Treatment costs and priority setting in health care: A qualitative study

The aim of this study is to investigate whether the public believes high cost patients should be a lower priority for public health care than low cost patients, other things being equal, in order to maximise health gains from the health budget. Semi-structured group discussions were used to help participants reflect critically upon their own views and gain exposure to alternative views, and in this way elicit underlying values rather than unreflective preferences. Participants were given two main tasks: first, to select from among three general principles for setting health care priorities the one that comes closest to their own views; second, to allocate a limited hospital budget between two groups of imaginary patients. Forty-one people, varying in age, occupation, income and education level, participated in a total of six group discussions with each group comprising between six and eight people

Nasal Acai Polysaccharides Potentiate Innate Immunity to Protect against Pulmonary Francisella tularensis and Burkholderia pseudomallei Infections

Pulmonary Francisella tularensis and Burkholderia pseudomallei infections are highly lethal in untreated patients, and current antibiotic regimens are not always effective. Activating the innate immune system provides an alternative means of treating infection and can also complement antibiotic therapies. Several natural agonists were screened for their ability to enhance host resistance to infection, and polysaccharides derived from the Acai berry (Acai PS) were found to have potent abilities as an immunotherapeutic to treat F. tularensis and B. pseudomallei infections. In vitro, Acai PS impaired replication of Francisella in primary human macrophages co-cultured with autologous NK cells via augmentation of NK cell IFN-γ. Furthermore, Acai PS administered nasally before or after infection protected mice against type A F. tularensis aerosol challenge with survival rates up to 80%, and protection was still observed, albeit reduced, when mice were treated two days post-infection. Nasal Acai PS administration augmented intracellular expression of IFN-γ by NK cells in the lungs of F. tularensis-infected mice, and neutralization of IFN-γ ablated the protective effect of Acai PS. Likewise, nasal Acai PS treatment conferred protection against pulmonary infection with B. pseudomallei strain 1026b. Acai PS dramatically reduced the replication of B. pseudomallei in the lung and blocked bacterial dissemination to the spleen and liver. Nasal administration of Acai PS enhanced IFN-γ responses by NK and γδ T cells in the lungs, while neutralization of IFN-γ totally abrogated the protective effect of Acai PS against pulmonary B. pseudomallei infection. Collectively, these results demonstrate Acai PS is a potent innate immune agonist that can resolve F. tularensis and B. pseudomallei infections, suggesting this innate immune agonist has broad-spectrum activity against virulent intracellular pathogens

Isotopic Discrimination of Aquifer Recharge Sources, Subsystem Connectivity and Flow Patterns in the South Fork Palouse River Basin, Idaho and Washington, USA

Groundwater studies in the South Fork Palouse River Basin have been unable to determine recharge sources, subsystem connectivity and flow patterns due to the discontinuity of pathways in the heterogeneous and anisotropic aquifers located in Columbia River flood basalts and interbedded sediments. Major ion, δ18O, δ2H, δ13C, δ34S and temperature for groundwater collected from 28 wells of varying depths indicate a primary recharge source dominated by snowmelt along the eastern basin margin. This recharge can be separated into two distinct sources—a deeper and relatively less altered snowmelt signal (−17.3‰ to −16.8‰ δ18O, −131‰ to −127‰ δ2H, −12.9‰ to −10‰ δ13C, 18⁻23 °C) and a more altered signal likely derived from a shallower mixture of snowmelt, precipitation and surface water (−16.1‰ to −15.5‰ δ18O, −121‰ to −117‰ δ2H, −15.9‰ to −12.9‰ δ13C, 12⁻19 °C). A mixing of the shallow and deep source waters is observed within the upper aquifer of the Grande Ronde Formation near Moscow, Idaho, which results in a homogenization of isotope ratios and geochemistry for groundwater at nearly any depth to the west of this mixing zone. This homogenized signal is prevalent in a likely primary productive zone of an intermediate depth in the overall aquifer system

Terrestrial surface stabilisation by modern analogues of the earliest land plants: A multi‐dimensional imaging study

Funder: Natural History Museum Origins and Evolution InitiativeThe evolution of the first plant‐based terrestrial ecosystems in the early Palaeozoic had a profound effect on the development of soils, the architecture of sedimentary systems, and shifts in global biogeochemical cycles. In part, this was due to the evolution of complex below‐ground (root‐like) anchorage systems in plants, which expanded and promoted plant–mineral interactions, weathering, and resulting surface sediment stabilisation. However, little is understood about how these micro‐scale processes occurred, because of a lack of in situ plant fossils in sedimentary rocks/palaeosols that exhibit these interactions. Some modern plants (e.g., liverworts, mosses, lycophytes) share key features with the earliest land plants; these include uni‐ or multicellular rhizoid‐like anchorage systems or simple roots, and the ability to develop below‐ground networks through prostrate axes, and intimate associations with fungi, making them suitable analogues. Here, we investigated cryptogamic ground covers in Iceland and New Zealand to better understand these interactions, and how they initiate the sediment stabilisation process. We employed multi‐dimensional and multi‐scale imaging, including scanning electron microscopy (SEM) and X‐ray Computed Tomography (μCT) of non‐vascular liverworts (Haplomitriopsida and complex thalloids) and mosses, with additional imaging of vascular lycopods. We find that plants interact with their substrate in multiple ways, including: (1) through the development of extensive surface coverings as mats; (2) entrapment of sediment grains within and between networks of rhizoids; (3) grain entwining and adherence by rhizoids, through mucilage secretions, biofilm‐like envelopment of thalli on surface grains; and (4) through grain entrapment within upright ‘leafy’ structures. Significantly, μCT imaging allows us to ascertain that rhizoids are the main method for entrapment and stabilisation of soil grains in the thalloid liverworts. This information provides us with details of how the earliest land plants may have significantly influenced early Palaeozoic sedimentary system architectures, promoted in situ weathering and proto‐soil development, and how these interactions diversified over time with the evolution of new plant organ systems. Further, this study highlights the importance of cryptogamic organisms in the early stages of sediment stabilisation and soil formation today

Isotopic discrimination of aquifer recharge sources, subsystem connectivity and flow patterns in the South Fork Palouse River Basin, Idaho and Washington, USA

Abstract Groundwater studies in the South Fork Palouse River Basin have been unable to determine recharge sources, subsystem connectivity and flow patterns due to the discontinuity of pathways in the heterogeneous and anisotropic aquifers located in Columbia River flood basalts and interbedded sediments. Major ion, δ18O, δ2H, δ13C, δ34S and temperature for groundwater collected from 28 wells of varying depths indicate a primary recharge source dominated by snowmelt along the eastern basin margin. This recharge can be separated into two distinct sources—a deeper and relatively less altered snowmelt signal (−17.3‰ to −16.8‰ δ18O, −131‰ to −127‰ δ2H, −12.9‰ to −10‰ δ13C, 18–23 °C) and a more altered signal likely derived from a shallower mixture of snowmelt, precipitation and surface water (−16.1‰ to −15.5‰ δ18O, −121‰ to −117‰ δ2H, −15.9‰ to −12.9‰ δ13C, 12–19 °C). A mixing of the shallow and deep source waters is observed within the upper aquifer of the Grande Ronde Formation near Moscow, Idaho, which results in a homogenization of isotope ratios and geochemistry for groundwater at nearly any depth to the west of this mixing zone. This homogenized signal is prevalent in a likely primary productive zone of an intermediate depth in the overall aquifer system

Daring to dream : the future of Australian health care

John Deeble reached three score years and ten in July 2001. At the start of this year we thought it would be most fitting if the health policy community in Australia were to celebrate his professional life and contributions to Australian health care by writing short chapters for a book in his honour. John we believe dared to dream and to work to create a better health care system in Australia. We felt that this volume ought to reflect that capacity to dream. We thus asked contributors to think positively of how Australian health care might develop over the next decade. They could do so on the whole institution or some sector such as general practice. They could look at particular disease programs or issues of social justice or better financing systems. We chose not to ‘prescribe’ areas. We asked contributors not to write about John’s work nor specifically to pay tribute to his work. We are grateful to all our authors for their contributions and to Linda Browning of Black Swan Press for her generous assistance