Assessment of the environmental status in Hellenic coastal waters (Eastern Mediterranean): from the Water Framework Directive to the Marine Strategy Water Framework Directive.

A  methodology is presented to assess the environmental status sensu the Marine Strategy Water Framework Directive (MSFD) based on data obtained from the monitoring of water quality in the Hellenic coastal waters within the Water Framework Directive (WFD).   An adapted decision tree used for integrating the results of the WFD in the Basque country was applied. Modifications lie to the evaluation of the physicochemical status based on a eutrophication index developed for Eastern Mediterranean waters. Results on hydromorphological, physicochemical and biological elements are presented. The chemical status was evaluated based on measurements of heavy metals in water. The evaluation of the biological quality was based on the use of metrics developed for phytoplankton biomass, benthic macroinvertebrates and macroalgae updated to accommodate MSFD needs. Results on the integrative status of the water bodies were validated by correlating classification results with a pressure index and environmental indicators in water column and sediment. Following this decision tree the majority of stations expected to be at risk of achieving the good status were found in moderate status. Benthos was found to be the element with the closest agreement with the integrated final status having an increased weighting in the decision tree. The quality of benthos and in some  limited cases  the eutrophication index determined largely the final status. The highest disagreement with the integrative classification was produced by macroalgae. All indicators used correlated with water and sediment parameters but benthos correlated better with sediment factors while phytoplankton and eutrophication index with water column parameters

Concurrent analysis of choice and control in childbirth?

Background: this paper reports original research on choice and control in childbirth. Eight women were interviewed as part of a wider investigation into locus of control in women with pre-labour rupture of membranes at term (PROM) [1].Methods: the following study uses concurrent analysis to sample and analyse narrative aspects of relevant literature along with these interviews in order to synthesise a generalisable analysis of the pertinent issues. The original PROM study had found that women experienced a higher degree of control in hospital, a finding that appeared at odds with contemporary notions of choice. However, this paper contextualises this finding by presenting narratives that lucidly subscribe to the dominant discourse of hospital as the safest place to give birth, under the premise of assuring a live healthy baby irrespective of their management type.Results: this complex narrative is composed of the following themes: 'perceiving risk', 'being prepared', 'reflecting on experience', maintaining control' and relinquishing control'. These themes are constructed within and around the medical, foetocentric, risk averse cultural context. Primary data are presented throughout to show the origins and interconnected nature of these themes.Conclusions: within this context it is clear that there is a highly valued role for competent health professionals that respect, understand and are capable of facilitating genuine choice for women

GOAL: a simplified mental test for emergency medical admissions

Background: Several scoring systems are used in screening for cognitive impairment, but none are suited to the busy medical assessment environment. Aim: To construct, validate and assess the reliability of a simple scale (Gwent Orientation and Awareness Listing, GOAL) for this purpose, and to examine its application in consecutive emergency admissions in two general hospitals. Design: Prospective cohort studies. Methods: The validity and reliability of GOAL was assessed in three studies of patients aged ≥65 years who had been pronounced medically fit for discharge. The evaluation studies were carried out over 4-week medical intake periods in each participating hospital. Results: Correlation of GOAL with the standard 30-point Mini-Mental State Examination was 0.89, and the inter-observer reliability was 0.90. Based on Receiver Operating Characteristics Curves, patients scoring 24 h, 952 were able and willing to be scored by GOAL, and of these 201 (21%) ‘failed’, with a score of <8. Discussion: Loss of orientation and awareness is common among patients admitted via medical intakes. GOAL is a practical brief screen for identifying and following-up these patients