Can we get there from here? Ecosystem based governance in the Bay of Fundy/Gulf of Maine region

Decades, even centuries, of resource extraction and exploitation by humans have taken a toll on the Bay of Fundy/Gulf of Maine ecosystems. The very real threats posed by population growth and coastal development, climate change, habitat loss, overharvesting, chemical pollution, nutrient overloading, and invasive species invasions show no sign of abating. Traditional methods of managing the human activities that impact the Bay of Fundy/Gulf of Maine are proving unable to keep pace with the growing threats. The Gulf of Maine Council and others have joined in the chorus calling for a broader, more holistic ecosystem approach to the governance of the human activities that impact the coastal margin. This study uses the framework of the Policy Sciences to suggest a model of Problem Orientation, Social Process, and Decision Process characteristics indicative of an ideal ecosystem-based approach to governance. The model is first used to analyze the governance regime that existed in the Great Lakes Basin during the first two decades under the International Joint Commission\u27s oversight of activities under the Great Lakes Water Quality Agreement. The framework model is then used to analyze the current governance regime in the Gulf of Maine/Bay of Fundy region. Using this analysis, the study concludes that an ecosystem-based approach to governance is not possible in the region as currently configured. The study further concludes that it will not be possible to transition to an ecosystem-based approach without the education and significant outreach necessary to create a knowledgeable and activist public able to understand the issues and threats and willing to press governance for improvement. Further, ecosystem-based governance will require the creation of an overarching and accountable entity that, with significant input from public and stakeholder partnerships can collect reliable ecosystem indicator data from both sides of the border, analyze the data, and direct the implementation of policy solutions, and change course as necessary

PERFORMANCE EVALUATION OF THE PERMANENT NEW JERSEY SAFETY SHAPE BARRIER – UPDATE TO NCHRP 350 TEST NO. 4-12 (2214NJ-2)

Based on the proposed changes to the National Cooperative Highway Research Program (NCHRP) Report No. 350 guidelines, NCHRP Project 22-14(2) researchers deemed it appropriate to evaluate permanent safety shape barrier systems prior to finalizing the new crash testing procedures and guidelines. For this effort, the permanent New Jersey Safety Shape barrier was selected for evaluation. One full-scale vehicle crash test was performed on the longitudinal barrier system in accordance with the Test Level 4 (TL-4) requirements presented in the Update to NCHRP Report No. 350. For the permanent barrier testing program, a 10000S single unit truck was used. The permanent safety shape barrier provided an unacceptable safety performance when impacted by the single unit truck, thus failing to meet the proposed TL-4 requirements presented in the Update to NCHRP Report No. 350

DEVELOPMENT OF STANDARDS FOR PLACEMENT OF STEEL GUARDRAIL POSTS IN ROCK

A steel post W-beam guardrail system was developed for installation in rock-soil foundations. The guardrail system was constructed with a 2.66-mm (12-gauge) thick W-beam rail, 53.34 m in length. The W-beam guardrail was supported by twenty-seven W152x13.4 by 1,346-mm long steel posts, spaced at 1,905 mm on center. The posts were installed in drilled holes in concrete, constructed by drilling three 203-mm diameter holes on 165- mm centers to a depth of 610 mm. The drilled holes were backfilled with compacted ASTM C33 coarse aggregate, size no. 57. One full-scale vehicle crash test, using a 3⁄4-ton pickup truck, was performed on the W-beam guardrail system. The test was conducted and reported in accordance with the requirements specified in the National Cooperative Highway Research Program (NCHRP) Report No. 350, Recommended Procedures for the Safety Performance Evaluation of Highway Features. The safety performance of the W-beam guardrail system with post placed in rock was determined to be acceptable according to the Test Level 3 (TL-3) evaluation criteria specified in NCHRP Report No. 350. Further, guardrail post placement recommendations were also developed for situations where rock is located below the surface. These recommendations were developed through an analysis of bogie testing of posts

Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice

Multicomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas which lack research in the context of ERPs are patient-reported outcome measures, patients with complex needs and assessment of factors pertaining to successful ERP implementation. The next generation of ERP studies should seek to develop our understanding in these key areas

Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation

BACKGROUND & AIMS: We determined the optimal HCV treatment prioritization strategy for interferon-free (IFN-free) HCV direct-acting antivirals (DAAs) by disease stage and risk status incorporating treatment of people who inject drugs (PWID). METHODS: A dynamic HCV transmission and progression model compared the cost-effectiveness of treating patients early vs. delaying until cirrhosis for patients with mild or moderate fibrosis, where PWID chronic HCV prevalence was 20, 40 or 60%. Treatment duration was 12weeks at £3300/wk, to achieve a 95% sustained viral response and was varied by genotype/stage in alternative scenarios. We estimated long-term health costs (in £UK=€1.3=$1.5) and outcomes as quality adjusted life-years (QALYs) gained using a £20,000 willingness to pay per QALY threshold. We ranked strategies with net monetary benefit (NMB); negative NMB implies delay treatment. RESULTS: The most cost-effective group to treat were PWID with moderate fibrosis (mean NMB per early treatment £60,640/£23,968 at 20/40% chronic prevalence, respectively), followed by PWID with mild fibrosis (NMB £59,258 and £19,421, respectively) then ex-PWID/non-PWID with moderate fibrosis (NMB £9,404). Treatment of ex-PWID/non-PWID with mild fibrosis could be delayed (NMB -£3,650). In populations with 60% chronic HCV among PWID it was only cost-effective to prioritize DAAs to ex-PWID/non-PWID with moderate fibrosis. For every one PWID in the 20% chronic HCV setting, 2 new HCV infections were averted. One extra HCV-related death was averted per 13 people with moderate disease treated. Rankings were unchanged with reduced drug costs or varied sustained virological response/duration by genotype/fibrosis stage. CONCLUSIONS: Treating PWID with moderate or mild HCV with IFN-free DAAs is cost-effective compared to delay until cirrhosis, except when chronic HCV prevalence and reinfection risk is very high

Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice

AbstractMulticomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas which lack research in the context of ERPs are patient-reported outcome measures, patients with complex needs and assessment of factors pertaining to successful ERP implementation. The next generation of ERP studies should seek to develop our understanding in these key areas.</jats:p

An investigation of the effects of lipid-lowering medications: genome-wide linkage analysis of lipids in the HyperGEN study

BACKGROUND: Use of anti-hyperlipidemic medications compromises genetic analysis because of altered lipid profiles. We propose an empirical method to adjust lipid levels for medication effects so that the adjusted lipid values substitute the unmedicated lipid values in the genetic analysis. RESULTS: Published clinical trials were reviewed for HMG-CoA reductase inhibitors and fibric acid derivatives as mono-drug therapy. HMG-CoA reductase inhibitors showed similar effects in African Americans (AA) and non-African Americans (non-AA) for lowering total cholesterol (TC, -50.7 mg/dl), LDL cholesterol (LDL-C, -48.1 mg/dl), and triglycerides (TG, -19.7 mg/dl). Their effect on increasing HDL cholesterol (HDL-C) in AA (+0.4 mg/dl) was lower than in Non-AA (+2.3 mg/dl). The effects of fibric acid derivatives were estimated as -46.1 mg/dl for TC, -40.1 mg/dl for LDL-C, and +5.9 mg/dl for HDL-C in non-AA. The corresponding effects in AA were less extreme (-20.1 mg/dl, -11.4 mg/dl, and +3.1 mg/dl). Similar effect for TG (59.0 mg/dl) was shown in AA and non-AA. The above estimated effects were applied to a multipoint variance components linkage analysis on the lipid levels in 2,403 Whites and 2,214 AA in the HyperGEN study. The familial effects did vary depending on whether the lipids were adjusted for medication use. For example, the heritabilities increased after medication adjustment for TC and LDL-C, but did not change significantly for HDL-C and TG. CONCLUSION: Ethnicity-specific medication adjustments using our empirical method can be employed in epidemiological and genetic analysis of lipids.National Heart, Lung, and Blood Institute (HL554471, HL54472, HL54473, HL54495, HL54496, HL54497, HL54509, HL54515

The medical student

The Medical Student was published from 1888-1921 by the students of Boston University School of Medicine

Meta-analysis of four new genome scans for lipid parameters and analysis of positional candidates in positive linkage regions

Lipid levels in plasma strongly influence the risk for coronary heart disease. To localise and subsequently identify genes affecting lipid levels, we performed four genome-wide linkage scans followed by combined linkage/association analysis. Genome-scans were performed in 701 dizygotic twin pairs from four samples with data on plasma levels of HDL- and LDL-cholesterol and their major protein constituents, apolipoprotein AI (ApoAI) and Apolipoprotein B (ApoB). To maximise power, the genome scans were analysed simultaneously using a well-established meta-analysis method that was newly applied to linkage analysis. Overall LOD scores were estimated using the means of the sample-specific quantitative trait locus (QTL) effects inversely weighted by the standard errors obtained using an inverse regression method. Possible heterogeneity was accounted for with a random effects model. Suggestive linkage for HDL-C was observed on 8p23.1 and 12q21.2 and for ApoAI on 1q21.3. For LDL-C and ApoB, linkage regions frequently coincided (2p24.1, 2q32.1, 19p13.2 and 19q13.31). Six of the putative QTLs replicated previous findings. After fine mapping, three maximum LOD scores mapped within 1cM of major candidate genes, namely APOB (LOD =2.1), LDLR (LOD =1.9) and APOE (LOD =1.7). APOB haplotypes explained 27% of the QTL effect observed for LDL-C on 2p24.1 and reduced the LOD-score by 0.82. Accounting for the effect of the LDLR and APOE haplotypes did not change the LOD score close to the LDLR gene but abolished the linkage signal at the APOE gene. In conclusion, application of a new meta-analysis approach maximised the power to detect QTLs for lipid levels and improved the precision of their location estimate. © 2005 Nature Publishing Group. All rights reserved