Colonoscopy skills improvement training improves patient comfort during colonoscopy

INTRODUCTION

We aimed to assess the effect of Colonoscopy Skills Improvement (CSI) training on patient comfort and sedation-related complications during colonoscopy.

METHODS

This retrospective cohort study was performed on 19 endoscopists practicing in a Canadian tertiary care center who completed CSI training between October 2014 and May 2016. Data from 50 procedures immediately prior to, immediately after, and eight months following CSI training were included for each endoscopist. The primary outcome variable was intraprocedural comfort, and secondary outcomes included intraprocedural hypotension and hypoxia. Data were extracted from an electronic medical record and analyzed using SPSS version 20.0. Univariate analysis and stepwise multivariable logistic regression were performed to determine if there was an association between patient comfort and CSI training. Predictors of these outcomes including patient age, gender, sedation use and dosing, procedure completion, quality of bowel preparation, endoscopist experience, and specialty were included in the analysis.

RESULTS

2533 colonoscopies were included in the study. The mean dose of sedatives was reduced immediately following CSI training and at 8 months for both Fentanyl (75.4 mcg v. 67.8 mcg v. 65.9 mcg, p < 0.001) and Midazolam (2.57 mg v. 2.27 mg v. 2.19 mg, p < 0.001). The percentage of patients deemed to have a comfortable exam improved following endoscopist participation in CSI training and remained improved at 8 months (55.1% v. 70.2% v. 69.8%, p < 0.001). No significant change in rates of intraprocedural hypoxia or hypotension were noted following CSI training.

CONCLUSION

CSI training is associated with improved patient comfort and reduced sedation requirements during colonoscopy.

The intrusion of polluted Fly River mud into Torres Strait

There is a concern that the Fly River plume from Papua New Guinea (PNG) may be delivering mine-derived polluted mud along the southern PNG coast into the northern Torres Strait, which is the northernmost extent of the Great Barrier Reef. To quantify this threat, the mud transport dynamics along the southern PNG coast were studied using the SLIM model. The model was qualitatively verified using historical field data on sediment dynamics and compared with more recent satellite-derived turbidity data. During strong south east winds and spring tides, about 5.4% of the Fly River mud discharge enters the Torres Strait, in agreement with previous field-derived results. The annual net movement of mud is westward, thus polluted Fly River mud progressively intrudes into Torres Strait. This intrusion is slow and may take a century to reach in significant quantities at Saibai Island, the nearest Australian island to the Fly River. Field data are needed to fully validate the model and provide greater confidence in these results.

Seagrass habitat in Tarawa Lagoon, Kiribati: Service benefits and links to national priority issues

This paper presents a review around seagrass habitat in Tarawa Lagoon, Kiribati and explores the links between seagrass occurrence and the national priority issues of climate change, urban development, human health, nearshore fisheries, threatened species, ocean policy, research capacity and awareness. The contribution of healthy seagrass habitats to many aspects of these national issues is often overlooked and there is need to establish the knowledge gaps and priority actions that can enable mitigation of issues that impact on valuable seagrass resources and their management. Research data on seagrass habitats in Kiribati, and the wider Pacific Island region, is limited and this hinders informed decisions at local, national and regional levels. We present a comprehensive review on seagrass within a national context to aid prioritisation and uptake of information for resource owners, and wider stakeholders, in Kiribati while acknowledging local expertise. The paper highlights data and knowledge gaps that if addressed, will provide information useful to Kiribati nationals, communities and government stakeholders. Recommendations for actions that fill these gaps and build understanding of seagrass resources in Kiribati are provided.

Fine sediment and particulate organic matter: A review and case study on ridge-to-reef transport, transformations, fates, and impacts on marine ecosystems

Studies documenting the effects of land-derived suspended particulate matter (SPM, i.e., particulate organic matter and mineral sediment) on marine ecosystems are typically disconnected from terrestrial studies that determine their origin, transport and fate. This study reviews sources, transport, transformations, fate and effects of SPM along the 'ridge-to-reef' continuum. We show that some of the SPM can be transported over long distances and transformed into large and easily resuspendible organic-rich sediment flocs. These flocs may lead to prolonged reductions in water clarity, impacting upon coral reef, seagrass and fish communities. Using the Great Barrier Reef (NE Australia) as a case study, we identify the latest research tools to determine thresholds of SPM exposure, allowing for an improved appreciation of marine risk. These tools are used to determine ecologically-relevant end-of-basin load targets and reliable marine water quality guidelines, thereby enabling enhanced prioritisation and management of SPM export from ridge-to-reef.

Microspatial variability in community structure and photophysiology of calcified macroalgal microbiomes revealed by coupling of hyperspectral and high-resolution fluorescence imaging

Calcifying coralline macroalgae provide biogenic habitats colonised by epiphytic microalgae that contribute significantly to community productivity. Georeferenced hyperspectral and high-resolution fluorescence imaging were coupled to microspatially mapped community composition and relative biomass of macroalgal host and epiphyte microalgal groups, and their weighted contributions to productivity within host fronds of Corallina officinalis on upper and lower zones of a rocky shore were determined. Lower shore epiphytes were dominated by filamentous diatoms (Bacillariophyta), confined to the apex of the frond structure, which were low light acclimated but retained a high capacity for photoprotective down regulation and contributed up to 51% of total community productivity. Upper shore epiphytes were dominated by green algae (Chlorophyta) and single-celled diatoms (principally Cocconeis spp.), which were high light acclimated but present at far lower relative biomass and contributed negligibly to productivity. The host, C. officinalis was the main primary producer. Variation in light environment resulting from differences in shore height and shading within the host macroalga, likely play a large role in determining patterns in epiphyte community structure, biomass and productivity observed. Additionally, microspatial gradients in photophysiological parameters along the host macroalga likely resulted from age-dependent variation in pigments as well as the gradient in light environment.

The effects of river run-off on water clarity across the central Great Barrier Reef

Changes in water clarity across the shallow continental shelf of the central Great Barrier Reef were investigated from ten years of daily river load, oceanographic and MODIS-Aqua data. Mean photic depth (i.e., the depth of 10% of surface irradiance) was related to river loads after statistical removal of wave and tidal effects. Across the ∼25,000 km(2) area, photic depth was strongly related to river freshwater and phosphorus loads (R(2)=0.65 and 0.51, respectively). In the six wetter years, photic depth was reduced by 19.8% and below water quality guidelines for 156 days, compared to 9 days in the drier years. After onset of the seasonal river floods, photic depth was reduced for on average 6-8 months, gradually returning to clearer baseline values. Relationships were strongest inshore and midshelf (∼12-80 km from the coast), and weaker near the chronically turbid coast. The data show that reductions in river loads would measurably improve shelf water clarity, with significant ecosystem health benefits.

Corallina and Ellisolandia (Corallinales, Rhodophyta) photophysiology over daylight tidal emersion: interactions with irradiance, temperature and carbonate chemistry

The photophysiology of three geniculate coralline algal species (Corallina officinalis, C. caespitosa and Ellisolandia elongata) was determined in intertidal rock pools in the south-west UK at Combe Martin (51°12'31N 4°2'19W) and Heybrook Bay (50°31'66N 4°11'41W), at the start, middle and end of summer (September 1 and 2) and winter (February 9 and 10) daylight tidal emersion periods, in relation to prevailing irradiance, temperature and carbonate chemistry conditions. Algal photophysiology was assessed from rapid light curves performed using pulse amplitude modulation fluorometry. Corallina and Ellisolandia experienced significant fluctuations in irradiance, temperature and carbonate chemistry over seasonal and tidal cycles. Rock pool carbonate chemistry was predictable (R² = 0.82, P < 0.0001) by photodose (summed irradiance) plus water temperature, but not significantly related to photophysiology. In contrast, Corallina and Ellisolandia relative maximum electron transfer rate showed a significant negative relationship (R² = 0.65, P < 0.0001) with irradiance plus water temperature. At a seasonal resolution, photoacclimation to maximize both light harvesting during winter months and photoprotection during summer months was observed for all species. Dynamic photoinhibition was apparent over both summer and winter tidal emersion, in relation to irradiance fluctuations. More effective photoinhibition was apparent during summer months, with greater sensitivity to irradiance and slower recovery in F_v/F_m, observed during winter. With sustained high irradiance over tidal emersion, the establishment of high pH/low inorganic carbon conditions may impact photochemistry. This study represents the first assessment of C. officinalis, C. caespitosa and E. elongata photophysiology underpinned by clear species concepts and highlights their ability to adapt to the dramatically fluctuating conditions experienced in intertidal rock pools.

Guiding principles for the improved governance of port and shipping impacts in the Great Barrier Reef

The Great Barrier Reef (GBR) region of Queensland, Australia, encompasses a complex and diverse array of tropical marine ecosystems of global significance. The region is also a World Heritage Area and largely within one of the world's best managed marine protected areas. However, a recent World Heritage Committee report drew attention to serious governance problems associated with the management of ports and shipping. We review the impacts of ports and shipping on biodiversity in the GBR, and propose a series of guiding principles to improve the current governance arrangements. Implementing these principles will increase the capacity of decision makers to minimize the impacts of ports and shipping on biodiversity, and will provide certainty and clarity to port operators and developers. A 'business as usual' approach could lead to the GBR's inclusion on the List of World Heritage in Danger in 2014.

Mapping the pollutants in surface riverine flood plume waters in the Great Barrier Reef, Australia

The extent of flood plume water over a 10 year period was mapped using quasi-true colour imagery and used to calculate long-term frequency of occurrence of the plumes. The proportional contribution of riverine loads of dissolved inorganic nitrogen, total suspended sediments and Photosystem-II herbicides from each catchment was used to scale the surface exposure maps for each pollutant. A classification procedure was also applied to satellite imagery (only Wet Tropics region) during 11 flood events (2000-2010) through processing of level-2 ocean colour products to discriminate the changing characteristics across three water types: "primary plume water", characterised by high TSS values; "secondary plume water", characterised by high phytoplankton production as measured by elevated chlorophyll-a (chl-a), and "tertiary plume water", characterised by elevated coloured dissolved and detrital matter (CDOM+D). This classification is a first step to characterise flood plumes.

Phytotoxicity induced in isolated zooxanthellae by herbicides extracted from Great Barrier Reef flood waters

To date there has been limited evidence anthropogenically sourced pollution from catchments reaching corals of the Great Barrier Reef (GBR). In this study, freshly isolated zooxanthellae were exposed to polar chemicals (chiefly herbicides) extracted from water samples collected in a flood plume in the GBR lagoon. Photosynthetic potential of the isolated zooxanthellae declined after exposure to concentrated extracts (10 times) from all but one of the sampling sites. Photosynthetic potential demonstrated a significant positive relationship with the concentration of diuron in the concentrated extracts and a significant inverse relationship with salinity measured at the sampling site. This study demonstrates that runoff from land based application of herbicides may reduce photosynthetic efficiency in corals of inshore reefs in the GBR. The ecological impacts of the chemicals in combination with other potential stressors on corals remain unclear.

Quantifying the sources of pollutants in the Great Barrier Reef catchments and the relative risk to reef ecosystems

Development of the Great Barrier Reef (GBR) catchments in the last 150 years has increased the loads of suspended sediment, nutrients and pesticides ('pollutants') delivered to the GBR. The scale and type of development, the pollutants generated and the ecosystems offshore vary regionally. We analysed the relative risk of pollutants from agricultural land uses and identified the sources of these pollutants from different land uses for each region to develop priorities for management. The assessment showed the Wet Tropics and Mackay Whitsunday regions to be of relatively high risk dominated by sugarcane cultivation, contributing pesticide and dissolved inorganic nitrogen (DIN). The Burdekin and Fitzroy ranked medium-high risk dominated by grazing suspended sediment inputs for both, and additionally sugarcane DIN and pesticide inputs for the Burdekin. The Burnett Mary ranked medium risk, dominated by grazing and sugarcane. Cape York was not formally ranked but is considered to be low risk.

Activation by c-Myc of transcription by RNA polymerases I, II and III

The proto-oncogene product c-Myc can induce cell growth and proliferation. It regulates a large number of RNA polymerase II-transcribed genes, many of which encode ribosomal proteins, translation factors and other components of the biosynthetic apparatus. We have found that c-Myc can also activate transcription by RNA polymerases I and III, thereby stimulating production of rRNA and tRNA. As such, c-Myc may possess the unprecedented capacity to induce expression of all ribosomal components. This may explain its potent ability to drive cell growth, which depends on the accumulation of ribosomes. The activation of RNA polymerase II transcription by c-Myc is often inefficient, but its induction of rRNA and tRNA genes can be very strong in comparison. We will describe what is known about the mechanisms used by c-Myc to activate transcription by RNA polymerases I and II.

Intra-domain communication between the N-terminal and DNA-binding domains of the androgen receptor: modulation of androgen response element DNA binding

The androgen receptor (AR) is a ligand-activated transcription factor that recognises and binds to specific DNA response elements upon activation by the steroids testosterone or dihydrotestosterone. In vitro, two types of response element have been characterised - non-selective elements that bind the androgen, glucocorticoid and progesterone receptors, and androgen receptor-selective sequences. In the present study, the allosteric effects of DNA binding on the receptor amino-terminal domain (NTD) were studied. Binding to both types of DNA response element resulted in changes in the intrinsic fluorescence emission spectrum for four tryptophan residues within the AR-NTD and resulted in a more protease-resistant conformation. In binding experiments, it was observed that the presence of the AR-NTD reduced the affinity of receptor polypeptides for binding to both selective and non-selective DNA elements derived from the probasin, PEM and prostatin C3 genes respectively, without significantly altering the protein-base pair contacts. Taken together, these results highlight the role of intra-domain communications between the AR-NTD and the DNA binding domain in receptor structure and function.

Terrestrial discharge into the Great Barrier Reef Lagoon: nutrient behavior in coastal waters

Pollution of coastal regions of the Great Barrier Reef World Heritage Area (GBRWHA) is dominated by river discharge associated with agricultural development of the adjacent catchments. Runoff of sediment, nutrients and pesticides has sharply increased since European settlement. Since 1991 plumes from river discharge entering the GBRWHA have been mapped by aerial mapping of plume edges and concentrations of contaminants in plumes measured. Plume dispersion is governed primarily by wind speed and direction. Most plumes spread in a band up to 50 km from the coast. Particulate material discharged in the plumes is trapped within 10 km of the coast. Dissolved nutrients disperse much further and elevated nutrient concentrations are measurable at distances of hundreds of kilometres from river mouths. This differential transport of particulate versus dissolved nutrients is important for the potential effects of these materials and management of their generation on the Great Barrier Reef catchment.

A multi-criteria approach to Great Barrier Reef catchment (Queensland, Australia) diffuse-source pollution problem

This paper presents a multi-criteria based tool for assessing the relative impact of diffuse-source pollution to the Great Barrier Reef (GBR) from the river basins draining into the GBR lagoon. The assessment integrates biophysical and ecological data of water quality and pollutant concentrations with socio-economic information pertaining to non-point source pollution and (potential) pollutant impact. The tool generates scores for each river basin against four criteria, thus profiling the basins and enabling prioritization of management alternatives between and within basins. The results support policy development for pollution control through community participation, scientific data integration and expert knowledge contributed by people from across the catchment. The results specifically provided support for the Reef Water Quality Protection Plan, released in October 2003. The aim of the plan is to provide a framework for reducing discharge of sediment, nutrient and other diffuse-source loads and (potential) impact of that discharge and for prioritising management actions both between and within river basins.

Nutrient loss and water quality under extensive grazing in the upper Burdekin river catchment, North Queensland

Increased sediment and nutrient losses resulting from unsustainable grazing management in the Burdekin River catchment are major threats to water quality in the Great Barrier Reef Lagoon. To test the effects of grazing management on soil and nutrient loss, five 1 ha mini-catchments were established in 1999 under different grazing strategies on a sedimentary landscape near Charters Towers. Reference samples were also collected from watercourses in the Burdekin catchment during major flow events. Soil and nutrient loss were relatively low across all grazing strategies due to a combination of good cover, low slope and low rainfall intensities. Total soil loss varied from 3 to 20 kg ha(-1) per event while losses of N and P ranged from 10 to 1900 g ha(-1) and from 1 to 71 g ha(-1) per event respectively. Water quality of runoff was considered moderate across all strategies with relatively low levels of total suspended sediment (range: 8-1409 mg l(-1)), total N (range: 101-4000 microg l(-1)) and total P (range: 14-609 microg l(-1)). However, treatment differences are likely to emerge with time as the impacts of the different grazing strategies on land condition become more apparent. Samples collected opportunistically from rivers and creeks during flow events displayed significantly higher levels of total suspended sediment (range: 10-6010 mg l(-1)), total N (range: 650-6350 microg l(-1)) and total P (range: 50-1500 microg l(-1)) than those collected at the grazing trial. These differences can largely be attributed to variation in slope, geology and cover between the grazing trial and different catchments. In particular, watercourses draining hillier, grano-diorite landscapes with low cover had markedly higher sediment and nutrient loads compared to those draining flatter, sedimentary landscapes. These preliminary data suggest that on relatively flat, sedimentary landscapes, extensive cattle grazing is compatible with achieving water quality targets, provided high levels of ground cover are maintained. In contrast, sediment and nutrient loss under grazing on more erodable land types is cause for serious concern. Long-term empirical research and monitoring will be essential to quantify the impacts of changed land management on water quality in the spatially and temporally variable Burdekin River catchment.

Sediments, nutrients and pesticide residues in event flow conditions in streams of the Mackay Whitsunday Region, Australia

The Mackay Whitsunday region covers 9000 km(2) in northeastern Australia. A study of diffuse pollutants during high flow events was conducted in coastal streams in this region. Sampling was conducted in the Pioneer River catchment during a high flow event in February 2002 and in Gooseponds Creek, Sandy Creek and Carmila Creek in March 2003. Concentrations of five herbicides; atrazine (1.3 microg l(-1)), diuron (8.5 microg l(-1)), 2,4-D (0.4 microg l(-1)), hexazinone (0.3 microg l(-1)) and ametryn (0.3 microg l(-1)) and high concentrations of nutrients (total nitrogen 1.14 mg l(-1), total phosphorus 0.20 mg l(-1)) and suspended sediments (620 mg l(-1)) were measured at Dumbleton Weir on the lower reaches of the Pioneer River. Drinking water guidelines for atrazine and 2,4-D were exceeded at Dumbleton Weir, low reliability trigger values for ecosystem protection for diuron were exceeded at three sites and primary industry guidelines for irrigation levels of diuron were also exceeded at Dumbleton Weir. Similar concentrations were found in the three smaller streams measured in 2003. Herbicides and fertilisers used in sugarcane cultivation were identified as the most likely major source of the herbicide residues and nutrients found.

Designing for mobility, collaboration and information use by blue-collar workers

The uptake of mobile phones in the UK has increased exponentially in the past two years, indicating that a wider range of users are now utilising mobile technologies in different contexts than ever before. Still little is known about how mobile technologies are used amongst different populations in specific contexts and this research addresses the context of work use by blue-collar workers with an aim to augmenting this with new mobile technologies better suited to their informational and communicative needs.Most of the current public domain research into mobile device use practice concentrates primarily on professional workers (the ubiquitous 'mobile professional') and 'knowledge workers' (e.g. Bellotti and Bly, 1996; O'Hara et al. 2001). It seeks to discover how mobile technology, particularly Personal Digital Assistants (PDA's) and 'communicators', can be designed to help mobile professionals retain a sense of awareness of their workplace and work colleagues while they are away from their traditional workplaces. To a lesser extent, 'teens' (Ling, 2000) using SMS/text messaging and novice users (e.g. Palen, 2000) are also examined, but there is very little understanding of the nature of other, and equally as important (in terms of the numbers of users and their importance to the economy), less well represented user groups.

Patient and practitioner characteristics predict brief alcohol intervention in primary care

BACKGROUND

The effectiveness of an evidence-based health care intervention depends on it being delivered consistently to appropriate patients. Brief alcohol intervention is known to be effective at reducing excessive drinking and its concomitant health and social problems. However, a recent implementation trial reported partial delivery of brief alcohol intervention by general practitioners (GPs) which is likely to have reduced its impact.

AIM

To investigate patient-practitioner characteristics influencing brief alcohol intervention in primary care.

DESIGN OF STUDY

Cross-sectional analysis of 12,814 completed Alcohol Use Disorders Identification Test (AUDIT) screening questionnaires.

SETTING

Eighty-four GPs who had implemented a brief alcohol intervention programme in a previous trial based in the Northeast of England.

METHOD

GPs were requested to screen all adults (aged over 16 years) presenting to their surgery and follow a structured protocol to give a brief intervention (five minutes of advice plus an information booklet) to all 'risk' drinkers. Anonymized carbon copies of the screening questionnaire were collected from all practices after a three-month implementation period.

RESULTS

Although AUDIT identified 4080 'risk' drinkers, only 2043 (50%) received brief intervention. Risk drinkers that were most likely to receive brief intervention were males (58%), unemployed (61%), and technically-trained patients (55%). Risk drinkers that were least likely to receive brief intervention were females (44%), students (38%), and university educated patients (46%). Logistic regression modelling showed that patients' risk status was the most influential predictor of brief intervention. Also, GPs' experience of relevant training and longer average practice consultations predicted brief intervention. However, personal characteristics relating to patients and GPs also predicted brief intervention in routine practice.

CONCLUSION

Interpersonal factors relating to patients and practitioners contributed to the selective provision of brief alcohol intervention in primary care. Ways should be found to remedy this situation or the impact of this evidence-based intervention may be reduced when implemented in routine practice.

Helplines. Getting through

A specialised cancer telephone advice line deals with 1,000 calls a week. But many callers don't get through first time. The helpline operates Monday to Friday, 9am-7pm. Peaks in demand follow television and newspaper coverage of cancer. The launch of a website has not led to a decrease in calls. Callers show a high degree of persistence.

ENCORE: the effect of nutrient enrichment on coral reefs. Synthesis of results and conclusions

Coral reef degradation resulting from nutrient enrichment of coastal waters is of increasing global concern. Although effects of nutrients on coral reef organisms have been demonstrated in the laboratory, there is little direct evidence of nutrient effects on coral reef biota in situ. The ENCORE experiment investigated responses of coral reef organisms and processes to controlled additions of dissolved inorganic nitrogen (N) and/or phosphorus (P) on an offshore reef (One Tree Island) at the southern end of the Great Barrier Reef, Australia. A multi-disciplinary team assessed a variety of factors focusing on nutrient dynamics and biotic responses. A controlled and replicated experiment was conducted over two years using twelve small patch reefs ponded at low tide by a coral rim. Treatments included three control reefs (no nutrient addition) and three + N reefs (NH4Cl added), three + P reefs (KH2PO4 added), and three + N + P reefs. Nutrients were added as pulses at each low tide (ca twice per day) by remotely operated units. There were two phases of nutrient additions. During the initial, low-loading phase of the experiment nutrient pulses (mean dose = 11.5 microM NH4+; 2.3 microM PO4(-3)) rapidly declined, reaching near-background levels (mean = 0.9 microM NH4+; 0.5 microM PO4(-3)) within 2-3 h. A variety of biotic processes, assessed over a year during this initial nutrient loading phase, were not significantly affected, with the exception of coral reproduction, which was affected in all nutrient treatments. In Acropora longicyathus and A. aspera, fewer successfully developed embryos were formed, and in A. longicyathus fertilization rates and lipid levels decreased. In the second, high-loading, phase of ENCORE an increased nutrient dosage (mean dose = 36.2 microM NH4+; 5.1 microM PO4(-3)) declining to means of 11.3 microM NH4+ and 2.4 microM PO4(-3) at the end of low tide) was used for a further year, and a variety of significant biotic responses occurred. Encrusting algae incorporated virtually none of the added nutrients. Organisms containing endosymbiotic zooxanthellae (corals and giant clams) assimilated dissolved nutrients rapidly and were responsive to added nutrients. Coral mortality, not detected during the initial low-loading phase, became evident with increased nutrient dosage, particularly in Pocillopora damicornis. Nitrogen additions stunted coral growth, and phosphorus additions had a variable effect. Coral calcification rate and linear extension increased in the presence of added phosphorus but skeletal density was reduced, making corals more susceptible to breakage. Settlement of all coral larvae was reduced in nitrogen treatments, yet settlement of larvae from brooded species was enhanced in phosphorus treatments. Recruitment of stomatopods, benthic crustaceans living in coral rubble, was reduced in nitrogen and nitrogen plus phosphorus treatments. Grazing rates and reproductive effort of various fish species were not affected by the nutrient treatments. Microbial nitrogen transformations in sediments were responsive to nutrient loading with nitrogen fixation significantly increased in phosphorus treatments and denitrification increased in all treatments to which nitrogen had been added. Rates of bioerosion and grazing showed no significant effects of added nutrients. ENCORE has shown that reef organisms and processes investigated in situ were impacted by elevated nutrients. Impacts were dependent on dose level, whether nitrogen and/or phosphorus were elevated and were often species-specific. The impacts were generally sub-lethal and subtle and the treated reefs at the end of the experiment were visually similar to control reefs. Rapid nutrient uptake indicates that nutrient concentrations alone are not adequate to assess nutrient condition of reefs. Sensitive and quantifiable biological indicators need to be developed for coral reef ecosystems. The potential bioindicators identified in ENCORE should be tested in future research on coral reef/nutrient interactions. Synergistic and cumulative effects of elevated nutrients and other environmental parameters, comparative studies of intact vs. disturbed reefs, offshore vs. inshore reefs, or the ability of a nutrient-stressed reef to respond to natural disturbances require elucidation. An expanded understanding of coral reef responses to anthropogenic impacts is necessary, particularly regarding the subtle, sub-lethal effects detected in the ENCORE studies.

Community and connectivity: summary of a community based monitoring program set up to assess the movement of nutrients and sediments into the Great Barrier Reef during high flow events

The Great Barrier Reef (GBR) system encompasses the largest system of corals and related life forms anywhere in the world. The health of this extensive system, particularly the inshore area, is dependent on the relationship between the GBR and adjacent coastal catchments. The major impact of agricultural practices on the GBR is the degradation of water quality in receiving (rivers) waters, caused by increased inputs of nutrients, suspended sediments and other pollutants. For the past three years, the Great Barrier Reef Marine Park Authority (GBRMPA) has been involved with the co-ordination of a river-monitoring program, specifically targeting the sampling of rivers during flood events. Representative sites were set up along two North Queensland rivers, the Russell-Mulgrave and Barron Rivers. This monitoring program is run in conjunction with the Queensland Department of Natural Resources' Waterwatch program. The program involves intensive sampling of first flush, extreme flow and post flood conditions over the two rivers. Extreme flow conditions are sampled over a limited time span (48 hours) with trained volunteers at 4-hour intervals. Concentrations measured in the flood events are dependent on land use characteristic, and extent of flow. Concentrations of dissolved and particulate nutrients are higher if the extreme flow event is part of the first flush cycle. Concentrations of DIN and DIP measured before, during and after a major flood event suggest that there is a large storage of inorganic material within the Barron and Russell-Mulgrave agricultural subcatchments that move over a period of days, and perhaps weeks. This program created a forum in which GBRMPA liased with the Barron and Russell-Mulgrave community about the connectivity existing between the river and the Great Barrier Reef lagoon.

Catchment management and the Great Barrier Reef

Pollution of coastal regions of the Great Barrier Reef is dominated by runoff from the adjacent catchment. Catchment land-use is dominated by beef grazing and cropping, largely sugarcane cultivation, with relatively minor urban development. Runoff of sediment, nutrients and pesticides is increasing and for nitrogen is now four times the natural amount discharged 150 years ago. Significant effects and potential threats are now evident on inshore reefs, seagrasses and marine animals. There is no effective legislation or processes in place to manage agricultural pollution. The Great Barrier Reef Marine Park Act does not provide effective jurisdiction on the catchment. Queensland legislation relies on voluntary codes and there is no assessment of the effectiveness of the codes. Integrated catchment management strategies, also voluntary, provide some positive outcomes but are of limited success. Pollutant loads are predicted to continue to increase and it is unlikely that current management regimes will prevent this. New mechanisms to prevent continued degradation of inshore ecosystems of the Great Barrier Reef World Heritage Area are urgently needed.

Correlation of qEEG with PET in schizophrenia

PET relative metabolism was correlated with quantitative EEG in 9 schizophrenic patients. The PET metabolic regions of interest were the frontal lobes, thalamus and basal ganglia, and right and left temporal lobes. Significant positive correlations were seen for the frontal lobes and delta EEG power, and alpha power with subcortical metabolism. The physiologic plausibility of those correlations is discussed with reference to the possible effect of neuroleptic medication.

A randomized controlled trial of Moderation-Oriented Cue Exposure

OBJECTIVE

A randomized controlled trial was conducted to examine the effectiveness of Moderation-Oriented Cue Exposure (MOCE) in comparison to Behavioral Self-Control Training (BSCT). The main hypothesis was that MOCE would be more effective than BSCT among a sample of problem drinkers aiming at moderate drinking. A subsidiary hypothesis was that MOCE would be relatively more effective than BSCT among problem drinkers with higher levels of alcohol dependence.

METHOD

Clients (N = 91; 75% men) were randomly allocated to either MOCE or BSCT. Treatment was delivered in weekly sessions by two trained therapists, in a nested design in which therapists switched to the alternative treatment modality approximately halfway through the trial. Follow-up was carried out 6 months following posttreatment assessment, with 85% successful contact.

RESULTS

There was no evidence for the general superiority of MOCE over BSCT. The subsidiary hypothesis was not confirmed. A subsample of clients (n = 14) showing levels of dependence at baseline above the commonly accepted cut-point for a moderation goal (Severity of Alcohol Dependence Questionnaire [SADQ] > 29) showed outcomes at least as favorable as those below the cut-point. The validity of self-reports of alcohol consumption and problems was supported by significant relationships with liver function tests (gamma-glutamyl transferase and alanine transferase).

CONCLUSIONS

These results provide no grounds for the replacement of BSCT by MOCE in routine, moderation-oriented treatment practice. Assuming they prefer it to abstinence and that it is not contra-indicated on other grounds, there seems no reason why clients showing a higher level of dependence (SADQ = 30-45) should not be offered a moderation goal.

The role of kreisler in segmentation during hindbrain development

The mouse kreisler gene is expressed in rhombomeres (r) 5 and 6 during neural development and kreisler mutants have patterning defects in the hindbrain that are not fully understood. Here we analyzed this phenotype with a combination of genetic, molecular, and cellular marking techniques. Using Hox/lacZ transgenic mice as reporter lines and by analyzing Eph/ephrin expression, we have found that while r5 fails to form in these mice, r6 is present. This shows that kreisler has an early role in the formation of r5. We also observed patterning defects in r3 and r4 that are outside the normal domain of kreisler expression. In both heterozygous and homozygous kreisler embryos some r5 markers are induced in r3, suggesting that there is a partial change in r3 identity that is not dependent upon the loss of r5. To investigate the cellular character of r6 in kreisler embryos we performed heterotopic grafting experiments in the mouse hindbrain to monitor its mixing properties. Control experiments revealed that cells from even- or odd-numbered segments only mixed freely with themselves, but not with cells of opposite character. Transposition of cells from the r6 territory of kreisler mutants reveals that they adopt mature r6 characteristics, as they freely mix only with cells from even-numbered rhombomeres. Analysis of Phox2b expression shows that some aspects of later neurogenesis in r6 are altered, which may be associated with the additional roles of kreisler in regulating segmental identity. Together these results suggest that the formation of r6 has not been affected in kreisler mutants. This analysis has revealed phenotypic and mechanistic differences between kreisler and its zebrafish equivalent valentino. While valentino is believed to subdivide preexisting segmental units, in the mouse kreisler specifies a particular segment. The formation of r6 independent of r5 argues against a role of kreisler in prorhombomeric segmentation of the mouse hindbrain. We conclude that the mouse kreisler gene regulates multiple steps in segmental patterning involving both the formation of segments and their A-P identity.

Evaluating the use of TalksBac, a predictive communication device for nonfluent adults with aphasia

This paper describes the design and evaluation of a computer-based communication system called 'TalksBac' with four nonfluent adults with aphasia. Despite the increased availability of computer-based augmentative and alternative communication (AAC) devices, their use with adults with aphasia is limited as few devices have been designed for this population. The TalksBac system was designed specifically for nonfluent adults with aphasia and was used by four nonfluent aphasic individuals for a period of 9 months. The TalksBac system is word-based and exploits the ability of some nonfluent individuals with aphasia to recognize familiar words and short sentences. The system consists of two programs. Personal sentences and stories are entered into the TalksBac database by use of a 'carer program'. The 'user program' assists the nonfluent aphasic user to retrieve these prestored conversational items by offering probable items based on previous use of the system. The database has a hierarchical structure, but the links to individual items adapt automatically to reflect usage by individual users over time. Four nonfluent adults with aphasia were selected to participate in the study. Each subject was assessed by use of a battery of tests to provide pre-intervention data about their comprehension, expression and communication skills. Subjects and their carers were trained to use the TalksBac system and were involved in developing personalized databases. They were supported in use of the personalized systems for an intervention period of 9 months. At the end of this period, subjects' communication skills wre reassessed by use of a battery of tests. Clients' conversational abilities with and without the TalksBac system were also compared to see if use of TalksBac did augment their conversation and allow the aphasic partner to participate more fully within conversations. This was done by analysing videotaped conversations between subjects and non-aphasic partners. Results from the formal assessments indicated that there was little change in the underlying comprehension and expressive abilities of the subjects. An analysis of videotaped conversations showed that 1 subject was unable to carry out conversations using TalksBac independently, so the data for this subject was not included in the results of the analysis of conversations. Results from the video analysis for the remaining three subjects indicated that when using the TalksBac system, the conversational abilities of two subjects improved. The conversational abilities of the other subject were not enhanced by using the system as he had developed his own nonverbal strategies which he found to be more effective. This study has shown that TalksBac has the potential to augment the communication abilities of nonfluent adults with aphasia, who have not been able to develop their own compensatory strategies. Work continues to improve the efficiency of the software and to develop techniques to facilitate the carers' ability to generate conversational information for the system.

Opioid receptor imaging and displacement studies with [6-O-[11C] methyl]buprenorphine in baboon brain

Buprenorphine (BPN) is a mixed opiate agonist-antagonist used as an analgesic and in the treatment of opiate addiction. We have used [6-O-[11C]methyl]buprenorphine ([11C]BPN) to measure the regional distribution in baboon brain, the test-retest stability of repeated studies in the same animal, the displacement of the labeled drug by naloxone in vivo, and the tissue distribution in mice. The regional distribution of radioactivity in baboon brain determined with PET was striatum > thalamus > cingulate gyrus > frontal cortex > parietal cortex > occipital cortex > cerebellum. This distribution corresponded to opiate receptor density and to previously published data (37). The tracer uptake in adult female baboons showed no significant variation in serial scans in the same baboon with no intervention in the same scanning session. HPLC analysis of baboon plasma showed the presence of labeled metabolites with 92% +/- 2.2% and 43% +/- 14.4% of the intact tracer remaining at 5 and 30 min, respectively. Naloxone, an opiate receptor antagonist, administered 30-40 min after tracer injection at a dose of 1.0 mg/kg i.v., reduced [11C]BPN binding in thalamus, striatum, cingulate gyrus, and frontal cortex to values 0.25 to 0.60 of that with no intervention. There were minimal (< 15%) effects on cerebellum. Naloxone treatment significantly reduced the slope of the Patlak plot in receptor-containing regions. These results demonstrate that [11C]BPN can be displaced by naloxone in vivo, and they affirm the feasibility of using this tracer and displacement methodology for short-term kinetics studies with PET. Mouse tissue distribution data were used to estimate the radiation dosimetry to humans. The critical organ was the small intestine, with a radiation dose estimate to humans of 117 nrad/mCi.

Cerebrovascular accident: relationship of demographic, diagnostic, and occupational therapy antecedents to rehabilitation outcomes

OBJECTIVE

This study was conducted to identify factors that were significant in predicting occupational therapy treatment choices and discharge outcomes after inpatient rehabilitation for 112 patients who had experienced a cerebrovascular accident.

METHOD

A retrospective descriptive study was conducted.

RESULTS

According to discriminant function analysis, the cerebrovascular accident disability score (i.e., level of functional disability) during the initial evaluation period was the predictor of discharge outcomes with the most clinical significance. A greater proportion of occupational therapy assessment units was the most influential occupational therapy factor associated with a positive discharge outcome. In one inpatient rehabilitation setting, a greater proportion of occupational therapy intervention for all study subjects was directed at the level of impairment compared to the level of disability.

CONCLUSION

Shorter inpatient stays, as well as shifts to outpatient rehabilitation, may require occupational therapists to examine whether intervention at the level of impairment or disability yields the best functional outcomes for patients who have sustained a cerebrovascular accident.

Firearm victims--who were they?

OBJECTIVE

To determine the characteristics of victims killed by firearms, whether they died by suicide, homicide or accident, and the types of firearms involved.

DESIGN

A retrospective and descriptive study.

SETTING AND SUBJECTS

Coronial autopsy data were obtained from the Brisbane Laboratory of Pathology and Microbiology. All 587 firearm deaths during the period 1980-1989 were included.

MAIN OUTCOME MEASURES

The proportions of deaths by suicide, homicide, accident or undetermined cause. In cases of homicide, we sought to define the relationship of the perpetrator to the victim.

RESULTS

The types of death were suicide 76%, homicide 18%, accidents 3% and undetermined 3%. Most homicides were of a domestic nature as opposed to crime. Small calibre rifles were the most common weapon; handguns were rarely used.

CONCLUSIONS

Recent debate regarding firearm legislation has failed to recognise the predominance of interpersonal and psychological issues in the causation of firearm deaths. Crime is a motive for only a minority. Medical practitioners may reduce firearm deaths both by organisational representation and individual efforts in clinical practice. In particular, attention should be given to the identification of individuals or families at risk, the detection and treatment of psychological disorder and advice regarding firearm disposal.

Effects of active and completed litigation on treatment results: workers' compensation patients compared with other litigation patients

Outcomes of multidisciplinary pain treatment in workers' compensation claimants and in the claimants of other insurance companies were studied. Patients were also segregated as to state of completion of the litigation process. No differences were found between the groups in organic and psychologic pathology. Significant improvement in outcome measures was found for the total group, but the workers' compensation claimants with completed litigation failed to show any significant improvement in these measures. The system itself and legal factors can be obstacles to rehabilitation of the patient with chronic pain. Early intervention is recommended to improve treatment outcome.

Simultaneous multifrequency observations of Markarian 421

The highly variable BL Lacertae object Mrk 421 has been observed simultaneously in the radio, optical ultraviolet, and X-ray bands over a period of 4 days in early 1984 December and once again in early 1985 January. Using the EXOSAT observatory, we found that dramatic changes occurred in the X-ray flux on a time scale of less than a mouth. During this time the 2-10 keV flux dropped by a factor of 8, whereas the 0.1-1 keV flux decreased by a factor of only 2. These changes were not reproduced at longer wavelengths during the period of simultaneous observations. However, a drop in the ultraviolet flux occurred some months later, which is consistent with the longer characteristic loss times for the lower energy electrons. Since the ultraviolet through radio flux is stable when the X-ray flux is changing, it is extremely unlikely that a simple synchrotron model can account for the full spectrum; in this model the whole spectrum is expected to rise uniformly and in phase as a result of the injection of energetic particles. A simple synchroton self-Compton model that is self-absorbed in the radio also requires an X-ray flux which is many orders of magnitude greater than is observed. However, this discrepancy may be explained by relativistic beaming of electrons with delta > approximately 40 or by a model in which the self-absorption turnover occurs in the optical, and the synchrotron break occurs in the X-rays. Shorter time scale (approximately 10,000 s) variability was also apparent in the 2-10 keV X-ray light curves, and we suggest that it may be a direct measure of the injection time scale. Although reasonable fits resulted when the X-ray data were compared with a simple power-law model with some absorption, a substantial improvement in chi 2 was obtained by adding a high-energy exponential cutoff. Use of this model produced a spectral index close to that typically found in the optical for BL Lacertae objects, in contrast to the high values usually inferred from X-ray spectra.

Effects of amphetamine on local cerebral metabolism in normal and schizophrenic subjects as determined by positron emission tomography

The effects of d-amphetamine (0.5 mg/kg PO) on regional cerebral glucose utilization were measured with Positron Emission Tomography (PET). Subjects included ten chronic schizophrenics and six controls who received amphetamine, and six chronic schizophrenics and nine controls who received placebo or no treatment. Amphetamine decreased glucose metabolism in all regions studied (frontal, temporal, and striatal) in normal and schizophrenic subjects. The metabolic effects of amphetamine were correlated with plasma level of the drug. Cortical atrophy was associated with a blunted metabolic response.

Putrescine metabolism in human brain tumors

The metabolism of the polyamines, putrescine, spermidine and spermine, was studied in human brain and brain tumors. Samples of brain and tumors were incubated with 3H-putrescine and the amounts of labeled polyamines were measured. The amount of putrescine conversion was found to be greater in tumors that in normal brain samples. Furthermore, the metabolism of putrescine in brain tumors was related to tumor type and appeared to correlate with the degree of malignancy. The significance of these findings with regard to positron emission tomographic scanning and therapy of patients with malignant gliomas is discussed.

Positron emission tomography and computed tomography assessments of the aging human brain

The relationship between alterations in brain structure and brain function was studied in vivo in both young and elderly human subjects. Computed tomography revealed significant age-related ventricular and cortical sulcal dilatation. The cortical changes were most closely related to age. Positron emission tomography failed to show regional changes in brain glucose metabolic rate. The results suggest that the normal aging brain undergoes structural atrophic changes without incurring regional metabolic changes. Examination of the correlations between the structural and the metabolic measures revealed no significant relationships. These data are discussed with respect to the significant structure-function relationships that have been reported in Alzheimer disease.

Positron emission tomographic studies of aging and Alzheimer disease

In this study the positron emission tomographic (PET)-18F-2-deoxy-2-fluoro-D-glucose (FDG) technique was used to study both normal aging and senile dementia. The results derived from 15 young normal subjects (mean age, 26 +/- 5 years) and 22 elderly normal subjects (mean age, 66 +/- 7 years) failed to indicate significant metabolic changes associated with age. A group of 24 patients with senile dementia (mean age, 73 +/- 7 years) showed consistent diminutions in regional glucose use relative to the elderly normals. Across all brain regions the diminutions were 17%-24%. There were also significant correlations between the measures of glucose use and the measures of cognitive functioning. Discriminant function classification analysis results indicate that better than 80% classification accuracy can be achieved for individual PET measures. These data suggest a possible future diagnostic use of PET in senile dementia.

Antibodies and the Aberdeen typhoid outbreak of 1964. II. Coombs', complement fixation and fimbrial agglutination tests

In a previous paper (Brodie, 1977) the value of the Widal test in the diagnosis of typhoid fever was shown to be limited. Evaluation of possible alternative tests showed that: (1) the sensitivity of the anti-human globulin (Coombs') test appeared greater than that of the agglutination test but the length of time (48 h) before results were available rendered it of little value in rapid diagnosis: (2) the complement fixation test offered no particular help towards diagnosis; (3) immunized and non-immunized typhoid fever patients developed fimbrial antibodies, as also did immunized healthy individuals. In this latter group, however, those immunized with alcoholized TAB vaccine had higher antibody titres to fimbrial antigen than those immunized with heat-killed phenolized vaccine.

Antibodies and the Aberdeen typhoid outbreak of 1964. I. The Widal reaction

The outbreak of typhoid fever in Aberdeen during 1964 (Walker, 1965) presented an opportunity to study the antibody titres of typhoid fever patients and of TAB immunized individuals to obtain further knowledge concerning the behaviour of these titres with the passage of time.This paper gives an abbreviated version of part of a research programme which followed the Aberdeen typhoid outbreak of 1964.The antibody titres of patients were followed up for a period of 2 years after discharge from hospital and the findings have been compared with those in TAB immunized healthy individuals. The following points emerged:(1) The value of the Widal test as an aid to diagnosis was limited;(2) the flagellar antibody titre in patients' sera provided a more reliable aid towards diagnosis than did the somatic antibody titre;(3) the response of immunized and non-immunized patients to the somatic antigens was poor and often delayed well into the period following discharge from hospital;(4) titres of 1/40 and over for Vi agglutinins were present in immunized and non-immunized patients for at least 12 months after discharge without their being S. typhi excretors;(5) Vi agglutinin titres as high as 1/40 were present in TAB immunized healthy individuals and also in members of the general public;(6) the presence of S. typhi septicaemia need not result in a high antibody titre;(7) patients who relapse, may do so without enhancement of previous antibody titres and may relapse even in the presence of earlier appreciable titres.

Antibiotics and the Aberdeen typhoid outbreak in 1964

This paper gives an abbreviated account of part of a research programme which followed the Aberdeen typhoid outbreak in 1964. Chloramphenicol, the main antibiotic used in treatment, was shown to have a minimum inhibitory concentration (MIC) of between 5 and 2-5 mug./ml. for the S. typhi phage type 34 of the outbreak. The MIC for methacycline was between 5 and 2-5 and 2 mug./ml. Whereas the deep and shallow broth techniques used gave similar results with these antibiotics, the MIC for ampicillin, and also cephaloridine, was less in the deep than in the shallow broths. Serum assays in patients given ampicillin or cephaloridine yielded abnormally high concentrations of both antiboitics when S. typhi phage type 34 was the test organism whereas, with other test organisms, the concentrations were within expectation. These abnormally high values fell within expected values when the sera under investigation had first been heated to 56 degrees C. for 30 min. before assay against the S. typhi of the outbreak. The findings with ampicillin suggested that dosages given were satisfactory. With cephaloridine the concentrations found in patients' sera seemed to show that twice daily doses of 0-5 g. fell short of adequacy.

Use of bacteriological investigations by general practitioners

The numbers of vaginal swabs, faecal specimens, throat swabs, and urine specimens submitted by 104 city general practitioners to the bacteriology laboratory at Aberdeen differed widely. The doctors who made most use of the laboratory service rarely did so equally for all four investigations but usually for only one or two. Similarly, those who used the service least often made frequent use of one particular investigation. Further studies are needed to identify and evaluate the reasons for the apparently substantial disagreement among general practitioners concerning the value of these diffferent bacteriological investigations in general practice.