Controls on the contemporary distribution of lake thecamoebians (testate amoebae) in the Greater Toronto Area and their potential as water quality indicators.

Thecamoebians were examined from 71 surface sediment samples collected from 21 lakes and ponds in the Greater Toronto Area to (1) elucidate the controls on faunal distribution in modern lake environments; and (2) to consider the utility of thecamoebians in quantitative studies of water quality change. This area was chosen because it includes a high density of kettle and other lakes which are threatened by urban development and where water quality has deteriorated locally as a result of contaminant inputs, particularly nutrients. Fifty-eight samples yielded statistically significant thecamoebian populations. The most diverse faunas (highest Shannon Diversity Index values) were recorded in lakes beyond the limits of urban development, although the faunas of all lakes showed signs of sub-optimal conditions. The assemblages were divided into five clusters using Q-mode cluster analysis, supported by Detrended Correspondence Analysis. Canonical Correspondence Analysis (CCA) was used to examine species-environment relationships and to explain the observed clusterings. Twenty-four measured environmental variables were considered, including water property attributes (e.g., pH, conductivity, dissolved oxygen), substrate characteristics, sediment-based phosphorus (Olsen P) and 11 environmentally available metals. The thecamoebian assemblages showed a strong association with phosphorus, reflecting the eutrophic status of many of the lakes, and locally to elevated conductivity measurements, which appear to reflect road salt inputs associated with winter de-icing operations. Substrate characteristics, total organic carbon and metal contaminants (particularly Cu and Mg) also influenced the faunas of some samples. A series of partial CCAs show that of the measured variables, sedimentary phosphorus has the largest influence on assemblage distribution, explaining 6.98% (P < 0.002) of the total variance. A transfer function was developed for sedimentary phosphorus (Olsen P) using 58 samples from 15 of the studied lakes. The best performing model was based on weighted averaging with inverse deshrinking (WA Inv, r jack 2= 0.33, RMSEP = 102.65 ppm). This model was applied to a small modern thecamoebian dataset from a eutrophic lake in northern Ontario to predict phosphorus and performed satisfactorily. This preliminary study confirms that thecamoebians have considerable potential as quantitative water quality indicators in urbanising regions, particularly in areas influenced by nutrient inputs and road salts.

Testate amoebae (thecamoebians) as water quality indicators in lakes: development of a modern distributional dataset from the Greater Toronto Area

Thecamoebians were examined from 123 surface sediment samples collected from 45 lakes in the Greater Toronto Area (GTA) and the surrounding region to i) elucidate the controls on faunal distribution in modern lake environments; and ii) to consider the utility of thecamoebians in quantitative studies of water quality change. This area was chosen because it includes a high density of lakes that are threatened by urban development and where water quality has deteriorated locally as a result of contaminant inputs, particularly nutrients. Canonical Correspondence analysis (CCA) and a series of partial CCAs were used to examine species-environment relationships. Twenty-four environmental variables were considered, including water properties (e.g. pH, DO, conductivity), substrate characteristics, nutrient loading, and environmentally available metals. The thecamoebian assemblages showed a strong association with Olsen's Phosphorus, reflecting the eutrophic status of many of the lakes, and locally to elevated conductivity measurements, which appear to reflect road salt inputs associated with winter de-icing operations. A transfer function was developed for Olsen P using this training set based on weighted averaging with inverse deshrinking (WA Inv). The model was applied to infer past changes in Phosphorus enrichment in core samples from several lakes, including eutrophic Haynes Lake within the GTA. Thecamoebian-inferred changes in sedimentary Phosphorus from a 210Pb dated core from Haynes Lake are related to i) widespread introduction of chemical fertilizers to agricultural land in the post WWII era; ii) a steep decline in Phosphorous with a change in agricultural practices in the late 1970s; and iii) the construction of a golf course in close proximity to the lake in the early 1990s. This preliminary study confirms that thecamoebians have considerable potential as indicators of eutrophication in lakes and can provide an estimate of baseline conditions.

UK consensus project on quality in palliative day services: developing a quality indicator set using the RAND/UCLA appropriateness method

Introduction
Evaluating quality of palliative day services is essential for assessing care across diverse settings, and for monitoring quality improvement approaches.

Aim
To develop a set of quality indicators for assessment of all aspects (structure, process and outcome) of care in palliative day services.

Methods
Using a modified version of the RAND/UCLA appropriateness method (Fitch et al., 2001), a multidisciplinary panel of 16 experts independently completed a survey rating the appropriateness of 182 potential quality indicators previously identified during a systematic evidence review. Panel members then attended a one day, face-to-face meeting where indicators were discussed and subsequently re-rated. Panel members were also asked to rate the feasibility and necessity of measuring each indicator.

Results
71 indicators classified as inappropriate during the survey were removed based on median appropriateness ratings and level of agreement. Following the panel discussions, a further 60 were removed based on appropriateness and feasibility ratings, level of agreement and assessment of necessity. Themes identified during the panel discussion and findings of the evidence review were used to translate the remaining 51 indicators into a final set of 27.

Conclusion
The final indicator set included information on rationale and supporting evidence, methods of assessment, risk adjustment, and recommended performance levels. Further implementation work will test the suitability of this ‘toolkit’ for measurement and benchmarking. The final indicator set provides the basis for standardised assessment of quality across services, including care delivered in community and primary care settings.

Reference

• Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA: RAND Corporation; 2001. http://www.rand.org/pubs/monograph_reports/MR1269

'Developing practice learning: student perspectives',

The introduction of the new social work degrees in the UK has further underlined the importance of practice learning in social work education. However, student perceptions of practice learning and their view of quality standards in this area have been under-researched. This paper reports on a two-year study of MSW students at Queen's University, Belfast that examined, from the students' perspective, a number of key quality indicators relating to practice learning. One of the main aims of the study was to identify significant contextual features of the practice environment that affect the quality of the students' learning experience. Northern Ireland provides a useful case study in this context as it is thought to have some advantages in its practice learning provision in comparison to other parts of the UK. The paper concludes with an analysis of the main implications of the research and highlights key issues which need to be considered by academic institutions and employing agencies in further developing quality standards of practice learning.

Identifying additional patients with diabetic nephropathy using the UK primary care initiative

AIMS:
The aim of this study was to use general practice data to estimate the prevalence of diabetic nephropathy within the registered diabetes patients and examine variation in practice prevalence and management performance since introduction of this initiative.
METHODS:
Reported quality indicators from the Northern Ireland General Practice Quality and Outcomes Framework were analysed for diabetes and diabetic nephropathy prevalence and management in the period 2004-2008. Variation in prevalence at practice level was assessed using multiple linear regression adjusting for age, practice size, deprivation and glycaemic control.
RESULTS:
In 2006-2007, 57,454 (4.1%) adult diabetic patients were registered in the denominator population of 1.4 million compared with 51,923 (3.8%) in 2004-2005 (mean practice range 0.5-7.7%). Diabetic nephropathy prevalence was 15.1 and 11.5%, respectively (8688 and 5955 patients). Documented diabetic nephropathy prevalence showed marked variation across practices (range 0-100%) and was significantly negatively correlated with diabetes list size, albumin creatinine ratio testing rates and renin-angiotensin-aldosterone system blockade use and positively correlated with exception reporting rates. Specifically, for every increase in 100 diabetic patients to a register, documented diabetic nephropathy prevalence reduced by 40% (P=0.003). On the positive side, median albumin-creatinine ratio testing rates doubled to 82% compared with figures in the pre-Framework era.
CONCLUSIONS:
Implementation of the Northern Ireland General Practice Quality and Outcomes Framework has positively benefitted testing for diabetic nephropathy and increased numbers of detected patients in a short space of time. Large variation in diabetic nephropathy prevalence remains and is associated with diabetes registry size, screening and treatment practices, suggesting that understanding this variation may help detect and better manage diabetic nephropathy.

Visual functioning and quality of life in the subfoveal radiotherapy study (SFRADS): SFRADS report 2

Aims: To determine whether or not self reported visual functioning and quality of life in patients with choroidal neovascularisation caused by age related macular degeneration (AMD) is better in those treated with 12 Gy external beam radiotherapy in comparison with untreated subjects. Methods: A multicentre single masked randomised controlled trial of 12 Gy of external beam radiation therapy (EBRT) delivered as 6x2 Gy fractions to the macula of an affected eye versus observation. Patients with AMD, aged 60 years or over, in three UK hospital units, who had subfoveal CNV and a visual acuity equal to or better than 6/60 (logMAR 1.0). Methods: Data from 199 eligible participants who were randomly assigned to 12 Gy teletherapy or observation were available for analysis. Visual function assessment, ophthalmic examination, and fundus fluorescein angiography were undertaken at baseline and at 3, 6, 12, and 24 months after study entry. To assess patient centred outcomes, subjects were asked to complete the Daily Living Tasks Dependent on Vision (DLTV) and the SF-36 questionnaires at baseline, 6, 12, and 24 months after enrolment to the study. Cross sectional and longitudinal analyses were conducted using arm of study as grouping variable. Regression analysis was employed to adjust for the effect of baseline co-variates on outcome at 12 months and 24 months. Results: Both control and treated subjects had significant losses in visual functioning as seen by a progressive decline in mean scores in the four dimensions of the DLTV. There were no statistically significant differences between treatment and control subjects in any of dimensions of the DLTV at 12 months or 24 months after study entry. Regression analysis confirmed that treatment status had no effect on the change in DLTV dimensional scores. Conclusions: The small benefits noted in clinical measures of vision in treated eyes did not translate into better self reported visual functioning in patients who received treatment when compared with the control arm. These findings have implications for the design of future clinical trials and studies.

Water quality impacts and palaeohydrogeology in the East Yorkshire Chalk Aquifer, UK

A large hydrochemical data-set for the East Yorkshire Chalk has been assessed. Controls on the distribution of water qualities within this aquifer reflect: water-rock interactions (affecting especially the carbonate system and associated geochemistry); effects of land-use change (especially where the aquifer is unconfined); saline intrusion and aquifer refreshening (including ion exchange effects); and aquifer overexploitation (in the semi-confined and confined zones of the aquifer). Both Sr and I prove useful indicators of groundwater ages, with I/Cl ratios characterising two sources of saline waters. The hydrochemical evidence clearly reveals the importance of both recent management decisions and palaeohydrogeology in determining the evolution and distribution of groundwater salinity within the artesian and confined zones of the aquifer. Waters currently encountered in the aquifer are identified as complex (and potentially dynamic) mixtures between modern recharge waters, modern seawater, and old seawaters which entered the aquifer many millennia ago.

Evaluation of the Q-method as a method of public participation in the selection of sustainable development indicators

The complexity of sustainable development means that it is often difficult to evaluate and communicate the concept effectively. One standard method to reduce complexity and improve Communication, while maintaining scientific objectivity, is to use selected indicators. The aim of this paper is to describe and evaluate a process Of public participation in the selection of sustainable development indicators that utilised the Q-method for discourse analysis. The Q-method was Utilised to combine public opinion with technical expertise to create a list of technically robust indicators that would be relevant to the public, The method comprises statement collection, statement analysis, Q-sorts and Q-sort analysis. The results of the Q-method generated a list of statements for which a preliminary list of indicators was then developed by a team of experts from the fields of environmental science, sustainable development and Psychology. Subsequently members of the public evaluated the preliminary list of indicators, to select a final list of indicators that were both technically sound and incorporated the views of the public. The Utilisation of the Q-method in this process was evaluated using previously published criteria. The application of the Q-method in this context needs to be considered not only by the quality of the indicators developed, but also from the perspective of the benefit of the process to the participants. it was concluded that the Q-method provided an effective framework for public participation in the selection of indicators as it allowed the public to discuss Sustainable development in familiar language and in the context of their daily lives. By combining this information with expert input, a list of technically robust indicators that resonate with the public was developed. The results demonstrated that many citizens are not aware Of Sustainable development, and if it is to be successfully communicated to them, then indicators and policy need to be couched in terms familiar and relevant to citizen and communities. (C) 2009 Elsevier Ltd. All rights reserved.

Energy sustainability indicators for urban environments

Sustainable development comprises of three dimensions. The three dimensions are the environment, the social and the economic. There have been many indicators used to measure the three dimensions of sustainability. For example air pollution, consumption of natural resources, quality of open space, noise, equity and opportunities and economic benefits from transport and land use. Urban areas constitute the most crucial factor in the sustainability. Urban systems affect and are affected by natural systems beyond their physical boundaries and in general the interdependence between the urban system and the regional and global environment is not reflected in urban decision making. The use of energy in the urban system constitutes the major element in the construction and function of urban areas. Energy impacts across the boundaries of the three dimensions of sustainability. The objective of this research is to apply energy-use-indicators to the urban system as a measure of sustainability. This methodology is applied to a case study in the United Kingdom.

Arcellacea (Testate Amoebae) as Bio-indicators of Road Salt Contamination in Lakes

Winter deicing operations occur extensively in mid- to high-latitude metropolitan regions around the world and result in a significant reduction in road accidents. Deicing salts can, however, pose a major threat to water quality and aquatic organisms. In this paper we examine the utility of Arcellacea (testate amoebae) for monitoring lakes that have become contaminated by winter deicing salts, particularly sodium chloride. We analysed 50 sediment samples and salt-related water-property variables (chloride concentrations; conductivity) from 15 lakes in the Greater Toronto Area and adjacent areas of southern Ontario, Canada. The sampled lakes included lakes in proximity to major highways and suburban roads, and control lakes in forested settings away from road influences. Samples from the most contaminated lakes, with chloride concentrations in excess of 400 mg/l and conductivities of >800 μS/cm, were dominated by species typically found in brackish and/or inhospitable lake environments and by lower faunal diversities (lowest Shannon Diversity Index values) than samples with lower readings. Q-R-mode cluster analysis and Detrended Correspondence Analysis (DCA) resulted in the recognition of four assemblage groupings. These reflect varying levels of salt contamination in the study lakes, along with other local influences, including nutrient loading. The response to nutrients can, however, be isolated if the planktic eutrophic indicator species Cucurbitella tricuspis is removed from the counts. The findings show that the group have considerable potential for biomonitoring in salt-contaminated lakes, and through application to lake sediment cores, may provide significant insights into long-term benthic community health, which is integral for remedial efforts.