How important are future marine and shipping aerosol emissions in a warming Arctic summer and autumn?

Future sea ice retreat in the Arctic in summer and autumn is expected to affect both natural and anthropogenic aerosol emissions: sea ice acts as a barrier between the ocean and the atmosphere, and reducing it increases dimethyl sulfide and sea salt emissions. Additionally, a decrease in the area and thickness of sea ice could lead to enhanced Arctic ship traffic, for example due to shorter routes of cargo ships. Changes in the emissions of aerosol particles can then influence cloud properties, precipitation, surface albedo, and radiation. Next to changes in aerosol emissions, clouds will also be affected by increases in Arctic temperatures and humidities. In this study, we quantify how future aerosol radiative forcings and cloud radiative effects might change in the Arctic in late summer (July–August) and early autumn (September–October). Simulations were conducted for the years 2004 and 2050 with the global aerosol–climate model ECHAM6-HAM2. For 2050, simulations with and without additional ship emissions in the Arctic were carried out to quantify the impact of these emissions on the Arctic climate. In the future, sea salt as well as dimethyl sulfide emissions and burdens will increase in the Arctic. The increase in cloud condensation nuclei, which is due to changes in aerosol particles and meteorology, will enhance cloud droplet number concentrations over the Arctic Ocean (+10 % in late summer and +29 % in early autumn; in-cloud values averaged between 75 and 90∘ N). Furthermore, both liquid and total water path will increase (+10 % and +8 % in late summer; +34 % and +26 % in early autumn) since the specific humidity will be enhanced due to higher temperatures and the exposure of the ocean's surface. Changes in both aerosol radiative forcings and cloud radiative effects at the top of the atmosphere will not be dominated by the aerosol particles and clouds themselves but by the decrease in surface albedo (and by the increase in surface temperature for the longwave cloud radiative effect in early autumn). Mainly due to the reduction in sea ice, the aerosol radiative forcing will become less positive (decreasing from 0.53 to 0.36 W m−2 in late summer and from 0.15 to 0.11 W m−2 in early autumn). The decrease in sea ice is also mainly responsible for changes in the net cloud radiative effect, which will become more negative in late summer (changing from −36 to −46 W m−2). Therefore, the cooling component of both aerosols and clouds will gain importance in the future. We found that future Arctic ship emissions related to transport and oil and gas extraction (Peters et al., 2011) will not have a large impact on clouds and radiation: changes in aerosols only become significant when we increase these ship emissions by a factor of 10. However, even with 10-fold ship emissions, the net aerosol radiative forcing shows no significant changes. Enhanced black carbon deposition on snow leads to a locally significant but very small increase in radiative forcing over the central Arctic Ocean in early autumn (no significant increase for average between 75 and 90∘ N). Furthermore, the 10-fold higher ship emissions increase the optical thickness and lifetime of clouds in late summer (net cloud radiative effect changing from −48 to −52 W m−2). These aerosol–cloud effects have a considerably larger influence on the radiative forcing than the direct effects of particles (both aerosol particles in the atmosphere and particles deposited on snow). In summary, future ship emissions of aerosols and their precursor gases might have a net cooling effect, which is small compared to other changes in future Arctic climate such as those caused by the decrease in surface albedo

Rehabilitation in Nursing Homes: A Cross-National Comparison of Recipients

Objective: To examine the prevalence of therapy use in nursing homes in selected countries and to describe the characteristics of nursing home residents who receive therapy. Design and sampling: The design of the study is cross-sectional, using Minimum Data Set (MDS) assessments of nursing home residents. The sample includes all nursing home residents in six US states (n=273491), in Copenhagen, Denmark (n=;3451), Reyjkavik, Iceland (n=1254), and selected locations in Italy (n=1089) and Japan (n=1255). Method: We determined who had received physical or occupational therapy treatments in the last 7 days. Demographic and clinical characteristics of recipients were compared relative to other nursing home residents within each country. Results: In the five countries, the prevalence of receiving therapy was 31% (Iceland), 30% Qapan), 23% (Denmark), 14% (Italy) and 11% (USA). Substantial proportions of the recipients were over the age of 85, were clinically stable and had been in the nursing home for longer than 90 days. Across all countries, residents with poorer activities of daily living (ADL) scores but good cognitive scores were more likely to receive therapy than other residents. Rehabilitation nursing, an adjunct to therapy, was concentrated on residents with poor ADL scores. Conclusions: Substantial numbers of long-stay residents receive therapy in nursing homes, including those over the age of 85 years and those with cognitive impairment. Hence, future rehabilitation outcome studies can involve these previously understudied patient population

Targeted colonic release formulations of mesalazine - A clinical pharmaco-scintigraphic proof-of-concept study in healthy subjects and patients with mildly active ulcerative colitis.

Colonic targeting of orally applied therapeutic drugs remains a challenge. Tablet coatings relying on gastrointestinal pH and colonic bacterial enzymes as triggers in association with an inner alkaline layer are expected to improve targeting efficiency. Mesalazine release from three differently coated tablets labelled with 1 MBq 153Sm was characterised in a single centre, open-label, parallel group study in nineteen healthy subjects and seven patients with mildly active ulcerative colitis. Two semi-organic and one aqueous-based outer coating with different ratios of enteric polymer and resistant starch were tested. All coatings showed comparable release lagtimes in biorelevant dissolution media and were not affected by neutron-activation of the samarium tracer. Mesalazine pharmacokinetics and gamma scintigraphy were used to characterise drug release, anatomical site of tablet disintegration and gastrointestinal transit. Initial tablet disintegration occurred at the ileo-caecal junction or beyond in 92% of the subjects Time to initial tablet disintegration was inversely correlated with maximal plasma concentrations and systemic mesalazine exposure. Although high inter-subject variability precluded detection of differences between solvent types and different enteric polymer to polysaccharide ratios, the dual pH and enzymatic triggered release system in combination with an inner alkaline layer promoted mesalazine release at the target site with high accuracy

Grassland Resistance and Resilience after Drought Depends on Management Intensity and Species Richness

The degree to which biodiversity may promote the stability of grasslands in the light of climatic variability, such as prolonged summer drought, has attracted considerable interest. Studies so far yielded inconsistent results and in addition, the effect of different grassland management practices on their response to drought remains an open question. We experimentally combined the manipulation of prolonged summer drought (sheltered vs. unsheltered sites), plant species loss (6 levels of 60 down to 1 species) and management intensity (4 levels varying in mowing frequency and amount of fertilizer application). Stability was measured as resistance and resilience of aboveground biomass production in grasslands against decreased summer precipitation, where resistance is the difference between drought treatments directly after drought induction and resilience is the difference between drought treatments in spring of the following year. We hypothesized that (i) management intensification amplifies biomass decrease under drought, (ii) resistance decreases with increasing species richness and with management intensification and (iii) resilience increases with increasing species richness and with management intensification

Assessment of explanatory models of mental illness: effects of patient and interviewer characteristics

Background: Explanatory models (EMs) refer to patients’ causal attributions of illness and have been shown to affect treatment preference and outcome. Reliable and valid assessment of EMs may be hindered by interviewer and respondent disparities on certain demographic characteristics, such as ethnicity. The present study examined (a) whether ethnic minority patients reported different EMs to ethnically similar interviewers in comparison with those with a different ethnicity, and (b) whether this effect was related to respondents’ social desirability, the perceived rapport with the interviewer and level of uncertainty toward their EMs. Methods: A total of 55 patients of Turkish and Moroccan origins with mood and anxiety disorders were randomly assigned to ethnically similar or dissimilar interviewers. EMs were assessed, using a semi-structured interview, across 11 different categories of causes. Results: Participants who were interviewed by an ethnically similar interviewer perceived interpersonal, victimization and religious/mystical causes as more important, whereas interviews by ethnically dissimilar interviewers generated higher scores on medical causes. These effects were not mediated by the perceived rapport with the interviewer, and social desirability had a modest impact on the results. Higher uncertainty among participants toward medical and religious/mystical causes seemed to be associated with greater adjustment in the report of these EMs. Conclusion: The findings have significant implications for interviewer selection in epidemiological research and clinical practice

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

<p>Abstract</p> <p>Background</p> <p>Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.</p> <p>Methods</p> <p>Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.</p> <p>Results</p> <p>Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.</p> <p>Conclusions</p> <p>Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.</p