GEDOS-SECOT consensus on the care process of patients with knee osteoarthritis and arthoplasty

OBJECTIVE

To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts.

METHODS

A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (i)efficacy and safety of fast-tracks; (ii)efficacy and safety of cognitive interventions in patients with catastrophic pain, and (iii) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation.

RESULTS

A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines.

CONCLUSIONS

There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period.

Energy, water and fish: biodiversity impacts of energy-sector water demand in the United States depend on efficiency and policy measures

Rising energy consumption in coming decades, combined with a changing energy mix, have the potential to increase the impact of energy sector water use on freshwater biodiversity. We forecast changes in future water use based on various energy scenarios and examine implications for freshwater ecosystems. Annual water withdrawn/manipulated would increase by 18-24%, going from 1,993,000-2,628,000 Mm(3) in 2010 to 2,359,000-3,271,000 Mm(3) in 2035 under the Reference Case of the Energy Information Administration (EIA). Water consumption would more rapidly increase by 26% due to increased biofuel production, going from 16,700-46,400 Mm(3) consumption in 2010 to 21,000-58,400 Mm(3) consumption in 2035. Regionally, water use in the Southwest and Southeast may increase, with anticipated decreases in water use in some areas of the Midwest and Northeast. Policies that promote energy efficiency or conservation in the electric sector would reduce water withdrawn/manipulated by 27-36 m(3)GJ(-1) (0.1-0.5 m(3)GJ(-1) consumption), while such policies in the liquid fuel sector would reduce withdrawal/manipulation by 0.4-0.7 m(3)GJ(-1) (0.2-0.3 m(3)GJ(-1) consumption). The greatest energy sector withdrawal/manipulation are for hydropower and thermoelectric cooling, although potential new EPA rules that would require recirculating cooling for thermoelectric plants would reduce withdrawal/manipulation by 441,000 Mm(3) (20,300 Mm(3) consumption). The greatest consumptive energy sector use is evaporation from hydroelectric reservoirs, followed by irrigation water for biofuel feedstocks and water used for electricity generation from coal. Historical water use by the energy sector is related to patterns of fish species endangerment, where water resource regions with a greater fraction of available surface water withdrawn by hydropower or consumed by the energy sector correlated with higher probabilities of imperilment. Since future increases in energy-sector surface water use will occur in areas of high fish endemism (e.g., Southeast), additional management and policy actions will be needed to minimize further species imperilment.

Global urban growth and the geography of water availability, quality, and delivery

Globally, urban growth will add 1.5 billion people to cities by 2030, making the difficult task of urban water provisions even more challenging. In this article, we develop a conceptual framework of urban water provision as composed of three axes: water availability, water quality, and water delivery. For each axis, we calculate quantitative proxy measures for all cities with more than 50,000 residents, and then briefly discuss the strategies cities are using in response if they are deficient on one of the axes. We show that 523 million people are in cities where water availability may be an issue, 890 million people are in cities where water quality may be an issue, and 1.3 billion people are in cities where water delivery may be an issue. Tapping into groundwater is a widespread response, regardless of the management challenge, with many cities unsustainably using this resource. The strategies used by cities deficient on the water delivery axis are different than for cities deficient on the water quantity or water quality axis, as lack of financial resources pushes cities toward a different and potentially less effective set of strategies.

Establishing IUCN Red List criteria for threatened ecosystems

The potential for conservation of individual species has been greatly advanced by the International Union for Conservation of Nature's (IUCN) development of objective, repeatable, and transparent criteria for assessing extinction risk that explicitly separate risk assessment from priority setting. At the IV World Conservation Congress in 2008, the process began to develop and implement comparable global standards for ecosystems. A working group established by the IUCN has begun formulating a system of quantitative categories and criteria, analogous to those used for species, for assigning levels of threat to ecosystems at local, regional, and global levels. A final system will require definitions of ecosystems; quantification of ecosystem status; identification of the stages of degradation and loss of ecosystems; proxy measures of risk (criteria); classification thresholds for these criteria; and standardized methods for performing assessments. The system will need to reflect the degree and rate of change in an ecosystem's extent, composition, structure, and function, and have its conceptual roots in ecological theory and empirical research. On the basis of these requirements and the hypothesis that ecosystem risk is a function of the risk of its component species, we propose a set of four criteria: recent declines in distribution or ecological function, historical total loss in distribution or ecological function, small distribution combined with decline, or very small distribution. Most work has focused on terrestrial ecosystems, but comparable thresholds and criteria for freshwater and marine ecosystems are also needed. These are the first steps in an international consultation process that will lead to a unified proposal to be presented at the next World Conservation Congress in 2012.

Scenarios for Global Biodiversity in the 21st Century

Quantitative scenarios are coming of age as a tool for evaluating the impact of future socioeconomic development pathways on biodiversity and ecosystem services. We analyze global terrestrial, freshwater, and marine biodiversity scenarios using a range of measures including extinctions, changes in species abundance, habitat loss, and distribution shifts, as well as comparing model projections to observations. Scenarios consistently indicate that biodiversity will continue to decline over the 21st century. However, the range of projected changes is much broader than most studies suggest, partly because there are major opportunities to intervene through better policies, but also because of large uncertainties in projections.

Global biodiversity: indicators of recent declines

In 2002, world leaders committed, through the Convention on Biological Diversity, to achieve a significant reduction in the rate of biodiversity loss by 2010. We compiled 31 indicators to report on progress toward this target. Most indicators of the state of biodiversity (covering species' population trends, extinction risk, habitat extent and condition, and community composition) showed declines, with no significant recent reductions in rate, whereas indicators of pressures on biodiversity (including resource consumption, invasive alien species, nitrogen pollution, overexploitation, and climate change impacts) showed increases. Despite some local successes and increasing responses (including extent and biodiversity coverage of protected areas, sustainable forest management, policy responses to invasive alien species, and biodiversity-related aid), the rate of biodiversity loss does not appear to be slowing.

Prospects for monitoring freshwater ecosystems towards the 2010 targets

Human activities have severely affected the condition of freshwater ecosystems worldwide. Physical alteration, habitat loss, water withdrawal, pollution, overexploitation and the introduction of non-native species all contribute to the decline in freshwater species. Today, freshwater species are, in general, at higher risk of extinction than those in forests, grasslands and coastal ecosystems. For North America alone, the projected extinction rate for freshwater fauna is five times greater than that for terrestrial fauna--a rate comparable to the species loss in tropical rainforest. Because many of these extinctions go unseen, the level of assessment and knowledge of the status and trends of freshwater species are still very poor, with species going extinct before they are even taxonomically classified. Increasing human population growth and achieving the sustainable development targets set forth in 2002 will place even higher demands on the already stressed freshwater ecosystems, unless an integrated approach to managing water for people and ecosystems is implemented by a broad constituency. To inform and implement policies that support an integrated approach to water management, as well as to measure progress in halting the rapid decline in freshwater species, basin-level indicators describing the condition and threats to freshwater ecosystems and species are required. This paper discusses the extent and quality of data available on the number and size of populations of freshwater species, as well as the change in the extent and condition of natural freshwater habitats. The paper presents indicators that can be applied at multiple scales, highlighting the usefulness of using remote sensing and geographical information systems technologies to fill some of the existing information gaps. Finally, the paper includes an analysis of major data gaps and information needs with respect to freshwater species to measure progress towards the 2010 biodiversity targets.

Geospatial indicators of emerging water stress: an application to Africa

This study demonstrates the use of globally available Earth system science data sets for water assessment in otherwise information-poor regions of the world. Geospatial analysis at 8 km resolution shows that 64% of Africans rely on water resources that are limited and highly variable. Where available, river corridor flow is critical in augmenting local runoff, reducing impacts of climate variability, and improving access to freshwater. A significant fraction of cropland resides in Africa's driest regions, with 39% of the irrigation nonsustainable. Chronic overuse and water stress is high for 25% of the population with an additional 13% experiencing drought-related stress once each generation. Paradoxically, water stress for the vast majority of Africans typically remains low, reflecting poor water infrastructure and service, and low levels of use. Modest increases in water use could reduce constraints on economic development, pollution, and challenges to human health. Developing explicit geospatial indicators that link biogeophysical, socioeconomic, and engineering perspectives constitutes an important next step in global water assessment.

Fragmentation and flow regulation of the world's large river systems

A global overview of dam-based impacts on large river systems shows that over half (172 out of 292) are affected by dams, including the eight most biogeographically diverse. Dam-impacted catchments experience higher irrigation pressure and about 25 times more economic activity per unit of water than do unaffected catchments. In view of projected changes in climate and water resource use, these findings can be used to identify ecological risks associated with further impacts on large river systems.