chickens had a characteristic clinical course and pathological lesions. Affected flocks had a higher death rate than normal, with no obvious clinical signs. Deaths from MLH began at two weeks of age; the mortality rate returned to a normal level by four weeks. The main necropsy finding was massive multiple liver hemorrhage with consequent profuse hemoperitoneum.

Procuring organs from a non-heart-beating cadaver: commentary on a case report.

Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will significantly increase the number of organs procured. "Non-heart-beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed.

The role of an ethics committee in a rehabilitation setting.

The ethics committee, initially developed in the acute care setting, can serve to address the particular issues and difficult dilemmas that characterize rehabilitation. The same mechanisms of educational programs, policy development, and case consultation serve to address ethical issues in rehabilitation as well as acute care settings. However, ethical issues in rehabilitation differ greatly from those common in acute care settings. Rehabilitation ethics committees must be prepared to consider issues that include the following: procurement of informed consent for services that are rarely discrete, variable levels of program participation, complex cost-benefit analyses that are subject to less relevant values and biases, unequal access to services, limits of confidentiality, and family/caregiver issues. These difficult issues, peculiar to rehabilitation and made much more complex when patients exhibit cognitive deficits, provide an opportunity for rigorously testing the utility of ethical theory in a complex medical arena.

"Biospheric medicine" as viewed from the two-year first closure of Biosphere 2.

Biosphere 2 is a 3.15-acre, 7-million ft. enclosed ecological space near Tucson, AZ. It contains five wilderness and two domestic biomes (rain forest, savanna, desert, ocean, marsh; agricultural station, living quarters), an original introduction of 3,800 species (approximately 20% extinctions have occurred), and a large basement "technosphere." Sealed inside Biosphere 2 in September 1991, four women and four men, including two of the authors, maintained themselves and the various systems for 2 yr, the longest-sustained "isolated confined environment" period on record. MMPI psychological profile scores for Biosphere 2 crewmembers correlated closely with those reported for astronauts and shuttle applicants. Major medical problems encountered during the 2 yr included adaptation to a low-calorie (1800-2200 kcal.d-1 per person) but otherwise nutritionally adequate diet, with substantial weight loss (18% for men, 10% for women), and a declining oxygen atmosphere (down to 14.2%). Life in a miniworld such as Biosphere 2 may differ substantially from life in a space station or temporary planetary base. These differences include multiple, shifting, sometimes opposing post-launch objectives; complete self-sustenance with recycling of virtually all materials within a highly complex biologic system; retooling of some areas of practical medicine; an attention to "culture" as a social dynamic and how that may influence crew and leadership selection in a societal rather than a quasi-military community. Assuming that long-term planetary colonies must be largely self-sustaining (due to costs of supply over great distances), they must of necessity approach the condition of biospheres. Subject to chaos dynamic (nonlinear dynamic) perturbations, the behavior of complex biospheres will be inherently non-predictable--as opposed to the linear dynamic situation of most space missions--and will require of the inhabitants, including the medical team, a wide range of coping abilities. Under the circumstances, and while strong similarities exist, important differences may serve to distinguish "biospheric medicine" from "space medicine."

Medical futility and life-sustaining treatment decisions.

By focusing our attention on the questions of "what are we trying to achieve" and "are we able to do it", the discussion of medical futility has contributed an important dimension to the ethics of treatment decision making near the end of life. It is not simply enough to ask and answer the question of what the patient wants. Healthcare professionals have a responsibility to offer only those life-sustaining efforts that have a reasonable chance of being beneficial. Futility policies should permit treatment-limiting decisions to be made without the agreement of the patient or surrogate at times, but such policies should also provide opportunities to challenge a judgement of futility. Above all, such policies should not be used as a reason to avoid communication. Patients or surrogates need to be informed about what treatments are options and what are not. The futility criterion for limiting treatment should be recognized as a means of contributing to communication and discussion regarding benefits, harms and medical goals. It should not be permitted to bypass such discussions. The recognition of the significance of the concept of futility means that discussion needs to continue at another level as well. The questions of "what are we trying to achieve" and "are we able to do it" are not easily answered. It is especially important, we think, that those who are experienced in working with patients with neurological impairments contribute to the on-going reflection on what constitutes benefit or what is the appropriate use of life-sustaining interventions for such patients.

Infectious laryngotracheitis in the niagara peninsula: a case control study.

The method(s) of spread of infectious laryngotracheitis in poultry flocks is uncertain. Based on an outbreak of the disease in the Niagara Peninsula in the summer of 1982, managers of infected (case) flocks and noninfected (control) flocks were interviewed to compare their management practices. The data were statistically analyzed; however, the results are not conclusive since only thirteen farms were involved in the outbreak. The results do suggest the following: farms with previous infectious laryngotracheitis infected flocks are more likely to have future outbreaks than are infectious laryngotracheitis-free farms, sanitation procedures of people entering the barns (changing boots and coveralls) appears to be related to infection status and air inlet location on the barn may be associated with infection. These items should be examined more thoroughly in future outbreaks.

OSHAs proposed ergonomic standards: impacts and outcomes.

OSHAs role in ergonomics is reviewed and recommendations for control of work-related musculoskeletal disorders are summarized. The potential impact of these proposed regulations is discussed. A case review of a food manufacturing plant implementing portions of these ergonomics guidelines is presented and preliminary outcomes are highlighted.

Limiting the role of the family in discontinuation of life sustaining treatment.

In matters of discontinuation of life-sustaining treatment, traditional role of the family to speak on behalf of the incompetent patient is questionable. We explore the reasons why physicians perceive patient autonomy to be transferrable to family members. Principle of patient autonomy may not suffice when futile treatment is demanded and may serve to erode the ethical integrity of medical profession. An enhanced role for bioethics committees is proposed when physicians propose to discontinue life-sustaining treatment against the wishes of the patient or their families.

Infant treatment decisions: ethics and cost.

Though society has been conditioned to believe that cost should not enter into medical care decisions, moral reasons do exist for considering cost in treatment decisions. Ethicists traditionally have distinguished between ordinary, or morally obligatory, means of preserving life and extraordinary, or morally optional, means. Treatment that offers a reasonable hope of benefit to the patient without excessive pain, expense, or other inconvenience would be considered ethically ordinary. Treatment that can not be obtained without excessive expense, which could greatly burden the patient's family and deprive them of other goods, could be legitimately withheld. The principle of proportionality, which requires balancing the probability and extent of potential harm against the probability and extent of good, also has been applied to medical care decisions. It has been used to focus attention on the cost of technologies and policies. Some have argued, however, that the individual patient--not a larger social good--should be the physician's only concern. Society should recognize that doing everything possible to save everyone who might survive leaves fewer resources to meet the needs of the poor and the disadvantaged. One way to limit the costs of intensive care, therefore, would be to limit the availability of neonatal treatment facilities. Infants would thus have to be selected for treatment according to prospects for survival or other medical indicators. Before society cuts back on infant care, however, it must address the question of justice. Since many low-birth weight babies are born to poor families, withholding infant treatment in some cases might increase, rather than reduce, the inequalities that already exist in health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethical downsizing. Managers must focus on justice and human dignity.

It is vital that leaders and managers focus on justice and human dignity in the workplace when faced with the possible need to downsize. First, administrators should clearly identify the goals of work force reduction, evaluate their importance, and consider whether they could be achieved through other means. Once they have made the decision to downsize, top managers must clearly communicate the reasons and the goals to those responsible for identifying the employees affected. Employees selected for layoff should be identified on the basis of the articulated goals for work force reduction, whenever possible. When this is not clear, the tough decisions can be based on a variety of factors: "across-the-board" reductions; employee abilities, qualifications, and performance; diversity goals; seniority; or multiple criteria. It is also important to respect human dignity in the layoff process. Affected employees should be informed in advance and given an honest explanation for the layoff. Ordinarily, they should be encouraged to work until the effective date. All employees need a clear and honest explanation of the reasons for and the expected effects of the layoff. There should be a stress on the free flow of information, without an effort to control it. How downsizing is handled says a lot about the nature of an organization and its leadership. Ethical downsizing is, first of all, a refusal to deny the complexity of the issues and evidence of the organization's commitment to justice and human dignity.

The business of ethics. Hospitals need to focus on managerial ethics as much as clinical ethics.

Business ethics begins with the recognition of the various values and "goods" involved in judgements of what to do. Four key values are individual rights, individual self-interest, the company's best interest, and the public good. Often a company has to choose which of these goals or values should be subordinated to another. Business ethics, then, must clarify priorities among these values and establish priority principles to resolve conflicts. One approach to contemporary business ethics emphasizes personal integrity, focusing on conflicts of interest; another approach stresses social responsibility, focusing on the effect of company policy on groups and individuals in society. In business, most of the attention to conflicts of interest focuses on the conflict between employee self-interest and the firm's interest. Healthcare organizations may need to focus on potential conflicts between the patient's interest and the institution's or physician's interest. Physician referrals and pharmaceutical companies' marketing practices are two areas with potential conflicts. Not-for-profit organizations have been quicker than the business world to acknowledge social responsibility. In many ways, however, the social impact of healthcare policies and decisions has not been as carefully considered as it should be. Institutionalizing deliberation about clinical ethical issues has helped to raise awareness about the ethical dimensions of medical care. It would also be useful to institutionalize attention to business ethics in healthcare.

The patient as citizen. A common-good approach to medical treatment decisions balances the emphasis on patient desires.

Individualism plays too strong a role in the arena of treatment decision making, frequently to the exclusion of any other consideration. Using a common-good or community-based ethic as a framework for treatment decision making may provide appropriate balance to the emphasis on patient desires. Self-determination is a good that must be balanced with other goods. When it is not, to quote Daniel Callahan, "Self-determination runs amok." For example, in the state of New Jersey, individuals are permitted to choose the criteria to be used in determining that their own death has occurred. Some of the principles that may lead to a reasonable understanding of the patient's rights in a "patient-as-citizen" ethical perspective are: Everyone has a legitimate claim to a basic level of healthcare. Everyone has a legitimate claim to respect for his or her refusal of recommended treatment. No one has a legitimate claim to nonbeneficial or futile treatment. No one has a legitimate claim to treatment that is being withheld as part of a just rationing system. No one has a legitimate claim to the ability to determine the medical criteria to be used for the diagnosis of his or her death. A just healthcare system is one in which individual desires for medical treatment beyond the basic level are accommodated whenever possible but not when they undermine the primary purpose of medicine to meet the basic healthcare needs of all persons.

Taking on organizational ethics. To do so, ethics committees must first prepare themselves.

Healthcare ethics committees which have focused almost entirely on clinical ethics, now need to prepare to deal with organizational ethics, a field that is attracting increasing attention. As they did with clinical ethics, ethics committees members must educate themselves in the demands of the newer field. As before, they must respect the perspectives of the actual decision makers while maintaining an independent framework for analyzing the issues at stake. They must ensure that management is properly represented on the committee if they need guidance from a professional ethicist they should seek one with a strong background in business ethics and social justice. Healthcare organizations are likely to need help with a wide range of ethical issues involving patient services (rationing of resources, for example), business and service plans (mergers and joint ventures, for example), business and professional integrity (conflicts of interest, for example), employee rights and responsibilities (downsizing, for example), and the organization's role in in the community (advocacy and lobbying, for example). To be helpful to the organization, the ethics committee must be prepared to say when cost factors trump other considerations and when they do not. An ethics committee will often be asked to give advice on specific occasions-a proposed new policy, for instance. The most important part of its response is its analysis of the issue. Finally, an ethics committee should view its organization as part of the larger social context.