Freshening by glacial meltwater enhances melting of ice shelves and reduces formation of Antarctic Bottom Water

Strong heat loss and brine release during sea ice formation in coastal polynyas act to cool and salinify waters on the Antarctic continental shelf. Polynya activity thus both limits the ocean heat flux to the Antarctic Ice Sheet and promotes formation of Dense Shelf Water (DSW), the precursor to Antarctic Bottom Water. However, despite the presence of strong polynyas, DSW is not formed on the Sabrina Coast in East Antarctica and in the Amundsen Sea in West Antarctica. Using a simple ocean model driven by observed forcing, we show that freshwater input from basal melt of ice shelves partially offsets the salt flux by sea ice formation in polynyas found in both regions, preventing full-depth convection and formation of DSW. In the absence of deep convection, warm water that reaches the continental shelf in the bottom layer does not lose much heat to the atmosphere and is thus available to drive the rapid basal melt observed at the Totten Ice Shelf on the Sabrina Coast and at the Dotson and Getz ice shelves in the Amundsen Sea. Our results suggest that increased glacial meltwater input in a warming climate will both reduce Antarctic Bottom Water formation and trigger increased mass loss from the Antarctic Ice Sheet, with consequences for the global overturning circulation and sea level rise

Seton drainage prior to transanal advancement flap repair: useful or not?

Introduction: Transanal advancement flap repair (TAFR) provides a useful tool in the treatment of high transsphincteric fistulas. Recent studies indicate that TAFR fails in one out of three patients. Until now, no definite predictive factor for failure has been identified. Although some authors have reported that preoperative seton drainage might improve the outcome of TAFR, this could not be confirmed by others. We conducted the present study to assess the influence of preoperative seton drainage on the outcome of TAFR in a relatively large series. Methods: Between December 1992 and June 2008, a consecutive series of 278 patients [M/F = 179:99, median age 46 years (range, 19-73 years)] with cryptoglandular, transsphincteric fistula, passing through the upper or middle third of the external anal sphincter underwent TAFR. Patients were recruited from the colorectal units of two university hospitals (Erasmus Medical Center, Rotterdam, n = 211; and Leiden University Medical Center, Leiden, n = 67). Baseline characteristics did not differ between the two clinics. Sixty-eight of these patients underwent preoperative seton drainage for at least 2 months and until the day of the flap repair. Results: Median healing time was 2.2 months. In patients without preoperative seton drainage, the healing rate was 63%, whereas the healing rate was 67% in patients who underwent preoperative seton drainage. This difference was not statistically significant. No differences in healing rates were found between the series from Leiden and Rotterdam. Conclusion: Preoperative seton drainage does not improve the outcome of TAFR

Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis: comparison with transesophageal echocardiography

<p>Abstract</p> <p>Background</p> <p>Although echocardiography has been incorporated into the diagnostic algorithm of patients with suspected infective endocarditis (IE), systematic usage in clinical practice remains ill defined. To determine the diagnostic accuracy of detecting vegetations using harmonic transthoracic echocardiography (hTTE) as compared to transesophageal echocardiography (TEE) in patients with an intermediate likelihood of native valve IE.</p> <p>Methods</p> <p>Between 2004 and 2005, 36 consecutive inpatients with an intermediate likelihood of disease were prospectively evaluated by hTTE and TEE.</p> <p>Results</p> <p>Of 36 patients (21 males with a mean age of 57 ± 15 years, range 32 to 86 years), 19 patients had definite IE by TEE. The sensitivity for the detection of vegetations by hTTE was 84%, specificity of 88%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 82%. The association between hTTE and TTE interpretation for the presence and absence of vegetations were high (kappa = 0.90 and 0.85 respectively).</p> <p>Conclusion</p> <p>In patients with an intermediate likelihood of native valve IE, TTE with harmonic imaging provides diagnostic quality images in the majority of cases, has excellent concordance with TEE and should be recommended as the first line test.</p

A meta-analysis of long-term effects of conservation agriculture on maize grain yield under rain-fed conditions

Conservation agriculture involves reduced tillage, permanent soil cover and crop rotations to enhance soil fertility and to supply food from a dwindling land resource. Recently, conservation agriculture has been promoted in Southern Africa, mainly for maize-based farming systems. However, maize yields under rain-fed conditions are often variable. There is therefore a need to identify factors that influence crop yield under conservation agriculture and rain-fed conditions. Here, we studied maize grain yield data from experiments lasting 5 years and more under rain-fed conditions. We assessed the effect of long-term tillage and residue retention on maize grain yield under contrasting soil textures, nitrogen input and climate. Yield variability was measured by stability analysis. Our results show an increase in maize yield over time with conservation agriculture practices that include rotation and high input use in low rainfall areas. But we observed no difference in system stability under those conditions. We observed a strong relationship between maize grain yield and annual rainfall. Our meta-analysis gave the following findings: (1) 92% of the data show that mulch cover in high rainfall areas leads to lower yields due to waterlogging; (2) 85% of data show that soil texture is important in the temporal development of conservation agriculture effects, improved yields are likely on well-drained soils; (3) 73% of the data show that conservation agriculture practices require high inputs especially N for improved yield; (4) 63% of data show that increased yields are obtained with rotation but calculations often do not include the variations in rainfall within and between seasons; (5) 56% of the data show that reduced tillage with no mulch cover leads to lower yields in semi-arid areas; and (6) when adequate fertiliser is available, rainfall is the most important determinant of yield in southern Africa. It is clear from our results that conservation agriculture needs to be targeted and adapted to specific biophysical conditions for improved impact

Attribution of physical complaints to the air disaster in Amsterdam by exposed rescue workers: an epidemiological study using historic cohorts

BACKGROUND: In 1992 a cargo aircraft crashed into a residential area of Amsterdam. A troublesome aftermath followed, with rumors on potential toxic exposures and health consequences. Health concerns remained even though no excess morbidity was predicted in retrospective risk evaluations. This study aimed to assess to what extent the rescue workers attribute long-term physical complaints to this disaster, including its aftermath, and to examine associations between such attribution and types of exposure and background variables. METHODS: Historic cohort study that collected questionnaire data on occupational disaster exposure, attribution of physical complaints, and background variables on average 8.5 years post-disaster. For the present study the workers who were exposed to the disaster were selected from the historic cohort, i.e. the professional firefighters (n = 334), police officers (n = 834), and accident and wreckage investigators (n = 241) who performed disaster-related tasks. RESULTS: Across the three occupational groups, a consistent percentage (ranging from 43% to 49%) of exposed workers with long-term physical complaints attributed these to the disaster, including its aftermath. Those with more physical complaints attributed these to a stronger degree. Multivariate logistic regression analyses showed that attribution was significantly more often reported by firefighters who rescued people, and by police officers who reported the identification and recovery of or search for victims and human remains, clean-up, or security and surveillance of the disaster area; who witnessed the immediate disaster scene; who had a close one affected by the disaster; and who perceived the disaster as the worst thing that ever happened to them. Age, sex and educational level were not significantly associated with attribution. CONCLUSION: This study provides further cross-sectional evidence for the role of causal attribution in post-disaster subjective physical health problems. After on average 8.5 years, almost a third (32%) of all the exposed workers, and almost half (45%) of the exposed workers with physical complaints, attributed these complaints to the disaster, including its aftermath. The similarity of the results across the occupational groups suggests a general rather than an occupation-specific attribution process. Longitudinal studies are needed to determine whether causal disaster attribution leads to persistence of post-disaster complaints and health care utilization

Do decision support systems influence variation in prescription?

<p>Abstract</p> <p>Background</p> <p>Translating scientific evidence into daily practice is problematic. All kinds of intervention strategies, using educational and/or directive strategies, aimed at modifying behavior, have evolved, but have been found only partially successful. In this article the focus is on (computerized) decision support systems (DSSs). DSSs intervene in physicians' daily routine, as opposed to interventions that aim at influencing knowledge in order to change behavior. We examined whether general practitioners (GPs) are prescribing in accordance with the advice given by the DSS and whether there is less variation in prescription when the DSS is used.</p> <p>Methods</p> <p>Data were used from the Second Dutch National Survey of General Practice (DNSGP2), collected in 2001. A total of 82 diagnoses, 749811 contacts, 133 physicians, and 85 practices was included in the analyses. GPs using the DSS daily were compared to GPs who do not use the DSS. Multilevel analyses were used to analyse the data. Two outcome measures were chosen: whether prescription was in accordance with the advice of the DSS or not, and a measure of concentration, the Herfindahl-Hirschman Index (HHI).</p> <p>Results</p> <p>GPs who use the DSS daily prescribe more according to the advice given in the DSS than GPs who do not use the DSS. Contradictory to our expectation there was no significant difference between the HHIs for both groups: variation in prescription was comparable.</p> <p>Conclusion</p> <p>We studied the use of a DSS for drug prescribing in general practice in the Netherlands. The DSS is based on guidelines developed by the Dutch College of General Practitioners and implemented in the Electronic Medical Systems of the GPs. GPs using the DSS more often prescribe in accordance with the advice given in the DSS compared to GPs not using the DSS. This finding, however, did not mean that variation is lower; variation is the same for GPs using and for GPs not using a DSS. Implications of the study are that DSSs can be used to implement guidelines, but that it should not be expected that variation is limited.</p

Arenas in the transition process. Case study: transition in agriculture and the food chain

Transities kunnen worden gezien als structurele maatschappelijke veranderingen. Zij vragen tijd, vele decennia soms. Het kan dus lang duren, voordat de resultaten van een transitie echt zichtbaar worden. Om de voortgang al in een vroeg stadium te kunnen beoordelen is dus meer nodig dan het in beeld brengen van de daadwerkelijke verandering. Het gaat om een analyse van vele activiteiten van vele actoren. In het beschreven onderzoek staan (verdere) ontwikkeling van de methodiek voor die analyse en de eerste toepassing voor de casus Nederlandse landbouw en voedingsketen centraal. Voor een overzichtelijke analyse zijn alle activiteiten in een transitieproces in dit onderzoek toegedeeld aan zes arena's. Een arena is daarmee gedefinieerd als een samenspel van activiteiten en actoren rond een bepaald onderdeel van de transitie. De structuur van arena's met hun onderlinge verbanden heeft geholpen om de relatie tussen gegevens op microniveau en inzicht op macroniveau vast te houden. Voor analyse binnen de arena's is modelinstrumentarium van het MNP-RIVM toegepast en verder ontwikkeld. De belangrijkste resultaten in de methodische ontwikkeling zijn een systematische, kwantitatieve benadering van de betekenis van toekomstbeelden voor de transitie, de operationalisatie van krachtenveldanalyses rond actoren en de verdere detaillering van de landbouw en voedingsketen in input-output modellen; op enkele punten worden voorstellen gedaan om gebruikte methoden nog een stap verder uit te werken en te koppelen aan monitoring. De methoden zijn behulpzaam gebleken bij het genereren van een zekere maat om de voortgang binnen een arena vast te stellen. Hiermee is het mogelijk gebleken ook de interactie tussen de arena's te evalueren, hetgeen voor het voorbeeld van biologische landbouw is uitgewerkt. In het kader van transitie-evaluatie kunnen conclusies worden getrokken op het niveau van een arena en voor een bepaald onderwerp over de arena's heen. Hiermee is de basis gelegd voor conclusies op het meest algemene niveau: over arena's en onderwerpen binnen de transitie heen. Dit laatste vraagt niet zozeer meer methoden, als wel meer gegevens en meer deelanalyses. Hoewel voor een complete inhoudelijke evaluatie van de transitie in de landbouw en voedingsketen nog onvoldoende gegevens beschikbaar waren, is het beeld ontstaan van een transitie met vele gerelateerde problemen, waarvoor steeds meer langetermijndoelen worden gesteld voor landbouw en milieu, veel minder voor de consumenten en hun voeding of de afwenteling op het buitenland. Deze probleemperceptie en doelen hebben tal van activiteiten in onderzoek (Nederland heeft relatief veel R&D op dit terrein) en praktijkexperimenten op gang gebracht. Diverse niches zijn (technisch en institutioneel) ingericht. Doorwerking in de daadwerkelijke systeemverandering hapert echter, mede doordat het toekomstbeeld op het punt van middelen (technieken en structuren) te weinig houvast biedt. Dat wordt veroorzaakt door de vele (gepercipieerde) nadelen, die naast de voordelen aan de nieuwe opties voor de lange termijn kleven. Bovendien laten krachtenveld- en actoranalyses zien, dat er nog grote weerstanden moeten worden overwonnen. Die hebben te maken met kosten van afbraak van het oude systeem en schaalvergroting van nieuwe processen, en zijn sterk afhankelijk van institutionele randvoorwaarden (onder andere internationaal).Abstract not availableRIV