Clinical Studies on Epidural and Spinal Postoperative Analgesia : With Special Reference to Continuous Techniques of Administration and Adjuvant Drugs

Continuous epidural analgesia (CEA) and continuous spinal postoperative analgesia (CSPA) provided by a mixture of local anaesthetic and opioid are widely used for postoperative pain relief. E.g., with the introduction of so-called microcatheters, CSPA found its way particularly in orthopaedic surgery. These techniques, however, may be associated with dose-dependent side-effects as hypotension, weakness in the legs, and nausea and vomiting. At times, they may fail to offer sufficient analgesia, e.g., because of a misplaced catheter. The correct position of an epidural catheter might be confirmed by the supposedly easy and reliable epidural stimulation test (EST). The aims of this thesis were to determine a) whether the efficacy, tolerability, and reliability of CEA might be improved by adding the α2-adrenergic agonists adrenaline and clonidine to CEA, and by the repeated use of EST during CEA; and, b) the feasibility of CSPA given through a microcatheter after vascular surgery. Studies I IV were double-blinded, randomized, and controlled trials; Study V was of a diagnostic, prospective nature. Patients underwent arterial bypass surgery of the legs (I, n=50; IV, n=46), total knee arthroplasty (II, n=70; III, n=72), and abdominal surgery or thoracotomy (V, n=30). Postoperative lumbar CEA consisted of regular mixtures of ropivacaine and fentanyl either without or with adrenaline (2 µg/ml (I) and 4 µg/ml (II)) and clonidine (2 µg/ml (III)). CSPA (IV) was given through a microcatheter (28G) and contained either ropivacaine (max. 2 mg/h) or a mixture of ropivacaine (max. 1 mg/h) and morphine (max. 8 µg/h). Epidural catheter tip position (V) was evaluated both by EST at the moment of catheter placement and several times during CEA, and by epidurography as reference diagnostic test. CEA and CSPA were administered for 24 or 48 h. Study parameters included pain scores assessed with a visual analogue scale, requirements of rescue pain medication, vital signs, and side-effects. Adrenaline (I and II) had no beneficial influence as regards the efficacy or tolerability of CEA. The total amounts of epidurally-infused drugs were even increased in the adrenaline group in Study II (p=0.02, RM ANOVA). Clonidine (III) augmented pain relief with lowered amounts of epidurally infused drugs (p=0.01, RM ANOVA) and reduced need for rescue oxycodone given i.m. (p=0.027, MW-U; median difference 3 mg (95% CI 0 7 mg)). Clonidine did not contribute to sedation and its influence on haemodynamics was minimal. CSPA (IV) provided satisfactory pain relief with only limited blockade of the legs (no inter-group differences). EST (V) was often related to technical problems and difficulties of interpretation, e.g., it failed to identify the four patients whose catheters were outside the spinal canal already at the time of catheter placement. As adjuvants to lumbar CEA, clonidine only slightly improved pain relief, while adrenaline did not provide any benefit. The role of EST applied at the time of epidural catheter placement or repeatedly during CEA remains open. The microcatheter CSPA technique appeared effective and reliable, but needs to be compared to routine CEA after peripheral arterial bypass surgery.

Specific language impairment in pre-adolescence, adolescence, and adulthood with special emphasis on health-related quality of life

This clinical study focused on effects of childhood specific language impairment (SLI) on daily functioning in late life. SLI is a neurobiological disorder with genetic predisposition and manifests as poor language production or comprehension or both in a child with age-level non-verbal intelligence and no other known cause for deficient language development. The prevalence rate of around 7% puts it among the most prevalent developmental disorders in childhood. Negative long-term effects, such as problems in learning and behavior, are frequent. In follow-up studies the focus has seldom been on self-perception of daily functioning and participation, which are considered important in the International Classification of Functioning, Disability, and Health (ICF). To investigate the self-perceived aspects of everyday functioning in individuals with childhood receptive SLI compared with age- and gender-matched control populations, the 15D, 16D, and 17D health-related quality of life (HRQoL) questionnaires were applied. These generic questionnaires include 15, 16, and 17 dimensions, respectively, and give both a single index score and a profile with values on each dimension. Information on different life domains (rehabilitation, education, employment etc.) from each age-group was collected with separate questionnaires. The study groups comprised adults, adolescents (12-16 years), and pre-adolescents (8-11 years) who had received a diagnosis of receptive SLI and had been examined, usually before school age, at the Department of Phoniatrics of Helsinki University Central Hospital, where children with language deficits caused by various etiologies are examined and treated by a multidisciplinary team. The adult respondents included 33 subjects with a mean age of 34 years. Measured with 15D, the subjects perceived their HRQoL to be nearly as good as that of their controls, but on the dimensions of speech, usual activities, mental functioning, and distress they were significantly worse off. They significantly more often lived with their parents (19%) or were pensioned (26%) than the adult Finnish population on average. Adults with self-perceived problems in finding words and in remembering instructions, manifestations of persistent language impairment, showed inferior every day functioning to the rest of the study group. Of the adolescents and pre-adolescents, 48 and 51, respectively, responded. The majority in both groups had received special education or extra educational support at school. They all had attended speech therapy at some point; at the time of the study only one adolescent, but every third pre-adolescent still received speech therapy. The 16D score of the adolescent or the 17D score of the pre-adolescents did not differ from that of their controls. The 16D profiles differed on some dimensions; subjects were significantly worse off on the dimension of mental functioning, but better off on the dimension of vitality than controls. Of the 17D dimensions, the study group was significantly worse off on speech, whereas the control group reported significantly more problems in sleeping. Of the childhood performance measures investigated, low verbal intelligence quotient (VIQ), which is often considered to reflect receptive language impairment, was in adults subjects significantly associated with some of the self-perceived problems, such as problems in usual activities and mental functioning. The 15D, 16D, and 17D questionnaires served well in measuring self-perceived HRQoL. Such standardized measures with population values are especially important in confirming with the ICF guidelines. In the future these questionnaires could perhaps be used on a more individual level in follow-up of children in clinics, and even in special schools and classes, to detect those children at greatest risk of negative long-term effects and perhaps diminished well-being regarding daily functioning and participation.

Charge transport in a Tomonaga-Luttinger liquid: Effects of pumping and bias

We study the current produced in a Tomonaga-Luttinger liquid by an applied bias and by weak, pointlike impurity potentials which are oscillating in time. We use bosonization to perturbatively calculate the current up to second order in the impurity potentials. In the regime of small bias and low pumping frequency, both the dc and ac components of the current have power-law dependences on the bias and pumping frequencies with an exponent 2K-1 for spinless electrons, where K is the interaction parameter. For K < 1/2, the current grows large for special values of the bias. For noninteracting electrons with K=1, our results agree with those obtained using Floquet scattering theory for Dirac fermions. We also discuss the cases of extended impurities and of spin-1/2 electrons.

Inhibition of CYP1A2-mediated drug metabolism in vitro and in humans : With special emphasis on rofecoxib and other NSAIDs

The cytochrome P450 1A2 (CYP1A2) is one of the major metabolizing enzymes. The muscle relaxant tizanidine is a selective substrate of CYP1A2, and the non-steroidal anti-inflammatory drug (NSAID) rofecoxib was thought to modestly in-hibit it. Cases suggesting an interaction between tizanidine and rofecoxib had been reported, but the mechanism was unknown. Also other NSAIDs are often used in combination with muscle relaxants. The aims of this study were to investigate the effect of rofecoxib, several other NSAIDs and female sex steroids on CYP1A2 ac-tivity in vitro and in vivo, and to evaluate the predictability of in vivo inhibition based on in vitro data. In vitro, the effect of several NSAIDs, female sex steroids and model inhibitors on CYP1A2 activity was studied in human liver microsomes, without and with preincubation. In placebo controlled, cross-over studies healthy volunteers ingested a single dose of tizanidine after a pretreament with the inhibitor (rofecoxib, tolfenamic acid or celecoxib) or placebo. Plasma (and urine) concentrations of tizanidine and its metabolites were measured, and the pharmacodynamic effects were recorded. A caffeine test was also performed. In vitro, fluvoxamine, tolfenamic acid, mefenamic acid and rofecoxib potently in-hibited CYP1A2. Ethinylestradiol, celecoxib, desogestrel and zolmitriptan were moderate, and etodolac, ciprofloxacin, etoricoxib and gestodene were weak inhibi-tors of CYP1A2. At 100 µM, other tested NSAIDs and steroids inhibited CYP1A2 less than 35%. Rofecoxib was found to be a mechanism-based inhibitor of CYP1A2. In vivo, rofecoxib greatly increased the plasma concentrations (over ten-fold) and the pharmacodynamic effects of tizanidine. Also the metabolism of caf-feine was impaired by rofecoxib. Despite the relatively strong in vitro CYP1A2 inhibitory effects, tolfenamic acid and celecoxib did not have a significant effect on tizanidine and caffeine concentrations in humans. Competitive inhibition model and the free plasma concentration of the inhibitor predicted well the effect of fluvoxam-ine and the lack of effect of tolfenamic acid and celecoxib on tizanidine concentra-tions in humans, and mechanism-based inhibition model explained the effects of rofecoxib. However, the effects of ciprofloxacin and oral contraceptives were un-derestimated from the in vitro data. Rofecoxib is a potent mechanism-based inhibitor of CYP1A2 in vitro and in vivo. This mechanism may be involved in the adverse cardiovascular effects of rofecoxib. Tolfenamic acid and celecoxib seem to be safe in combination with tizanidine, but mefenamic acid might have some effect on tizanidine concentrations in vivo. Con-sidering the mechanism of inhibition, and using the free plasma concentration of the inhibitor, many but not all CYP1A2 interactions can be predicted from in vitro data.

Molecular mechanisms of hypertension-induced heart failure : Experimental studies with special emphasis on local renin-angiotensin system, cardiac metabolism and levosimendan

Hypertension is a major risk factor for stroke, ischaemic heart disease, and the development of heart failure. Hypertension-induced heart failure is usually preceded by the development of left ventricular hypertrophy (LVH), which represents an adaptive and compensatory response to the increased cardiac workload. Biomechanical stress and neurohumoral activation are the most important triggers of pathologic hypertrophy and the transition of cardiac hypertrophy to heart failure. Non-clinical and clinical studies have also revealed derangements of energy metabolism in hypertensive heart failure. The goal of this study was to investigate in experimental models the molecular mechanisms and signalling pathways involved in hypertension-induced heart failure with special emphasis on local renin-angiotensin-aldosterone system (RAAS), cardiac metabolism, and calcium sensitizers, a novel class of inotropic agents used currently in the treatment of acute decompensated heart failure. Two different animal models of hypertensive heart failure were used in the present study, i.e. hypertensive and salt-sensitive Dahl/Rapp rats on a high salt diet (a salt-sensitive model of hypertensive heart failure) and double transgenic rats (dTGR) harboring human renin and human angiotensinogen genes (a transgenic model of hypertensive heart failure with increased local RAAS activity). The influence of angiotensin II (Ang II) on cardiac substrate utilization and cardiac metabolomic profile was investigated by using gas chromatography coupled to time-of-flight mass spectrometry to detect 247 intermediary metabolites. It was found that Ang II could alter cardiac metabolomics both in normotensive and hypertensive rats in an Ang II receptor type 1 (AT1)-dependent manner. A distinct substrate use from fatty acid oxidation towards glycolysis was found in dTGR. Altered cardiac substrate utilization in dTGR was associated with mitochondrial dysfunction. Cardiac expression of the redox-sensitive metabolic sensor sirtuin1 (SIRT1) was increased in dTGR. Resveratrol supplementation prevented cardiovascular mortality and ameliorated Ang II-induced cardiac remodeling in dTGR via blood pressure-dependent pathways and mechanisms linked to increased mitochondrial biogenesis. Resveratrol dose-dependently increased SIRT1 activity in vitro. Oral levosimendan treatment was also found to improve survival and systolic function in dTGR via blood pressure-independent mechanisms, and ameliorate Ang II-induced coronary and cardiomyocyte damage. Finally, using Dahl/Rapp rats it was demonstrated that oral levosimendan as well as the AT1 receptor antagonist valsartan improved survival and prevented cardiac remodeling. The beneficial effects of levosimendan were associated with improved diastolic function without significantly improved systolic changes. These positive effects were potentiated when the drug combination was administered. In conclusion, the present study points to an important role for local RAAS in the pathophysiology of hypertension-induced heart failure as well as its involvement as a regulator of cardiac substrate utilization and mitochondrial function. Our findings suggest a therapeutic role for natural polyphenol resveratrol and calcium sensitizer, levosimendan, and the novel drug combination of valsartan and levosimendan, in prevention of hypertension-induced heart failure. The present study also provides a better understanding of the pathophysiology of hypertension-induced heart failure, and may help identify potential targets for novel therapeutic interventions.

Applications of Treatment Effects Models and Semiparametric Estimation

This thesis is composed of an introductory chapter and four applications each of them constituting an own chapter. The common element underlying each of the chapters is the econometric methodology. The applications rely mostly on the leading econometric techniques related to estimation of causal effects. The first chapter introduces the econometric techniques that are employed in the remaining chapters. Chapter 2 studies the effects of shocking news on student performance. It exploits the fact that the school shooting in Kauhajoki in 2008 coincided with the matriculation examination period of that fall. It shows that the performance of men declined due to the news of the school shooting. For women the similar pattern remains unobserved. Chapter 3 studies the effects of minimum wage on employment by employing the original Card and Krueger (1994; CK) and Neumark and Wascher (2000; NW) data together with the changes-in-changes (CIC) estimator. As the main result it shows that the employment effect of an increase in the minimum wage is positive for small fast-food restaurants and negative for big fast-food restaurants. Therefore, it shows that the controversial positive employment effect reported by CK is overturned for big fast-food restaurants and that the NW data are shown, in contrast to their original results, to provide support for the positive employment effect. Chapter 4 employs the state-specific U.S. data (collected by Cohen and Einav [2003; CE]) on traffic fatalities to re-evaluate the effects of seat belt laws on the traffic fatalities by using the CIC estimator. It confirms the CE results that on the average an implementation of a mandatory seat belt law results in an increase in the seat belt usage rate and a decrease in the total fatality rate. In contrast to CE, it also finds evidence on compensating-behavior theory, which is observed especially in the states by the border of the U.S. Chapter 5 studies the life cycle consumption in Finland, with the special interest laid on the baby boomers and the older households. It shows that the baby boomers smooth their consumption over the life cycle more than other generations. It also shows that the old households smoothed their life cycle consumption more as a result of the recession in the 1990s, compared to young households.

On the force potential of strategy texts: a critical discourse analysis of a strategic plan and its power effects in a city organization

Despite increasing interest in the discursive aspects of strategy, few studies have examined strategy texts and their power effects. We draw from Critical Discourse Analysis to better understand the power of strategic plans as a directive genre. In our empirical analysis, we examined the creation of the official strategic plan of the City of Lahti in Finland. As a result of our inductive analysis, we identified five central discursive features of this plan: self-authorization, special terminology, discursive innovation, forced consensus and deonticity. We argue that these features can, with due caution, be generalized and conceived as distinctive features of the strategy genre. We maintain that these discursive features are not trivial characteristics; they have important implications for the textual agency of strategic plans, their performative effects, impact on power relations and ideological implications.

The Size-Dependent Elastic Properties of Nanofilms with Surface Effects

Size-dependent elastic constants are investigated theoretically with reference to a nanoscale single-crystal thin film. A three-dimensional _3D_ model is presented with the relaxation on the surface of the nanofilm taken into consideration. The constitutive relation of the 3D model is derived by using the energy approach, and analytical expressions for the four nonzero elastic constants of the nanofilm are obtained. The size effects of the four elastic constants are then discussed, and the dependence of these elastic constants on the surface relaxation and the ambiguity in the definition of the thickness of the nanofilm are also analyzed. In addition, the elastic moduli of the nanofilm in two kinds of plane problem are obtained and discussed in the case of a special boundary condition.

A nanoindentation analysis of the effects of microstructure on elastic properties of Al2O3/SiC composites

Nanoindentation tests were carried out to investigate certain elastic properties of Al2O3/SiCp composites at microscopic scales (nm up to mu m) and under ultra-low loads from 3 mN to 250 mN, with special attention paid to effects caused by SiC particles and pores. The measured Young's modulus depends on the volume fraction of SiC particles and on the composite porosity and it can compare with that of alumina. The Young's modulus exhibits large scatters at small penetrations, but it tends to be constant with lesser dispersion as the indentation depth increases. Further analysis indicated that the scatter results from specific microstructural heterogeneities. The measured Young's moduli are in agreement with predictions, provided the actual role of the microstructure is taken into account. (C) 2007 Elsevier Ltd. All rights reserved.

Florida's West Coast inlets: shoreline effects and recommended action

This report responds to the 1986 Beaches Bill which, in recognition of the potential deleterious impact on Florida's beaches of inlets modified for navigation, mandated a study of those inlets with identification of recommended action to reduce the impacts. This report addresses west Coast inlets; East Coast inlets are the subject of a companion report. There are 37 inlets along that portion of Florida's West Coast commencing from Pensacola Bay Entrance to Caxambas Pass at the south end of Marco Island. Compared to those on the East Coast, most West Coast inlets have not had the deleterious effects on the adjacent beaches, yet all modified inlets without proper management have the potential of impacting unfavorably on the adjacent shorelines. Moreover, at present there is interest in opening three West Coast entrances which either have been open in the past (Midnight Pass) or which have opened occasionally (Navarre Pass and Entrance to Phillips Lake). A review of inlets in their natural condition demonstrates the presence of a shallow broad outer bar across which the longshore transport Occurs. These shallow and shifting bar features were unsuitable for navigation which in many cases has led to the deepening of the channels and fixing with one or two jetty structures. Inlets in this modified state along with inappropriate maintenance practices have the potential of placing great ero$ional stress along the adjacent beaches. Moreover. channel dredging can reduce wave sheltering of the shoreline by ebb tidal shoals and alter the equilibrium of the affected shoreline segments. The ultimate in poor sand management practice is the placement of good quality beach sand in water depths too great for the sand to reenter the longshore system under natural forces; depths of 12 ft. or less are considered appropriate for Florida in order to maintain the sand in the system. With the interference of the nearshore sediment transport processes by inlets modified for navigation, if the adjacent beaches are to be stabilized there must be an active monitoring program with commitment to placement of dredged material of beach quality on shoreline segments of documented need. Several East Coast inlets have such transfer facilities; however. the quantities of sand transferred should be increased. Although an evolution and improvement in the technical capability to manage sand resources in the vicinity of inlets is expected, an adequate capability exists today and a concerted program should be made to commence a scheduled implementation of this capability at those entrances causing greatest erosional stress on the adjacent shorelines. A brief summary review for each of the 37 West Coast inlets is presented including: a scaled aerial photograph, brief historical information, several items related to sediment losses at each inlet and special characteristics relevant to State responsibilities. For each inlet, where appropriate, the above infor~tion is utilized to develop a recommenced action. (PDF has 101 pages.)

The integrated approach of water hyacinth control on Lake Kainji: with special regard to the design, construction and installation of a water hyacinth barrier across the River Niger

This document lists the undesirable effects of water hyacinth (Eichhornia crassipes) on fisheries in Lake Kainji (Nigeria) and the integrated Water Hyacinth Control Programme in its ongoing fisheries management and development activities on the lake. Special regard is given to the design, construction and installation of a water hyacinth barrier across the River Niger. (PDF contains 44 pages)

Surface effects on spinwave resonance in thin magnetic films

Over the past few decades, ferromagnetic spinwave resonance in magnetic thin films has been used as a tool for studying the properties of magnetic materials. A full understanding of the boundary conditions at the surface of the magnetic material is extremely important. Such an understanding has been the general objective of this thesis. The approach has been to investigate various hypotheses of the surface condition and to compare the results of these models with experimental data. The conclusion is that the boundary conditions are largely due to thin surface regions with magnetic properties different from the bulk. In the calculations these regions were usually approximated by uniform surface layers; the spins were otherwise unconstrained except by the same mechanisms that exist in the bulk (i.e., no special "pinning" at the surface atomic layer is assumed). The variation of the ferromagnetic spinwave resonance spectra in YIG films with frequency, temperature, annealing, and orientation of applied field provided an excellent experimental basis for the study.

This thesis can be divided into two parts. The first part is ferromagnetic resonance theory; the second part is the comparison of calculated with experimental data in YIG films. Both are essential in understanding the conclusion that surface regions with properties different from the bulk are responsible for the resonance phenomena associated with boundary conditions.

The theoretical calculations have been made by finding the wave vectors characteristic of the magnetic fields inside the magnetic medium, and then combining the fields associated with these wave vectors in superposition to match the specified boundary conditions. In addition to magnetic boundary conditions required for the surface layer model, two phenomenological magnetic boundary conditions are discussed in detail. The wave vectors are easily found by combining the Landau-Lifshitz equations with Maxwell's equations. Mode positions are most easily predicted from the magnetic wave vectors obtained by neglecting damping, conductivity, and the displacement current. For an insulator where the driving field is nearly uniform throughout the sample, these approximations permit a simple yet accurate calculation of the mode intensities. For metal films this calculation may be inaccurate but the mode positions are still accurately described. The techniques necessary for calculating the power absorbed by the film under a specific excitation including the effects of conductivity, displacement current and damping are also presented.

In the second part of the thesis the properties of magnetic garnet materials are summarized and the properties believed associated with the two surface regions of a YIG film are presented. Finally, the experimental data and calculated data for the surface layer model and other proposed models are compared. The conclusion of this study is that the remarkable variety of spinwave spectra that arises from various preparation techniques and subsequent treatments can be explained by surface regions with magnetic properties different from the bulk.

Testable models of aquatic systems: A NERC special topic for integrating experiments and modelling

A major part of the support for fundamental research on aquatic ecosystems continues to be provided by the Natural Environment Research Council (NERC). Funds are released for ”thematic” studies in a selected special topic or programme. ”Testable Models of Aquatic Ecosystems” was a Special Topic of the NERC, initiated in 1995, the aim of which was to promote ecological modelling by making new links between experimental aquatic biologists and state-of-the-art modellers. The Topic covered both marine and freshwater systems. This paper summarises projects on aspects of the responses of individual organisms to the effects of environmental variability, on the assembly, permanence and resilience of communities, and on aspects of spatial models. The authors conclude that the NERC Special Topic has been highly successful in promoting the development and application of models, most particularly through the interplay between experimental ecologists and formal modellers.

Real-World Social Cognition: Context Effects in Face and Threat Processing

As borne out by everyday social experience, social cognition is highly dependent on context, modulated by a host of factors that arise from the social environment in which we live. While streamlined laboratory research provides excellent experimental control, it can be limited to telling us about the capabilities of the brain under artificial conditions, rather than elucidating the processes that come into play in the real world. Consideration of the impact of ecologically valid contextual cues on social cognition will improve the generalizability of social neuroscience findings also to pathology, e.g., to psychiatric illnesses. To help bridge between laboratory research and social cognition as we experience it in the real world, this thesis investigates three themes: (1) increasing the naturalness of stimuli with richer contextual cues, (2) the potentially special contextual case of social cognition when two people interact directly, and (3) a third theme of experimental believability, which runs in parallel to the first two themes. Focusing on the first two themes, in work with two patient populations, we explore neural contributions to two topics in social cognition. First, we document a basic approach bias in rare patients with bilateral lesions of the amygdala. This finding is then related to the contextual factor of ambiguity, and further investigated together with other contextual cues in a sample of healthy individuals tested over the internet, finally yielding a hierarchical decision tree for social threat evaluation. Second, we demonstrate that neural processing of eye gaze in brain structures related to face, gaze, and social processing is differently modulated by the direct presence of another live person. This question is investigated using fMRI in people with autism and controls. Across a range of topics, we demonstrate that two themes of ecological validity — integration of naturalistic contextual cues, and social interaction — influence social cognition, that particular brain structures mediate this processing, and that it will be crucial to study interaction in order to understand disorders of social interaction such as autism.

Investigations on phytoplankton with special reference to water usage

Experiments and observations on the phytoplankton of certain lakes in the English Lake District were made from early 1973 to the end of March, 1974. They included laboratory and lake bioassays and observations on the quantity and quality of the phytoplankton in six lakes. The introductory sections of the report are about algae, the ecology of phytoplankton and the scope of the contracted work. Laboratory bioassays on water from one lake, Blelham Tarn, showed that phosphorus, silicon (for diatoms) and organic substances forming complexes with iron were the major substances limiting the growth of the algae tested. The growth of the test algae was limited to different degrees by those substances and, to some extent, to a greater or lesser degree at different times of year. It is suggested that a relatively simple form of bioassay could give valuable information to water undertakings. Lake bioassays and other experiments were carried out by using large in situ tubular plastic enclosures. Two such investigations are described. The effects of a change in sewerage in two drainage basins on the phytoplankton of three lakes is described and some data given about changes since 1945 in three other lakes in the same overall drainage basin. These latter lakes have been affected too by changes in sewerage and by increasing inputs of domestic and agricultural wastes. Throughout, the relevance of the work done to practical problems of water usage is kept in mind and discussed. In the last section special reference is made to the largely unpredictable results of water transfers. The report ends with a note on river phytoplankton.