The development of a classification system for inland aquatic ecosystems in South Africa

A classification system is described that was developed for inland aquatic ecosystems in South Africa, including wetlands. The six-tiered classification system is based on a top-down, hierarchical  classification of aquatic ecosystems, following the functionally-oriented hydrogeomorphic (HGM)  approach to classification but incorporating structural attributes at the lower levels of the hierarchy. At Level 1, a distinction is made between inland, estuarine and shallow marine systems using the degree of connectivity to the open ocean as the key discriminator. Inland systems are characterised by the  complete absence of marine exchange and/or tidal influence. At Level 2, inland systems are grouped according to the most appropriate spatial framework for the particular application. At Level 3, four  primary Landscape Units are distinguished (Valley floor, Slope, Plain, Bench) on the basis of the  topographic position within which a particular inland aquatic ecosystem is situated, in recognition of the influence that the landscape setting has over hydrological and hydrodynamic processes acting within an aquatic ecosystem. Level 4 identifies HGM Units, defined primarily according to landform, hydrological characteristics and hydrodynamics. The following primary HGM Units (or HGM Types), which represent the main units of analysis for the classification system, are distinguished at Level 4A: (1) River; (2) Floodplain Wetland; (3) Channelled Valley-Bottom Wetland; (4) Unchannelled Valley-Bottom Wetland; (5) Depression; (6) Seep; (7) Wetland Flat. Secondary discriminators are applied at Level 5 to classify the hydrological regime of an HGM Unit, and Descriptors at Level 6 to categorise a range of biophysical attributes. The HGM Unit at Level 4 and the Hydrological Regime at Level 5 together constitute a Functional Unit, which represents the focal point of the classification system. The utility of the  classification system is ultimately dependent on the level to which ecosystem units are classified, which is in turn constrained by the type and extent of information available.Keywords: freshwater ecosystems, hydrogeomorphic (HGM) units, inland water ecosystems,  wetlands, wetland classification syste

A randomised sham controlled trial of vertebroplasty for painful acute osteoporotic vertebral fractures (VERTOS IV)

<p>Abstract</p> <p>Background</p> <p>The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF) is conservative therapy. Percutaneous vertebroplasty (PV), a minimally invasive technique, is a new treatment option. Recent randomized controlled trials (RCT) provide conflicting results: two sham-controlled studies showed no benefit of PV while an unmasked but controlled RCT (VERTOS II) found effective pain relief at acceptable costs. The objective of this study is to compare pain relief after PV with a sham intervention in selected patients with an acute osteoporotic VCF using the same strict inclusion criteria as in VERTOS II. Secondary outcome measures are back pain related disability and quality of life.</p> <p>Methods</p> <p>The VERTOS IV study is a prospective, multicenter RCT with pain relief as primary endpoint. Patients with a painful osteoporotic VCF with bone edema on MR imaging, local back pain for 6 weeks or less, osteopenia and aged 50 years or older, after obtaining informed consent, are included and randomized for PV or a sham intervention. In total 180 patients will be enrolled. Follow-up is at regular intervals during a 1-year period with a standard Visual Analogue Scale (VAS) score for pain and pain medication. Necessary additional therapies and complications are recorded.</p> <p>Discussion</p> <p>The VERTOS IV study is a methodologically sound RCT designed to assess pain relief after PV compared to a sham intervention in patients with an acute osteoporotic VCF selected on strict inclusion criteria.</p> <p>Trial registration</p> <p>This study is registered at ClinicalTrials.gov., <a href="http://www.clinicaltrials.gov/ct2/show/NCT01200277">NCT01200277</a>.</p

Stress and prevalence of hearing problems in the Swedish working population

<p>Abstract</p> <p>Background</p> <p>Current human and experimental studies are indicating an association between stress and hearing problems; however potential risk factors have not been established. Hearing problems are projected to become among the top ten disabilities according to the WHO in the near future. Therefore a better understanding of the relationships between stress and hearing is warranted. Here we describe the prevalence of two common hearing problems, i.e. hearing complaints and tinnitus, in relation to different work-and health-related stressors.</p> <p>Methods</p> <p>A total of 18,734 individuals were invited to participate in the study, out of which 9,756 (52%) enrolled.</p> <p>Results</p> <p>The results demonstrate a clear and mostly linear relationship between higher prevalence of hearing problems (tinnitus or hearing loss or both) and different stressors, e.g. occupational, poorer self-rated health, long-term illness, poorer sleep quality, and higher burnout scores.</p> <p>Conclusions</p> <p>The present study unambiguously demonstrates associations between hearing problems and various stressors that have not been previously described for the auditory system. These findings will open new avenues for future investigations.</p

Non-technical Skills in Healthcare

AbstractNon-technical Skills (NTS) are a set of generic cognitive and social skills, exhibited by individuals and teams, that support technical skills when performing complex tasks. Typical NTS training topics include performance shaping factors, planning and preparation for complex tasks, situation awareness, perception of risk, decision-making, communication, teamwork and leadership. This chapter provides a framework for understanding these skills in theory and practice, how they interact, and how they have been applied in healthcare, as well as avenues for future research

Attrition in Web-Based Treatment for Problem Drinkers

Background: Web-based interventions for problem drinking are effective but characterized by high rates of attrition. There is a need to better understand attrition rates in order to improve the completion rates and the success of Web-based treatment programs.\ud \ud Objective: The objectives of our study were to (1) examine attrition prevalence and pretreatment predictors of attrition in a sample of open-access users of a Web-based program for problem drinkers, and (2) to further explore attrition data from our randomized controlled trial (RCT) of the Web-based program.Methods\ud Attrition data from two groups of Dutch-speaking problem drinkers were collected: (1) open-access participants enrolled in the program in 2009 (n = 885), and (2) RCT participants (n = 156). Participants were classified as noncompleters if they did not complete all 12 treatment sessions (9 assignments and 3 assessments). In both samples we assessed prevalence of attrition and pretreatment predictors of treatment completion. Logistic regression analysis was used to explore predictors of treatment completion. In the RCT sample, we additionally measured reasons for noncompletion and participants’ suggestions to enhance treatment adherence. The qualitative data were analyzed using thematic analysis.\ud \ud Results: The open-access and RCT group differed significantly in the percentage of treatment completers (273/780, 35.0% vs 65/144, 45%, χ2 1 = 5.4, P = .02). Logistic regression analysis revealed a significant contribution of treatment readiness, gender, education level, age, baseline alcohol consumption, and readiness to change to predict treatment completion. The key reasons for noncompletion were personal reasons, dissatisfaction with the intervention, and satisfaction with their own improvement. The main suggestions for boosting strategies involved email notification and more flexibility in the intervention.\ud \ud Conclusions: The challenge of Web-based alcohol treatment programs no longer seems to be their effectiveness but keeping participants involved until the end of the treatment program. Further research should investigate whether the suggested strategies to improve adherence decrease attrition rates in Web-based interventions. If we can succeed in improving attrition rates, the success of Web-based alcohol interventions will also improve and, as a consequence, their public health impact will increase