Mapping the quality of basic and comprehensive emergency obstetric care services in Haiti

OBJECTIVE

To investigate geographical inequalities and changes in the quality of emergency obstetric care services available in Haiti over time.

METHODS

We utilized data from the Service Provision Assessment survey of all health facilities in Haiti in 2013 and 2017.We developed a quality index for basic emergency obstetric care (BEmOC) and comprehensive emergency obstetric care (CEmOC) based on the items in the signal functions of an emergency obstetric care framework, using a structure, process and outcome framework. We measured the quality index of all facilities in 2013 and 2017. We also assessed geographical trends and changes in quality between 2013 and 2017 using geospatial analysis.

RESULT

Our analysis showed that basic structure items such as connection to electricity grid, manual vacuum extractors, vacuum aspirators and dilation and curettage kits were widely unavailable at healthcare facilities. There was a significant improvement in indicators of structure (P < 0.001) and BEmOC (P = 0.03) in primary facilities; however, there was no significant change in the quality of CEmOC in primary facilities (P = 0.18). Similarly, there was no significant change in any of the structure or process indicators at secondary care facilities.

CONCLUSION

The availability of BEmOC at several Haitian facilities remains poor; however, there was significant improvement at primary care facilities, with little to no change in overall quality at secondary health facilities.

Extreme changes in salinity drive population dynamics of Catostylus mosaicus medusae in a modified estuary

Modifications to estuaries through the construction of barrages alter the natural dynamics of inhabitant species by controlling freshwater inputs into those systems. To understand the effects of modified freshwater flows on a native scyphozoan jellyfish, Catostylus mosaicus, and to identify the environmental drivers of medusa occurrence, we analysed a 20-year observational dataset composed of 11 environmental variables and medusa presence/absence from 15 sampling stations located below the Fitzroy Barrage, in the Fitzroy River, Queensland. Major decreases in salinity (minimum salinity 0) occurred approximately 16 times during the 20-year period and medusae disappeared from the estuary following every major freshwater flow event. Salinity was identified as the most influential variable contributing to variation in the number of upper estuary sites reporting jellyfish. We then ran two laboratory experiments to test the following hypotheses: (i) prolonged decreases in salinity impair survival, pulsation, and respiration rates of C. mosaicus medusae; and (ii) transient decreases temporarily impair pulsation and respiration but medusae recover when salinity returns to normal levels. Medusae were unable to survive extended periods at extreme low salinities, such that they would experience when a barrage opens fully, but had significantly higher survival and recovery rates following smaller, transient changes to salinity that might occur following a moderate rainfall event. This demonstrates for the first time that modification of freshwater flow by a barrage regulates the population dynamics of an estuarine jellyfish, and highlights the need for robust, long term datasets, and to firmly embed experimental approaches in realistic ecological contexts.

Location biases in ecological research on Australian terrestrial reptiles

Understanding geographical biases in ecological research is important for conservation, planning, prioritisation and management. However, conservation efforts may be limited by data availability and poor understanding of the nature of potential spatial bias. We conduct the first continent-wide analysis of spatial bias associated with Australian terrestrial reptile ecological research. To evaluate potential research deficiencies, we used Maxent modelling to predict the distributions of 646 reptile studies published from 1972 to 2017. Based on existing distributions of 1631 individual reptile study locations, reptile species richness, proximity to universities, human footprint and location of protected areas, we found the strongest predictor of reptile research locations was proximity to universities (40.8%). This was followed by species richness (22.9%) and human footprint (20.1%), while protected areas were the weakest predictor (16.2%). These results highlight that research effort is driven largely by accessibility and we consequently identify potential target areas for future research that can be optimised to ensure adequate representation of reptile communities.

Stable isotopes demonstrate the effectiveness of a tidally-staged sewage release system

Nutrient loading from sewage wastewater discharge contributes to the eutrophication of coastal waters. Wastewater from the Gold Coast, Australia is discharged into the Gold Coast Seaway (GCS) for 13.5 h d^-1 primarily on the ebbing tide to disperse wastewater seawards. Nitrogen stable isotopes were used to assess how effectively the tidally staged release system dispersed wastewater out of the GCS and identified pathways by which sewage-N was incorporated into food webs. Turf algae, limpets and barnacles were sampled at the GCS, at two coastal sites and at the mouth of a control estuary that lacked point-source discharge. In the GCS δ¹⁵N values of algae and limpets returned to coastal baseline levels within 250 m of the diffusers. In contrast, δ¹⁵N of filter-feeding barnacles did not significantly vary indicating wastewater-N does not dominate the pelagic food web. Nitrogen stable isotopes clearly demonstrated that the tidally-staged wastewater release system effectively disperses wastewater offshore.

Antimony and arsenic exhibit contrasting spatial distributions in the sediment and vegetation of a contaminated wetland

Antimony is a priority environmental contaminant that is relatively poorly studied compared to other trace metal(loid)s. In particular, the behaviour of antimony in wetland sediments, where anaerobic conditions often dominate, has received considerably less attention compared to well-drained terrestrial soil environments. Here we report the results of a spatial assessment of antimony in the sediments and vegetation of a freshwater wetland exposed to stibnite tailings for the past forty years. The concentration of antimony in the sediment decreased rapidly with distance from the tailings deposit, from a maximum of ∼22,000 mg kg^-1 to ∼1000 mg kg^-1 at a distance of ∼150 m. In contrast, arsenic was distributed more evenly across the wetland, indicating that it was more mobile under the prevailing hypoxic/anoxic conditions. Less clear trends were observed in the tissues of wetland plants, with the concentrations of antimony in waterlilies (2.5-195 mg kg^-1) showing no clear trends with distance from the tailings deposit, and no correlation with sediment concentrations. Sedges and Melaleuca sp. trees had lower antimony concentrations (<25 mg kg^-1 and 5 mg kg^-1, respectively) compared to waterlilies, but showed a non-significant trend of higher concentrations closer to the tailings. For all vegetation types sampled, antimony concentrations were consistently lower than arsenic concentrations (Sb:As = 0.27-0.31), despite higher concentrations of antimony in the sediment. Overall, the results of this study highlight clear differences in the behaviour of antimony and arsenic in freshwater wetlands, which should be considered during the management and remediation of such sites.

Preparing strata titled communities for climate change: an empirical examination

Purpose

– The purpose of this paper is twofold: first, to advance a set of recommendations concerned with enhancing residential strata title (ST) communities’ preparation for property management in a world of climate change (CC) and second, to examine the Australian ST community’s perceptions of the recommendations advanced.

Design/methodology/approach

– The study comprised three empirical phases: three meetings with an 11 person industry reference group, conduct of 18 exploratory interviews and also an on-line questionnaire survey. The survey was designed to gauge the relative merit of sixteen recommendations developed during the study’s exploratory interview phase. The survey was completed by 450 individuals representing a broad cross-section of ST stakeholders.

Findings

– The study’s findings are extensive. Amongst them it is notable that the survey respondents ranked procedures taken prior and during a ST building’s construction as more important CC management opportunities than steps and procedures implemented post-building construction.

Research limitations/implications

– While considerable care was taken to approach the analysis of interview data in an objective manner, it should be acknowledged that, like any research based on qualitative data, a researcher’s background is bound to introduce some biases in the way that themes in the collected data are determined and interpreted.

Practical implications

– The range of practical implications arising from the study are very evident from the range of issues addressed in the 16 recommendations advanced by the study. These implications range widely from internal management suggestions such as identifying a CC champion in ST complexes, to insurance issues such as creating a low insurance or “uninsurable” ST building category.

Social implications

– The survey findings reveal the extent to which expressed opinions concerning how best to adapt ST buildings and communities for CC are affected by the stakeholder group that is expressing the opinion. This highlights the likelihood that any new ST policy making relating to CC is likely to become highly politicised due to conflicting lobbying interests represented by these distinct ST stakeholders.

Originality/value

– The study is believed to embody an exceedingly high level of originality. It is the first to: provide an examination of the vulnerability of ST complexes to CC, and advance recommendations concerned with changes that should be made to the building and management of ST complexes in order to address the CC challenge.

Decline in recycled water quality during short-term storage in open ponds

Changes were assessed in urban wastewater treatment plant (WWTP) effluent quality during short-term storage in open surface ponds. Water quality was monitored over five years at the inlets and outlets of open storage ponds located at three biological nutrient removal plants. Pond influent temperature, rainfall and sewage inflow were not found to be major factors. However, there was a trend for water temperature to be correlated negatively with nitrogenous nutrient and positively with faecal coliform values. The observed increases in faecal coliforms, nutrients and chemical oxygen demand were most likely caused through avian faecal contamination. These increases challenge the notion that pond storage has a positive or negligible effect on effluent quality. The observed one to two orders of magnitude increase in faecal coliforms may affect reuse scheme viability by limiting the range of uses under Australian water recycling guidelines. Potential improvements to short-term recycled water storage management at WWTPs could include the integration of monitoring requirements in WWTP discharge licences and recycling guidelines and the monitoring of all water quality parameters, including microbiological ones, at the point of entry into the recycled water distribution system, after WWTP storage, rather than directly post-disinfection.

Copper and sewage inputs from recreational vessels at popular anchor sites in a semi-enclosed Bay (Qld, Australia): estimates of potential annual loads

Environmental impacts of vessels are well documented; Cu pollution as result of Cu based antifouling paints and nutrient pollution (such as N) from marine sewage are two examples of such disturbances. Understanding environmental impacts as well as the use of coastal waterways by recreational vessels is of concern to regulatory authorities, waterway users and local residents. In this study more than 55 aerial surveys were conducted of selected popular anchorages in eastern Moreton Bay, Queensland, Australia. Numbers of recreational vessels at certain times during the year were used in multiple linear regression analyses to develop predictive models for recreational vessel numbers. Over one year approximately 10,000 locally registered recreational craft (>6m length overall) generated an estimated 59,000 vessel nights. With Cu leaching rates from the literature, and estimates of sewage inputs (assuming little or no use of pump-out facilities), load estimates associated with overnight use of 20 popular anchor sites were calculated as 141+/-46 kg of Cu and 1.17+/-0.38 t of nitrogen (N) annually. More importantly, the models showed vessel activity to be highly variable, and focused at peak holiday times, with 14% of vessel activity and associated pollutant loads entering the environment during Christmas and Easter. This study highlighted the inherent difficulties in managing a popular maritime amenity and Marine Parks such as the Moreton Bay Marine Protected Area, Queensland, Australia with its variety of stakeholders and types and intensities of uses.

Evaluation of the in situ, time-integrated DGT technique by monitoring changes in heavy metal concentrations in estuarine waters

Various natural and anthropogenic processes influence heavy metal concentrations within estuaries. In situ, time-integrated DGT measurements made over concurrent tidal phases found significantly higher concentrations of Cu (probability p=0.017), Zn (p=0.003) and Ni (p=0.003) during the flood phase, because the incoming tide passes several point sources. DGT-reactive Cu concentrations significantly decreased with increased tidal-flushing and vice versa within a marina (correlation r=-0.788, p=0.02). DGT measurements also recorded significant increases in Cu (4 out of 4 sites, p<0.001) and Zn (3 out of 4 sites, p< or =0.015) after a 24 mm rainfall event. Finally, DGT-reactive Cu increased significantly (p<0.001) during peak boating times, due to increased numbers of Cu-antifouled boats. This study demonstrates that, with judicious selection of deployment times, DGT measurements enable changes in heavy metal concentrations to be related to various cycles and events within estuaries.

Detection of intermittent sewage pollution in a subtropical, oligotrophic, semi-enclosed embayment system using sterol signatures in sediments

A field study was conducted to investigate sewage inputs at popular anchorages in Moreton Bay, a sub-tropical, semienclosed embayment system in Southeast Queensland, Australia. Sterol biomarkers were quantified in sediments revealing low levels over a spatial and temporal scale consistent with a shallow, oligotrophic, highly dynamic, sand dominated system. Despite low concentrations (ng/g) and high variability, relevant sterol/stanol pairs remained well-correlated and were successful in identifying an unexpected once-off pollution event from a point source at Moreton Bay Island. During this incident, the main human sewage biomarker, coprostanol, was found at a concentration of 1.4 microg/g, with a coprostanol/5alpha-cholestanol ratio of 3.2. Other than this one incident, sterol levels were consistently low even when anchorages were at full capacity. Thus, sewage from recreational vessels was found to have very little effect on sediment quality at anchorages in Moreton Bay and Gold Coast Broadwater.

Investigation of recreational boats as a source of copper at anchorage sites using time-integrated diffusive gradients in thin film and sediment measurements

Antifouling paints on small to medium recreational vessels were first recognized as an important source of pollution in the 1970s. One of the principle biocides in these paints is Cu. Results from a field program in the Gold Coast Broadwater, Queensland, demonstrate a clear correlation between recreational boat numbers at anchorage sites and water column Cu concentrations, for both time-integrated 24 h DGT measurements (n=14, r=0.815, p<0.001) and measurements on composite 0.45 mum-filtered grab samples (n=14, r=0.698, p<0.01) collected every 4 h over 24 h. At boat numbers above 30 the 0.45 microm-filterable Cu concentrations were mostly above the relevant guideline value (1.3 microgl(-1)) but the DGT-reactive Cu concentrations were well below this value at all boat numbers studied. For three-day DGT deployments in Moreton Bay, Queensland, correlations between Cu levels and vessel numbers were not observed, possibly because of uncertain estimates of boat numbers. However, using a multi-factorial ANOVA, DGT-reactive Cu concentrations showed a significant effect for 'sites with vessels vs. sites without vessels' (alpha=0.10, p=0.077) and for 'sampling period' (non-holiday weekdays, weekends, holiday weekdays, holiday weekends) at alpha=0.10, p=0.02. Cu levels in sediments at the same sites were strongly influenced by fraction of clay (<63 microm) material but also by whether the samples were collected at an anchorage or control site. Results from this study further support the view that Cu emissions from antifouling paints may become an important source in waters with high boat numbers and should be taken into account when designing management instruments for coastal waterways.

The localized environmental degradation of protected areas adjacent to bird feeding stations: a case study of the Australian brush-turkey Alectura lathami

This study investigated the potential for wildlife feeding to artificially increase population densities of the Australian brush-turkey, Alectura lathami and assessed the indirect adverse effects that this may have on surrounding forest floor vegetation. Census counts and observations of feeding activity conducted in recreation areas of Australia's Gold Coast hinterland confirmed that brush-turkey population densities were significantly elevated by the provision of food by humans. Brush-turkey densities were high at sites where birds are actively fed, moderate at sites where birds feed opportunistically and low at sites where humans have negligible impact on local food availability. Brush-turkeys caused significant environmental impact at sites where their population densities have been substantially elevated by active feeding. Across all sites, increases in brush-turkey density were accompanied by a significant decline in ground cover, leaf litter weight, seed density and seedling density. Natural environmental variables such as gradient, vegetation type and canopy cover did not explain the observed impacts. The impacts were consistent with those described in trampling studies and suggest that at high density, even small animals can have significant trampling impacts on their local environment. This study demonstrates that wildlife feeding can have detrimental impacts on the integrity of local environments and recommends greater consideration of small animals and their potential indirect impacts when regulating wildlife feeding in National Parks and other nature conservation areas.

Evaluation of the diffusive gradient in a thin film technique for monitoring trace metal concentrations in estuarine waters

Monitoring trace metal concentrations in dynamic estuarine waters is not straightforward. This study demonstrated that important information could be obtained from intensive sampling of physicochemical parameters and trace metal concentrations, in the Gold Coast Broadwater, Australia. A regular pattern of variation in Cu and Ni concentrations was related to the movement of water passed point sources with tidal flows, rather than due to conventional estuarine mixing of end-member waters. However, this approach was logistically demanding and expensive. The diffusive gradients in a thin film (DGT) technique was used as an alternative method due to its continual time-integrated response to changes in trace metal concentrations. Significant correlations were found between 24 h DGT-labile measurements and 0.45-microm filterable measurements, on time-averaged composite samples (grab samples combined every 4 h for 24 h), for Cu (n = 24, r = 0.965, p < 0.001), Pb (n = 24, r = 0.799, p < 0.001), Zn (n = 17, r = 0.909, p < 0.001), and Ni (n = 23, r = 0.916, p < 0.001). DGT-labile measurements as a fraction of 0.45 microm-filterable concentrations were 21 +/- 2% for Cu, 29 +/- 11% for Pb, 28 +/- 5% for Zn, and 27 +/- 12% for Ni, demonstrating the speciation capabilities of DGT. Although DGT measurements were confirmed as being highly operationally defined, DGT was still found to be very promising as a monitoring approach, particularly for dynamic estuarine waters.

Survey of users and providers of recycled water: quality concerns and directions for applied research

Users and providers of recycled water in Queensland, Australia, were canvassed to ascertain concerns about recycled water quality and directions for applied research. Some 79% of respondents had concerns about recycled water quality including microbiological components, such as viruses, parasites and bacteria, salinity related components, aggregate components, such as pH and solids, nutrients, organic components, including pesticides and endocrine disruptors, as well as quality variability. Relative differences in the proportion of concern for some quality characteristics were observed between the areas of different population density with those from the low population areas being more concerned than those from medium or high areas. Some users and providers observed changes in recycled water quality during distribution including nutrients, chlorine, solids, colour and odour. Some 52% of providers and 19% of current users propose to expand their usage and 30% of non-users propose to commence doing so in the next 5 years. Recycled water quality characteristics identified for applied research included microbiological components, organic components, nutrients and salinity.

Golf course development in a major tourist destination: implications for planning and management

The planning and design of golf course developments is influenced by many factors. This paper focuses on the environmental ramifications of insufficient or lack of compliance with standard environmental and economic planning practices. Specifically, it looks at a tourist destination location that was under the influence of extensive land development and investment speculation. The Gold Coast in Australia was the focal point for large overseas investment due to changes in government legislation regarding foreign investment. Due to the economic climate in the second half of the 1980s many golf course resort developments were built, approved, or planned. Many of these circumvented normal business and environment planning processes. The result has been a dangerous concentration of golf facilities in environmentally sensitive areas and an oversupply of golf facilities. Both of these matters are discussed in terms of the general planning process and the potential economic and environmental impacts to the Gold Coast and similar destinations in other parts of the world.

Monitoring Diffuse Impacts: Australian Tourism Developments

/ The scientific quality of monitoring for diffuse environmental impacts has rarely been quantified. This paper presents an analysis of all formal environmental monitoring programs for Australian tourism developments over a 15-year period from 1980 to 1995. The tourism sector provides a good test bed for this study because tourism developments are (1) often adjacent to or even within conservation reserves and other relatively undisturbed natural environments, and (2) often clustered, with resulting cumulative impacts that require detection at an early stage. Here we analyze the precision and reliability with which monitoring programs as actually implemented can detect diffuse environmental impacts against natural variation. Of 175 Australian tourism developments subject to EIA from 1980 to 1993 inclusive, only 13 were subject to formal monitoring. Only 44 individual parameters, in total, were monitored for all these developments together. No baseline monitoring was conducted for nine of the 44 parameters. For the remaining 35, only one was monitored for a full year. Before, after, control, impact, paired sampling (BACIP) monitoring designs were used for 24 of the 44 parameters, and power analysis in 10. The scientific quality of monitoring was significantly better for developments subject to control by the Great Barrier Reef Marine Park Authority (GBRMPA). The key factor appears to be the way in which GBRMPA uses external referees and manages external consultants. The GBRMPA model merits wider adoption.