Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe

Background: Acute pain is among the leading causes of referral to the emergency department (ED) in industrialized countries. Its management mainly depends on intensity. Moderateto- severe pain is treated with intravenous (IV) administered opioids, of which morphine is the most commonly used in the ED. We have estimated the burden of IV administration of morphine in the five key European countries (EU5) using a micro-costing approach. Scope: A structured literature review was conducted to identify clinical guidelines for acute pain management in EU5 and clinical studies conducted in the ED setting. The data identified in this literature review constituted the source for all model input parameters, which were clustered as analgesic (morphine), material used for IV morphine administration, nurse workforce time and management of morphine-related adverse events and IV-related complications. Findings: The cost per patient of IV morphine administration in the ED ranges between €18.31 in Spain and €28.38 in Germany. If costs associated with the management of morphine-related adverse events and IV-related complications are also considered, the total costs amount to €121.13–€132.43. The main driver of those total costs is the management of IV-related complications (phlebitis, extravasation and IV prescription errors; 73% of all costs) followed by workforce time (14%). Conclusions: IV morphine provides effective pain relief in the ED, but the costs associated with the IV administration inflict an economic burden on the respective national health services in EU5. An equally rapid-onset and efficacious analgesic that does not require IV administration could reduce this burden

Dissolved organic carbon bioreactivity and DOC:DIN stoichiometry control ammonium uptake in an intermittent Mediterranean stream

1. Heterotrophic organisms in streams use dissolved organic carbon (DOC) and dissolved inorganic nitrogen (DIN) from the water column to meet their growth and energy requirements. However, the role of DOC availability in driving DIN uptake in headwater streams is still poorly understood. In this study, we focus on how DOC:DIN stoichiometry and DOC bioreactivity control ammonium (NH$_4$$^+$) uptake and heterotrophic aerobic respiration, and how this influence varies among seasons in a forested Mediterranean headwater stream. 2. We estimated in-stream NH$_4$$^+$ uptake rates seasonally by conducting whole-reach constant-rate additions of NH$_4$$^+$ with and without amendments of either lignin (recalcitrant DOC) or acetate (labile DOC). During each addition, we characterised microbial community composition by molecular analyses, stream metabolism with the single-station method, and heterotrophic aerobic respiration by adding a metabolic tracer (resazurin). 3. The stream was heterotrophic (net ecosystem production 800% higher during the co-additions of acetate than when adding NH$_4$$^+$ either alone or with lignin. 4. Our results indicate that in-stream NH$_4$$^+$ uptake was largely controlled by heterotrophic bacteria, and that the stoichiometric balance between organic resources and nutrients was key to explaining the variability of in-stream NH$_4$$^+$ uptake and heterotrophic aerobic respiration. Moreover, the observed increase in NH$_4$$^+$ uptake during acetate additions suggests that heterotrophic activity was limited by labile DOC availability. 5. Our study highlights that both DOC:DIN stoichiometry and DOC bioreactivity are relevant factors driving the seasonal pattern of in-stream N processing in this forested Mediterranean headwater stream

High mountain lakes: extreme habitats and witnesses of environmental changes.

33 páginas, 14 figuras, 3 tablas.[EN]High mountain lakes offer research opportunities beyond what could be expected from their quantitative relevance in the Earth system. In this article we present a brief summary of the research carried out in the lakes of the Pyrenees in the last twenty years by the group of limnology of the Centre for High Mountain Research (CRAM) of the University of Barcelona. The studies can be included in three main topics: life in extreme conditions, catchment-lake relationships and environmental changes.[ES]Los lagos de montaña ofrecen oportunidades de estudio que van mucho más allá de lo que su disposición en el territorio y abundancia pudieran sugerir. En este artículo presentamos un breve resumen de los temas que hemos abordado a lo largo de poco más de veinte años de investigación en los lagos de los Pirineos por parte del grupo de limnología del Centro de Investigaciones de Alta Montaña (CRAM) de la Universidad de Barcelona. Los estudios se enmarcan fundamentalmente en tres líneas generales: la vida en condiciones extremas, las relaciones cuenca-lago y los cambios ambientales.Peer reviewe

The microbial food web during the artic winter

Trabajo presentado en la International Polar Year Oslo Science Conference, celebrada en Oslo (Noruega), del 8 al 12 de junio de 201