Economic aspects of pharmacotherapy for chronic constipation

Constipation is one of the most common digestive complaints. It is a symptom, not a disease. The subjectivity that this involves means that assessments of clinical epidemiology, socioeconomic costs and pharmacotherapy are difficult, since there is no definition of 'normal' bowel habit. Although constipation can affect all ages, the problem increases with age, and is of particular concern for those who are frail and in long term care. Cultural influences may affect the prevalence in older people. Drug therapy of constipation cannot be considered in isolation, since there are issues in the prevention of constipation and the principles of good management that also apply. Furthermore, some consideration of the pathophysiology and diagnosis is important. This is because a number of remediable causes can be identified, and the diagnostic process involves patient education, which in turn may be effective in reducing costs. It is the complaint of constipation which leads either to self-medication or to consultation with the medical profession. Both of these courses of action have a significant influence on utilisation of laxatives (cathartics), obtained both over-the-counter and by prescription. Although there are a large number of laxative preparations available, therapy has changed little in half a century. Costs may vary considerably, and with such a significant problem there is a need for comparative studies. However, study methodologies are difficult, and a significant placebo response may be found. Education and preventive measures have been shown to reduce laxative use and costs in institutions. Unfortunately, there are few comparative studies of individual laxatives and even fewer cost-effectiveness studies. Those that there are have been based in institutions, and so extrapolation to other situations may be difficult. In general, little attention is given to constipation. It is, however, an area with significant resource implications in which education and preventive measures have been shown to be beneficial. Even so, there is still a need for good comparative studies, particularly where cost effectiveness is concerned.

Predicting the impacts of climate change on the distribution of threatened forest-restricted birds in Madagascar

The greatest common threat to birds in Madagascar has historically been from anthropogenic deforestation. During recent decades, global climate change is now also regarded as a significant threat to biodiversity. This study uses Maximum Entropy species distribution modeling to explore how potential climate change could affect the distribution of 17 threatened forest endemic bird species, using a range of climate variables from the Hadley Center's HadCM3 climate change model, for IPCC scenario B2a, for 2050. We explore the importance of forest cover as a modeling variable and we test the use of pseudo-presences drawn from extent of occurrence distributions. Inclusion of the forest cover variable improves the models and models derived from real-presence data with forest layer are better predictors than those from pseudo-presence data. Using real-presence data, we analyzed the impacts of climate change on the distribution of nine species. We could not predict the impact of climate change on eight species because of low numbers of occurrences. All nine species were predicted to experience reductions in their total range areas, and their maximum modeled probabilities of occurrence. In general, species range and altitudinal contractions follow the reductive trend of the Maximum presence probability. Only two species (Tyto soumagnei and Newtonia fanovanae) are expected to expand their altitude range. These results indicate that future availability of suitable habitat at different elevations is likely to be critical for species persistence through climate change. Five species (Eutriorchis astur, Neodrepanis hypoxantha, Mesitornis unicolor, Euryceros prevostii, and Oriola bernieri) are probably the most vulnerable to climate change. Four of them (E. astur, M. unicolor, E. prevostii, and O. bernieri) were found vulnerable to the forest fragmentation during previous research. Combination of these two threats in the future could negatively affect these species in a drastic way. Climate change is expected to act differently on each species and it is important to incorporate complex ecological variables into species distribution models.

Understanding the socio-economic distribution of multiple deprivation: An application of self-organising maps

In this paper we seek to contribute to recent efforts to develop and implement multi-dimensional approaches to social exclusion by applying self-organising maps (SOMs) to a set of material deprivation indicators from the Irish component of EU-SILC. The first stage of our analysis involves the identification of sixteen clusters that confirm the multi-dimensional nature of deprivation in contemporary Ireland and the limitations of focusing solely on income. In going beyond this mapping stage, we consider both patterns of socio-economic differentiation in relation to cluster membership and the extent to which such membership contributes to our understanding of economic stress. Our analysis makes clear the continuing importance of traditional forms of stratification relating to factors such as income, social class and housing tenure in accounting for patterns of multiple deprivation. However, it also confirms the role of acute life events and life cycle and location influences. Most importantly, it demonstrates that conclusions relating to the relative impact of different kinds of socio-economic influences are highly dependent on the form of deprivation being considered. Our analysis suggests that debates relating to the extent to which poverty and social exclusion have become individualized should take particular care to distinguish between different kinds of outcomes. Further analysis demonstrates that the SOM approach is considerably more successful than a comparable latent class analysis in identifying those exposed to subjective economic stress. (C) 2010 International Sociological Association Research Committee 28 on Social Stratification and Mobility. Published by Elsevier Ltd. All rights reserved.

Impacts of Electric Vehicle charging under electricity market operations

The Irish government set a target in 2008 that 10% of all vehicles in the transport fleet be powered by electricity by 2020. Similar electric vehicle targets have been introduced in other countries. In this study the effects of 213,561 electric vehicles on the operation of the single wholesale electricity market for the Republic of Ireland and Northern Ireland is investigated. A model of Ireland’s electricity market in 2020 is developed using the power systems market model called PLEXOS for power systems. The amount of CO2 emissions associated with charging the EVs and the impacts with respect to Ireland’s target for renewable energy in transport is also quantified. A single generation portfolio and two different charging scenarios, arising from a peak and off-peak charging profile are considered. Results from the study confirm that offpeak charging is more beneficial than peak charging and that charging EVs will contribute 1.45% energy supply to the 10% renewable energy in transport target. The net CO2 reductions are 147 and 210 kt CO2 respectively.

Landfill cap models under simulated climate change precipitation::Impacts of cracks and root growth

Desiccation crack formation is a key process that needs to be understood in assessment of landfill cap performance under anticipated future climate change scenarios. The objectives of this study were to examine: (a) desiccation cracks and impacts that roots may have on their formation and resealing, and (b) their impacts on hydraulic conductivity under anticipated climate change precipitation scenarios. Visual observations, image analysis of thin sections and hydraulic conductivity tests were carried out on cores collected from two large-scale laboratory trial landfill cap models (∼80 × 80 × 90 cm) during a year of four simulated seasonal precipitation events. Extensive root growth in the topsoil increased percolation of water into the subsurface, and after droughts, roots grew deep into low-permeability layers through major cracks which impeded their resealing. At the end of 1 year, larger cracks had lost resealing ability and one single, large, vertical crack made the climate change precipitation model cap inefficient. Even though the normal precipitation model had developed desiccation cracks, its integrity was preserved better than the climate change precipitation model.

Numerical assessment of potential impacts of hydraulically fractured Bowland Shale on overlying aquifers

Natural gas extracted from hydraulically fractured shale formations potentially has a big impact on the global energy landscape. However, there are concerns of potential environmental impacts of hydraulic fracturing of the shale formations, particularly those related to water quality. To evaluate the potential impact of hydraulically fractured shale on overlying aquifers, we conduct realizations of numerical modeling simulations to assess fluid flow and chloride transport from a synthetic Bowland Shale over a period of 11,000 years. The synthetic fractured shale was represented by a three-dimensional discrete fracture model that was developed by using the data from a Bowland Shale gas exploration in Lancashire, UK. Chloride mass exchange between fractures and the rock matrix was fully accounted for in the model. The assessment was carried out to investigate fluid and chloride mass fluxes before, during, and after hydraulic fracturing of the Bowland Shale. Impacts of the upward fracture height and aperture, as well as hydraulic conductivity of the multilayered bedrock system, are also included this assessment. This modeling revealed that the hydraulically fractured Bowland Shale is unlikely to pose a risk to its overlying groundwater quality when the induced fracture aperture is ≤200 µm. With the fracture aperture ≥1000 µm, the upward chloride flux becomes very sensitive to the upward fracture height growth and hydraulic conductivity of the multilayered bedrock system. In the extremely unlikely event of the upward fracture growth directly connecting the shale formation to the overlying Sherwood Sandstone aquifer with the fracture aperture ≥1000 µm, the upward chloride mass flux could potentially pose risks to the overlying aquifer in 100 years. The model study also revealed that the upward mass flux is significantly intercepted by the horizontal mass flux within a high permeable layer between the Bowland Shale and its overlying aquifers, reducing further upward flux toward the overlying aquifers.

Geophysical and hydrogeological characterisation of the impacts of on-site wastewater treatment discharge to groundwater in a poorly productive bedrock acquifer

Contaminants discharging from on-site wastewater treatment systems (OSWTSs) can impact groundwater quality, threatening human health and surface water ecosystems. Risk of negative impacts becomes elevated in areas of extreme vulnerability with high water tables, where thin unsaturated intervals limit vadose zone attenuation. A combined geophysical/hydrogeological investigation into the effects of an OSWTS, located over a poorly productive aquifer (PPA) with thin subsoil cover, aimed to characterise effluent impacts on groundwater. Groundwater, sampled from piezometers down-gradient of the OSWTS percolation area displayed spatially erratic, yet temporally consistent, contaminant distributions. Electrical resistivity tomography identified an area of gross groundwater contamination close to the percolation area and, when combined with seismic refraction and water quality data, indicated that infiltrating effluent reaching the water table discharged to a deeper more permeable zone of weathered shale resting on more competent bedrock. Subsurface structure, defined by geophysics, indicated that elevated chemical and microbiological contaminant levels encountered in groundwater samples collected from piezometers, down-gradient of sampling points with lower contaminant levels, corresponded to those locations where piezometers were screened close to the weathered shale/competent rock interface; those immediately up-gradient were too shallow to intercept this interval, and thus the more impacted zone of the contaminant plume. Intermittent occurrence of faecal indicator bacteria more than 100 m down gradient of the percolation area suggested relatively short travel times. Study findings highlight the utility of geophysics as part of multidisciplinary investigations for OSWTS contaminant plume characterisation, while also demonstrating the capacity of effluent discharging to PPAs to impact groundwater quality at distance. Comparable geophysical responses observed in similar settings across Ireland suggest the phenomena observed in this study are more widespread than previously suspected.

Predicting the ecological impacts of a new freshwater invader:Functional responses and prey selectivity of the 'killer shrimp', Dikerogammarus villosus, compared to the native Gammarus pulex

The ability to predict the likely ecological impacts of invasive species in fresh waters is a pressing research requirement. Whilst comparisons of species traits and considerations of invasion history have some efficacy in this respect, we require robust methods that can compare the effects of native and invasive species. Here, we utilise comparative functional responses and prey selectivity experiments to understand and predict the ecological impact of an invader as compared to a native. We compared the predatory functional responses of an emerging invasive species in Europe, the 'killer shrimp', Dikerogammarus villosus, and an analogous native species, Gammarus pulex, towards three representative prey species: Asellus aquaticus, Daphnia magna and Chironomus sp. Furthermore, as ecological impact may be greater for invasive species with more indiscriminate feeding habits, we compared the selectivity for the three prey types between the invasive and native species. In both the presence and absence of experimental habitats, large D. villosus, and those matched for body size with G. pulex, generally showed higher (Type II) functional responses than G. pulex, with the invasive species exhibiting higher maximum feeding rates. Further, D. villosus exhibited significantly more indiscriminate prey selection compared with G. pulex, a trait that became more evident as the invader increased in size. Differences in functional responses and prey selectivity were prey species specific, with higher to lower predicted impacts in the order A. aquaticus, D. magna and Chironomus sp. This is in accord with the impact of this invasive species on macroinvertebrates in the field. We thus provide understanding of the known ecological impact of D. villosus and discuss the utility of the phenomenological use of comparative functional responses and resource use as a tool through which the potential ecological impacts of invasive species may be identified. © 2013 John Wiley & Sons Ltd.