Salty chemical cocktails as water quality signatures: Longitudinal trends and breakpoints along different U.S. streams.

Along urban streams and rivers, various processes, including road salt application, sewage leaks, and weathering of the built environment, contribute to novel chemical cocktails made up of metals, salts, nutrients, and organic matter. In order to track the impacts of urbanization and management strategies on water quality, we conducted longitudinal stream synoptic (LSS) monitoring in nine watersheds in five major metropolitan areas of the U.S. During each LSS monitoring survey, 10-53 sites were sampled along the flowpath of streams as they flowed along rural to urban gradients. Results demonstrated that major ions derived from salts (Ca2+, Mg2+, Na+, and K+) and correlated elements (e.g. Sr2+, N, Cu) formed 'salty chemical cocktails' that increased along rural to urban flowpaths. Salty chemical cocktails explained 46.1% of the overall variability in geochemistry among streams and showed distinct typologies, trends, and transitions along flowpaths through metropolitan regions. Multiple linear regression predicted 62.9% of the variance in the salty chemical cocktails using the six following significant drivers (p < 0.05): percent urban land, wastewater treatment plant discharge, mean annual precipitation, percent silicic residual material, percent volcanic material, and percent carbonate residual material. Mean annual precipitation and percent urban area were the most important in the regression, explaining 29.6% and 13.0% of the variance. Different pollution sources (wastewater, road salt, urban runoff) in streams were tracked downstream based on salty chemical cocktails. Streams flowing through stream-floodplain restoration projects and conservation areas with extensive riparian forest buffers did not show longitudinal increases in salty chemical cocktails, suggesting that there could be attenuation via conservation and restoration. Salinization represents a common urban water quality signature and longitudinal patterns of distinct chemical cocktails and ionic mixtures have the potential to track the sources, fate, and transport of different point and nonpoint pollution sources along streams across different regions.

The EPA Ecosystem Services Tool Selection Portal.

The dynamics of an environmental decision-making context can be complicated. The use of decision support tools can help better facilitate restoring and maintaining ecosystems that provide environmental benefits (ecosystem services) to people. Although an ecosystem services assessment tool is designed for specific purposes, having access to a comprehensive suite of tools offers the user additional insight and resources to help in decision making. A range of approaches exist to connect ecosystem services to a given decision context ranging from less to more complex: using the best professional judgment; applying examples from other efforts; testing individual tool applications; and using a systematic, decision-tree approach to navigate among relevant tools and frameworks. The U.S. Environmental Protection Agency developed a decision-tree approach for a user to navigate the question of how to choose among a suite of ecosystem services assessment tools for three decision contexts: (1) ecological risk assessments; (2) cleanup of contaminated sites; (3) and generic structured decision-making processes. This tool selection navigator was developed with/for the intended user, including developing crosswalks between tool functionality and the user's language for what they require in a tool. To navigate the tool, the user first chooses one of three decision contexts. Second, the user selects among the different phases of the decision process. Third, the user selects among a few ecosystem-services related tasks relevant to the decision context chosen to identify potential tools. The tool uses simple language to navigate the decision pathways and provides the user with a suite of potential ES resources and tools for their given decision context.

A review of ecosystem services from edge-of-field practices in tile-drained agricultural systems in the United States Corn Belt Region.

Edge-of-field management practices that reduce nutrient pollution from tile drainage while contributing habitat and other ecosystem services are needed to enhance agricultural systems in the US Corn Belt Region. In this review, we identified edge-of-field and catchment scale agricultural conservation practices for intercepting and treating tile drainage. The reviewed conservation practices were (1) controlled drainage, also known as drainage water management (USDA-NRCS Code 554); (2) drainage water recycling (USDA-NRCS Code 447); (3) denitrifying bioreactors (USDA-NRCS Code 605); (4) saturated buffers (USDA-NRCS Code 604); and (5) constructed or restored wetlands designed for water quality improvement (USDA-NRCS Code 656) herein referred to as water quality wetlands. We examined 119 studies that had information on one or more of the following ecosystem services: water retention, water quality improvement (e.g., nitrate, phosphate, sediment, or pesticide retention), wetland habitat (for birds, aquatic organisms, and pollinators), crop yield improvement, and other benefits (e.g., recreation, education, aesthetic appreciation, greenhouse gas retention). We found the five edge-of-field practices were all effective at removing nitrate with varying degrees of other potential benefits and disservices (e.g., greenhouse gas production). Drainage water recycling and water quality wetlands have the potential to provide the most co-benefits as they provide surface water systems for capturing surface flows in addition to tile drainage while also potentially providing habitat and recreation opportunities. However, the following research needs are identified: 1) the disservices and benefits associated with drainage water recycling have not been adequately evaluated; 2) surface flow dynamics are understudied across all reviewed management practices; 3) a complete accounting of phosphorus species and flow pathways for all management practices is needed; 4) field evaluations of the habitat benefit of all management practices are needed; and 5) greenhouse gas dynamics are understudied across all management practices. While all management practices are expected to reduce nitrate loads, addressing these knowledge gaps will help inform holistic management decisions for diverse stakeholders across the US Corn Belt.

Longitudinal stream synoptic monitoring tracks chemicals along watershed continuums: a typology of trends.

There are challenges in monitoring and managing water quality due to spatial and temporal heterogeneity in contaminant sources, transport, and transformations. We demonstrate the importance of longitudinal stream synoptic (LSS) monitoring, which can track combinations of water quality parameters along flowpaths across space and time. Specifically, we analyze longitudinal patterns of chemical mixtures of carbon, nutrients, greenhouse gasses, salts, and metals concentrations along 10 flowpaths draining 1,765 km2 of the Chesapeake Bay region. These 10 longitudinal stream flowpaths are drained by watersheds experiencing either urban degradation, forest and wetland conservation, or stream and floodplain restoration. Along the 10 longitudinal stream flowpaths, we monitored over 300 total sampling sites along a combined stream length of 337 km. Synoptic monitoring along longitudinal flowpaths revealed: (1) increasing, decreasing, piecewise, or no trends and transitions in water quality with increasing distance downstream, which provide insights into water quality processes along flowpaths; (2) longitudinal trends and transitions in water quality along flowpaths can be quantified and compared using simple linear and non-linear statistical relationships with distance downstream and/or land use/land cover attributes, (3) attenuation and transformation of chemical cocktails along flowpaths depend on: spatial scales, pollution sources, and transitions in land use and management, hydrology, and restoration. We compared our LSS patterns with others from the global literature to synthesize a typology of longitudinal water quality trends and transitions in streams and rivers based on hydrological, biological, and geochemical processes. Applications of LSS monitoring along flowpaths from our results and the literature reveal: (1) if there are shifts in pollution sources, trends, and transitions along flowpaths, (2) which pollution sources can spread further downstream to sensitive receiving waters such as drinking water supplies and coastal zones, and (3) if transitions in land use, conservation, management, or restoration can attenuate downstream transport of pollution sources. Our typology of longitudinal water quality responses along flowpaths combines many observations across suites of chemicals that can follow predictable patterns based on watershed characteristics. Our typology of longitudinal water quality responses also provides a foundation for future studies, watershed assessments, evaluating watershed management and stream restoration, and comparing watershed responses to non-point and point pollution sources along streams and rivers. LSS monitoring, which integrates both spatial and temporal dimensions and considers multiple contaminants together (a chemical cocktail approach), can be a comprehensive strategy for tracking sources, fate, and transport of pollutants along stream flowpaths and making comparisons of water quality patterns across different watersheds and regions.

The final ecosystem goods and services Voltron: the power of tools together.

Environmental decision-making benefits from considering ecosystem services to ensure that aspects of the environment that people rely upon are fully evaluated. By focusing consideration of ecosystem services on final ecosystem goods and services (FEGS), the aspects of the environment directly enjoyed, used, or consumed by humans, these analyses can be more streamlined and effective. The U.S. Environmental Protection Agency has developed a set of tools to facilitate this consideration. The central feature of FEGS is that ecosystems are viewed through the diverse ways people directly benefit from them. The National Ecosystem Services Classification System (NESCS) Plus provides a framework for describing and identifying FEGS consistently. The standardization made available by NESCS Plus allows other tools and databases to interact using the NESCS Plus architecture and taxonomy, providing diverse insights for decision makers. Here, we examine the synergy of using the following four tools together: (1) the FEGS Scoping Tool; (2) the FEGS Metrics Report; (3) the EnviroAtlas; and (4) the EcoService Models Library. The FEGS Scoping Tool helps users determine what ecosystem services are relevant to a decision by harnessing FEGS understanding to enable communities to identify the relative importance of beneficiaries relevant to a decision and biophysical aspects of the environment of direct relevance to those beneficiaries. The FEGS Metrics Report can guide which metrics to monitor or model to represent those priority services. The EnviroAtlas, a powerful tool containing geospatial data and other resources related to ecosystem services, chemical and non-chemical stressors, and human health, and the EcoService Models Library, a database of ecosystem models, are two tools that support users in mapping and modeling endpoints relevant to priority services. While each of these tools is valuable on its own, together, they provide a powerful approach to easily incorporate and operationalize ecosystem services efforts into different parts of decision-making processes across different types of decisions. We illustrate how these integrated tools can be used together with a hypothetical example of a complex environmental management case study and the combined benefit of using the FEGS tools together.

A global review of beaver dam impacts: Stream conservation implications across biomes.

Beaver are recolonizing previously occupied regions, expanding into new territories, and increasingly being introduced and protected for stream conservation and restoration across numerous biomes. However, beaver dam effects on the physical, chemical, and biological characteristics of streams may vary within and among biomes. A comprehensive review of these impacts is lacking. The goals of this review were to: 1) summarize the distribution of studies by biome on beaver dam effects related to channel morphology, hydrology, water quality, and aquatic biota, as well as on beaver habitat selection, 2) summarize the extent to which beaver dam impacts have been consistent within and among biomes, and 3) share testable hypotheses regarding beaver impacts within understudied biomes. We quantify the directionality of beaver dam impacts from 267 peer-reviewed studies. Results show that the majority of studies have been completed within temperate forest environments and that many biomes are understudied. Across biomes, beaver preferred sites for dam development characterized by relatively low gradients and unconfined reaches with small drainage areas. Overall, parameters related to stream morphology and hydrology showed relatively consistent responses to beaver dams within and among biomes, yet water quality and biotic responses were variable among biomes. Responses also varied by parameter within water quality and biotic impact categories. The findings of this study can be useful for stream conservation and restoration efforts that introduce or protect beaver. Additional studies are needed within arid and cold biomes historically occupied by beaver and in novel biomes where beaver populations are currently expanding.

Potential of water quality wetlands to mitigate habitat losses from agricultural drainage modernization.

Given widespread biodiversity declines, a growing global human population, and demands to improve water quality, there is an immediate need to explore land management solutions that support multiple ecosystem services. Agricultural water quality wetlands designed to provide both water quality benefits and wetland and grassland habitat are an emerging restoration solution that may reverse habitat declines in intensive agricultural areas. Installation of water quality wetlands in the Upper Midwest, USA, when considered alongside the repair and modification of aging agricultural tile drainage infrastructure, is a likely scenario that may mitigate nutrient pollution exported from agricultural systems and improve crop yields. The capacity of water quality wetlands to provide habitat within the wetland pool and the surrounding grassland is not well-studied, particularly with respect to potential habitat changes resulting from drainage infrastructure upgrades. For the current study, we produced spatially explicit models of 37 catchments distributed throughout an important region for agriculture and biodiversity, the Des Moines Lobe of Iowa. Four scenarios were considered - with and without improved drainage and with and without water quality wetlands - to estimate the net potential habitat implications of these scenarios for amphibians, grassland birds, and wild bees. Model results indicate that drainage modification alone will likely result in moderate direct losses of suitable amphibian habitat and large declines in overall habitat quality. However, inclusion of water quality wetlands at the catchment scale may mitigate these amphibian habitat losses while also increasing grassland bird and pollinator habitat. The impacts of water quality wetlands and drainage modernization on waterfowl in the region require additional study.

Long-term assessment of floodplain reconnection as a stream restoration approach for managing nitrogen in ground and surface waters.

Stream restoration is a popular approach for managing nitrogen (N) in degraded, flashy urban streams. Here, we investigated the long-term effects of stream restoration involving floodplain reconnection on riparian and in-stream N transport and transformation in an urban stream in the Chesapeake Bay watershed. We examined relationships between hydrology, chemistry, and biology using a Before/After-Control/Impact (BACI) study design to determine how hydrologic flashiness, nitrate (NO3 -) concentrations (mg/L), and N flux, both NO3 - and total N (kg/yr), changed after the restoration and floodplain hydrologic reconnection to its stream channel. We examined two independent surface water and groundwater data sets (EPA and USGS) collected from 2002-2012 at our study sites in the Minebank Run watershed. Restoration was completed during 2004 and 2005. Afterward, the monthly hydrologic flashiness index, based on mean monthly discharge, decreased over time from 2002 and 2008. However, from 2008-2012 hydrologic flashiness returned to pre-restoration levels. Based on the EPA data set, NO3 - concentration in groundwater and surface water was significantly less after restoration while the control site showed no change. DOC and NO3 - were negatively related before and after restoration suggesting C limitation of N transformations. Long-term trends in surface water NO3 - concentrations based on USGS surface water data showed downward trends after restoration at both the restored and control sites, whereas specific conductance showed no trend. Comparisons of NO3 - concentrations with Cl- concentrations and specific conductance in both ground and surface waters suggested that NO3 - reduction after restoration was not due to dilution or load reductions from the watershed. Modeled NO3 - flux decreased post restoration over time but the rate of decrease was reduced likely due to failure of restoration features that facilitated N transformations. Groundwater NO3 - concentrations varied among stream features suggesting that some engineered features may be functionally better at creating optimal conditions for N retention. However, some engineered features eroded and failed post restoration thereby reducing efficacy of the stream restoration to reduce flashiness and NO3 - flux. N management via stream restoration will be most effective where flashiness can be reduced and DOC made available for denitrifiers. Stream restoration may be an important component of holistic watershed management including stormwater management and nutrient source control if stream restoration and floodplain reconnection can be done in a manner to resist the erosive effects of large storm events that can degrade streams to pre-restoration conditions. Long-term evolution of water quality functions in response to degradation of restored stream channels and floodplains from urban stressors and storms over time warrants further study, however.

Defining community revitalization in Great Lakes Areas of Concern and investigating how revitalization can be catalyzed through remediation and restoration.

An international effort to restore contaminated areas across the Great Lakes has been underway for over 50 years. Although experts have increasingly recognized the inherent connections between ecological conditions and community level benefits, Great Lakes community revitalization continues to be a broad and complex topic, lacking a comprehensive definition. The purpose of this study was to generate a testable "AOC-Revitalization Framework" for linking remediation and restoration success, represented by Beneficial Use Impairment (BUI) removal in U.S. Great Lakes Areas of Concern (AOC), to community revitalization. Using directed content analysis, we conducted a literature review and identified 433 potential revitalization metrics and indicators and grouped them into 15 broader community revitalization attributes to develop the following definition of Great Lakes community revitalization: "locally driven community resurgence resulting in resilient and equitable enhancements to social, economic, and environmental community structures." We surveyed experts within the Great Lakes AOC program on the likelihood remediation and restoration success, would positively impact revitalization attributes. Focus groups triangulated survey results. Results identified BUI removal was expected to positively affect revitalization, but the type of revitalization outcome was based on the BUI being removed. The AOC-Revitalization Framework is the first to empirically outline these possible linkages, providing a clear testable structure for future research; it can be used to better understand how environmental improvements are or are not leading to community revitalization and more accurately identify components of revitalization impacted, thus supporting more equitable representation, communication, and measurement of the relationship.

Digital electrical impedance analysis for single bacterium sensing and antimicrobial susceptibility testing.

Single-molecule and single-cell analysis techniques have opened new opportunities for characterizing and analyzing heterogeneity within biological samples. These detection methods are often referred to as digital assays because the biological sample is partitioned into many small compartments and each compartment contains a discrete number of targets (e.g. cells). Using digital assays, researchers can precisely detect and quantify individual targets, and this capability has made digital techniques the basis for many modern bioanalytical tools (including digital PCR, single cell RNA sequencing, and digital ELISA). However, digital assays are dominated by optical analysis systems that typically utilize microscopy to analyze partitioned samples. The utility of digital assays may be dramatically enhanced by implementing cost-efficient and portable electrical detection capabilities. Herein, we describe a digital electrical impedance sensing platform that enables direct multiplexed measurement of single cell bacterial cells. We outline our solutions to the challenge of multiplexing impedance sensing across many culture compartments and demonstrate the potential for rapidly differentiating antimicrobial resistant versus susceptible strains of bacteria.

Interdisciplinary Collaboration on Green Infrastructure for Urban Watershed Management: An Ohio Case Study.

Many older Midwestern cities of the United States are challenged by costly aging water infrastructure while working to revitalize urban areas. These cities developed much of their water infrastructure before the Clean Water Act became law and have struggled to mitigate contaminant loading to surface waters. An increasingly common approach to resolving these challenges is the integration of green infrastructure with gray infrastructure improvements to manage point and non-point source pollution. Stakeholder engagement and collaboration during green infrastructure planning can help address impairments and promote community involvement through the revitalization process. Mill Creek watershed in Cincinnati, OH, USA has seen improvement in watershed integrity indicators after being impaired for many decades by flashy hydrology, combined sewer overflows, and water quality degradation. A workshop was conducted to examine how integrated green and gray infrastructure has contributed to improvements in Mill Creek over the past several decades. This effort sought to examine internal and external factors that influence a multi-stakeholder watershed approach to planning, implementing, and evaluating green infrastructure techniques. Community investment and physical infrastructure, access to datasets, and skills and knowledge exchange were essential in improving use attainment in the Mill Creek. Strategic placement of green infrastructure has the potential to maximize water quality benefits and ecosystem services. However, green infrastructure deployment has been more opportunistic due to the diversity of stakeholder and decision maker interests. Future work should consider collaborative approaches to address scaling challenges and workforce development to maximize green infrastructure benefits.

Watershed 'Chemical Cocktails': Forming Novel Elemental Combinations in Anthropocene Fresh Waters.

In the Anthropocene1, watershed chemical transport is increasingly dominated by novel combinations elements, which are hydrologically linked together as 'chemical cocktails.' Chemical cocktails are novel because human activities greatly enhance elemental concentrations and their probability for biogeochemical interactions and shared transport along hydrologic flowpaths. A new chemical cocktail approach advances our ability to: trace contaminant mixtures in watersheds, develop chemical proxies with high-resolution sensor data, and manage multiple water quality problems. We explore the following questions: (1) Can we classify elemental transport in watersheds as chemical cocktails using a new approach? (2) What is the role of climate and land use in enhancing the formation and transport of chemical cocktails in watersheds? To address these questions, we first analyze trends in concentrations of carbon, nutrients, metals, and salts in fresh waters over 100 years. Next, we explore how climate and land use enhance the probability of formation of chemical cocktails of carbon, nutrients, metals, and salts. Ultimately, we classify transport of chemical cocktails based on solubility, mobility, reactivity, and dominant phases: (1) sieved chemical cocktails (e.g., particulate forms of nutrients, metals and organic matter); (2) filtered chemical cocktails (e.g., dissolved organic matter and associated metal complexes); (3) chromatographic chemical cocktails (e.g., ions eluted from soil exchange sites); and (4) reactive chemical cocktails (e.g., limiting nutrients and redox sensitive elements). Typically, contaminants are regulated and managed one element at a time, even though combinations of elements interact to influence many water-quality problems such as toxicity to life, eutrophication, infrastructure and water treatment. A chemical cocktail approach significantly expands evaluations of water-quality signatures and impacts beyond single elements to mixtures. High-frequency sensor data (pH, specific conductance, turbidity, etc.) can serve as proxies for chemical cocktails and improve real-time analyses of water-quality violations, identify regulatory needs, and track water quality recovery following and extreme climate events. Ultimately, a watershed chemical cocktail approach is necessary for effectively co-managing groups of contaminants and provides a more holistic approach for studying, monitoring, and managing water quality in the Anthropocene.

Executive attentional resources in timing: Effects of inhibitory control and cognitive aging.

This research is based on an executive resource theory of timing, which postulates that time perception relies on specialized attentional resources that support executive cognitive functions. In 4 experiments, older and younger participants performed a timing task and an executive task emphasizing inhibitory control under both single-task and dual-task conditions. The timing task in each experiment was serial temporal production. The executive tasks, representing different types of inhibitory control, were the flanker task (Experiment 1), the number-letter task (Experiment 2), the go/no-go task (Experiment 3), and the antisaccade task (Experiment 4). The results showed (a) a pattern of bidirectional interference in each experiment, in that the concurrent inhibition tasks interfered with timing performance and concurrent timing interfered with inhibition performance, (b) the older participants demonstrated a stronger bidirectional interference effect relative to younger participants in 3 experiments, and (c) weaker versions of the inhibition tasks produced weaker interference effects. These findings support the idea that temporal processing relies on executive attentional resources.

Identification of Francisella noatunensis in novel host species French grunt (Haemulon flavolineatum) and Caesar grunt (Haemulon carbonarium).

Francisella noatunensis is an emerging pathogen of fish that has been isolated from several cultured species worldwide. Here presented is a case involving several hundred marine grunts that were caught near the Florida Keys for display in public aquaria. These fish were maintained in a recirculating system where they began to experience mortalities approximately two weeks post-stocking. Postmortem examination revealed disseminated systemic granulomatous disease most severely affecting spleen and kidney. Splenic and renal tissue homogenates inoculated in modified Thayer Martin agar media yielded colonies consistent with F. noatunensis 4 days post inoculation. Bacterial colonies and tissues were confirmed positive after real-time PCR amplification of the intracellular growth loci gene (iglC) specific for F. noatunensis subspecies orientalis. Consequently, multiple novel host species for this pathogen were identified, including the French grunt (Haemulon flavolineatum) and the Caesar grunt (Haemulon carbonarium).

Histological and dermatoscopic description of sphynx cat skin.

BACKGROUND: Histological and hair coat abnormalities of the alopecic sphynx cat have not been described in detail. The hairless allele (hr) in sphynx cats represents a mutation in the gene for keratin 71, a protein expressed in the inner root sheath of humans and mice. HYPOTHESIS/OBJECTIVES: To describe the histological and dermatoscopic abnormalities of sphynx cat skin. ANIMALS: Skin biopsies were collected from 14 sphynx cats and five cats with normal coats. Dermatoscopic examinations were performed on 11 sphynx cats and six additional control cats. METHODS: Vertical and horizontal sections of skin biopsy samples from sphynx and control cats were reviewed. Dermatoscopic images were compared between sphynx and control cats. RESULTS: Sphynx cat hair follicles were often small, curved and kinked and demonstrated infundibular hyperkeratosis and dilatation. Changes in the inner root sheath of sphynx cats included a poorly defined Henle's layer in addition to vacuolar-like changes and eosinophilic globules in Huxley's layer. Dermal papillae in sphynx cat anagen bulbs lacked the normal flame shape and were surrounded by epithelial cells arranged in a disorderly manner. The degree of follicular abnormalities varied between follicles. Follicular density was similar for both sphynx cats and control animals. Sphynx cat hair shafts were misshapen, smaller in diameter and rarely medullated. Dermatoscopy revealed similar hair coat density in sphynx and control cats. CONCLUSIONS AND CLINICAL IMPORTANCE: Sphynx cats demonstrated hair follicle dysplasia, with abnormal shaft production but without a decrease in follicle quantity. Abnormalities in sphynx cat follicles are similar to those in murine KRT71 mutants and suggest abnormal hair shaft keratinization.

Nutrition assessment and management in advanced liver disease.

Malnutrition commonly complicates the course of patients with cirrhosis and has a multifactorial etiology. Despite the important role that nutrition plays in the prognosis of those with cirrhosis, the nutrition assessment process can be challenging in this setting. A number of tools are available to aid in the nutrition assessment of the cirrhotic patient; however, none are without limitations. Although the assessment process can be difficult, the ability to properly manage the nutrient needs of the patient presents an additional set of challenges because of the catabolic nature of the disease process and common occurrence of anorexia and other symptoms leading to poor oral intake. In this review, the nutrition assessment tools and general guidelines for nutrition management in patients with advanced liver disease are discussed to promote recognition of the nutrition issues affecting this patient population and lead to their improved survival and reduced morbidity.

Queensland's proposed surrogacy legislation: an opportunity for national reform.

Surrogacy has existed since Biblical times when Hagar, the maidservant of the infertile Sarah, acted as a surrogate to bear Sarah and her husband, Abraham, a son. Despite the longevity of the practice of surrogacy, modern society has been reluctant to embrace surrogacy arrangements due to the ethical and sometimes practical debates they spark. This reluctance is evidenced by the general lack of legislative support for surrogacy arrangements in Australia and worldwide. In 2009 it was announced that Queensland will decriminalise altruistic surrogacy. While this decision is a step towards bringing Queensland in line with other Australian jurisdictions, it also has the potential to open up a Pandora's Box of legal and ethical issues. This article provides a snapshot of the anticipated new Queensland surrogacy legislation together with a brief overview of the regulation of surrogacy in all Australian jurisdictions. Recommendations are made as to whether there is a need for further reform of surrogacy regulation in certain Australian jurisdictions and if so, whether the proposed Queensland legislation constitutes an appropriate model on which to base such reform.

Photo screening around the world: Lions Club International Foundation experience.

PURPOSE: To describe the use of photoscreening for preschool vision screening in several diverse locations throughout the world. METHODS: The MTI photo screener was used to screen pre-verbal children; photographs were interpreted using standard criteria. RESULTS: The Tennessee vision screening program remains successful, screening over 200,000 children during the past 8 years. Similar programs modeled across the United States have screened an additional 500,000 children. A pilot demonstration project in Hong Kong, Beijing, and Brazil screened over 5000 additional children with good success and appropriately low referral rates. CONCLUSION: Photoscreening can be an appropriate technique for widespread vision screening of preschool children throughout the world.

User participation in mental health nurse decision-making: a co-operative enquiry.

AIM: This paper is a report of a study to encourage participants to work together to identify strategies for increasing user participation in clinical decisions and to evaluate the value of co-operative inquiry as a vehicle for supporting learning in practice. BACKGROUND: Service user participation in the clinical practice decisions of mental health nurses is considered essential for good practice. Methods need to be found which enable opportunities for shared learning, facilitate practice development and empower service users. METHOD: A co-operative inquiry design engaged all participants (n = 17) as co-researchers and involved repeated cycles of action and reflection, using multiple data collection methods. The research was conducted over a two year period in 2004-2005, with mental health nursing students collaborating with service users. FINDINGS: Factors inhibiting participation included stigmatizing and paternalistic approaches, where clinical judgments were made solely on the basis of diagnosis. Enhancing factors were a respectful culture which recognized users ''expertise' and communicated belief in individual potential. Inquiry benefits included insight into service users' perspectives, enhanced confidence in decision-making, appreciation of power issues in helping relationships and deconstruction of decision-making within a safe learning environment. CONCLUSION: Learning from novel approaches which enable nursing students to develop their reflective and reflexive ability is essential to avoid practice which disempowers and potentially harms service users' recovery. Co-operative inquiry is a valuable vehicle for developing professional practice in higher education and practice environments.

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.