Recreational, Cultural and Aesthetic Services from Estuarine and Coastal Ecosystems

The role of economic analysis in guiding the sustainable development of estuarine and coastal ecosystems is investigated based on a comprehensive review of the literature on the valuation of the recreation, cultural and aesthetic services. The implications of the findings for the sustainable management of coral reefs, Marine Protected Areas, and Small Island Developing States are discussed. Finally, the potential of meta-analytical benefit transfer and scaling up of values at various aggregation levels is demonstrated in the context of coastal tourism and recreation in Europe. The results of the study support the conclusion that the non-material values provided by coastal and estuarine ecosystems in terms of recreational, cultural and aesthetic services represent a substantial component of human well-being.Aesthetic Values, Coastal Recreation, Coral Reefs, Cultural Values, Ecosystem Services Valuation, Ecosystem Services, Estuarine Ecosystems, Marine Protected Areas, Non-market Valuation, Non-use Values, Passive Values, Recreational Fishing, Small Island Developing States, Spiritual and Religious Values.

Portal vein thrombosis following laparoscopic cholecystectomy complicated by dengue viral infection: a case report

<p>Abstract</p> <p>Introduction</p> <p>Portal vein thrombosis is an uncommon post-operative complication following abdominal surgery. Although therapeutic anticoagulation is recommended, this treatment may be questionable when the patient has an associated bleeding diathesis.</p> <p>Case presentation</p> <p>We report a case of a 63-year-old woman of Asian Indian ethnicity who developed portal vein thrombosis following an uneventful laparoscopic cholecystectomy for symptomatic gallstones. Her condition was further complicated by dengue viral infection in the post-operative period, with thrombocytopenia immediately preceding the diagnosis of portal vein thrombosis. The etiological connections between dengue viral infection with thrombocytopenia, laparoscopic cholecystectomy, portal vein thrombosis as well as the treatment dilemmas posed in treating a patient with portal vein thrombosis with a bleeding diathesis are discussed.</p> <p>Conclusion</p> <p>When portal vein thrombosis occurs in patients with contraindications to anticoagulation, there is a role for initial conservative management without aggressive anticoagulation therapy and such patients must be approached on an individualized basis.</p

Exploring recruitment, willingness to participate, and retention of low-SES women in stress and depression prevention

Contains fulltext : 90907.pdf (publisher's version ) (Open Access)Background Recruitment, willingness to participate, and retention in interventions are indispensable for successful prevention. This study investigated the effectiveness of different strategies for recruiting and retaining low-SES women in depression prevention, and explored which sociodemographic characteristics and risk status factors within this specific target group are associated with successful recruitment and retention. Methods The process of recruitment, willingness to participate, and retention was structurally mapped and explored. Differences between women who dropped out and those who adhered to the subsequent stages of the recruitment and retention process were investigated. The potential of several referral strategies was also studied, with specific attention paid to the use of GP databases. Results As part of the recruitment process, 12.1% of the target population completed a telephone screening. The most successful referral strategy was the use of patient databases from GPs working in disadvantaged neighborhoods. Older age and more severe complaints were particularly associated with greater willingness to participate and with retention. Conclusions Low-SES women can be recruited and retained in public health interventions through tailored strategies. The integration of mental health screening within primary care might help to embed preventive interventions in low-SES communities.8 p

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR) : an international multicentre prospective cohort study

Introduction Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. Methods This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone–iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. Results A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. Conclusion The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary

The Guillain-Barré Syndrome at Two Hospitals in Trinidad, West Indies: A Review of 26 Patients

Over a four-year period, 26 consecutive patients with Guillain-Barré syndrome (GBS) were seen. Their ages ranged from 18 months to 68 years. Fifteen were male and 11 female. The crude annual incidence was estimated to be 1.5 per 100 000 population. East Indians made up the majority of the patients. An antecedent infection was reported in 65% of patients. Significant pain was present in half of the cohort. F-wave abnormalities were the commonest electrophysiological disturbance. Twenty-nine per cent of patients required ventilation. Intravenous immunoglobulin (IVIG) treatment was beneficial in 88% of patients. Eighty-four per cent made a complete or near complete recovery. One patient died. Keywords: Guillain-Barré Syndrome, Trinidad "El Síndrome de Guillain-Barré en Trinidad, West Indies Una revisión de 26 pacientes" A Esack, S Teelucksingh RESUMEN Por un periodo de cuatro años, se atendieron 26 pacientes consecutivos con el síndrome de Guillain-Barré (GBS). Sus edades fluctuaban de 18 meses a 68 años. Quince eran varones y 11 hembras. Se calculó que la incidencia anual bruta era 1.5 por 100 000 población. La mayor parte de los pacientes eran indo-orientales. El 65% de pacientes reportó antecedentes de infección. La mitad de la cohorte presentaba dolor significativo. El trastorno electrofisiológico más común fue las anormalidades de la onda F. Veintinueve por ciento de los pacientes necesitaron ventilación. El tratamiento de inmunoglobulina intravenosa (IVIG) fue beneficioso en 88% de los pacientes. Ochenta y cuatro por ciento tuvo una recuperación completa o casi completa. Un paciente murió. Palabras claves: Síndrome de Guillain-Barré, Trinida

Biodiversity Valuation in Developing Countries: A Focus on Small Island Developing States (SIDS)

The Millennium Development Goals explicitly recognise “sustainable development” as a target. A step towards this is a greater understanding of the significant role of biodiversity in rural communities of developing countries who depend most on the ecosystem goods and services and who as a result may suffer most from its continued degradation. Understanding the input of biodiversity in developing countries to the provision of the ecosystem goods and services (EGS) that are essential to their human well-being is seen as a significant first step in sustainable development, and environmental valuation is a necessary tool for achieving this objective. However, valuing biodiversity in a developing country context can be an intricate affair. While economic valuation literature yields a range of tried and tested methodological techniques for measuring biodiversity, the question remains as to whether these generalised techniques are capable of revealing the complexities of local environmental use in developing countries. A heterogeneous group, “developing countries” can be characterised by a range of factors existing in different intensities that can (1) impact the ways in which local communities interact with their environmental resources (2) impact the efficacy of the methodological and data collection process (3) impact the values obtained from the application of valuation techniques and (4) impact the implementation, success and sustainability of policy and management prescriptions. This paper attempts to address these issues by discussing the main characteristics of developing countries that can impact the biodiversity valuation process and, with specific reference to Small Island Developing States (SIDS), discussing how knowledge of these characteristics can assist the valuation process to better reveal the complex interaction between biodiversity and human welfare in a developing country context