Levels of cadmium and zinc in soil and plants following the toxic spill from a pyrite mine, Aznalcollar, Spain

On 25 April 1998, a breach of the tailings dam of the Los Frailes pyrite mine in southwestern Spain resulted in the release of 6 million m(3) of acidic water and toxic sludge high in heavy metals. Contaminated material extended 40 km downstream, affecting agricultural land and parts of the wildlife-rich Donana Natural and National Parks, including the Entremuros, a very important area for birds. We report on the concentrations, distributions and bioavailability of zinc and cadmium in soil and vegetation from the Entremuros in November 1998 and October 1999, following 2 'cleanup' operations. Levels of Zn and Cd in soil increased significantly over this period, although this was not reflected consistently in metal concentrations in emergent macrophytes. We recommend monitoring of further cleanup attempts in order to develop means of minimizing potential impacts to wildlife in the area.

Arsenic behaviour from groundwater and soil to crops:impacts on agriculture and food safety

High levels of As in groundwater commonly found in Bangladesh and other parts of Asia not only pose a risk via drinking water consumption but also a risk in agricultural sustainability and food safety. This review attempts to provide an overview of current knowledge and gaps related to the assessment and management of these risks, including the behaviour of As in the soil-plant system, uptake, phytotoxicity, As speciation in foods, dietary habits, and human health risks. Special emphasis has been given to the situation in Bangladesh, where groundwater via shallow tube wells is the most important source of irrigation water in the dry season. Within the soil-plant system, there is a distinct difference in behaviour of As under flooded conditions, where arsenite (AsIII) predominates, and under nonflooded conditions, where arsenate (AsV) predominates. The former is regarded as most toxic to humans and plants. Limited data indicate that As-contaminated irrigation water can result in a slow buildup of As in the topsoil. In some cases the buildup is reflected by the As levels in crops, in others not. It is not yet possible to predict As uptake and toxicity in plants based on soil parameters. It is unknown under what conditions and in what time frame As is building up in the soil. Representative phytotoxicity data necessary to evaluate current and future soil concentrations are not yet available. Although there are no indications that crop production is currently inhibited by As, long-term risks are clearly present. Therefore, with concurrent assessments of the risks, management options to further prevent As accumulation in the topsoil should already have been explored. With regard to human health, data on As speciation in foods in combination with food consumption data are needed to assess dietary exposure, and these data should include spatial and seasonal variability. It is important to control confounding factors in assessing the risks. In a country where malnutrition is prevalent, levels of inorganic As in foods should be balanced against the nutritional value of the foods. Regarding agriculture, As is only one of the many factors that may pose a risk to the sustainability of crop production. Other risk factors such as nutrient depletion and loss of organic matter also must be taken into account to set priorities in terms of research, management, and overall strategy.

Can we meet targets for biofuels and renewable energy in transport given the constraints imposed by policy in agriculture and energy?

The deployment of biofuels is significantly affected by policy in energy and agriculture. In the energy arena, concerns regarding the sustainability of biofuel systems and their impact on food prices led to a set of sustainability criteria in EU Directive 2009/28/EC on Renewable Energy. In addition, the 10% biofuels target by 2020 was replaced with a 10% renewable energy in transport target. This allows the share of renewable electricity used by electric vehicles to contribute to the mix in achieving the 2020 target. Furthermore, only biofuel systems that effect a 60% reduction in greenhouse gas emissions by 2020 compared with the fuel they replace are allowed to contribute to meeting the target. In the agricultural arena, cross-compliance (which is part of EU Common Agricultural Policy) dictates the allowable ratio of grassland to total agricultural land, and has a significant impact on which biofuels may be supported. This paper outlines the impact of these policy areas and their implications for the production and use of biofuels in terms of the 2020 target for 10% renewable transport energy, focusing on Ireland. The policies effectively impose constraints on many conventional energy crop biofuels and reinforce the merits of using biomethane, a gaseous biofuel. The analysis shows that Ireland can potentially satisfy 15% of renewable energy in transport by 2020 (allowing for double credit for biofuels from residues and ligno-cellulosic materials, as per Directive 2009/28/EC) through the use of indigenous biofuels: grass biomethane, waste and residue derived biofuels, electric vehicles and rapeseed biodiesel. © 2010 Elsevier Ltd. All rights reserved.

Rural Support Networks in the UK and Canada: The Influence of the Patrilineal Culture of Family Farming

Rural support organisations have emerged since agricultural restructuring of the 1980s. The paper draws on research from the UK and Canada to suggest that the support in both countries is derived from a patrilineal culture that still dominates family farming. The paper begins by outlining a conceptual basis for arguing that such a culture can be understood as comprising of male and female relational gender identities capable of explaining farm relationships, farm survival and adjustment strategies and community engagement. These components, it is argued, are facets of the patrilineal farming culture which must be understood if its impacts on all its members are to be appropriately comprehended and supported.

The paper has two key aims, therefore. Firstly it suggests that a more nuanced understanding of farming „culture? which is persistently patrilineal in nature is now required which is capable of addressing the realities of farming individuals?
lives as they perceive them. The conceptualisation of such a culture is informed
by drawing on insights from gender theory, agricultural geography and rural studies. This conceptual discussion provides the context for the paper?s second aim which is to demonstrate how rural support in both the UK and Canada is derived „from? and is influenced by such a patrilineal culture . Findings are
presented identifying five key themes from this conceptualization which influence the support of such organisations. Thus, it is suggested, that the nature of rural support can be better understood and the appropriateness of the support interrogated when such conceptualization is taken on board.

Bereavement Adjustment and Support among Caregivers

The objective of this study was to examine the influence of health status, demographics, duration of bereavement, caregiving experience, and the use of formal services on bereavement adjustment for caregivers. Participants were 151 bereaved family caregivers who participated in a telephone survey. The most frequently reported symptoms by caregivers were sleeplessness, followed by depression, and loss of appetite. One hundred thirty-five respondents (89%) felt that things were going reasonably well for themselves at the time of the interview, and 91 respondents (60%) had come to terms with their loved one's death. Hierarchical regression models revealed that being a younger caregiver, reporting poorer mental health status, and being the spouse of the care recipient were predictive of a greater number of reported depressive symptoms in bereavement. Poorer mental health status, being a spousal caregiver, and reporting negative consequences of caregiving on caregiver's health were predictive of poorer recovery in bereavement. Study results also revealed that relatives and friends played an important role in assisting the bereaved to manage the bereavement process. This article identifies factors associated with poor reactions in bereavement and that bereavement as a social process where family and friends play an important role in the recovery process.

Assessing Historical and Current Threats to Common Frog (Rana Temporaria) Populations in Ireland

Ponds are an ephemeral feature of the landscape but their large-scale loss can have profound implications for biodiversity and the persistence of amphibian populations. We quantified rates of pond loss throughout Ireland over a period of approximately 125 yr. Environmental parameters and perceived risk factors associated with the current occurrence and density of the Common Frog, Rana temporaria, were also analyzed. The numbers of farmland ponds declined by 54% between 1887–1913 and 2005–11, with most ponds and the greatest losses
in the East, coincident with agricultural intensification and human habitation. The decline of pond numbers was significant but, at approximately 0.5% per annum, was substantially less than losses recorded in other European countries. Losses were coincident with major changes to the agricultural landscape including extensive land drainage. However, losses of pond and natural wetland habitats throughout Ireland may have been partially or wholly mitigated by a synchronous expansion of artificial field margin ditches associated with drainage projects during the mid-20th Century. The ecology of the Common Frog in Ireland was similar to its ecology elsewhere and it appears largely unaffected by pollution and disturbance. Consequently, the conservation status of the frog in Ireland was judged ‘‘favorable’’ and should remain so for the foreseeable future.

How Outcomes Are Defined in Clinical Trials of Mechanically Ventilated Adults and Children

Systematic reviews have considerable potential to provide evidence-based data to aid clinical decision-making. However, there is growing recognition that trials involving mechanical ventilation lack consistency in the definition and measurement of ventilation outcomes, creating difficulties in combining data for meta-analyses. To address the inconsistency in outcome definitions, international standards for trial registration and clinical trial protocols published recommendations, effectively setting the “gold standard” for reporting trial outcomes. In this Critical Care Perspective, we review the problems resulting from inconsistent outcome definitions and inconsistent reporting of outcomes (outcome sets). We present data highlighting the variability of the most commonly reported ventilation outcome definitions. Ventilation outcomes reported in trials over the last 6 years typically fall into four domains: measures of ventilator dependence; adverse outcomes; mortality; and resource use. We highlight the need, first, for agreement on outcome definitions and, second, for a minimum core outcome set for trials involving mechanical ventilation. A minimum core outcome set would not restrict trialists from measuring additional outcomes, but would overcome problems of variability in outcome selection, measurement, and reporting, thereby enhancing comparisons across trials.

Performance management systems and Public Value Strategy: a case study

Purpose
This article aims to analyze the role of performance management systems (PMS) in supporting public value strategies.

Design/methodology/approach
This article draws on the public value dynamic model by Horner and Hutton (2010). It presents the results of a case study of implementation of a PMS model, the ‘Value Pyramid’ (VP).

Findings
The results stress the need for an improved conceptualization of PMS within public value strategy. Through experimentation using the VP, the case site was able to measure and visualize what it considered public value and reflect on the internal/external causes of both creation and destruction of public value.

Research limitations/implication
This article is limited to just one case study, although in-depth and longitudinal.

Originality/value
This article is one of the first attempting to understand the role of PMS within the public value strategy framework, answering the call of Benington and Moore (2010) to consider public value from an accounting perspective.

Doing Focus Groups and Interviews with Recent Migrants to Northern Ireland: A Dynamic Interplay of Ethics, Language and Access

This case describes a qualitative social science research project that was conducted in 2009 and that examined the experiences of recent migrants to Northern Ireland. While background to the research and key findings are presented, the topic forms a backdrop to the case. The following aspects of the study are presented: the theoretical context; formulating the research question, design and methodology; key methodological issues; data collection and analysis; project dissemination; and research funding and reporting. The case pays particular attention to the needs and impact of different groups including the researcher, the funding body, the researcher’s employer and the researched. The significance of access, language and ethics to this study are examined. Finally, the way in which the research unfolded in an often-unpredictable way throughout the implementation process is highlighted in the narrative.

Accuracy of LightCycler SeptiFast for the detection and identification of pathogens in the blood of patients with suspected sepsis: a systematic review and meta-analysis

Purpose: There is an urgent need to develop diagnostic tests to improve the detection of pathogens causing life-threatening infection (sepsis). SeptiFast is a CE-marked multi-pathogen real-time PCR system capable of detecting DNA sequences of bacteria and fungi present in blood samples within a few hours. We report here a systematic review and meta-analysis of diagnostic accuracy studies of SeptiFast in the setting of suspected sepsis.

Methods: A comprehensive search strategy was developed to identify studies that compared SeptiFast with blood culture in suspected sepsis. Methodological quality was assessed using QUADAS. Heterogeneity of studies was investigated using a coupled forest plot of sensitivity and specificity and a scatter plot in receiver operator characteristic space. Bivariate model method was used to estimate summary sensitivity and specificity.

Results: From 41 phase III diagnostic accuracy studies, summary sensitivity and specificity for SeptiFast compared with blood culture were 0.68 (95 % CI 0.63–0.73) and 0.86 (95 % CI 0.84–0.89) respectively. Study quality was judged to be variable with important deficiencies overall in design and reporting that could impact on derived diagnostic accuracy metrics.

Conclusions: SeptiFast appears to have higher specificity than sensitivity, but deficiencies in study quality are likely to render this body of work unreliable. Based on the evidence presented here, it remains difficult to make firm recommendations about the likely clinical utility of SeptiFast in the setting of suspected sepsis.

Later prehistoric vegetation dynamics and Bronze Age agriculture at Hobbister, Orkney, Scotland

The Bronze Age in Britain was a time of major social and cultural changes, reflected in the division of the landscape into field systems and the establishment of new belief systems and ritual practices. Several hypotheses have been advanced to explain these changes, and assessment of many of them is dependent on the availability of detailed palaeoenvironmental data from the sites concerned. This paper explores the development of a later prehistoric landscape in Orkney, where a Bronze Age field system and an apparently ritually-deposited late Bronze Age axe head are located in an area of deep blanket peat from which high-resolution palaeoenvironmental sequences have been recovered. There is no indication that the field system was constructed to facilitate agricultural intensification, and it more likely reflects a cultural response to social fragmentation associated with a more dispersed settlement pattern. There is evidence for wetter conditions during the later Bronze Age, and the apparent votive deposit may reflect the efforts of the local population to maintain community integrity during a time of perceptible environmental change leading to loss of farmland. The study emphasises the advantages of close integration of palaeoenvironmental and archaeological data for interpretation of prehistoric human activity. The palaeoenvironmental data also provide further evidence for the complexity of prehistoric woodland communities in Orkney, hinting at greater diversity than is often assumed. Additionally, differing dates for woodland decline in the two sequences highlight the dangers of over-extrapolation from trends observed in a single pollen profile, even at a very local scale.

Rapid detection of health-care-associated bloodstream infection in critical care using multipathogen real-time polymerase chain reaction technology: a diagnostic accuracy study and systematic review

Background: There is growing interest in the potential utility of real-time polymerase chain reaction (PCR) in diagnosing bloodstream infection by detecting pathogen deoxyribonucleic acid (DNA) in blood samples within a few hours. SeptiFast (Roche Diagnostics GmBH, Mannheim, Germany) is a multipathogen probe-based system targeting ribosomal DNA sequences of bacteria and fungi. It detects and identifies the commonest pathogens causing bloodstream infection. As background to this study, we report a systematic review of Phase III diagnostic accuracy studies of SeptiFast, which reveals uncertainty about its likely clinical utility based on widespread evidence of deficiencies in study design and reporting with a high risk of bias. 

Objective: Determine the accuracy of SeptiFast real-time PCR for the detection of health-care-associated bloodstream infection, against standard microbiological culture. 

Design: Prospective multicentre Phase III clinical diagnostic accuracy study using the standards for the reporting of diagnostic accuracy studies criteria. 

Setting: Critical care departments within NHS hospitals in the north-west of England. 

Participants: Adult patients requiring blood culture (BC) when developing new signs of systemic inflammation. 

Main outcome measures: SeptiFast real-time PCR results at species/genus level compared with microbiological culture in association with independent adjudication of infection. Metrics of diagnostic accuracy were derived including sensitivity, specificity, likelihood ratios and predictive values, with their 95% confidence intervals (CIs). Latent class analysis was used to explore the diagnostic performance of culture as a reference standard. 

Results: Of 1006 new patient episodes of systemic inflammation in 853 patients, 922 (92%) met the inclusion criteria and provided sufficient information for analysis. Index test assay failure occurred on 69 (7%) occasions. Adult patients had been exposed to a median of 8 days (interquartile range 4–16 days) of hospital care, had high levels of organ support activities and recent antibiotic exposure. SeptiFast real-time PCR, when compared with culture-proven bloodstream infection at species/genus level, had better specificity (85.8%, 95% CI 83.3% to 88.1%) than sensitivity (50%, 95% CI 39.1% to 60.8%). When compared with pooled diagnostic metrics derived from our systematic review, our clinical study revealed lower test accuracy of SeptiFast real-time PCR, mainly as a result of low diagnostic sensitivity. There was a low prevalence of BC-proven pathogens in these patients (9.2%, 95% CI 7.4% to 11.2%) such that the post-test probabilities of both a positive (26.3%, 95% CI 19.8% to 33.7%) and a negative SeptiFast test (5.6%, 95% CI 4.1% to 7.4%) indicate the potential limitations of this technology in the diagnosis of bloodstream infection. However, latent class analysis indicates that BC has a low sensitivity, questioning its relevance as a reference test in this setting. Using this analysis approach, the sensitivity of the SeptiFast test was low but also appeared significantly better than BC. Blood samples identified as positive by either culture or SeptiFast real-time PCR were associated with a high probability (> 95%) of infection, indicating higher diagnostic rule-in utility than was apparent using conventional analyses of diagnostic accuracy. 

Conclusion: SeptiFast real-time PCR on blood samples may have rapid rule-in utility for the diagnosis of health-care-associated bloodstream infection but the lack of sensitivity is a significant limiting factor. Innovations aimed at improved diagnostic sensitivity of real-time PCR in this setting are urgently required. Future work recommendations include technology developments to improve the efficiency of pathogen DNA extraction and the capacity to detect a much broader range of pathogens and drug resistance genes and the application of new statistical approaches able to more reliably assess test performance in situation where the reference standard (e.g. blood culture in the setting of high antimicrobial use) is prone to error.

A review of behaviour change theories and techniques used in group based self-management programmes for chronic low back pain and arthritis

Background: Medical Research Council (MRC) guidelines recommend applying theory within complex interventions to explain how behaviour change occurs. Guidelines endorse self-management of chronic low back pain (CLBP) and osteoarthritis (OA), but evidence for its effectiveness is weak. Objective: This literature review aimed to determine the use of behaviour change theory and techniques within randomised controlled trials of group-based self-management programmes for chronic musculoskeletal pain, specifically CLBP and OA. Methods: A two-phase search strategy of electronic databases was used to identify systematic reviews and studies relevant to this area. Articles were coded for their use of behaviour change theory, and the number of behaviour change techniques (BCTs) was identified using a 93-item taxonomy, Taxonomy (v1). Results: 25 articles of 22 studies met the inclusion criteria, of which only three reported having based their intervention on theory, and all used Social Cognitive Theory. A total of 33 BCTs were coded across all articles with the most commonly identified techniques being '. instruction on how to perform the behaviour', '. demonstration of the behaviour', '. behavioural practice', '. credible source', '. graded tasks' and '. body changes'. Conclusion: Results demonstrate that theoretically driven research within group based self-management programmes for chronic musculoskeletal pain is lacking, or is poorly reported. Future research that follows recommended guidelines regarding the use of theory in study design and reporting is warranted.

Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis

BACKGROUND: Seasonal/perennial allergic conjunctivitis is the most common allergic conjunctivitis, usually with acute manifestations when a person is exposed to allergens and with typical signs and symptoms including itching, redness, and tearing. The clinical signs and symptoms of allergic conjunctivitis are mediated by the release of histamine by mast cells. Histamine antagonists (also called antihistamines) inhibit the action of histamine by blocking histamine H1 receptors, antagonising the vasoconstrictor, and to a lesser extent, the vasodilator effects of histamine. Mast cell stabilisers inhibit degranulation and consequently the release of histamine by interrupting the normal chain of intracellular signals. Topical treatments include eye drops with antihistamines, mast cell stabilisers, non-steroidal anti-inflammatory drugs, combinations of the previous treatments, and corticosteroids. Standard treatment is based on topical antihistamines alone or topical mast cell stabilisers alone or a combination of treatments. There is clinical uncertainty about the relative efficacy and safety of topical treatment.

OBJECTIVES: The objective of this review was to assess the effects of topical antihistamines and mast cell stabilisers, alone or in combination, for use in treating seasonal and perennial allergic conjunctivitis.

SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2014, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2014), EMBASE (January 1980 to July 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 July 2014. We also searched the reference lists of review articles and relevant trial reports for details of further relevant publications.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing topical antihistamine and mast cell stabilisers, alone or in combination, with placebo, no treatment or to any other antihistamine or mast cell stabiliser, or both, that examined people with seasonal or perennial allergic conjunctivitis, or both. The primary outcome was any participant-reported evaluation (by questionnaire) of severity of four main ocular symptoms: itching, irritation, watering eye (tearing), and photophobia (dislike of light), both separately and, if possible, by an overall symptom score. We considered any follow-up time between one week and one year.

DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. Disagreements were resolved by discussion among review authors and the involvement of a third review author. We followed standard methodological approaches used by Cochrane.

MAIN RESULTS: We identified 30 trials with a total of 4344 participants randomised, with 17 different drugs or treatment comparisons. The following antihistamines and mast cell stabilisers were evaluated in at least one RCT: nedocromil sodium or sodium cromoglycate, olopatadine, ketotifen, azelastine, emedastine, levocabastine (or levocabastine), mequitazine, bepotastine besilate, combination of antazoline and tetryzoline, combination of levocabastine and pemirolast potassium. The most common comparison was azelastine versus placebo (nine studies).We observed a large variability in reporting outcomes. The quality of the studies and reporting was variable, but overall the risk of bias was low. Trials evaluated only short-term effects, with a range of treatment of one to eight weeks. Meta-analysis was only possible in one comparison (olopatadine versus ketotifen). There was some evidence to support that topical antihistamines and mast cell stabilisers reduce symptoms and signs of seasonal allergic conjunctivitis when compared with placebo. There were no reported serious adverse events related to the use of topical antihistamine and mast cell stabilisers treatment.

AUTHORS' CONCLUSIONS: It seems that all reported topical antihistamines and mast cell stabilisers reduce symptoms and signs of seasonal allergic conjunctivitis when compared with placebo in the short term. However, there is no long-term data on their efficacy. Direct comparisons of different antihistamines and mast cell stabilisers need to be interpreted with caution. Overall, topical antihistamines and mast cell stabilisers appear to be safe and well tolerated. We observed a large variability in outcomes reported. Poor quality of reporting challenged the synthesis of evidence.

Public Value as Performance: Politicians’ and Managers’ Perspectives on the Importance of Budgetary, Accruals and Non-Financial Information

Purpose
The study contributes to the literature on public value and performance examining politicians’ and managers’ perspectives by investigating the importance they attach to the different facets of performance information (i.e. budgetary, accrual based- and non-financial information (NFI)).

Design/methodology/approach
We survey politicians and managers in all Italian municipalities of at least 80,000 inhabitants.

Findings
Overall, NFI is more appreciated than financial information (FI). Moreover, budgetary accounting is preferred to accrual accounting. Politicians’ and managers’ preferences are generally aligned.

Research limitations/implications
NFI as a measure of public value is not alternative, but rather complementary, to FI. The latter remains a fundamental element of public sector accounting due to its role in resource allocation and control.

Practical implications
The preference for NFI over FI and of budgetary over accruals accounting suggests that the current predominant emphasis on (accrual-based) financial reporting might be misplaced.

Originality/value
Public value and performance are multi-faceted concepts. They can be captured by different types of information and evaluated according to different criteria, which will also depend on the category of stakeholders or users who assesses public performance. So far, most literature has considered the financial and non-financial facets of performance as virtually separate. Similarly, in the practice, financial management tends to be decoupled from non-financial performance management. However, this research shows that only by considering their joint interactions we can achieve an accurate representation of what public value really is.