108 research outputs found

    Incorporating episodicity into estimates of Critical Loads for juvenile salmonids in Scottish streams

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    International audienceCritical Load (CL) methodology is currently used throughout Europe to assess the risks of ecological damage due to sulphur and nitrogen emissions. Critical acid neutralising capacity (ANCCRIT) is used in CL estimates for freshwater systems as a surrogate for biological damage. Although UK CL maps presently use an ANC value of 0 ?eq l-1, this value has been based largely on Norwegian lake studies, in which brown trout is chosen as a representative indicator organism. In this study, an ANC value specific for brown trout in Scottish streams was determined and issues were addressed such as salmon and trout sensitivity in streams, episodicity, afforestation and complicating factors such as dissolved organic carbon (DOC) and labile aluminium (Al-L). Catchments with significant forest cover were selected to provide fishless sites and to provide catchment comparisons in unpolluted areas. Chemical factors were the primary determinant with land use a secondary determinant of the distribution of salmonid populations at the twenty-six study sites. ANC explained more variance in brown trout density than pH. The most significant index of episodicity was percent of time spent below an ANC of 0 ?eq l-1. An ANCCRIT value of 39 ?eq l-1 was obtained based on a 50% probability of brown trout occurrence. The use of this revised ANCCRIT value in the CL equation improved the relationship between trout status and exceedance of CLs. Uncertainties associated with variations in Al-L at any fixed ANCCRIT, particularly within forested catchments, and the role of DOC in modifying the toxicity of Al-L are discussed. Keywords: Critical Load, Critical acid neutralising capacity, brown trout, episodes, stream

    Recent Decisions

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    Comments on recent decisions by Ralph H. Witt, Raymond Brown, Thomas A. McNish, Daniel J. Manelli, Stanley B. Nelson, George A. Pelletier, Jr., David T. Link, and Thomas Kavadas, Jr

    Legal Framework of Public Intervention in Industrial Disputes

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    This survey was prepared by G. R. Blakey, A.B., LL.B., and Matthew T. Hogan, A.B., LL.B., both of the class of 1960, and John J. Coffey, Thomas A. McNish and Edward O\u27Toole of THE LAWYER\u27S Senior Staff

    Canada's Patented Medicine Notice of Compliance regulations: balancing the scales or tipping them?

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    <p>Abstract</p> <p>Background</p> <p>In order to comply with the provisions of the North American Free Trade Agreement, in 1993 the Canadian federal government introduced the Patented Medicine Notice of Compliance Linkage Regulations. These regulations were meant to achieve a balance between the timely entry of generic medicines and the rights of patent holders. The regulations tied the regulatory approval of generic medicines to the patent status of the original brand-name product.</p> <p>Discussion</p> <p>Since their introduction the regulations have been a source of contention between the generic and the brand-name industry. While the regulations have generated a considerable amount of work for the Federal Court of Canada both sides dispute the interpretation of the "win rate" in the court cases. Similarly, there is no agreement on whether multiple patents on single drugs represent a legitimate activity by the brand-name industry or an "evergreening" tactic. The generic industry's position is that the regulations are being abused leading to the delay in the introduction of lower cost generic products by as much as 8 years. The brand-name companies counter that the regulations are necessary because injunctions against the introduction of generic products are frequently unavailable to them. The regulations were amended in 2006 and again in 2008 but both sides continue to claim that the regulations favour the other party. The battle around the regulations also has an international dimension with interventions by PhRMA, the trade association representing the United States based multinational companies, arguing that the regulations are not stringent enough and that Canada needs to be placed on the U.S. Priority Watch List of countries. Finally, there are multiple costs to Canadian society as a result of the NOC regulations.</p> <p>Summary</p> <p>Despite the rhetoric there has been almost no empiric academic research done into the effect of the regulations. In order to develop rational policy in this area a number of key research questions have been formulated.</p

    Experimental analysis of gas-sensitive Braitenberg vehicles

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    This article addresses the problem of localizing a static gas source in an indoor environment by a mobile robot. In contrast to previous works, the environment is not artificially ventilated to produce a strong unidirectional airflow. Here, the dominant transport mechanisms of gas molecules are turbulence and convection flow rather than diffusion, which results in a patchy, chaotically fluctuating gas distribution. Two Braitenberg-type strategies (positive and negative tropotaxis) based on the instantaneously measured spatial concentration gradient were investigated. Both strategies were shown to be of potential use for gas source localization. As a possible solution to the problem of gas source declaration (the task of determining with certainty that the gas source has been found), an indirect localization strategy based on exploration and concentration peak avoidance is suggested. Here, a gas source is located by exploiting the fact that local concentration maxima occur more frequently near the gas source compared to distant regions

    Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

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    BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

    Global economic burden of unmet surgical need for appendicitis

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    Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US 92492millionusingapproach1and92 492 million using approach 1 and 73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was 95004millionusingapproach1and95 004 million using approach 1 and 75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

    Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

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    Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

    Sq and EEJ—A Review on the Daily Variation of the Geomagnetic Field Caused by Ionospheric Dynamo Currents

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