Re-opening the black box in societal metabolism: the application of MuSIASEM to water

In this paper we address the complexity of the analysis of water use in relation to the issue of sustainability. In fact, the flows of water in our planet represent a complex reality which can be studied using many different perceptions and narratives referring to different scales and dimensions of analysis. For this reason, a quantitative analysis of water use has to be based on analytical methods that are semantically open: they must be able to define what we mean with the term “water” when crossing different scales of analysis. We propose here a definition of water as a resource that deal with the many services it provides to humans and ecosystems. WE argue that water can fulfil so many of them since the element has many characteristics that allow for the resource to be labelled with different attributes, depending on the end use –such as drinkable. Since the services for humans and the functions for ecosystems associated with water flows are defined on different scales but still interconnected it is necessary to organize our assessment of water use across different hierarchical levels. In order to do so we define how to approach the study of water use in the Societal Metabolism, by proposing the Water Metabolism, tganized in three levels: societal level, ecosystem level and global level. The possible end uses we distinguish for the society are: personal/physiological use, household use, economic use. Organizing the study of “water use” across all these levels increases the usefulness of the quantitative analysis and the possibilities of finding relevant and comparable results. To achieve this result, we adapted a method developed to deal with multi-level, multi-scale analysis - the Multi-Scale Integrated Analysis of Societal and Ecosystem Metabolism (MuSIASEM) approach - to the analysis of water metabolism. In this paper, we discuss the peculiar analytical identity that “water” shows within multi-scale metabolic studies: water represents a flow-element when considering the metabolism of social systems (at a small scale, when describing the water metabolism inside the society) and a fund-element when considering the metabolism o ecosystems (at a larger scale when describing the water metabolism outside the society). The theoretical analysis is illustrated using two case which characterize the metabolic patterns regarding water use of a productive system in Catalonia and a water management policy in Andarax River Basin in Andalusia.

Predictors of nonresponse in a questionnaire-based outcome study of vocational rehabilitation patients.

OBJECTIVE: To identify predictors of nonresponse to a self-report study of patients with orthopedic trauma hospitalized for vocational rehabilitation between November 15, 2003, and December 31, 2005. The role of biopsychosocial complexity, assessed using the INTERMED, was of particular interest. DESIGN: Cohort study. Questionnaires with quality of life, sociodemographic, and job-related questions were given to patients at hospitalization and 1 year after discharge. Sociodemographic data, biopsychosocial complexity, and presence of comorbidity were available at hospitalization (baseline) for all eligible patients. Logistic regression models were used to test a number of baseline variables as potential predictors of nonresponse to the questionnaires at each of the 2 time points. SETTING: Rehabilitation clinic. PARTICIPANTS: Patients (N=990) hospitalized for vocational rehabilitation over a period of 2 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Nonresponse to the questionnaires was the binary dependent variable. RESULTS: Patients with high biopsychosocial complexity, foreign native language, or low educational level were less likely to respond at both time points. Younger patients were less likely to respond at 1 year. Those living in a stable partnership were less likely than singles to respond at hospitalization. Sex, psychiatric, and somatic comorbidity and alcoholism were never associated with nonresponse. CONCLUSIONS: We stress the importance of assessing biopsychosocial complexity to predict nonresponse. Furthermore, the factors we found to be predictive of nonresponse are also known to influence treatment outcome and vocational rehabilitation. Therefore, it is important to increase the response rate of the groups of concern in order to reduce selection bias in epidemiologic investigations.

A dynamic assessment of medication-taking behavior during pregnancy and postpartum: should cART adherence be reinforced during postpartum?

This study compared adherence (persistence and execution) during pregnancy and postpartum in HIV-positive women having taken part in the adherence-enhancing program of the Community Pharmacy of the Department of Ambulatory Care and Community Medicine in Lausanne between 2004 and 2012. This interdisciplinary program combined electronic drug monitoring and semi-structured, repeated motivational interviews. This was a retrospective, observational study. Observation period spread over from first adherence visit after last menstruation until 6 months after childbirth. Medication-taking was recorded by electronic drug monitoring. Socio-demographic and delivery data were collected from Swiss HIV Cohort database. Adherence data, barriers and facilitators were collected from pharmacy database. Electronic data were reconciled with pill-count and interview notes in order to include reported pocket-doses. Execution was analyzed over 3-day periods by a mixed effect logistic model, separating time before and after childbirth. This model allowed us to estimate different time slopes for both periods and to show a sudden fall associated with childbirth. Twenty-five pregnant women were included. Median age was 29 (IQR: 26.5, 32.0), women were in majority black (n_17,68%) and took a cART combining protease and nucleoside reverse transcriptase inhibitors (n_24,96%). Eleven women (44%) were ART-naı¨ve at the beginning of pregnancy. Twenty women (80%) were included in the program because of pregnancy. Women were included at all stages of pregnancy. Six women (24%) stopped the program during pregnancy, 3 (12%) at delivery, 4 (16%) during postpartum and 12 (48%) stayed in program at the end of observation time. Median number of visits was 4 (3.0, 6.3) during pregnancy and 3 (0.8, 6.0) during postpartum. Execution was continuously high during pregnancy, low at beginning of postpartum and increased gradually during the 6 months of postpartum. Major barriers to adherence were medication adverse events and difficulties in daily routine. Facilitators were motivation for promoting child-health and social support. The dramatic drop and very slow increase in cART adherence during postpartum might result in viral rebound and drug resistance. Although much attention is devoted to pregnant women, interdisciplinary care should also be provided to women in the community during first trimester of postpartum to support them in sustaining cART adherence.

New bench test for venous cannula performance assessment.

Cannula design is of prime importance for venous drainage during cardiopulmonary bypass (CPB). To evaluate cannulas intended for CPB, an in vitro circuit was set up with silicone tubing between the test cannula encased in a movable preload reservoir and another static reservoir. The pressure-drop (DeltaP) value (P-drainage - P-preload) was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasound flowmeter. Data display and data recording were controlled using a LabView application, custom made particularly for our experiments. Our results demonstrated that DeltaP, Q, and cannula resistance (DeltaP/Q) values were significantly decreased when the cannula diameter was increased for Smart and Medtronic cannulas. Smartcanula showed 36% and 43% less resistance compared to Medtronic venous and Medtronic femoral cannulas, respectively. The cannula shape (straight- or curved-tips) did not affect the DLP cannula resistance. Out of five cannulas tested, the Smartcanula outperforms the other commercially available cannulas. The mean (DeltaP/Q) values were 3.3 +/- 0.08, 4.07 +/- 0.08, 5.58 +/- 0.10, 5.74 +/- 0.15, and 6.45 +/- 0.15 for Smart, Medtronic, Edwards, Sarns, and Gambro cannulas, respectively (two-way ANOVA, p < 0.0001). In conclusion, the present assay allows discrimination between different forms of cannula with high or low lumen resistance.

Evaluation cardiologique préopératoire avant chirurgie non cardiaque: stratification du risque cardiovasculaire [Preoperative cardiac assessment before non-cardiac surgery: cardiac risk stratification].

Perioperative cardiac events occurring in patients undergoing non-cardiac surgery are a common cause of morbidity and mortality. Current guidelines recommend an individualized approach to preoperative cardiac risk stratification prior to non-cardiac surgery, integrating risk factors both for the patient (active cardiac conditions, clinical risk factors, functional capacity) and for the planned surgery. Preoperative cardiac investigations are currently limited to high-risk patients in whom they may contribute to modify the perioperative management. A multidisciplinary approach to such patients, integrating the general practitioner, is recommended in order to define an individualized peri-operative strategy.

Health Impact Assessment Screening tool

The screening tool provides assistance to those conducting HIA to quickly and systematically establish whether a particular policy, programme or project has an impact on health and whether a HIA is appropriate or necessary

Health Impact Assessment Scoping tool

The scoping tool provides a framework for the development of the HIA workplan

Health Impact Assessment Policy analysis tool

The policy analysis tool provides a framework to review government and other relevant agency policy related to the proposal.

Health Impact Assessment Collating information tool

The collating information tool provides a framework for all information gathered as part of the HIA process to be collated.

Health Impact Assessment Prioritising health impacts tool

The prioritising health impacts tool provides a framework for prioritising health impacts.

Health Impact Assessment Tool for forming recommendations

The forming recommendation tool provides a template to record the recommendations and how they will be implemented by the decision-maker

Health Impact Assessment Reviewing the implementation of HIA recommendations

This tool provides a template to monitor the implementation of the HIA recommendations by identified decision-makers

Health Impact Assessment Presentation

This presentation provided an overview of Health Impact Assessment

Health Impact Assessment

This presentation provided an overview of Health Impact Assessment