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Summary: Background: Risk benefit strategies in managing inflammatory bowel diseases (IBD) are dependent upon understanding the risks of uncontrolled inflammation vs those of treatments. Malignancy and mortality in IBD have been associated with disease‐related inflammation and immune suppression, but data are limited due to their rare occurrence. Aim: To identify and describe the most common causes of mortality, types of cancer and previous or current therapy among children and young adults with paediatric‐onset IBD. Methods: Information on paediatric‐onset IBD patients diagnosed with malignancy or mortality was prospectively collected via a survey in 25 countries over a 42‐month period. Patients were included if death or malignancy occurred after IBD diagnosis but before the age of 26 years. Results: In total, 60 patients were identified including 43 malignancies and 26 fatal cases (9 due to cancer). Main causes of fatality were malignancies (n = 9), IBD or IBD‐therapy related nonmalignant causes (n = 10; including 5 infections), and suicides (n = 3). Three cases, all fatal, of hepatosplenic T‐cell lymphoma were identified, all were biologic‐naïve but thiopurine‐exposed. No other haematological malignancies were fatal. The 6 other fatal cancer cases included 3 colorectal adenocarcinomas and 3 cholangiocarcinomas (CCAs). Primary sclerosing cholangitis (PSC) was present in 5 (56%) fatal cancers (1 colorectal carcinoma, 3 CCAs and 1 hepatosplenic T‐cell lymphoma). Conclusions: We report the largest number of paediatric‐onset IBD patients with cancer and/or fatal outcomes to date. Malignancies followed by infections were the major causes of mortality. We identified PSC as a significant risk factor for cancer‐associated mortality. Disease‐related adenocarcinomas were a commoner cause of death than lymphomas. [ABSTRACT FROM AUTHOR]

River flooding is a serious hazard in the UK with interest driven by recent widespread events. This paper reviews different approaches to flood risk management and the borders (physical, conceptual and organisational) that are involved. The paper showcases a multi-method approach to negotiating flood risk management interventions. We address three fundamental issues around flood risk management: differences and similarities between a variety of approaches; how different approaches work across borders between professionals, lay people, organisations and between different planning regimes; and, whether the science evidence base is adequate to support different types of flood risk management. We explore these issues through a case study on the River Tweed using Q methodology, community mapping and focus groups, participatory GIS, and interviews, which enabled co-production of knowledge around possible interventions to manage flooding. Our research demonstrated that excellent networks of practice exist to make decisions about flood risk management in the Scottish-English borders. Physical and organisational borders were continually traversed in practice. There was an overwhelming desire from professional flood managers and local communities for an alternative to simply structural methods of flood management. People were keen to make use of the ability of catchments to store water, even if land needed to be sacrificed to do so. There was no difference in the desire to embrace natural flood management approaches between people with different roles in flood management, expertise, training or based in different locations. Thus conceptual borders were also crossed effectively in practice. [ABSTRACT FROM AUTHOR]

Catchment management in the developed world is undergoing a fundamental reconfiguration in which top-down governance is being challenged by local organisations promoting collaborative decisionmaking. Local, participation-based organisations are emerging as mediators of relations between governments and publics. These organisations, defined here as participatory catchment organisations ( PCOs), are emergent at a time when developed world catchment management is itself undergoing substantial change. Through in-depth engagement with four PCOs, and using six case studies, we identify the principles associated with successful problem resolution. The findings illustrate the importance of PCOs as two-way bridges between publics and governments. We identify three principles shared by these organisations (i.e. trust brokers, collaborative decisionmaking and win-wins) that show how, through participatory approaches founded on trust, complex problems can be resolved in ways that do not unduly punish groups or individuals. In conclusion, we identify four questions that highlight the need to consider the practicality of evolving relations amongst governments, publics, and the organisations that have come to mediate catchment management. [ABSTRACT FROM AUTHOR]

In this article, the authors discuss ecosystem services and international water law. They discuss the linkages between land and water management through integrated water resource management (IWRM). They also discuss the report "Economics of Ecosystem and Biodiversity" that highlights that politicians are ignoring the value of ecosystems to economies and society by failing to take proper account of wildlife and the natural environment.

Background, Adalimumab is efficacious therapy for adults with Crohn’s disease (CD). Aim, To summarise the United Kingdom and Republic of Ireland paediatric adalimumab experience. Methods, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) members with Inflammatory Bowel Disease (IBD) patients <18 years old commencing adalimumab with at least 4 weeks follow-up. Patient demographics and details of treatment were then collected. Response and remission was assessed using the Paediatric Crohn’s Disease Activity Index (PCDAI)⁄ Physicians Global Assessment (PGA). Results, Seventy-two patients [70 CD, 1 ulcerative colitis (UC), 1 IBD unclassified (IBDU)] from 19 paediatric centres received adalimumab at a median age f 14.8 (IQR 3.1, range 6.1–17.8) years; 66 ⁄ 70 CD (94%) had previously received infliximab. A dose of 80 mg then 40 mg was used for induction in 41(59%) and 40 mg fortnightly for maintenance in 61 (90%). Remission rates were 24%, 58% and 41% at 1, 6 and 12 months, respectively. Overall 43 (61%) went into remission at some point, with 24 (35%) requiring escalation of therapy. Remission rates were higher in those on concomitant immunosuppression cf. those not on immunosuppression [34 ⁄ 46 (74%) vs. 9 ⁄ 24 (37%), respectively, (v28.8, P = 0.003)]. There were 15 adverse events (21%) including four (6%) serious adverse events with two sepsis related deaths in patients who were also on immunosuppression and home parenteral nutrition (3% mortality rate). Conclusions, Adalimumab is useful in treatment of refractory paediatric patients with are emission rate of 61%. This treatment benefit should be balanced against side effects, including in this study a 3% mortality rate. [ABSTRACT FROM AUTHOR]

This study tested the hypothesis (H1) that surf swimming involves a quantifiable experience component. Sixty-five beach lifeguards with (n=35) and without surf experience (n=30) completed: a best effort 200-m swim in a 25-m pool, a calm and a surf sea; an anthropometric survey; maximum effort 30-s swim bench test; 50-m pool swim (25m underwater). In both groups, time to swim 200 m was slower in calm seas than in the pool and slower in surf than in either calm seas or the pool (p <0.05). Calm sea swim times of the two groups did not differ significantly, but the no experience group was, on average (Sp-pooled variance), 49 s (62) slower on the 200-m swim in the surf conditions (p< 0.05). A stepwise regression identified surf experience as a predictor of surf swim time (R2 = 0.32, p <0.01). It is concluded that there is a significant and quantifiable (18%) experience factor in surf swimming. This limits the usefulness of pool swim times and other land-based tests as predictors of surf swimming performance. The hypothesis (H1) is accepted. [ABSTRACT FROM AUTHOR]

Lead poisoning of waterfowl through the ingestion of spent gunshot and discarded anglers' weights continues to be a problem worldwide. We took blood samples from 363 whooper swans Cygnus cygnus at wintering sites in Britain and Ireland and at moulting sites in Iceland during 2001–2005, and analysed them for total blood lead. Lead levels were generally low in swans in Iceland; 6% of samples exceeded 1.21 μmol L−1, the level indicative of elevated lead and above background levels. The proportion of swans with elevated lead was much higher in the wintering range, varying between 43 and 70% at three sites monitored over the winters 2003/2004–2005/2006, and with blood lead levels ranging up to 19.6 μmol L−1. The highest levels were in samples taken from swans in Scotland, with a mean value of 3.0 μmol L−1, but nevertheless they indicated a marked decrease compared with blood lead levels measured for whooper swans at the same site 20 years ago. There also appeared to be a significant long-term decrease in the proportion of swans with elevated blood lead in Iceland, from 60% of birds in 1984 to 8% in 2005, although this may be due to the birds being caught in different parts of Iceland. The most likely source of elevated lead in whooper swans is spent gunshot. Management measures to reduce the impact of lead in the environment on the birds are discussed. [ABSTRACT FROM AUTHOR]

In the 1970s several reports highlighted the long delay in diagnosis often experienced by children with Crohn's disease. In recent years this disorder has attracted much publicity, and many believe that the incidence has increased substantially. The aim of this investigation was to determine whether heightened awareness had shortened the interval to diagnosis, improved clinical management and reduced morbidity. A retrospective study was therefore carried out on 112 children with inflammatory bowel disease (64 Crohn's disease, 41 ulcerative colitis, 7 indeterminate colitis) referred to a paediatric gastroenterology department in the UK between 1994 and 1998. In Crohn's disease the median interval to diagnosis was 47 wk (maximum 7 y). In those without diarrhoea this was longer (66 vs 28 wk; p = 0.005). In ulcerative colitis the median interval was 20 wk (maximum 3 y). Even in severe colitis the median interval was 5.5 wk (range 3-9 wk) and 4 required urgent colectomy soon after referral. Many with unrecognized Crohn's disease had undergone inappropriate treatments, such as growth hormone or psychiatric therapy. Nineteen (17%) had undergone endoscopic investigations in adult units prior to referral. Malnutrition was equally common in Crohn's disease and ulcerative colitis (11%). Short stature was present in 19% with Crohn's disease, and 5% with ulcerative colitis, and was severe in 8% with Crohn's disease. There was a significant correlation between symptom duration and the degree of growth impairment present (r [sub s] =-0.4; p = 0.004) Conclusion: This study suggests that late diagnosis and inappropriate investigation and management are still significant problems. [ABSTRACT FROM AUTHOR]

Unlabelled: Congenital hypopituitarism is a recognized cause of neonatal hepatitis, but the diagnosis may be difficult to establish even if clinically suspected. In order to determine the natural history of this disorder, the outcome of 12 infants with neonatal hepatitis secondary to hypopituitarism is reviewed. The clinical diagnosis of hypopituitarism was established on a combination of features, which include dysmorphism (4 infants), optic nerve hypoplasia (8 infants), micropenis (5 male infants) and recurrent hypoglycaemia (blood glucose < 2.4 mmol/l (8 infants)). Endocrine investigation revealed low free thyroxine (T4) levels (< 10 pmol/l), with normal thyroid stimulating hormone (TSH) levels (0.4-4.5 mU/l) (11 infants), and serum cortisol levels which were inappropriately low (< 200 nmol/l). In 9 of 12 infants, liver disease resolved within 6 wk following treatment with thyroxine, hydrocortisone and, where appropriate, growth hormone, including Cases 9 and 1 in whom diagnosis and treatment were delayed until 3 mo and 3 y of age, respectively. Liver disease resolved spontaneously in two infants prior to starting hormone replacement therapy (Cases 11, 12), and one male infant (Case 10), in whom the diagnosis and hormone replacement therapy were delayed until 5 y of age, developed cirrhosis and portal hypertension and later underwent liver transplantation.Conclusion: The diagnosis of hypopituitarism should always be considered in infants with unexplained neonatal hepatitis. Delay in diagnosis and appropriate treatment was associated with persistently abnormal liver function tests and may lead to irreversible liver disease. [ABSTRACT FROM AUTHOR]

(1) Fenitrothion, an organophosphorus insecticide, has been used i.n Scotland to control outbreaks of pine beauty moth. (Panolis flammea D. & S.) in lodgepole pine (Pinus contorta Loud.) plantations. Fenitrothion is applied, at 300 g ha -1 from helicopters using ultra-low-volume techniques. This study (1982-84) investigated the effects of spraying on five species of passerine birds in two 70 ha. plots, which were compared with two neighbouring unsprayed plots. (2) Annual changes in breeding-bird populations. as measured by Common Bird Census techniques, were not affected by fenitrothion. (3) Changes in the numbers of singing birds from 5 days before until 5 days after spraying were either not significantly different or were inconsistent between sprayed and unsprayed plots. (4) There were no differences in coal tits (Pants ater L.) breeding i.n nestboxes between sprayed and unsprayed plots, nor in the proportion of broods hatched, or fledged, clutch size, or brood size at hatching or fledging. (5) Residues of fenitrothion were detected in two coal tit nestlings found dead within 4 days after spraying, but not in six others found 10-46 days! later. (6) Regression analyses of nestling growth in weight, wing and tarsus measurements did not reveal significant effects of spraying, although a non-significant trend for slower growth resulting in a lower final weight was indicated for nestlings in sprayed plots. (7) Visiting rates! by parent coal tits to their nests and the diets of their nestlings were examined using camera nestboxes. The differences between nests in unsprayed and sprayed areas were complex and could have been caused by factors other than spraying. [ABSTRACT FROM AUTHOR]

This study provides an assessment of Cormorant occupancy and impact at stillwater game fisheries in England and Wales, during 1988/1989 to 1992/1993. A total of 167 waterbodies operated as 'put-and-take' trout fisheries was included within a questionnaire survey, and this provided the bulk of the data used in the analyses. The results show that Cormorants are widespread at inland stillwater game fisheries in England and Wales throughout the year, with higher densities present during October--March. Peak counts by fishery managers at 45 of the fisheries increased by about 20% per year, regardless of season. Site use by Cormorants is investigated and the results imply that large, low altitude sites that are close to rivers in southern England are more likely to be used by these birds. The survey revealed that Cormorants are widely perceived by fishery managers to be responsible for significant economic losses through consumption and/or injury of stock fish. While this may be justified locally, we found no overall relationship between Cormorant density and anglers' catches of Rainbow Trout, the principal stock fish. [ABSTRACT FROM AUTHOR]