Effects and significance of groundwater for vegetation: A systematic review

Groundwater represents a critical water source for plants, especially during drought, with continuous groundwater availability widely associated with the presence of ecological refugia and the preservation of biodiversity during periods of adverse conditions. Here, we present a systematic quantitative literature review of global groundwater and ecosystem interactions to synthesise current knowledge and identify key knowledge gaps and research priorities through a management lens. Despite increasing research on groundwater dependent vegetation since the late 1990s, significant geographical and ecological biases are evident with papers focused on arid regions or areas with significant anthropogenic changes. Of the 140 papers reviewed, desert and steepe arid landscapes accounted for 50.7 % and desert and xeric shrublands were represented in 37.9 % of papers. A third of papers (34.4 %) quantified groundwater uptake by ecosystems and groundwater contributions to transpiration, with studies examining the influence of groundwater on vegetation productivity, distribution, and composition also well represented. In contrast, groundwater influences on other ecosystem functions are relatively poorly explored. The research biases introduce uncertainty in the transferability of findings between locations and ecosystems limiting the generality of our current understanding. This synthesis contributes to consolidating a solid knowledge base of the hydrological and ecological interrelationships for managers, planners, and other decision-makers that is relevant to the landscapes and environments they manage, so can more effectively deliver ecological and conservation outcomes.

The Role of Community Health Workers in the Health and Well-Being of Vulnerable Older Adults during the COVID Pandemic

The COVID-19 pandemic disrupted social support networks as well as resource access for participants. The purpose of this study was to: analyze the experiences of older adults enrolled in a geriatric-focused community health worker (CHW) support program, to gain a better understanding of how CHWs might enhance care delivery, and to further understand how COVID-19 affected the social and emotional needs and well-being of older adults during the first 18 months of the pandemic. Qualitative analysis was performed on notes entered by CHWs based on 793 telephone encounters with 358 participants between March 2020 and August 2021. Analysis was performed by two reviewers independently coding the data. Weighing the benefits of seeing family against the risks of COVID exposure was a source of emotional distress for participants. Our qualitative analysis suggests that CHWs were effective in providing emotional support and connecting participants to resources. CHWs are capable of bolstering the support networks of older adults and carrying out some of the responsibilities conventionally fulfilled by family supports. CHWs addressed participant needs that are frequently unmet by healthcare team members and provided emotional support to participants contributing to health and well-being. CHW assistance can fill gaps in support left by the healthcare system and family support structures.

Racial Differences in Retention in a Community-based Addiction Reduction Program Implemented by Peer Recovery Coaches for Women of Reproductive Age

To identify program characteristics that influence the retention of women of reproductive age in the Community-based Addiction Reduction program (CARE), mixed-method analyses of CARE survey data and CARE Peer Recovery Coach (PRC) narrative entries of participant encounters were performed. About 251 women were enrolled in this prospective community-based implementation science intervention. We compared survey responses by race for treatment status, treatment motivation scales, and retention in the program at intake, 2-, 6-, 9-, and 12-month follow ups using Chi-square/T-tests. Qualitative analysis of PRC narrative entries was conducted following thematic analysis and crystallization immersion analytic methods. White compared with Black women in CARE were significantly more likely to be in treatment at intake (P < .001) and more motivated to engage in recovery treatment (P < .001). However, Black women were retained longer in CARE at 2- (P < .006), 6- (P < .011), and 9- (P < .004) months. PRC narrative entries were coded, and emergent themes mapped well to the 4 types of supports provided by PRC as outlined by the Substance Abuse and Mental Health Services Administration: emotional, instrumental, informational, and affiliational. Analysis of narrative entries by race revealed that Black women were given more detailed information, communications with PRC were more encouraging and proactive in identifying and meeting needs, and PRC took a more hands-on approach when assisting and linking to resources. The inclusion of PRC as integral members of SUD recovery programs may preferentially provide Black women with SUD the opportunity to build more trusting relationships with these peer coaches, thereby increasing their participation and retention.

SyncMRT: a solution to image-guided synchrotron radiotherapy for quality assurance and pre-clinical trials

In this work, a new image guidance system and protocols for delivering image-guided radiotherapy (IGRT) on the Imaging and Medical Beamline (IMBL) at the ANSTO Australian Synchrotron are introduced. The image guidance methods used and the resulting accuracy of tumour alignment in in vivo experiments are often under-reported. Image guidance tasks are often complex, time-consuming and prone to errors. If unchecked, they may result in potential mis-treatments. We introduce SyncMRT, a software package that provides a simple, image guidance tool-kit for aligning samples to the synchrotron beam. We have demonstrated sub-millimetre alignment using SyncMRT and the small-animal irradiation platform (the DynamicMRT system) on the IMBL. SyncMRT has become the standard for carrying out IGRT treatments on the IMBL and has been used in all pre-clinical radiotherapy experiments since 2017. Further, we introduce two quality assurance (QA) protocols to synchrotron radiotherapy on the IMBL: the Winston-Lutz test and hidden target test. It is shown that the presented QA tests are appropriate for picking up geometrical setup errors and assessing the end-to-end accuracy of the image guidance process. Together, these tools make image guidance easier and provide a mechanism for reporting the geometric accuracy of synchrotron-based IGRT treatments. Importantly, this work is scalable to other delivery systems, and is in continual development to support the upcoming veterinary radiotherapy trials on the IMBL.

Complexities of care: Common components of models of care in geriatrics

As people age, they are more likely to have an increasing number of medical diagnoses and medications, as well as healthcare providers who care for those conditions. Health professionals caring for older adults understand that medical issues are not the sole factors in the phenomenon of this “care complexity.” Socioeconomic, cognitive, functional, and organizational factors play a significant role. Care complexity also affects family caregivers, providers, and healthcare systems and therefore society at large. The American Geriatrics Society (AGS) created a work group to review care to identify the most common components of existing healthcare models that address care complexity in older adults. This article, a product of that work group, defines care complexity in older adults, reviews healthcare models and those most common components within them and identifies potential gaps that require attention to reduce the burden of care complexity in older adults.

Inequalities in life expectancy in Australia according to education level: a whole-of-population record linkage study

Background

Life expectancy in Australia is amongst the highest globally, but national estimates mask within-country inequalities. To monitor socioeconomic inequalities in health, many high-income countries routinely report life expectancy by education level. However in Australia, education-related gaps in life expectancy are not routinely reported because, until recently, the data required to produce these estimates have not been available. Using newly linked, whole-of-population data, we estimated education-related inequalities in adult life expectancy in Australia.

Methods

Using data from 2016 Australian Census linked to 2016-17 Death Registrations, we estimated age-sex-education-specific mortality rates and used standard life table methodology to calculate life expectancy. For men and women separately, we estimated absolute (in years) and relative (ratios) differences in life expectancy at ages 25, 45, 65 and 85 years according to education level (measured in five categories, from university qualification [highest] to no formal qualifications [lowest]).

Results

Data came from 14,565,910 Australian residents aged 25 years and older. At each age, those with lower levels of education had lower life expectancies. For men, the gap (highest vs. lowest level of education) was 9.1 (95 %CI: 8.8, 9.4) years at age 25, 7.3 (7.1, 7.5) years at age 45, 4.9 (4.7, 5.1) years at age 65 and 1.9 (1.8, 2.1) years at age 85. For women, the gap was 5.5 (5.1, 5.9) years at age 25, 4.7 (4.4, 5.0) years at age 45, 3.3 (3.1, 3.5) years at 65 and 1.6 (1.4, 1.8) years at age 85. Relative differences (comparing highest education level with each of the other levels) were larger for men than women and increased with age, but overall, revealed a 10–25 % reduction in life expectancy for those with the lowest compared to the highest education level.

Conclusions

Education-related inequalities in life expectancy from age 25 years in Australia are substantial, particularly for men. Those with the lowest education level have a life expectancy equivalent to the national average 15–20 years ago. These vast gaps indicate large potential for further gains in life expectancy at the national level and continuing opportunities to improve health equity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01513-3.

Understanding social workers' hidden roles in medication safety for older adults: A qualitative study

Older adults are vulnerable to risks associated with medications. This study explores the roles of Social Workers in facilitating medication safety for older adults. Eight social workers from federally qualified health centers participated in a case-based and interactive medication safety curriculum. They participated in an in-depth, semi-structured interview to explore their roles and strategies in assisting older adults and caregivers with medication management. Findings were transcribed and analyzed. Six themes characterizing social workers' roles in medication management were identified: a) Referral: matching patients and medication-related resources within the health-care system and community; b) Communication: connecting providers, patients, caregivers, and support system; c) Access to medicine: addressing unique needs of each patient to foster their ability to obtain their medicines; d) Social Determinants of Health: investigating the social challenges of each patient and facilitating specific medication management approaches to meet identified needs; e) Engagement: engaging patients in co-developing a treatment plan; f) Caregiver Support: preparing caregivers to assist in medication management. Social workers are trained and well positioned to provide a multi-faceted approach to improve medication management for older adults. Their unique perspectives and skills are important in addressing the complex challenges of medication management.

Opioid Treatment for Neonatal Opioid Withdrawal Syndrome: Current Challenges and Future Approaches

Chronic intrauterine exposure to psychoactive drugs often results in neonatal opioid withdrawal syndrome (NOWS). When nonpharmacologic measures are insufficient in controlling NOWS, morphine, methadone, and buprenorphine are first-line medications commonly used to treat infants with NOWS because of in utero exposure to opioids. Research suggests that buprenorphine may be the leading drug therapy used to treat NOWS when compared with morphine and methadone. Currently, there are no consensus or standardized treatment guidelines for medications prescribed for NOWS. Opioids used to treat NOWS exhibit large interpatient variability in pharmacokinetics (PK) and pharmacodynamic (PD) response in neonates. Organ systems undergo rapid maturation after birth that may alter drug disposition and exposure for any given dose during development. Data regarding the PK and PD of opioids in neonates are sparse. Pharmacometric methods such as physiologically based pharmacokinetic and population pharmacokinetic modeling can be used to explore factors predictive of some of the variability associated with the PK/PD of opioids in newborns. This review discusses the utility of pharmacometric techniques for enhancing precision dosing in infants requiring opioid treatment for NOWS. Applying these approaches may contribute to optimizing the outcome by reducing cumulative drug exposure, mitigating adverse drug effects, and reducing the burden of NOWS in neonates.

Formalising $$\varSigma $$-Protocols and Commitment Schemes Using CryptHOL

Machine-checked proofs of security are important to increase the rigour of provable security. In this work we present a formalised theory of two fundamental two party cryptographic primitives: $$\varSigma $$ Σ -protocols and Commitment Schemes. $$\varSigma $$ Σ -protocols allow a prover to convince a verifier that they possess some knowledge without leaking information about the knowledge. Commitment schemes allow a committer to commit to a message and keep it secret until revealing it at a later time. We use CryptHOL (Lochbihler in Archive of formal proofs, 2017) to formalise both primitives and prove secure multiple examples namely; the Schnorr, Chaum-Pedersen and Okamoto $$\varSigma $$ Σ -protocols as well as a construction that allows for compound (AND and OR) $$\varSigma $$ Σ -protocols and the Pedersen and Rivest commitment schemes. A highlight of the work is a formalisation of the construction of commitment schemes from $$\varSigma $$ Σ -protocols (Damgard in Lecture notes, 2002). We formalise this proof at an abstract level using the modularity available in Isabelle/HOL and CryptHOL. This way, the proofs of the instantiations come for free.

A Monte Carlo model of synchrotron radiotherapy shows good agreement with experimental dosimetry measurements: Data from the imaging and medical beamline at the Australian Synchrotron

Experimental measurement of Synchrotron Radiotherapy (SyncRT) doses is challenging, especially for Microbeam Radiotherapy (MRT), which is characterised by very high dynamic ranges with spatial resolutions on the micrometer scale. Monte Carlo (MC) simulation is considered a gold standard for accurate dose calculation in radiotherapy, and is therefore routinely relied upon to produce verification data. We present a MC model for Australian Synchrotron's Imaging and Medical Beamline (IMBL), which is capable of generating accurate dosimetry data to inform and/or verify SyncRT experiments. Our MC model showed excellent agreement with dosimetric measurement for Synchrotron Broadbeam Radiotherapy (SBBR). Our MC model is also the first to achieve validation for MRT, using two methods of dosimetry, to within clinical tolerances of 5% for a 20×20 mm² field size, except for surface measurements at 5 mm depth, which remained to within good agreement of 7.5%. Our experimental methodology has allowed us to control measurement uncertainties for MRT doses to within 5-6%, which has also not been previously achieved, and provides a confidence which until now has been lacking in MRT validation studies. The MC model is suitable for SyncRT dose calculation of clinically relevant field sizes at the IMBL, and can be extended to include medical beamlines at other Synchrotron facilities as well. The presented MC model will be used as a validation tool for treatment planning dose calculation algorithms, and is an important step towards veterinary SyncRT trials at the Australian Synchrotron.

Electronic Health Record-Embedded Decision Support Platform for Morphine Precision Dosing in Neonates

Morphine is the opioid most commonly used for neonatal pain management. In intravenous form, it is administered as continuous infusions and intermittent injections, mostly based on empirically established protocols. Inadequate pain control in neonates can cause long-term adverse consequences; however, providing appropriate individualized morphine dosing is particularly challenging due to the interplay of rapid natural physiological changes and multiple life-sustaining procedures in patients who cannot describe their symptoms. At most institutions, morphine dosing in neonates is largely carried out as an iterative process using a wide range of starting doses and then titrating to effect based on clinical response and side effects using pain scores and levels of sedation. Our background data show that neonates exhibit large variability in morphine clearance resulting in a wide range of exposures, which are poorly predicted by dose alone. Here, we describe the development and implementation of an electronic health record-integrated, model-informed decision support platform for the precision dosing of morphine in the management of neonatal pain. The platform supports pharmacokinetic model-informed dosing guidance and has functionality to incorporate real-time drug concentration information. The feedback is inserted directly into prescribers' workflows so that they can make data-informed decisions. The expected outcomes are better clinical efficacy and safety with fewer side effects in the neonatal population.

Utilizing Pediatric Physiologically Based Pharmacokinetic Models to Examine Factors That Contribute to Methadone Pharmacokinetic Variability in Neonatal Abstinence Syndrome Patients

Chronic intrauterine exposure to psychoactive drugs often results in neonatal abstinence syndrome (NAS). NAS is the symptomatic drug withdrawal in newborns that generally occurs after in utero chronic opioid exposure. Methadone is an opioid analgesic commonly prescribed for pharmacologic management of NAS. It exhibits high pharmacokinetic (PK) variability. The current study used physiologically based PK modeling to predict the PK profile of methadone in 20 newborns treated for NAS. The physiologically based PK simulations adequately predicted the PK profile of the clinical data for 45% of the patients. Sensitivity analyses were conducted to explore contributing factors to methadone PK variability. The data suggest that P450 enzymatic activity impacts the clearance of methadone in virtual adults and neonates, while the contribution of cardiac output may be negligible. Understanding maturational and/or pharmacogenetic changes in cytochrome P450 enzymatic activity may further explain the large PK variability of methadone in newborns with NAS and will help individualized treatment.

Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process

AIMS

A 10-month project funded by the NewMind network sought to develop the specification of a visualisation toolbox that could be applied on digital platforms (web- or app-based) to support adults with lived experience of mental health difficulties to present and track their personal wellbeing in a multi-media format.

METHODS

A participant co-design methodology, Double Diamond from the Design Council (Great Britain), was used consisting of four phases: Discover - a set of literature and app searches of wellbeing and health visualisation material; Define - an initial workshop with participants with lived experience of mental health problems to discuss wellbeing and visualisation techniques and to share personal visualisations; Develop - a second workshop to add detail to personal visualisations, for example, forms of media to be employed, degree of control over sharing; and Deliver - to disseminate the learning from the exercise.

RESULTS

Two design workshops were held in December 2017 and April 2018 with 13 and 12 experts-by-experience involved, respectively, including two peer researchers (co-authors) and two individual-carer dyads in each workshop, with over 50% of those being present in both workshops. A total of 20 detailed visualisations were produced, the majority focusing on highly personal and detailed presentations of wellbeing.

DISCUSSION

While participants concurred on a range of typical dimensions of wellbeing, the individual visualisations generated were in contrast to the techniques currently employed by existing digital wellbeing apps and there was a great diversity in preference for different visualisation types. Participants considered personal visualisations to be useful as self-administered interventions or as a step towards seeking help, as well as being tools for self-appraisal.

CONCLUSION

The results suggest that an authoring approach using existing apps may provide the high degree of flexibility required. Training on such tools, delivered via a module on a recovery college course, could be offered.

POLST Facilitation in Complex Care Management: A Feasibility Study

BACKGROUND:

The Physician Orders for Life-Sustaining Treatment (POLST) form is an advance care planning tool designed for seriously ill patients. The discussions needed for high-quality POLST decision-making are time intensive and often do not occur in the outpatient setting.

OBJECTIVE:

We conducted a single-arm feasibility study of POLST facilitation by nonphysicians using Respecting Choices Last Steps, a standardized, structured approach to facilitation of POLST conversations.

SETTING/PARTICIPANTS:

Community-dwelling adults aged 65 and older enrolled in a complex care management program in a Midwestern urban hospital.

MEASUREMENTS:

We assessed the feasibility and acceptability by determining the proportion of eligible patients who enrolled and completed the study, by adherence to the Respecting Choices protocol, and by responses to qualitative and quantitative survey items about the intervention.

RESULTS:

We enrolled 18 (58.1%) of 31 eligible patients, with a mean age of 77.8 years (standard deviation: 6.95); 12 were African American. The POLST facilitation was delivered to all 18; 10 (55.6%) completed POLST forms. Direct observation of intervention delivery using a checklist found 85% of the required elements were performed by facilitators. We completed 6- to 8-week follow-up interviews in 16 of 18 patients (88.9%). We found 87.5% of decision makers agreed or strongly agreed that "Talking about the (POLST) form helped me think about what I really want."

CONCLUSIONS:

The POLST facilitation can be successfully delivered to frail older adults in a complex care management setting, with high fidelity to protocol. Further research is needed to demonstrate the effects of this approach on decision quality and other patient-reported outcomes.

Resilience theory incorporated into urban wastewater systems management. State of the art

Government bodies, utilities, practitioners, and researchers have growing interest in the incorporation of resilience into wastewater management. Since resilience is a multidisciplinary term, it is important to review what has been achieved in the wastewater sector, and describe the future research directions for the forthcoming years. This work presents a critical review of studies that deal with resilience in the wastewater treatment sector, with a special focus on understanding how they addressed the key elements for assessing resilience, such as stressors, system properties, metrics and interventions to increase resilience. The results showed that only 17 peer-reviewed papers and 6 relevant reports, a small subset of the work in wastewater research, directly addressed resilience. The lack of consensus in the definition of resilience, and the elements of a resilience assessment, is hindering the implementation of resilience in wastewater management. To date, no framework for resilience assessment is complete, comprehensive or directly applicable to practitioners; current examples are lacking key elements (e.g. a comprehensive study of stressors, properties and metrics, examples of cases study, ability to benchmark interventions or connectivity with broader frameworks). Furthermore, resilience is seen as an additional cost or extra effort, instead of a means to overcome project uncertainty that could unlock new opportunities for investment.

Dermatologic conditions in patients of color who are pregnant

Certain dermatoses that present during pregnancy have a predilection for populations with skin of color (SOC). Additionally, certain systemic diseases such as systemic lupus erythematosus tend to be more aggressive during pregnancy and confer worse prognoses in women with SOC. The purpose of this review is to highlight the unique implications of selected diseases during pregnancy as it relates to SOC. Dermatologists should be vigilant for the unique clinical variations of dermatological conditions in patients of color who are pregnant to ensure correct diagnoses and optimize treatment outcomes.

Structural studies of substrate and product complexes of 5-aminolaevulinic acid dehydratase from humans,Escherichia coliand the hyperthermophilePyrobaculum calidifontis

A number of X-ray analyses of an enzyme involved in a key early stage of tetrapyrrole biosynthesis are reported. Two structures of human 5-aminolaevulinate dehydratase (ALAD), native and recombinant, have been determined at 2.8 Å resolution, showing that the enzyme adopts an octameric quaternary structure in accord with previously published analyses of the enzyme from a range of other species. However, this is in contrast to the finding that a disease-related F12L mutant of the human enzyme uniquely forms hexamers [Breiniget al.(2003),Nature Struct. Biol.10, 757–763]. Monomers of all ALADs adopt the TIM-barrel fold; the subunit conformation that assembles into the octamer includes the N-terminal tail of one monomer curled around the (α/β)8barrel of a neighbouring monomer. Both crystal forms of the human enzyme possess two monomers per asymmetric unit, termedAandB. In the native enzyme there are a number of distinct structural differences between theAandBmonomers, with the latter exhibiting greater disorder in a number of loop regions and in the active site. In contrast, the second monomer of the recombinant enzyme appears to be better defined and the active site of both monomers clearly possesses a zinc ion which is bound by three conserved cysteine residues. In native human ALAD, theAmonomer also has a ligand resembling the substrate ALA which is covalently bound by a Schiff base to one of the active-site lysines (Lys252) and is held in place by an ordered active-site loop. In contrast, these features of the active-site structure are disordered or absent in theBsubunit of the native human enzyme. The octameric structure of the zinc-dependent ALAD from the hyperthermophilePyrobaculum calidifontisis also reported at a somewhat lower resolution of 3.5 Å. Finally, the details are presented of a high-resolution structure of theEscherichia coliALAD enzyme co-crystallized with a noncovalently bound moiety of the product, porphobilinogen (PBG). This structure reveals that the pyrrole side-chain amino group is datively bound to the active-site zinc ion and that the PBG carboxylates interact with the enzymeviahydrogen bonds and salt bridges with invariant residues. A number of hydrogen-bond interactions that were previously observed in the structure of yeast ALAD with a cyclic intermediate resembling the product PBG appear to be weaker in the new structure, suggesting that these interactions are only optimal in the transition state.

Performance evaluation of conventional and water saving taps

The rapid pace of urbanisation comes with considerable environmental implications including pressures on already stressed limited water resources. In urban areas, most of the water use is associated with water consumption in buildings. The second largest use of water is via taps. It is often assumed that water taps with low flow rates can contribute to reduced per capita water consumption. However, this is based on very little evidence. This paper presents the synthesis of a 13,000 high resolution observations made to investigate the actual water consumption of innovative (water saving) electronic taps and conventional mixer taps. High resolution flow-meters and data loggers were fitted into two washrooms in two different buildings of a higher education institution to record the water use through the basin taps. The recorded data provided information on duration, frequency of use and volume of water consumption per use. The data was helpful in identifying trends in hot and cold water use and therefore can be useful in estimating energy for producing hot water and associated greenhouse gas emissions. Analysis of the observed data suggests that the low flow taps have greater mean water consumption per event than the conventional taps and water consumption is more influenced by user behaviour rather than the technology.

Surface water sewer misconnections in England and Wales: Pollution sources and impacts

In urban areas served by separate sewerage consisting of separate pipe systems it is not uncommon for misconnections to be made either accidentally or deliberately, whereby the wrong effluent is connected to the wrong sewer. The main focus of this problem has been on in-household appliances that are wrongly connected to separate surface water sewers, potentially leading to pollution of receiving waters and non-compliance with statutory water quality standards. This paper examines the available evidence to evaluate the potential scale, severity and cost of the problem in England and Wales in comparison to that reported from investigations in the United States. The particular difficulties associated with distinguishing specific sewage sources in the wastewater "cocktail" discharged at polluted surface water outfalls are reviewed. The deficiencies of existing legislation and enforcing compliance with respect to misconnections are also discussed and the pollution potential resulting from domestic misconnections is explored based on sampled data.

Quantifying carbon sequestration on sheep grazing land in Australia for life cycle assessment studies

The sheep industry has played an important role in Australia’s development and economy over the 220 years since European settlement and remains an important land use in Australia, occupying an estimated 85 million ha of continental land mass. Historically, deforestation was carried out in many sheep-rearing regions to promote pasture growth but this has not occurred within recent decades and many wool producers have invested in planting trees as well as preserving patches of remnant vegetation. Although the limitations of single environmental impact studies are recognised, this paper focuses on the contribution of carbon sequestration in trees and shrubs on sheep farms to the global warming potential impact category in life cycle assessment of wool. The analysis represents three major wool-producing zones of Australia. Based on default regional yields as applied in Australia’s National Inventory model, FullCAM, CO2 removals in planted exotic pines and mixed native species were estimated to be 5.0 and 3.0 t CO2 ha–1 year–1, respectively, for the Northern Tablelands of New South Wales in the ‘high-rainfall zone’ and 1.4 t CO2 ha–1 year–1 for mixed native species in the ‘sheep-wheat zone’ of Western Australia. Applying modified factors allowing for the higher measured growth rates in regions with rainfall >300 mm, gave values for native species reforestation of 4.4 and 2.0 t CO2 ha–1 year–1 for New South Wales and Western Australia, respectively. Sequestration was estimated to be 0.07 t CO2 ha–1 year–1 over 100 years for chenopod shrublands of the ‘pastoral zone’ of South Australia but this low rate is significant because of the extent of regeneration. Sequestration of soil organic carbon in improved permanent pastures in the New South Wales Northern Tablelands was evaluated to be highly uncertain but potentially significant over large areas of management. Improved data and consistent methodologies are needed for quantification of these benefits in life cycle assessment studies for wool and sheep meat, and additional impact categories, such as biodiversity, need to be included if the public and private benefits provided by good management of vegetation resources on farms are to be more fully recognised.

A life cycle assessment approach to quantifying greenhouse gas emissions from land-use change for beef production in eastern Australia

In life cycle assessment studies, greenhouse gas (GHG) emissions from direct land-use change have been estimated to make a significant contribution to the global warming potential of agricultural products. However, these estimates have a high uncertainty due to the complexity of data requirements and difficulty in attribution of land-use change. This paper presents estimates of GHG emissions from direct land-use change from native woodland to grazing land for two beef production regions in eastern Australia, which were the subject of a multi-impact life cycle assessment study for premium beef production. Spatially- and temporally consistent datasets were derived for areas of forest cover and biomass carbon stocks using published remotely sensed tree-cover data and regionally applicable allometric equations consistent with Australia’s national GHG inventory report. Standard life cycle assessment methodology was used to estimate GHG emissions and removals from direct land-use change attributed to beef production. For the northern-central New South Wales region of Australia estimates ranged from a net emission of 0.03 t CO2-e ha–1 year–1 to net removal of 0.12 t CO2-e ha–1 year–1 using low and high scenarios, respectively, for sequestration in regrowing forests. For the same period (1990–2010), the study region in southern-central Queensland was estimated to have net emissions from land-use change in the range of 0.45–0.25 t CO2-e ha–1 year–1. The difference between regions reflects continuation of higher rates of deforestation in Queensland until strict regulation in 2006 whereas native vegetation protection laws were introduced earlier in New South Wales. On the basis of liveweight produced at the farm-gate, emissions from direct land-use change for 1990–2010 were comparable in magnitude to those from other on-farm sources, which were dominated by enteric methane. However, calculation of land-use change impacts for the Queensland region for a period starting 2006, gave a range from net emissions of 0.11 t CO2-e ha–1 year–1 to net removals of 0.07 t CO2-e ha–1 year–1. This study demonstrated a method for deriving spatially- and temporally consistent datasets to improve estimates for direct land-use change impacts in life cycle assessment. It identified areas of uncertainty, including rates of sequestration in woody regrowth and impacts of land-use change on soil carbon stocks in grazed woodlands, but also showed the potential for direct land-use change to represent a net sink for GHG.

Clustering analysis of water distribution systems: identifying critical components and community impacts

Large water distribution systems (WDSs) are networks with both topological and behavioural complexity. Thereby, it is usually difficult to identify the key features of the properties of the system, and subsequently all the critical components within the system for a given purpose of design or control. One way is, however, to more explicitly visualize the network structure and interactions between components by dividing a WDS into a number of clusters (subsystems). Accordingly, this paper introduces a clustering strategy that decomposes WDSs into clusters with stronger internal connections than external connections. The detected cluster layout is very similar to the community structure of the served urban area. As WDSs may expand along with urban development in a community-by-community manner, the correspondingly formed distribution clusters may reveal some crucial configurations of WDSs. For verification, the method is applied to identify all the critical links during firefighting for the vulnerability analysis of a real-world WDS. Moreover, both the most critical pipes and clusters are addressed, given the consequences of pipe failure. Compared with the enumeration method, the method used in this study identifies the same group of the most critical components, and provides similar criticality prioritizations of them in a more computationally efficient time.

Pleomorphic lobular carcinoma of the breast: a morphologically and clinically distinct variant of lobular carcinoma

Pleomorphic lobular carcinoma is an uncommon variant of lobular carcinoma, characterized by significant cytologic atypia that contrasts with the low pleomorphism of classical lobular carcinoma. It accounts for approximately 1% of all epithelial breast malignancies. In addition to its pleomorphism, it is characterized by aggressive behavior and shortened patient survival. Although the morphologic features of pleomorphic lobular carcinoma are well described, it often eludes accurate pathologic characterization. Some controversy surrounds the pathogenesis of pleomorphic lobular carcinoma; however, it is now considered a well-defined variant of invasive lobular carcinoma. Pleomorphic lobular carcinoma shares molecular alterations with classical lobular carcinoma, such as alterations in the gene CDH1 on chromosome band 16q22 that results in changes in E-cadherin protein function. The aggressive biology of pleomorphic lobular carcinoma relates to the acquisition of genetic alterations typical of high-grade ductal carcinoma, such as overexpression of HER2/neu and c-myc.

Octreotide for chylous effusions in congenital diaphragmatic hernia

BACKGROUND/PURPOSE

Chylothorax is a frequent complication in congenital diaphragmatic hernia (CDH) infants and is associated with significant morbidity. The optimal treatment strategy remains unclear. We hypothesize that octreotide decreases chylous effusions in infants with CDH.

METHODS

This is a retrospective study of all infants with CDH admitted to our institution from October 2006 to October 2011.

RESULTS

Eleven (12%) infants developed a chylothorax. Five infants were managed conservatively with thoracostomy and total parenteral nutrition. Six infants were started on octreotide therapy. None of the infants required surgical intervention to stop the effusion. There was no significant difference in survival to discharge, length of stay, or average daily chest tube output between groups. There appeared to be a temporally associated drop in chest tube output upon initiation of octreotide in two infants; however, the overall rate of decline in chest tube drainage was unchanged. In addition, there were infants in the conservative group who demonstrated a similar drop in daily chest tube output despite the absence of octreotide.

CONCLUSIONS

Our data suggest that the majority of chylous effusions in CDH infants resolve with conservative therapy alone.

Performance of a large building rainwater harvesting system

Rainwater harvesting is increasingly becoming an integral part of the sustainable water management toolkit. Despite a plethora of studies modelling the feasibility of the utilisation of rainwater harvesting (RWH) systems in particular contexts, there remains a significant gap in knowledge in relation to detailed empirical assessments of performance. Domestic systems have been investigated to a limited degree in the literature, including in the UK, but there are few recent longitudinal studies of larger non-domestic systems. Additionally, there are few studies comparing estimated and actual performance. This paper presents the results of a longitudinal empirical performance assessment of a non-domestic RWH system located in an office building in the UK. Furthermore, it compares actual performance with the estimated performance based on two methods recommended by the British Standards Institute - the Intermediate (simple calculations) and Detailed (simulation-based) Approaches. Results highlight that the average measured water saving efficiency (amount of mains water saved) of the office-based RWH system was 87% across an 8-month period, due to the system being over-sized for the actual occupancy level. Consequently, a similar level of performance could have been achieved using a smaller-sized tank. Estimated cost savings resulted in capital payback periods of 11 and 6 years for the actual over-sized tank and the smaller optimised tank, respectively. However, more detailed cost data on maintenance and operation is required to perform whole life cost analyses. These findings indicate that office-scale RWH systems potentially offer significant water and cost savings. They also emphasise the importance of monitoring data and that a transition to the use of Detailed Approaches (particularly in the UK) is required to (a) minimise over-sizing of storage tanks and (b) build confidence in RWH system performance.

Development of a software model to estimate daily greenhouse gas emissions of pasture-fed ruminant farming systems

A software model has been developed to estimate greenhouse gas emissions of pasture-fed ruminant farming systems. The model estimates on-farm emissions associated with livestock (sheep and beef), fertiliser, petrol, diesel and electricity. Carbon sequestration from native and exotic forestry is then included to produce an on-farm carbon footprint, in the form of carbon dioxide equivalents. This paper describes the livestock model, which has been designed to record the movement of animals within individual farm units according to defined livestock classes. Allowances are made for unrecorded deaths, by estimating the number of animals missing within a defined time period and spreading the deaths according to expected seasonal variation in mortality. The enteric methane and nitrous oxide emissions are predicted using a combination of customised growth and lactation curves, and internationally recognised formulae to predict nutrient energy requirements. Customised growth and lactation curves allow estimation of liveweights and energy requirements associated with maintenance, growth, pregnancy and lactation on a daily basis. Daily estimation of emissions reduces errors introduced by monthly or seasonal averaging of livestock numbers and liveweights. The model has been developed into a commercial application (Alliance Group hoofprint) for use by New Zealand sheep and beef farmers, and could be adapted for other international livestock farming operations.

Environmental implications of water efficient microcomponents in residential buildings

The Code for Sustainable Homes (CSH) in England sets out various water efficiency targets/levels, which form part of environmental performance criteria against which the sustainability of a building is measured. The code is performance based and requires reduction in per capita water consumption in households. The water efficiency related targets can be met using a range of water efficient microcomponents (WC, showers, kitchen taps, basin taps, dishwashers, washing machines, and baths). However, while the CSH aims at reducing the adverse environmental implications associated with the dwellings by promoting reduction in water consumption, little is known about the energy consumption and the environmental impacts (e. g. carbon emissions) resulting from water efficient end uses. This paper describes a methodology to evaluate the energy consumption and carbon emissions associated with the CSH's water efficiency levels. Key findings are that some 96% and 87% of energy use and carbon emissions, respectively associated with urban water provision are attributable to in-house consumption (principally related to hot water), and that achieving a defined water efficiency target does not automatically save energy or reduce carbon emissions.

Rainwater harvesting: model-based design evaluation

The rate of uptake of rainwater harvesting (RWH) in the UK has been slow to date, but is expected to gain momentum in the near future. The designs of two different new-build rainwater harvesting systems, based on simple methods, are evaluated using three different design methods, including a continuous simulation modelling approach. The RWH systems are shown to fulfill 36% and 46% of WC demand. Financial analyses reveal that RWH systems within large commercial buildings maybe more financially viable than smaller domestic systems. It is identified that design methods based on simple approaches generate tank sizes substantially larger than the continuous simulation. Comparison of the actual tank sizes and those calculated using continuous simulation established that the tanks installed are oversized for their associated demand level and catchment size. Oversizing tanks can lead to excessive system capital costs, which currently hinders the uptake of systems. Furthermore, it is demonstrated that the catchment area size is often overlooked when designing UK-based RWH systems. With respect to these findings, a recommendation for a transition from the use of simple tools to continuous simulation models is made.

Impacts of residence time during storage on potential of water saving for grey water recycling system

Grey water recycling has been generally accepted and is about to move into practice in terms of sustainable development. Previous research has revealed the bacteria re-growth in grey water and reclaimed municipal water during storage. However, in most present grey water recycling practices, impacts of water quality changes during storage on the system's performance and design regulation have not been addressed. In this paper, performance of a constructed wetland based grey water recycling system was analysed by taking the constraint of residence time during storage into account using an object based household water cycle model. Two indicators, water saving efficiency (WSE) and residence time index (RTI), are employed to reflect the system's performance and residence time during storage respectively. Results show that WSE and RTI change with storage tank volumes oppositely. As both high WSE and RTI cannot be achieved simultaneously, it is concluded that in order to achieve the most cost-effective and safe solution, systems with both small grey and green tanks are needed, whilst accepting that only relatively modest water saving efficiency targets can be achieved. Higher efficiencies will only be practicable if water quality deterioration in the green water tank can be prevented by some means (e.g. disinfection).