Nitrogen Leaching from Cattle, Sheep and Deer Grazed Pastures in New Zealand

The impacts of intensified grazing in New Zealand are being reflected in declining quality of groundwater, streams and lake water. Manipulation of ratios of grazing animal species may be one way farmers can reduce nitrogen (N) emissions to ground water. The present research quantifies nitrate and ammonium leaching losses from rotationally grazed sheep, cattle and deer pastures in a common environment

Intensive Livestock Farming on New Zealand Hill Country Farms Creates Critical Source Areas of Potential Pollution

Oral Session

Intensive Livestock Farming on New Zealand Hill Country Farms Creates Critical Source Areas of Potential Pollution

Oral Session

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Evaluating the Effects of SARS-CoV-2 Spike Mutation D614G on Transmissibility and Pathogenicity.

Global dispersal and increasing frequency of the SARS-CoV-2 spike protein variant D614G are suggestive of a selective advantage but may also be due to a random founder effect. We investigate the hypothesis for positive selection of spike D614G in the United Kingdom using more than 25,000 whole genome SARS-CoV-2 sequences. Despite the availability of a large dataset, well represented by both spike 614 variants, not all approaches showed a conclusive signal of positive selection. Population genetic analysis indicates that 614G increases in frequency relative to 614D in a manner consistent with a selective advantage. We do not find any indication that patients infected with the spike 614G variant have higher COVID-19 mortality or clinical severity, but 614G is associated with higher viral load and younger age of patients. Significant differences in growth and size of 614G phylogenetic clusters indicate a need for continued study of this variant

Die rechtliche Regelung des Instituts der kostenlosen Rechtshilfe in der Republik Kroatien mit besonderer Berücksichtigung der gesetzlichen Regelungen in den postjugoslawischen Staaten

“Pravo i pravdu nećemo nikome prodati, uskratiti ili odgoditi.” 40. paragraf Velike povelje sloboda Pravo na pristup pravosuđu (access to justice) jedno je od temeljnih ljudskih prava. Ostvarivanje toga prava uvelike ovisi o dostupnosti pravne pomoći svim građanima bez obzira na njihov socioekonomski status. Stoga je postojanje učinkovitog sustava besplatne pravne pomoći u svakoj zemlji jedan od temeljnih jamaca ostvarivanja ljudskih prava u svakodnevnom životu. U radu se razmatra razvoj i uređenje instituta besplatne pravne pomoći u Republici Hrvatskoj te u ostalim postjugoslavenskim državama s ciljem regionalnog prikaza njegova uređenja.«To no one will we sell, to no one will we refuse or delay, right or justice» 40th paragraph of the Magna Charta The paper considers the development and regulation of the institute of legal aid in the Republic of Croatia and in the other post-Yugoslav states with the aim of providing a regional outline of their regulation. In recent years legislators in the post-Yugoslav states have been increasingly involved in the regulation of legal aid and, in order to develop modern legal systems, they adopted laws aimed at ensuring and protecting the right to legal aid. The normative activities for regulating legal aid began with the constitutional guarantee for such aid, and were made effective by the provisions of the criminal codes and the civil procedure acts. Later, under the influence of the acquis communautaire of the modern European states they were to be included in the provisions of separate laws of the post-Yugoslav states. This shows that there was an evolution in the development of the right to legal aid, not only as the right to such aid in the form of good will and charity of the state, but also as one of the fundamental human rights guaranteed by constitutional and legal norms.“Niemandem werden wir Recht oder Gerechtigkeit verkaufen, verweigern oder verzögern.“ Magna Carta, § 40 In dieser Arbeit werden die Entwicklung und Regelung des Instituts der kostenlosen Rechtshilfe in der Republik Kroatien und in den anderen postjugoslawischen Staaten erörtert, wodurch seine Regelung in der Region dargestellt werden soll. In den letzten Jahren ist die Regelung des Anspruchs auf kostenlose Rechtshilfe zu einer wichtigen Aufgabe für die Gesetzgeber in den postjugoslawischen Staaten geworden, die zwecks Aufbau moderner Rechtsordnungen Gesetze verabschiedeten, deren Gegenstand die Wahrnehmung und der Schutz des Rechts auf kostenlose Rechtshilfe ist. Die normative Aktivität zur Einrichtung der kostenlosen Rechtshilfe begann mit der Verfassungsgarantie des Rechtsanspruches auf kostenlose Rechtshilfe, die in den Bestimmungen der Straf- und der Zivilprozessordnung ihren konkreten Niederschlag fanden, um sich unter dem Einfluss der Trends in der Gesetzgebung der modernen europäischen Staaten zu Bestimmungen in Sondergesetzen der postjugoslawischen Staaten zu verwandeln. Dies belegt eine Evolution in der Entwicklung des Rechtsanspruchs auf kostenlose Rechtshilfe als nicht allein des Anspruchs auf Hilfe in Form einer wohltäterischen Geste von staatlichem guten Willen, sondern als eines Grundrechts, das durch Verfassungs- und Gesetzesnormen garantiert wird

Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with gemtuzumab ozogamicin improves event-free survival in younger patients with newly diagnosed aml and overall survival in patients with npm1 and flt3 mutations

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). Results There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. Conclusion Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit

Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study

Background: The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. Methods: This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. Findings: Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low. Interpretation: This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant. Funding: Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research