Restoration of marine ecosystems: Understanding possible futures for optimal outcomes.

Accelerating declines in the extent, quality and functioning of the world's marine ecosystems have generated an upsurge in focus on practical solutions, with ecosystem restoration becoming an increasingly attractive mitigation strategy for systems as diverse as coral reefs, mangroves and tidal flats. While restoration is popular because it promises positive outcomes and a return to something approaching unimpacted condition and functioning, it involves substantial public and private investment, both for the initial restoration activity and for on-going maintenance of the restored asset. This investment often affords one big chance to get things right before irretrievable damage is done. As a result, precise, well considered and accountable decision-making is needed to determine the specific focus for restoration, the scale of restoration, the location for deploying restoration activities, and indeed whether or not restoration is necessary or even possible. We explore the environmental/ecological considerations and constraints governing optimal decisions about the nature, location and prioritisation of restoration activities in marine ecosystems, and in particular the constraints on achieving understanding of possible futures and the likelihood of achieving them. We conclude that action must be informed by a context-specific understanding of the historical situation, the current situation, the constraints on change, the range of potential outcome scenarios, and the potential futures envisioned.

Combined effects of aerobiological pollutants, chemical pollutants and meteorological conditions on asthma admissions and A & E attendances in Derbyshire UK, 1993-96.

BACKGROUND: The effect of outdoor aeroallergen exposure in asthma may be enhanced by air pollutants, including ozone, nitrogen dioxide and particulates, and by certain weather conditions. It is not yet established whether these interactions are important in determining asthma morbidity at the population level. OBJECTIVE: We have investigated the joint effects of aeroallergens, rainfall, thunderstorms and outdoor air pollutants on daily asthma admissions and Accident and Emergency (A & E) attendance using routinely collected data between 1993 and 1996 from Derby in central England. METHODS: Daily counts during the aeroallergen season of grass and birch pollen, basidiospores, Didymella, Alternaria and Cladosporium, maximum 1 hour ozone and nitrogen dioxide and daily average black smoke measurements, all made in the vicinity of the city centre, were categorized in tertiles. Rainfall was classified as dry, light ( 2 mm). The modifying effect of outdoor pollutant levels, and rainfall or the occurrence of a thunderstorm, upon the effects of individual aeroallergens on asthma admissions and A & E attendance were investigated by fitting appropriate interactions in log linear autoregression models with adjustment for potential confounders. RESULTS: We found a significant interaction between the effects of grass pollen and weather conditions upon A & E attendance, such that the increase with grass pollen count was most marked on days of light rainfall (adjusted rate ratio for >/= 50 vs < 10 grains/m3 at lag 2 days = 2.1, 95% CI 1.4, 3.3). Asthma admissions increased with Cladosporium count. We found no statistically significant interactions between effects of any individual aeroallergen and outdoor air pollutant upon either measure of asthma morbidity. CONCLUSIONS: Rainfall and thunderstorms are important effect modifiers in the relation between grass pollen and measures of acute asthma morbidity. Interactions between ambient levels of aeroallergens and chemical pollutants in the Derby area do not play a major role in determining asthma admissions and A & E attendance.

An assessment of sources of information in post-perinatal infant death reviews.

The objective of this study was to identify adverse social and medical factors contributory to post-perinatal deaths and at which stage of the case study each factor was found. The sources of information assessed were: (i) recorded data from case notes, laboratory and postmortem findings, and (ii) created information from (a) home interview and (b) case discussion held in the family doctor's office. The deaths were categorized into seven clinicopathological groups and adverse factors into general demographic and personal psychosocial. Among the 87 sequential post-perinatal infant deaths, 325 adverse factors were identified; of these, 125 (38%) were judged to be actionable by the carers. Of 183 (56%) adverse factors found in the case notes, only 36 were actionable. Forty-five more adverse factors were found at home interview; 26 (58%) of these were actionable. At case discussion another 97 adverse factors were revealed; 63 (65%) were actionable, thus proving the most important source of actionable information.

Jarman index related to post-perinatal mortality.

Post-perinatal infant deaths in North and Southern Derbyshire District Health Authorities were calculated by electoral ward over a period of two years and related to Jarman scores of deprivation. The deaths were categorised into clinical-pathological groupings after full confidential enquiry. The post-perinatal death rates were significantly related to Jarman score of deprivation.

Differences in postperinatal infant deaths between north and southern Derbyshire.

In depth confidential inquiries on all post-perinatal infant deaths were carried out for two years in North and Southern Derbyshire District Health Authorities in order to explore why the postperinatal death rates and cot death rates have been consistently higher in Southern than in North Derbyshire. It was found that the death rates for probably inevitable deaths and for 'idiopathic' cot deaths were the same in both districts. The differences in the death rates lay in the group of partly explained cot deaths. Adverse social factors associated with each death were recorded and an estimate made of their relevance to the individual deaths. The group of deaths most amenable to intervention was those of category B (partly explained cot deaths). As judged by the Jarman index there are more areas of deprivation in Southern than in North Derbyshire.

Child abuse and cot deaths.

A search was made of the Child Protection Register for children with siblings who died of SIDS. The Child Health Department in Southern Derbyshire Health Authority (population 522,000; 7,100 births per year) undertakes confidential inquiries into all child deaths and registered SIDS deaths are noted. This study looked at all children born between January 1, 1984 and June 30, 1988 whose names appeared on the Child Protection Register as victims of abuse or who were considered to be at risk for abuse. From a cohort of 288 children on the Child Protection Register, one in 30 of the children on the Register had a sibling whose death was registered as caused by SIDS. In Southern Derbyshire there is an association between child abuse and about 10% of deaths of children diagnosed as SIDS.

The crystal structure of 2 beta,4 beta-cyclo-5 alpha-androstane-3 alpha,17 beta-diol diacetate.

An X-ray crystal structure determination was performed on 2 beta,4 beta-cyclo-5 alpha- and rostane-3 alpha,17 beta-diol diacetate. The parent diol, but not its 3 beta-epimer, had been shown to be an effective inhibitor of a 3 beta-hydroxysteroid dehydrogenase.

Autoimmune haemolytic anaemia with the unusual combination of both IgM and IgG autoantibodies.

Two patients with autoimmune haemolytic anaemia of no obvious aetiology are presented. Both cases had IgM autoantibodies which were cold agglutinins with anti-I specificity and were complement binding. Both cases also had IgG autoantibodies which were incomplete, of wide thermal range and also had anti-I specificity, but were not complement binding. The red cells of both patients were coated with C4/C3d and IgG.

Warm IgM anti-IT causing autoimmune haemolytic anaemia.

A patient with autoimmune haemolytic anaemia due to an autoagglutinin of anti-IT specificity is reported. The antibody was of the IgM class and bound complement; unexpectedly, it reacted optimally at 37 degrees C. A prozone was noted when testing serial dilutions of the patient's serum against appropriate red cells in saline, but was not found when testing an eluate prepared from the patient's red cells. Investigations suggested that the prozone was due to a blocking antibody of high molecular weight, which appeared to be specific for I and IT.

Unusual delayed haemolytic transfusion reaction characterised by slow destruction of red cells.

In a delayed haemolytic transfusion reaction due to an apparently typical complement-binding IgG anti-Jka, it was possible to show that transfused Jk (a+b+) cells were destroyed progressively over a period of about 3 weeks. The slow destruction may have been due partly to the fact that the patient had been splenectomised.

Optimal conditions for the use of sulphydryl compounds in dissociating red cell antibodies.

Optimal conditions for the use of 2-mercaptoethanol (2-ME) and dithiothreitol (DTT) in the inactivation of IgM red cell antibodies were investigated. 0.2 M 2-ME was better than 0.01 M DTT; higher concentrations of these 2 substances could not conveniently be used because of gel formation. Incubation at 37 degrees C led to far more rapid inactivation than incubation at 22 degrees C; with 2-ME a period of 15 min at 37 degrees C was sufficient except with very potent antibodies, which were not inactivated even after 3 h incubation. When indirect antiglobulin tests were carried out on 2-ME-treated serum which had not been dialysed, false-positive results were obtained, although only with the mixture of equal volumes of undiluted serum and of 2-ME; results were negative in tests on dilutions of the mixture in saline. False-positive results could also be avoided by incubating the serum for 3 h with iodoacetamide, but this method also involves dilution of the serum. The only method whereby 2-ME-treated serum can be tested without diluting it and without obtaining false-positive reactions is to dialyse it overnight against saline. Since this method also gets rid of the noxious smell of 2-ME it is to be preferred for most purposes.