Juncus Bulbosus Tissue Nutrient Concentrations and Stoichiometry in Oligotrophic Ecosystems: Variability with Seasons, Growth Forms, Organs and Habitats

Aquatic plant nutrient concentrations provide important information to characterise their role in nutrient retention and turnover in aquatic ecosystems. While large standing biomass of aquatic plants is typically found in nutrient-rich localities, it may also occur in oligotrophic ecosystems. Juncus bulbosus is able to form massive stands even in very nutrient-dilute waters. Here we show that this may be achieved by tissues with very high carbon-to-nutrient ratios combined with perennial (slow) growth and a poor food source for grazers inferred from plant stoichiometry and tissue nutrient thresholds. We also show that the C, N, P and C:N:P stoichiometric ratios of Juncus bulbosus vary with the time of year, habitats (lakes versus rivers) and organs (roots versus shoots). We found no differences between growth forms (notably in P, inferred as the most limiting nutrient) corresponding to small and large plant stands. The mass development of J. bulbosus requires C, N and P, whatever the ecosystem (lake or river), and not just CO2 and NH4, as suggested in previous studies. Since macrophytes inhabiting oligotrophic aquatic ecosystems are dominated by isoetids (perennial plants with a high root/shoot ratio), attention should be paid to quantifying the role of roots in aquatic plant stoichiometry, nutrient turnover and nutrient retention.publishedVersio

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Inventory of current EU paediatric vision and hearing screening programmes

Background: We examined the diversity in paediatric vision and hearing screening programmes in Europe. Methods: Themes relevant for comparison of screening programmes were derived from literature and used to compile three questionnaires on vision, hearing and public-health screening. Tests used, professions involved, age and frequency of testing seem to influence sensitivity, specificity and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU fullmember, candidate and associate states. Answers were cross-checked. Results: Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% more than once. First measurement of VA varies from three to seven years of age, but is usually before the age of five. At age three and four picture charts, including Lea Hyvarinen are used most, in children over four Tumbling-E and Snellen. As first hearing screening test otoacoustic emission (OAE) is used most in healthy neonates, and auditory brainstem response (ABR) in premature newborns. The majority of hearing testing programmes are staged; children are referred after one to four abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Conclusion: Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4) and funding sources (8)

Juncus Bulbosus Tissue Nutrient Concentrations and Stoichiometry in Oligotrophic Ecosystems: Variability with Seasons, Growth Forms, Organs and Habitats

Aquatic plant nutrient concentrations provide important information to characterise their role in nutrient retention and turnover in aquatic ecosystems. While large standing biomass of aquatic plants is typically found in nutrient-rich localities, it may also occur in oligotrophic ecosystems. Juncus bulbosus is able to form massive stands even in very nutrient-dilute waters. Here we show that this may be achieved by tissues with very high carbon-to-nutrient ratios combined with perennial (slow) growth and a poor food source for grazers inferred from plant stoichiometry and tissue nutrient thresholds. We also show that the C, N, P and C:N:P stoichiometric ratios of Juncus bulbosus vary with the time of year, habitats (lakes versus rivers) and organs (roots versus shoots). We found no differences between growth forms (notably in P, inferred as the most limiting nutrient) corresponding to small and large plant stands. The mass development of J. bulbosus requires C, N and P, whatever the ecosystem (lake or river), and not just CO2 and NH4, as suggested in previous studies. Since macrophytes inhabiting oligotrophic aquatic ecosystems are dominated by isoetids (perennial plants with a high root/shoot ratio), attention should be paid to quantifying the role of roots in aquatic plant stoichiometry, nutrient turnover and nutrient retention

Rapid colonization of aquatic communities in an urban stream after daylighting

Restoring aquatic ecosystems is still at an early stage and the outcomes of the remediation techniques used are often not reported, which limit opportunities to learn and further improve these methods. One common remediation technique in urban areas is daylighting, which involves the re-opening of once buried streams with the aim of restoring ecosystem functions and services. In this study, we monitored the colonization of two important aquatic communities, benthic algae and macroinvertebrates, and assessed the nutrient retention capacity of a recently daylighted urban stream in the city of Oslo, Norway. The approach used involved transforming a buried channel into an open stream consisting of interconnected riffles and ponds seeded with aquatic and terrestrial plants. Benthic algal and macroinvertebrate communities begun to colonize the restored stretch within a relatively short time, 9 months following daylighting. The dynamics of the two aquatic communities differed, indicating that spatial processes are influential in determining the establishment of benthic algae, whereas time is more important for macroinvertebrate communities. The observed net nutrient retention from the daylighted stretch for phosphate, total nitrogen, total phosphorus, and calcium were 226, 128, 38 and 14%, respectively. However, the efficiency of the daylighted stretch to sequester nutrients was limited by the lack of controlling nutrient inputs from diffuse sources. This highlights the importance of addressing the influence of broader-scale processes, extending beyond the boundaries of the restored reach, which can otherwise demise the success of daylighting

The strengths and difficulties questionnaire as a screening instrument for norwegian child and adolescent mental health services, application of UK scoring algorithms

Background The use of screening instruments can reduce waiting lists and increase treatment capacity. The aim of this study was to examine the usefulness of the Strengths and Difficulties Questionnaire (SDQ) with the original UK scoring algorithms, when used as a screening instrument to detect mental health disorders among patients in the Norwegian Child and Adolescent Mental Health Services (CAMHS) North Study. Methods A total of 286 outpatients, aged 5 to 18 years, from the CAMHS North Study were assigned diagnoses based on a Development and Well-Being Assessment (DAWBA). The main diagnostic groups (emotional, hyperactivity, conduct and other disorders) were then compared to the SDQ scoring algorithms using two dichotomisation levels: 'possible' and 'probable' levels. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (ORD) were calculated. Results Sensitivity for the diagnostic categories included was 0.47-0.85 ('probable' dichotomisation level) and 0.81-1.00 ('possible' dichotomisation level). Specificity was 0.52-0.87 ('probable' level) and 0.24-0.58 ('possible' level). The discriminative ability, as measured by ORD, was in the interval for potentially useful tests for hyperactivity disorders and conduct disorders when dichotomised on the 'possible' level. Conclusions The usefulness of the SDQ UK-based scoring algorithms in detecting mental health disorders among patients in the CAMHS North Study is only partly supported in the present study. They seem best suited to identify children and adolescents who do not require further psychiatric evaluation, although this as well is problematic from a clinical point of view

Innfrysing av krypsiv nedstrøms Brokke kraftverk vinteren 2011; vurdering av drift og sedimentasjon av løsrevet krypsiv på stasjoner i Otra nedstrøms tiltaket

I februar 2011 ble det utført et tiltak med innfrysning av krypsiv nedstrøms Brokke kraftverk i Otra. Da kraftverket startet opp igjen, ble store mengder fastfrosset krypsiv revet løs fra elvebunnen og ført nedover vassdraget. Målet med dette prosjektet har vært å dokumentere eventuelle negative effekter av innfrysningstiltaket (drift og sedimentasjon av løsrevet krypsiv) på kjente gyteplasser for bleke samt i strandsonen av Åraksfjorden og Byglandsfjorden. Undersøkelsene høsten 2011 viste at det generelt var lite dødt krypsivmateriale på land og i vann i Åraksfjorden og Byglandsfjorden. Store mengder løsrevet krypsiv-materiale ble bare registrert på én lokalitet (Reiårsfossen). Massebestander av fastsittende krypsivplanter er vanlig i dybde­området 1,5-3 m dyp i begge innsjøene. Be­standene har vært registrert her lenge og har ingenting å gjøre med løsrevet materiale fra innfrysningen. Heller ikke på noen av gyteplassene for bleke ble det registret mengder av sedimentert eller nyetablert krypsiv som ble vurdert som begrensende for gytemulighetene. Det ble enkelte steder observert nyetablert krypsiv som hadde festet seg på kvister på bunnen og som kan skyldes løsrevet krypsiv fra innfrysingen. Undersøkelsen avdekket ikke vesentlige negative effekter av innfrysningen på de deler av vassdraget som ligger nedenfor målområdet for tiltaket, og resultatene gir heller ikke grunnlag for å fraråde at tilsvarende tiltak blir gjennomført i årene framover. Det er imidlertid foreslått oppfølgende undersøkelser samt gitt råd om elementer som kan inngå i et løpende overvåkingsprogram for å dokumentere eventuelle negative effekter av kommende innfrysningstiltak.Fylkesmannen i Aust-Agde