Ancillary Benefits of Reduced Air Pollution in the United States from Moderate Greenhouse Gas Mitigation Policies in the Electricity Sector

This paper considers how moderate actions to slow atmospheric accumulation of greenhouse gases from fossil fuel use also could reduce conventional air pollutants in the United States. The benefits that result would be “ancillary” to greenhouse gas abatement. Moreover, the benefits would tend to accrue locally and in the near term, while benefits from reduced climate change mostly accrue globally and over a time frame of several decades or longer. The previous literature suggests that changes in nitrogen oxides (NOx) would be the most important consequence of moderate carbon policies. We calculate these changes in a detailed electricity model linked to an integrated assessment framework to value changes in human health. A tax of $25 per metric ton of carbon emissions would yield NOx related health benefits of about$8 per metric ton of carbon reduced in the year 2010 (1997 dollars). Additional savings accrue from reduced investment in NOx and SO2 abatement in order to comply with emission caps. These savings sum to $4-$7 per ton of carbon reduced. Total ancillary benefits of a $25 carbon tax are estimated to be$12-$14, which appear to justify the costs of a$25 tax, although marginal benefits are less than marginal costs. At a tax of $75 per ton carbon, greater health benefits and abatement cost savings are achieved but the value of ancillary benefits per ton of carbon reductions remains roughly constant at about$12.climate change, greenhouse gas, ancillary benefits, air pollution, co-control benefits, nitrogen oxides, sulfur dioxide, carbon dioxide, particulates, health

Minimising medicine use in organic dairy herds through animal health and welfare planning

Livestock is important in many organic farming systems, and it is an explicit goal to ensure high levels of animal health and welfare (AHW) through good management. This will lead to reduced medicine use and better quality of animal products. In two EU network projects NAHWOA & SAFO it was concluded that this is not guaranteed merely by following organic standards. Both networks recommended implementation of individual animal health plans to stimulate organic farmers to improve AHW. These plans should include a systematic evaluation of AHW and be implemented through dialogue with each farmer in order to identify goals and plan improvements. 15 research institutions in 8 European countries are involved in the proposed project with the main objective to minimise medicine use in organic dairy herds through active and well planned AHW promotion and disease prevention. The project consists of 5 work packages, 4 of which comprise research activities building on current research projects, new applications across borders, exchange of knowledge, results and conclusions between participating countries, and adopting them to widely different contexts. International and national workshops facilitate this exchange. Focus areas are animal health planning, AHW assessment using animal based parameters and development of advisory systems and farmer groups. Epidemiological analyses of the effect on AHW from reduced medicine use and herd improvements are planned in all participating countries

Presence of arthralgia exacerbates decreased quality of life in hidradenitis suppurativa patients

Hidradenitis suppurativa is characterized by chronic follicular occlusion that presents with recurrent nodules, inflamed abscesses, and scarring. Research has shown that these patients have a decreased quality of life. In addition to its psychosocial effects, hidradenitis suppurativa has recently been associated with joint pathology. In this study, we distributed a survey consisting of the Short Form 12 Health Survey, used for assessing health outcomes, along with additional questions about joint pain to an online hidradenitis suppurativa support group in order to understand the effect of comorbid arthralgia on quality of life in this disease. The respondents in this study had significantly reduced physical health composite scores-12 (PCS-12), (35.8 versus 50, P<0.001) and mental health composite scores-12 (MCS-12), (33.7 versus 50, P<0.001) scores compared to the general population. Additionally, patients reporting severe arthralgia had significantly lower PCS-12 (32.3 versus 36.5; P<0.05) and MCS-12 (33.3 versus 40.5; P<0.001) scores compared to those with mild arthralgia. Despite the effect of comorbid arthralgia on quality of life, only 11% reported having been asked about joint pain by their dermatologist. Routine screening questions concerning associated arthralgia and diminished quality of life may be helpful during clinician assessment and treatment of hidradenitis suppurativa patients

Welfare benchmarking and herd health plans on organic dairy farms (OF0343)

Introduction In response to the recommendations of recent studies on the health and welfare of dairy cattle (Whay et al. 2003) and to assist farmers to meet legislative requirements, promoting farm animal welfare and meeting consumer demand, this study investigated, by means of farmer interviews, the effectiveness of herd health and welfare assessment and benchmarking as a farm management tool. The aims of the study were to • offer support to the organic farming sector and provide detail relevant to all dairy farms utilising herd health plans; • provide information to both organic dairy farmers and their veterinary advisors on the most important elements of herd health plans and the benefits of their effective implementation; and • identify the benefits and constraints to the use and adoption of comparative animal health and welfare assessment as a herd health management tool. From this information, recommendations for practical application and future research would be developed. Other DEFRA funded projects would benefit from findings relevant to their objectives, the development of herd health planning and improvement of farm animal welfare. Objectives As part of a larger study with an objective to carry out health and welfare assessment and benchmarking on organic dairy farms in order to assist farmers and their advisors to identify strengths and weaknesses in herd health and welfare performance, the objectives of this study were to • use qualitative research interviews to a. evaluate farmer responses to the welfare assessment and benchmarking, b. assess the impact and evaluate the effectiveness of the intervention in delivering animal health and welfare improvements and c. as a tool to develop herd health plans for organic systems; • ensure that the results are effectively disseminated to farmers, veterinarians and advisors. Background Benchmarking of production performance has been actively used by many farmers to compare their achievements with those of others and to target areas for improvement with the aim of increasing financial returns from dairy, beef, sheep and other farm enterprises. A protocol to apply this benchmarking concept to farm animal health and welfare has been developed using animal based observations. By observing the animals it becomes possible to compare production systems with different resource provisions, such as quality of flooring, amount of trough space and stocking density, and management approaches. This approach facilitates the identification of strengths and weaknesses in the different management systems assessed and through comparison with others, can demonstrate what it is possible to achieve and where improvements might be made. Qualitative research interviews enable the researcher to gather insights on the interviewee’s perception and opinion. They allow the beliefs and concerns of interviewees to be explored and enable the consistency and weight of the story told to be evaluated. This technique has been used in a range of subject areas including in a farm animal welfare context. However this method for collection of information provides a descriptive account based upon the observations and interpretation of the interview material by the researcher, rather than attempting to quantify opinion or experience. It cannot be used to provide statistically valid numerical data. Summary of assessment and benchmarking process a) Phase 1 During winter 2002 to 2003, 15 organic dairy farms in SW England took part in a herd health and welfare assessment and benchmarking project. The response to the benchmarking process was evaluated by qualitative research interviews. Farmers had implemented changes and requested that there should be a repeat assessment to identify any effect of the changes on cow welfare on their farms. b) Phase 2 In response to this farmer request, fourteen of the fifteen organic dairy farms which had participated in Phase 1 were recruited to Phase 2 of a herd health and welfare assessment and benchmarking study in September 2003. The sample size was increased by the recruitment of a further fourteen new farms following the award of additional funding for the study. On-farm health and welfare assessment and benchmarking of the 28 organic dairy herds was carried out during winter housing period 2003 to 2004. Methodology Semi-structured qualitative research interviews were used to obtain farmer feedback on their participation in comparative assessment of herd health and welfare. Interviews were conducted with all participating farmers between August and November 2004, on a one to one basis on farm either in the house or in the farm office, by the same interviewer. The interviews were recorded onto mini-discs then transcribed in full. Data were analysed using a ‘Grounded Theory’ approach in which common themes across interviews were identified. Results The average length of the research interviews was one hour and fifteen minutes (range thirty minutes to two hours and thirty minutes). Five common and inter-related themes were identified from the farmer interviews: 1. Sensitivities and misgivings Some participants admitted to experiencing feelings of exposure and vulnerability as a result of allowing such a process to be carried out on their herds. Others experienced feelings of shock, failure and disappointment as a result of the assessment outcome. There was considerable concern about the potential for mis-interpretation and mis-use of the results by others outside farming and research circles, particularly if taken out of context and without clear explanation and understanding of the assessment process. Some expressed concerns that that the findings from the assessment and benchmarking might be used in the development of new legislation or that the process might become a requirement of farm quality assurance schemes. 2. Acceptability of scoring methodology and indicators assessed On the whole, the measures used for the assessment were considered to be relevant to herd health and welfare. Farmers were critical of the way in which scores were applied and questioned the relevance, at low/mild levels, of indicators assessed to animal health and welfare. This was particularly true of some scores for mild degrees of dirtiness, lameness and injuries from the environment where the assessment was considered to have been marked ‘severely’, ‘overly critically’ or ‘harshly’. Some were particularly distressed that their efforts to keep their animals clean had apparently failed and were at a loss as to what steps could be taken to improve the situation further. Whilst farmers acknowledged that lameness was a major herd health problem, their initial reactions were of shock and disbelief at the percentage of their cows that were classified as lame on the day of the assessment. Some were of the opinion that if detection of very mild lameness was so difficult, the measure at such a mild level was impractical and had no relevance to day to day management of herd health and welfare. Others considered that where detection and investigation of very mild cases of lameness was possible, it might have some value as a management tool in preventing more serious problems from developing. Injury to hocks, ranging in severity from slight rubbing of the hair to swelling and ulceration was a main focus of farmers’ attention. Although scores given were again at three levels of severity, interestingly there was greater acceptance of the significance of mild levels of incidence of hock injury. Furthermore, the links between hock damage, aspects of the housing environment and lameness were clearly recognised. It was suggested that the assessment should include all dairy animals, from calves, rearing and in calf heifers, dry and milking cows, to bulls. Respondents also considered that the addition of medicine use, fertility and calving indices and mastitis management to the assessment and benchmarking would add value to the process. 3. Raised awareness and motivation to improve Farmers commented that participation in the assessment, had raised their awareness about their animals’ health and welfare and of factors that might affect animal health and welfare within their individual farming systems. Most participants had been keen to affect improvements and had changed at least one element of their system with the aim of better health and welfare for the herd. The main foci for change were the causes of lameness, dirtyness, injuries from the environment mainly involving damage to hocks and necks and condition scoring. There was strong agreement amongst participants that the health and welfare of the cows and financial considerations were the main drivers for change on the farm. Most were of the opinion that the two were inextricably linked in that the health and welfare status of the cows would directly affect performance and therefore financial returns. Constraints to improving animal welfare on farm were largely related to housing issues and lack of finance to implement change in both old cubicle housing and in new and refurbished systems, representing considerable and often recent investment. 4. Veterinary support and herd health planning It was clear that some participants had a very good working relationship with their veterinary advisors. A number of these farms had actively sought out a new veterinary advisor in order to improve the quality of veterinary support for their organic system. Others reported that they were dissatisfied with the service they had received from their veterinary practices and had become reluctant to involve their veterinarians in routine aspects of herd health and welfare management. The degree to which Herd Health Plans had been developed as a useful management tool was clearly linked to the level of interest and quality of veterinary support available to the farmer. 5. Value of assessment and benchmarking With regard to benchmarking, the main focus of attention was on the identification of particular strengths and weaknesses and how improvements to weaker elements might be affected within individual farming systems. Keen to improve their own situation year on year, farmers were interested to learn if management or structural changes they had introduced translated into improvements to herd health and welfare and lead to improved performance within the benchmarking league table. Nevertheless, a number of participants suggested that breed, calving pattern, herd size, housing and other system differences made benchmarking between farms less useful than it might at first appear. Instead they considered that year on year within farm comparison was the more useful measure to determine where progress had been made. Implicit in these comments was the desire to participate in further on-farm health and welfare assessment and to continue the process of improvement into the future. Although farmers suggested a range of timescales from six months to five years, within which repeat assessments should occur, most considered that the interval should be greater than one year. Most considered that the ideal assessor would be a veterinarian with a farm and cattle background. Others thought that whilst a veterinary qualification was probably not essential, the assessor should have a clear understanding of farm animal health and welfare. Farmers voiced concerns over inter-observer reliability. Of utmost concern was that continuity and the validity of any comparison between farms and between years might be lost if more than one person carried out the assessments for a particular group of farms. Recommendations 1. It is recommended that the provision of clear explanation and support is built into all future development and implementation of on-farm welfare assessments to ensure that individuals and groups of farmers fully understand the process in which they participate. 2. It is recommended that • a system of acceptable tolerance levels of welfare indicators is developed in conjunction with a scoring system that applies positive scores to the assessment procedure which takes into account the difficulties of practical application on farm and establishes realistic and achievable goals in welfare improvement. • assessment protocols should only include indicators proven by sound scientific evidence to be appropriate to the goal of improved farm animal health and welfare. 3. There is a requirement for the development of an assessment protocol for calves in order that a complete picture of dairy herd health and welfare can be produced. 4. It is recommended that the need for investigation and clarification of which changes are likely to improve animal welfare and the timescale within which improvements can be expected to occur within farming systems is addressed before widespread implementation of farm animal health and welfare assessment is introduced. 5. It is strongly recommended that an animal welfare payment scheme is introduced to • assist in making improvements in animal welfare • act as an incentive and reward the achievement of improved welfare status, whilst at the same time, • ease the financial burden for farmers. This should be linked to the updating and redevelopment of farm buildings where such action is justified on animal health and welfare grounds. 6. To address this shortfall veterinary training should be expanded to include organic farming principles, preventative and reduced medicine use and homeopathy. 7. It is recommended that in order that such problematic issues are identified, the formation of assessment groups of farms should be supported and encouraged. It is further recommended that areas where difficulties in affecting welfare improvement are experienced should be targeted for further research. 8. A system of training and accreditation of assessors that includes regular monitoring of performance and updating of skills should be developed as an integral part of farm animal health and welfare assessment. 9. A system of training and accreditation of assessors that includes regular monitoring of performance and updating of skills should be developed as an integral part of farm animal health and welfare assessment. It is recommended that the evaluation of the consistency and reliability of welfare assessment over time, and the impacts of potential errors on farming businesses should be made the focus of future research. 10. What is now required is to develop simpler yet robust approaches that enable farmer perception and opinion to be included as key elements in future herd health and welfare endeavours. Clarity of purpose would appear to be an imperative. A starting point may be to examine the approach taken by other disciplines, such as human medicine and environmental management

Proceed with Caution: Transition from Paper to Computerized Pain Body Maps

AbstractPatients with advanced-stage cancer often have a high symptom burden and reduced functional status, implying that the patients themselves should be involved in development and testing of interactive assessment tools. This paper reports on an assessment of use of a pain tool, which led to changes in both medium and program in order to adapt to the patients’ needs and abilities. Our study shows how a change in medium for pain assessment from paper via laptop to iPad affects the interaction with the tool on important aspects of use. We also show how changes of medium affect the readability of the output for health care workers. We achieved better results with an iPad-based pain assessment tool developed through user-centered design compared to both a paper-based and conventional laptop-based tool

Automated Estimation of Elder Activity Levels from Anonymized Video Data

Significant declines in quality of life for elders in assisted living communities are typically triggered by health events. Given the necessary information, such events can often be predicted, and thus, be avoided or reduced in severity. Statistics on activities of daily living and activity level over an extended period of time provide important data for functional assessment and health prediction. However, persistent activity monitoring and continuous collection of this type of data is extremely labor-intensive, time-consuming, and costly. In this work, we propose a method for automated estimation of activity levels based on silhouettes segmented from video data, and subsequent extraction of higher order information from the silhouettes. By building a regression model from this higher order information, our system can automatically estimate elder activity levels

Nutritional support in cancer patients: A position paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE)

Malnutrition is a frequent problem in cancer patients, which leads to prolonged hospitalization, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse overall prognosis. The attitude towards this issue varies considerably and many malnourished patients receive inadequate nutritional support. We reviewed available data present in the literature, together with the guidelines issued by scientific societies and health authorities, on the nutritional management of patients with cancer, in order to make suitable and concise practical recommendations for appropriate nutritional support in this patient population. Evidence from the literature suggests that nutritional screening should be performed using validated tools (the Nutritional Risk Screening 2002 [NRS 2002], the Malnutrition Universal Screening Tool [MUST], the Malnutrition Screening Tool [MST] and the Mini Nutritional Assessment [MNA]), both at diagnosis and at regular time points during the course of disease according to tumor type, stage and treatment. Patients at nutritional risk should be promptly referred for comprehensive nutritional assessment and support to clinical nutrition services or medical personnel with documented skills in clinical nutrition, specifically for cancer patients. Nutritional intervention should be actively managed and targeted for each patient; it should comprise personalized dietary counseling and/or artificial nutrition according to spontaneous food intake, tolerance and effectiveness. Nutritional support may be integrated into palliative care programs. "Alternative hypocaloric anti-cancer diets" (e.g. macrobiotic or vegan diets) should not be recommended as they may worsen nutritional status. Well-designed clinical trials are needed to further our knowledge of the nutritional support required in different care settings for cancer patients

Peer-Victimization and Mental Health Problems in Adolescents: Are Parental and School Support Protective?

The aim of this study was to investigate the frequency and effects of peer-victimization on mental health problems among adolescents. Parental and school support were assumed as protective factors that might interact with one another in acting as buffers for adolescents against the risk of peer-victimization. Besides these protective factors, age and gender were additionally considered as moderating factors. The Social and Health Assessment survey was conducted among 986 students aged 11–18 years in order to assess peer-victimization, risk and protective factors and mental health problems. For mental health problems, the Strengths and Difficulties Questionnaire (SDQ) was used. Effects of peer-victimization on mental health problems were additionally compared with normative SDQ data in order to obtain information about clinically relevant psychopathology in our study sample. Results of this study show that peer-victimization carries a serious risk for mental health problems in adolescents. School support is effective in both male and female adolescents by acting as a buffer against the effect of victimization, and school support gains increasing importance in more senior students. Parental support seems to be protective against maladjustment, especially in peer-victimized girls entering secondary school. Since the effect of peer-victimization can be reduced by parental and school support, educational interventions are of great importance in cases of peer-victimization