Primary production of microphytobenthos in the Ems-Dollard Estuary

From 1976 through 1978 primary production of microphytobenthos was measured at 6 stations on intertidal flats in the Ems-Dollard estuary using the 14C method. The purpose of the measurements was to estimate the annual primary production at different sites in the estuary and to investigate the factors that influence the rates of primary production. Therefore benthic chlorophyll a and a set of environmental factors were measured. Only primary production correlated sigruficantly with chlorophyll a concentration in the superficial (0.5 cm) sediment layer; other factors (temperature. in situ irradiance) did not correlate with primary production, primary production rate or assimilation number. Annual primary production ranged from ca. 50 g C m-' to 250 g C m-2 and was closely related to elevation of the tidal flat station. However, highest values were also recorded at the station closest to a waste water discharge point in the inner part of the estuary. Annual primary production can be roughly estimated from the mean annual content of chlorophyll a in the sediment. Use of different calculation methods results in annual primary production values that do not differ greatly from each other. Also productivity rates did not differ much over most of the estuary, except at the innermost station which showed a high production rate in combination with high microalgal biomass; this could not be explained by the high elevation of the station alone. A hypothesis is offered to explain the limited primary production of microphytobenthic vegetations

Measuring and managing changes in estuaries and lagoons: Morphological and eco-toxicological aspects

No abstract available

Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys

Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys - 17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) - carried out as part of the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful

Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Approximately 20-40% of outpatients with diabetes experience elevated levels of emotional distress, varying from disease-specific distress to general symptoms of anxiety and depression. The patient's emotional well-being is related to other unfavorable outcomes, like reduced quality of life, sub-optimal self-care, impaired glycemic control, higher risk of complications, and increased mortality rates. The purpose of this study is to test the effectiveness of a new diabetes-specific, mindfulness-based psychological intervention. First, with regard to reducing emotional distress; second, with respect to improving quality of life, dispositional mindfulness, and self-esteem of patients with diabetes; third, with regard to self-care and clinical outcomes; finally, a potential effect modification by clinical and personality characteristics will be explored.</p> <p>Methods/Design</p> <p>The Diabetes and Mindfulness study (DiaMind) is a randomized controlled trial. Patients with diabetes with low levels of emotional well-being will be recruited from outpatient diabetes clinics. Eligible patients will be randomized to an intervention group or a wait-list control group. The intervention group will receive the mindfulness program immediately, while the control group will receive the program eight months later. The primary outcome is emotional distress (anxiety, stress, depressive symptoms), for which data will be collected at baseline, four weeks, post intervention, and after six months follow-up. In addition, self-report data will be collected on quality of life, dispositional mindfulness, self-esteem, self-care, and personality, while complications and glycemic control will be assessed from medical files and blood pressure will be measured. Group differences will be analyzed with repeated measures analysis of covariance.</p> <p>The study is supported by grants from the Dutch Diabetes Research Foundation and Tilburg University and has been approved by a medical ethics committee.</p> <p>Discussion</p> <p>It is hypothesized that emotional well-being, quality of life, dispositional mindfulness, self-esteem, self-care, and blood pressure will improve significantly more in the mindfulness group compared to the control group. Results of this study can contribute to a better care for patients with diabetes with lowered levels of emotional well-being. It is expected that the first results will become available in 2012.</p> <p>Trial registration</p> <p>Dutch Trial Register <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2145">NTR2145</a>.</p

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Phytoplankton bloom dynamics in turbid, well-mixed estuaries : A model study

To gain insight into mechanisms underlying phytoplankton bloom dynamics in turbid, well-mixed estuaries, experiments were conducted with an exploratory model that couples physical and biological processes. The motivation for choosing exploratory models is that they allow investigation of individual processes in isolation, therefore yielding fundamental insight into the mechanisms of the system. The Ems estuary (between the Netherlands and Germany) was selected as the prototype estuary, in which a zone of high turbidity is observed in the middle and upper reach. Results show that the model is capable of capturing the main features of the observed phytoplankton population density (P) patterns, that is, in the lower reach a spring bloom occurs, followed by a secondary bloom in autumn. Results of sensitivity studies reveal that the along-estuary distribution of suspended particulate matter (SPM) is a determining factor for the along-estuary location of blooms and it largely affects the intensity of blooms. The along-estuary advection of nutrients by the subtidal current is important for obtaining blooms with high intensities. In this model, the seasonally varying water temperature has a larger impact on the timing of spring blooms than the seasonally varying incident light intensity. The occurrence of an autumn bloom is due to the fact that during the summer season, the net specific growth rate of phytoplankton decreases. The latter is likely to result from an optimum water temperature (smaller than the maximum water temperature) for phytoplankton growth. Nevertheless, the occurrence and characteristics of autumn blooms are also influenced by seasonal variations in other aspects, for instance, loss of phytoplankton due to grazing

Phytoplankton bloom dynamics in turbid, well-mixed estuaries : A model study

To gain insight into mechanisms underlying phytoplankton bloom dynamics in turbid, well-mixed estuaries, experiments were conducted with an exploratory model that couples physical and biological processes. The motivation for choosing exploratory models is that they allow investigation of individual processes in isolation, therefore yielding fundamental insight into the mechanisms of the system. The Ems estuary (between the Netherlands and Germany) was selected as the prototype estuary, in which a zone of high turbidity is observed in the middle and upper reach. Results show that the model is capable of capturing the main features of the observed phytoplankton population density (P) patterns, that is, in the lower reach a spring bloom occurs, followed by a secondary bloom in autumn. Results of sensitivity studies reveal that the along-estuary distribution of suspended particulate matter (SPM) is a determining factor for the along-estuary location of blooms and it largely affects the intensity of blooms. The along-estuary advection of nutrients by the subtidal current is important for obtaining blooms with high intensities. In this model, the seasonally varying water temperature has a larger impact on the timing of spring blooms than the seasonally varying incident light intensity. The occurrence of an autumn bloom is due to the fact that during the summer season, the net specific growth rate of phytoplankton decreases. The latter is likely to result from an optimum water temperature (smaller than the maximum water temperature) for phytoplankton growth. Nevertheless, the occurrence and characteristics of autumn blooms are also influenced by seasonal variations in other aspects, for instance, loss of phytoplankton due to grazing

Linking biodiversity indicators, ecosystem functioning, provision ofservices and human well-being in estuarine systems: Application of aconceptual framework

Assuming that human well-being strongly relies on the services provided by well-functioning ecosys-tems, changes in the ecological functioning of any system can have direct and indirect effects on humanwelfare. Intensive land use and tourism have expanded in recent decades along coastal ecosystems,together with increasing demands for water, food and energy; all of these factors intensify the exploita-tion of natural resources. Many of the interrelations between ecosystem functioning and the provisionof ecosystem services (ES) still require quantification in estuarine systems. A conceptual framework toassess such links in a spatially and temporally explicit manner is proposed and applied to the Mondegoestuary (Portugal). This framework relies on three consecutive steps and discriminates among biodi-versity structural components, ecosystem functioning and stability and the services provided by theecosystem.Disturbances in abiotic factors were found to have a direct effect on biodiversity, ecosystem functioningand the provision of ES. The observed changes in the species composition of communities had a positiveeffect on the ecosystem’s productivity and stability. Moreover, the observed changes in the estuarineES provision are likely to arise from changing structural and abiotic factors and in the present casefrom the loss or decline of locally abundant species. This study also indicates that linear relationshipsbetween biodiversity, ecosystem functioning and services provision are unlikely to occur in estuarinesystems. Instead, cumulative and complex relations are observed between factors on both temporaland spatial scales. In this context, the results suggest several additional conclusions: (1) biodiversityand ecosystem functioning interaction with human well-being need to be incorporated into decision-making processes aimed at the conservative management of systems; (2) the institutional use of researchresults must be part of the design and implementation of sustainable management activities; and (3)more integrative tools/studies are required to account for the interactions of estuarine ecosystems withsurrounding socio-economic activities. Therefore, when performing integrated assessments of ecosystemdynamics, it becomes essential to consider not only the effects of biodiversity and ecosystem functioningon services provision but also the effects that human well-being and ES provision may have on estuarinebiodiversity and ecosystem functioning.The proposed framework implies taking into account both the functional and the commoditiespoints of view upon natural ecosystems and by this representing a line of thought which will deservefurther research to explore more in detail the conceptual links between biodiversity–ecosystemfunctioning–services provided.The present work was prepared within the scope ofthe research project 3M-RECITAL (LTER/BIA-BEC/0019/2009).Additionally, it benefited from one grant, attributed by FCT(SFRH/BPD/90675/2012)