Phosphorus in the landscape: diffuse sources to surface waters. Land and Water Resources Research and Development Corporation. Occasional Paper 16/98

The National Eutrophication Management Program (NEMP) and Environment Australia convened a workshop to develop a coherent overview of the sources and transport of diffuse phosphorus in Australian catchments based on the latest knowledge. The Land and Water Resources Research and Development Corporation (LWRRDC) and the Murray–Darling Basin Commission (MDBC) jointly fund NEMP. A select group of scientists attended the workshop and developed a coherent statement about phosphorus sources and transport in Australian catchments. The group did not extend this statement to include recommended management practices. This paper reports the findings from the workshop. State governments have developed algal and nutrient management strategies in response to concerns about the frequency and severity of algal blooms, including cyanobacterial blooms, in Australian rivers and estuaries. There is an emphasis on phosphorus management, particularly in rural environments, now that nutrients are recognised as fundamental drivers of algal growth. Best management practices (BMPs) were developed for these strategies on the basis of the limited scientific evidence that was available at the time. The absence of a significant body of Australian information meant that there was a reliance on overseas research findings to develop such BMPs. A number of research projects have been completed in recent years on the sources and transport of nutrients in Australian catchments that challenge the Northern Hemisphere model of nutrient behaviour and will have implications for future development of BMPs. Principal conclusions 1. The studies presented in the workshop demonstrate that control of phosphorus entering surface waters must start with land management that minimises accelerated erosion and overland flow of water potentially rich in phosphorus. Heavily grazed lands, irrigation areas and intensive animal and horticultural industries are at risk, especially at the onset of rainy seasons and during periods of high rain intensity. 2. The transport of phosphorus from diffuse sources in landscapes can occur in both dissolved and particulate form. This can be due to different mobilisation and delivery mechanisms operating in different environments. Phosphorus mobilisation and delivery 1. Diffuse sources of phosphorus are the dominant component in most Australian catchments. Episodic rainfall is responsible for the bulk of phosphorus loss from the landscape. The mechanisms vary with each catchment. 2. Particulate phosphorus is carried by overland flow, resulting from run-off and erosion. In high to medium rainfall environments most is carried as filterable reactive phosphorus of less than 0.45 microns. Although most of the coarser materials from high parts of the landscape are deposited before they reach a watercourse, the particles ultimately carried into drainage lines are phosphorus-enriched by processes of sorting and filtration. 3. In river systems studied in the Murray–Darling Basin river sediments that originate from gully erosion and stream-bank collapse of readily dispersible soils carry most of the diffuse-source phosphorus. It is very likely that most of the phosphorus on these sediments is ‘native’ phosphorus coming from subsoils. 2 Phosphorus in the landscape: diffuse sources to surface waters Although the major episodes of gully formation occurred several decades ago, inputs of sediments and phosphorus from these sources continue at a high rate. Reduced input rates can best be achieved by targeting the gullies themselves and stabilising them by conservation works—particularly in small headwater catchments. 4. In larger dry-land catchments, fertiliser phosphorus is generally not an important component of phosphorus loss/export, although it may be locally significant. 5. Local soil, vegetation, terrain and climate conditions dictate whether surface erosion is the dominant source of phosphorus into a watercourse. To describe phosphorus exports from a specific landscape by surface erosion requires local studies. However, guidelines can be developed for management purposes to identify and minimise sources of phosphorus carried by overland flow. 6. Potential sources of diffuse phosphorus run-off occur wherever fertilisers are applied to soils that are already wet at the surface, or that may become wet by seasonally emerging groundwater. The magnitude of the loss will be greater if the application occurs on bare soils, or if it is next to a waterbody. 7. Dissolved phosphorus (from fertilisers and other sources) is readily mobilised and transported directly where the soil has both little ability to bind the phosphorus and a high leaching rate, as occurs in sandy regions of high rainfall around the continent. Phosphorus-laden water then travels via overland or shallow sub-surface flow to surface waterbodies quite quickly, unless other processes impede the movement. If the dissolved phosphorus moves via deep groundwater the time scales for its reappearance in surface water are generally large. 8. Dissolved phosphorus may also enter tributary waterbodies in headwater catchments via shortcircuit pathways, such as macropores, but this is only likely to be important over distances of hundreds of metres. However, these sub-surface pathways may reduce the effectiveness of local management practices that do not take them into account. 9. Large amounts of dissolved phosphorus are also being produced from irrigated dairy pastures (and possibly from other irrigation enterprises also). There is little or no sub-surface movement because soils are generally high in clay and flat. Phosphorus-laden water is pumped or drained across the land surface to channels. The time scale of dissolved phosphorus movement is comparable with the time with which the water itself moves. Once within drainage channels and streambeds the dissolved phosphorus fraction may be partially re-adsorbed onto particulates. 10. Large quantities of dissolved phosphorus are found in surface waters next to areas where animal excreta or over-fertilised market gardens give rise to phosphorus in surface wastewater that flows directly into waterways. These situations are most likely to arise in catchments that contain mixtures of horticultural, dairying, hobby-farming and similar land uses. Where farm dams are abundant a significant fraction of this phosphorus will not enter streams but will be retarded or retained in the landscape

Epidemiology of Untreated Psychoses in 3 Diverse Settings in the Global South: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II).

IMPORTANCE: Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world. OBJECTIVE: To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group. DESIGN, SETTING, AND PARTICIPANTS: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022. MAIN OUTCOMES AND MEASURES: The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination. RESULTS: Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100 000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100 000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100 000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100 000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100 000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100 000 person-years; 95% CI, 42.0-59.5). CONCLUSIONS AND RELEVANCE: This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally

Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya

Despite innovations in HIV counseling and testing (HCT), important gaps remain in understanding linkage to care. We followed a cohort diagnosed with HIV through a community-based HCT campaign that trained persons living with HIV/AIDS (PLHA) as navigators. Individual, interpersonal, and institutional predictors of linkage were assessed using survival analysis of self-reported time to enrollment. Of 483 persons consenting to follow-up, 305 (63.2%) enrolled in HIV care within 3 months. Proportions linking to care were similar across sexes, barring a sub-sample of men aged 18–25 years who were highly unlikely to enroll. Men were more likely to enroll if they had disclosed to their spouse, and women if they had disclosed to family. Women who anticipated violence or relationship breakup were less likely to link to care. Enrolment rates were significantly higher among participants receiving a PLHA visit, suggesting that a navigator approach may improve linkage from community-based HCT campaigns.Vestergaard Frandse

A qualitative study of the feasibility and community perception on the effectiveness of artemether-lumefantrine use in the context of home management of malaria in south-west Nigeria

<p>Abstract</p> <p>Background</p> <p>In Nigeria ACT use at the community level has not been evaluated and the use of antimalarial drugs (commonly chloroquine (CQ)) at home has been shown to be largely incorrect. The treatment regimen of ACT is however more complicated than that of CQ. There is thus a need to determine the feasibility of using ACT at the home level and determine community perception on its use.</p> <p>Methods</p> <p>A before and after qualitative study using key informant interviews (KII) and focus group discussions (FGDs) was conducted in selected villages in Ona-Ara local government area. At baseline, 14 FGDs and 14 KIIs were conducted. Thereafter, community medicine distributors (CMDs) were trained in each village to dispense artemeter-lumenfantrine (AL) to febrile children aged 6–59 months presumed to have uncomplicated malaria. After one year of drug distribution, nine KIIs and 10 FGDs were conducted. Participants and key informants were mothers and fathers with children under five years, traditional heads of communities, opinion leaders and health workers.</p> <p>Results</p> <p>None of the participants have heard of AL prior to study. Participants were favourably disposed to introduction of AL into the community. Mothers/caregivers were said to have used AL in place of the orthodox drugs and herbs reported commonly used prior to study after commencement of AL distribution. The use of CMDs for drug distribution was acceptable to the participants and they were judged to be efficient as they were readily available, distributed correct dose of AL and mobilised the community effectively. AL was perceived to be very effective and no significant adverse event was reported. Major concerns to the sustainability of the program were the negative attitudes of health workers towards discharge of their duties, support to the CMDs and the need to provide CMDs incentives. In addition regular supply of drugs and adequate supervision of CMDs were advised.</p> <p>Conclusion</p> <p>Our findings showed that the use of AL at home and community level is feasible with adequate training of community medicine distributors and caregivers. Community members perceived AL to be effective thus fostering acceptability. The negative attitudes of the health workers and issue of incentives to CMDs need to be addressed for successful scaling-up of ACT use at community level.</p

Reassessing the Impact of High Performance Workplaces

High performance workplace practices were extolled as an efficient means to increase firm productivity. The empirical evidence is disputed, however. To assess the productivity effects of a broad variety of measures, we simultaneously account for both unobserved heterogeneity and endogeneity using establishment panel data for Germany. We show that increasing employee participation enhances firm productivity in Germany, whereas incentive systems do not foster productivity. Our results further indicate that firms with structural productivity problems tend to introduce organisational changes that increase employee participation whereas well performing firms are more likely to offer incentives

Packages of Care for Epilepsy in Low- and Middle-Income Countries

In the second in a series of six articles on packages of care for mental health disorders in low- and middle-income countries, Caroline Mbuba and Charles Newton discuss treatment for epilepsy

Orofacial manifestations in outpatients with anorexia nervosa and bulimia nervosa focusing on the vomiting behavior

Objective: This case-control study aims to evaluate the oral health status and orofacial problems in a group of outpatients with eating disorders (ED)—either anorexia nervosa (AN) or bulimia nervosa (BN)—further focusing on the influence of vomit. Materials and methods: Fifty-five women outpatients with AN or BN diagnosis were invited to participate, of which 33 agreed. ED outpatients and matched controls were submitted to a questionnaire and clinical oral examination. Results: Multivariate analysis identified a significantly higher incidence of teeth-related complications (i.e., tooth decay, dental erosion, and self-reported dentin hypersensitivity), periodontal disease, salivary alterations (i.e., hyposalivation and xerostomia), and oral mucosa-related complications in ED outpatients. Dental erosion, self-reported dentin hypersensitivity, hyposalivation, xerostomia, and angular cheilitis were found to be highly correlated with the vomiting behavior. Conclusions: ED outpatients were found to present a higher incidence of oral-related complications and an inferior oral health status, compared to gender- and age-matched controls. Alterations verified within outpatients were acknowledged to be quite similar to those previously reported within inpatients, in both of nature and severity, thus sustaining that the cranio-maxillofacial region is significantly affected by ED, even in the early/milder forms of the condition, as expectedly verified within outpatients.The work was supported by the Faculty of Dental Medicine, U. Porto