Recurrent Die-Offs of Adult Coho Salmon Returning to Spawn in Puget Sound Lowland Urban Streams

Several Seattle-area streams in Puget Sound were the focus of habitat restoration projects in the 1990s. Post-project effectiveness monitoring surveys revealed anomalous behaviors among adult coho salmon returning to spawn in restored reaches. These included erratic surface swimming, gaping, fin splaying, and loss of orientation and equilibrium. Affected fish died within hours, and female carcasses generally showed high rates (>90%) of egg retention. Beginning in the fall of 2002, systematic spawner surveys were conducted to 1) assess the severity of the adult die-offs, 2) compare spawner mortality in urban vs. non-urban streams, and 3) identify water quality and spawner condition factors that might be associated with the recurrent fish kills. The forensic investigation focused on conventional water quality parameters (e.g., dissolved oxygen, temperature, ammonia), fish condition, pathogen exposure and disease status, and exposures to metals, polycyclic aromatic hydrocarbons, and current use pesticides. Daily surveys of a representative urban stream (Longfellow Creek) from 2002–2009 revealed premature spawner mortality rates that ranged from 60–100% of each fall run. The comparable rate in a non-urban stream was <1% (Fortson Creek, surveyed in 2002). Conventional water quality, pesticide exposure, disease, and spawner condition showed no relationship to the syndrome. Coho salmon did show evidence of exposure to metals and petroleum hydrocarbons, both of which commonly originate from motor vehicles in urban landscapes. The weight of evidence suggests that freshwater-transitional coho are particularly vulnerable to an as-yet unidentified toxic contaminant (or contaminant mixture) in urban runoff. Stormwater may therefore place important constraints on efforts to conserve and recover coho populations in urban and urbanizing watersheds throughout the western United States

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Folly and the museum : re-imagining psychiatry using MacIntyre and Irigaray

The thesis aims to reconstruct psychiatry using features from the thought of Alasdair MacIntyre. These features are his pre-modern model of knowledge and his ‘tradition-constituted’ method of enquiry. It also uses Luce Irigaray`s philosophy to widen this approach to psychotherapy. MacIntyre`s model of knowledge is changed such that patients have legitimate knowledge, in part because they have been acted upon. Folly, in the sense of retaining good reasons for action while being irresponsible, is a key concept in this. Tradition-constituted enquiry is developed using the institutions of the museum and the assembly to think about Aristotelian knowledge in a way which would facilitate a move to a pre-modern paradigm in psychiatry. Aspects of MacIntyre`s philosophy which depend on his encounter with Marxism are also used in the model. The above model is then applied to psychiatry. The tradition of psychiatry is brought into dialogue with Christianity. By drawing on the work of the mental health service user movement, I propose collective advocacy as a way of providing a space where those acted on can contribute to practical wisdom in psychiatry. Analysing the role of technique and the positivist paradigm in psychotherapy shows it currently sits in the cultural space of community and prayer. I read Irigaray as a feminist theologian and critic of psychotherapy and her philosophy allows an expansion of the pre-modern approach to psychotherapy. I argue for a shift to a modified pre-modern paradigm in psychiatry, for MacIntyrean objectivity in psychiatry, a widening of the practice space, a re-invigorated public health function for psychiatry, patients to become authoritative authors of their life`s narrative and a reassessment of the cultural position of psychotherapy. This philosophical framework for psychiatry can then become the basis of more spiritual ways of caring for the mentally ill.EThOS - Electronic Theses Online ServiceGBUnited Kingdo