Guiding phosphorus stewardship for multiple ecosystem services

The essential role of phosphorus (P) for agriculture and its impact on water quality has received decades of research attention. However, the benefits of sustainable P use and management for society due to its downstream impacts on multiple ecosystem services are rarely acknowledged. We propose a conceptual framework—the “phosphorus-ecosystem services cascade” (PESC)—to integrate the key ecosystem processes and functions that moderate the relationship between P released to the environment from human actions and ecosystem services at distinct spatial and temporal scales. Indirect pathways in the cascade via soil and aquatic processes link anthropogenic P to biodiversity and multiple services, including recreation, drinking water provision, and fisheries. As anthropogenic P cascades through catchments, it often shifts from a subsidy to a stressor of ecosystem services. Phosphorus stewardship can have emergent ecosystem service co-benefits due to synergies with other societal or management goals (e.g., recycling of livestock manures and organic wastes could impact soil carbon storage). Applying the PESC framework, we identify key research priorities to align P stewardship with the management of multiple ecosystem services, such as incorporating additional services into agri-environmental P indices, assessing how widespread recycling of organic P sources could differentially impact agricultural yields and water quality, and accounting for shifting baselines in P stewardship due to climate change. Ultimately, P impacts depend on site-specific agricultural and biogeophysical contexts, so greater precision in targeting stewardship strategies to specific locations would help to optimize for ecosystem services and to more effectively internalize the downstream costs of farm nutrient management

‘An almost continuous picture of sordid vice’: The Keeler Affair, the Profumo Scandal and ‘Political’ Film Censorship in the 1960s

In 1963, the Profumo affair brought Christine Keeler to public attention and transformed her, briefly, into one of the most talked about women in the world. Seeking to exploit her notoriety, Topaz Films entered into an agreement with Keeler to make a cinematic version of her life story, The Keeler Affair. This article explores some of the controversies surrounding The Keeler Affair, especially in terms of the way in which the British Board of Film Censors dealt with the film. The Keeler Affair was submitted to the BBFC on two occasions – once when it was completed and then again in 1969 when Keeler's memoirs were serialised in the News of the World – and was rejected both times. On the second occasion, The Keeler Affair was also submitted to, and rejected by, the Greater London Council. The article seeks to establish some of the political factors that shaped the BBFC's and the GLC's attitudes towards politically contentious films, and demonstrates that the decisions made by the censors were guided not simply by the content of The Keeler Affair, but also by personal relationships, shared Establishment attitudes, concerns about public perceptions of the film industry and a desire not to be drawn into political controversies. Consequently, the article serves to reinforce the idea that censorship is best understood as a dynamic process shaped by a host of determining factors, many of which might best be described as extra- or para-cinematic

Bose-Einstein Correlations of Three Charged Pions in Hadronic Z^0 Decays

Bose-Einstein Correlations (BEC) of three identical charged pions were studied in 4 x 10^6 hadronic Z^0 decays recorded with the OPAL detector at LEP. The genuine three-pion correlations, corrected for the Coulomb effect, were separated from the known two-pion correlations by a new subtraction procedure. A significant genuine three-pion BEC enhancement near threshold was observed having an emitter source radius of r_3 = 0.580 +/- 0.004 (stat.) +/- 0.029 (syst.) fm and a strength of \lambda_3 = 0.504 +/- 0.010 (stat.) +/- 0.041 (syst.). The Coulomb correction was found to increase the \lambda_3 value by \~9% and to reduce r_3 by ~6%. The measured \lambda_3 corresponds to a value of 0.707 +/- 0.014 (stat.) +/- 0.078 (syst.) when one takes into account the three-pion sample purity. A relation between the two-pion and the three-pion source parameters is discussed.Comment: 19 pages, LaTeX, 5 eps figures included, accepted by Eur. Phys. J.

Impact and Cost-Effectiveness of Culture for Diagnosis of Tuberculosis in HIV-Infected Brazilian Adults

Culture of Mycobacterium tuberculosis currently represents the closest "gold standard" for diagnosis of tuberculosis (TB), but operational data are scant on the impact and cost-effectiveness of TB culture for human immunodeficiency (HIV-) infected individuals in resource-limited settings.We recorded costs, laboratory results, and dates of initiating TB therapy in a centralized TB culture program for HIV-infected patients in Rio de Janeiro, Brazil, constructing a decision-analysis model to estimate the incremental cost-effectiveness of TB culture from the perspective of a public-sector TB control program. Of 217 TB suspects presenting between January 2006 and March 2008, 33 (15%) had culture-confirmed active tuberculosis; 23 (70%) were smear-negative. Among smear-negative, culture-positive patients, 6 (26%) began TB therapy before culture results were available, 11 (48%) began TB therapy after culture result availability, and 6 (26%) did not begin TB therapy within 180 days of presentation. The cost per negative culture was US$17.52 (solid media)-$23.50 (liquid media). Per 1,000 TB suspects and compared with smear alone, TB culture with solid media would avert an estimated eight TB deaths (95% simulation interval [SI]: 4, 15) and 37 disability-adjusted life years (DALYs) (95% SI: 13, 76), at a cost of $36 (95$25, $50) per TB suspect or$962 (95% SI: $469,$2642) per DALY averted. Replacing solid media with automated liquid culture would avert one further death (95% SI: -1, 4) and eight DALYs (95% SI: -4, 23) at $2751 per DALY (95$680, dominated). The cost-effectiveness of TB culture was more sensitive to characteristics of the existing TB diagnostic system than to the accuracy or cost of TB culture.TB culture is potentially effective and cost-effective for HIV-positive patients in resource-constrained settings. Reliable transmission of culture results to patients and integration with existing systems are essential

Local iontophoretic administration of cytotoxic therapies to solid tumors

Parenteral and oral routes have been the traditional methods of administering cytotoxic agents to cancer patients. Unfortunately, the maximum potential effect of these cytotoxic agents has been limited because of systemic toxicity and poor tumor perfusion. In an attempt to improve the efficacy of cytotoxic agents while mitigating their side effects, we have developed modalities for the localized iontophoretic delivery of cytotoxic agents. These iontophoretic devices were designed to be implanted proximal to the tumor with external control of power and drug flow. Three distinct orthotopic mouse models of cancer and a canine model were evaluated for device efficacy and toxicity. Orthotopic patient-derived pancreatic cancer xenografts treated biweekly with gemcitabine via the device for 7 weeks experienced a mean log2 fold change in tumor volume of −0.8 compared to a mean log2 fold change in tumor volume of 1.1 for intravenous (IV) gemcitabine, 3.0 for IV saline, and 2.6 for device saline groups. The weekly coadministration of systemic cisplatin therapy and transdermal device cisplatin therapy significantly increased tumor growth inhibition and doubled the survival in two aggressive orthotopic models of breast cancer. The addition of radiotherapy to this treatment further extended survival. Device delivery of gemcitabine in dogs resulted in more than 7-fold difference in local drug concentrations and 25-fold lower systemic drug levels than the IV treatment. Overall, these devices have potential paradigm shifting implications for the treatment of pancreatic, breast, and other solid tumors

What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care.</p> <p>Methods</p> <p>We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria.</p> <p>Results</p> <p>From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51%) but the remainder showed no correlation (16/51 31%) or a paradoxical correlation (9/51 18%).</p> <p>Conclusion</p> <p>The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.</p