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Background Women diagnosed with substance use disorders (SUDs) have higher rates of major medical conditions compared to women without SUDs. Cervical cancer is the second leading cause of cancer death in women aged 20–39 years worldwide and women with SUDs have an increased risk of cervical cancer compared to women without SUD. The National Drug Treatment Centre (NDTC) cervical screening programme, derived from the national CervicalCheck programme, offers free cervical screening to patients attending for treatment of SUDs. Aims This study aimed to audit adherence to the NDTC Cervical Screening guidelines before and after the implementation of an awareness-raising educational intervention. Methods The electronic clinical records of women aged between 25 and 60 years attending the lead consultant’s (M.S.) outpatient clinic were reviewed for documentary evidence indicating that information about the cervical screening programme had been discussed. This was completed before and one month after the implementation of an awareness-raising educational intervention. Results All women (n = 46, mean age 36.3 (SD = 6.5) years) had an opioid use disorder; 85% had a benzodiazepine use disorder, and 24% had an alcohol use disorder. Of these, 80% had at least one chronic medical condition, 76% had a psychiatric disorder, and 59% were homeless. Adherence to the NDTC cervical screening guideline, as indicated by documentary evidence in clinical records, was 33% (14/43) at baseline, and rose to 88% (36/41) (p < 0.0001) one month after the intervention. Conclusions This completed audit cycle shows that an awareness-raising educational intervention can significantly improve adherence to a cervical screening programme in women with SUDs.

Depression is the leading contributor to the burden of disease worldwide. Stigma and negative attitudes to depression can act as barriers to treatment and to social inclusion. Understanding attitudes to depression and treatment has implications for individual outcomes and societal mental health.To explore public attitudes to, and management of depression, including lifestyle factors, medication, and psychotherapy.A nationally representative online population survey of Irish adults was conducted by RED C.Nine hundred ninety-one people completed the survey. The majority thought that depression was a medical illness (90%), was different to sadness or stress (89%), and that awareness of depression was increasing (89%), while stigma was reducing (69%). Self-reported lifetime depression rates were high and were significantly higher in younger people (18-34 yrs) (63% vs 55%, p = 0.017), and in urban areas (60% vs 44%, p 0.0001). Younger people were less likely to contact their GP (46% vs 61%, p = 0.034) and reported more stigma around antidepressants (ADTs) compared to older people ( 55 years) (74% vs 58%, p 0.0001). There were negative attitudes to ADTs and a preference for talking therapies and lifestyle changes. Males were more likely to hold negative attitudes to ADTs.Stigma around depression is reducing and public awareness is improving. However, the very high self-reported lifetime rates of depression may reflect milder forms or emotional/psychological distress, rather than clinical depression. Negative attitudes and stigma towards ADTs remains high. A collaborative, sustained effort is required to advance public appreciation of mood and its management, across the severity spectrum, in tandem with destigmatising the targeted use of ADTs.

Context Green infrastructure may improve water quality and mitigate flooding in forest-urban watersheds, but reliably quantifying all benefits is challenging because most land cover maps depend on moderate- to low-resolution data. Complex and spatially heterogeneous landscapes that typify forest-urban watersheds are not fully represented with these types of data. Hence important questions concerning how green infrastructure influences water quality and quantity at different spatial scales remain unanswered. Objectives Demonstrate the feasibility of creating novel high-resolution land cover maps across entire watersheds and highlight deficiencies of standard land cover products. Methods We used object-based image analysis (OBIA) to create high-resolution (0.5 m) land cover maps and detect tree canopy overlapping impervious surfaces for a representative forest-urban watershed in Duluth, MN, USA. Unbiased estimates of accuracy and area were calculated and compared with similar metrics for the 30-m National Land Cover Database (NLCD). Results Mapping accuracies for the high-resolution land cover and canopy overlap maps were ~90 %. Error-adjusted estimates of area indicated that impervious surfaces comprised ~21 % of the watershed, tree canopy overlapped ~10 % of impervious surfaces, and that three high-resolution land cover classes differed significantly from similar NLCD classes. Conclusions OBIA can efficiently generate high-resolution land cover products of entire watersheds that are appropriate for research and inclusion in the decision-making process of managers. Metrics derived from these products will likely differ from standard land cover maps and may produce new insights, especially when considering the unprecedented opportunity to evaluate fine-scale spatial heterogeneity across watersheds.

We used carbon and nitrogen stable isotope ratios to identify changes in organic matter (OM) sources supporting fish larvae along the river–lake mixing zone in three Lake Superior coastal tributaries. We used a stable isotope mixing model to quantify how the number and origin of OM sources supporting fish larvae changed with respect to the relative fraction of tributary and lake water along the coastal mixing zone. Fish stable isotope ratios, after adjusting for trophic fractionation, generally were intermediate between the measured OM sources, indicating widespread nutritional support from multiple OM sources. Mixing model results indicated that more OM sources supported fish larvae in river and mixed regions than in the lake; however, the number of OM sources did not change linearly with respect to tributary water fraction. Contributions from allochthonous OM were highest in the mixed and lake regions; most fish larvae obtained some energy from food sources originating outside the region where the fish larvae were collected. At the species level, principal component analysis revealed that the number of OM sources was positively correlated with percent terrestrial OM contribution and greatest in demersal fish larvae that were captured in the mixed region. Our findings demonstrate that these coastal habitats do function as a “mosaic”, wherein proximal and some more distal habitats and ecosystems contribute to fish growth during a critical life stage. By extension, the findings suggest the need for conservation measures to consider upland, wetland, and coastal habitat, whether or not fish directly occupy all of those habitats.

There is growing interest in applying δ15N in biota as an indicator of anthropogenic nutrient inputs to coastal environments because changes in δ15N correlate to inputs of land-based nutrients. In complex coastal receiving waters, however, land-use effects on biota δ15N may be masked by local hydrologic processes, especially exchange with coastal waters of different geochemical character. We examined δ15N differences among larval fish, a novel biotic indicator, in coastal receiving waters at both among and within watershed scales. Our goal was to characterize how hydrologic processes within coastal river mouths and embayments mediate the effect of land-based N sources on larval fish δ15N. We sampled three Lake Superior river-embayment systems from watersheds that span a large population density gradient. Over all stations, mean fish δ15N ranged from 2.7 ‰ to 10.8 ‰. Within each system, we found a different pattern in δ15N across the river–lake transition zone. Correlations between fish δ15N and water quality, particularly NH 4 + and total nitrogen, were highly significant and corresponded to known differences in sewage waste water inputs. A multivariate model that included both watershed-based population density and NH 4 + was found to provide the best fit to the δ15N data among a series of multi- and univariate candidate models. These results demonstrate that: (1) fish larvae δ15N responded at within watershed scales, and (2) within coastal receiving waters, fish larvae δ15N was related to waste water inputs at the watershed scale; however, expression at specific locations within a coastal system was strongly influenced by local hydrologic processes.

Our goal in the development of a nearshore monitoring method has been to evaluate and refine an in situ mapping approach to assess the nearshore waters across the Great Lakes. The report here for Lake Huron is part of a broader effort being conducted across all five Great Lakes. We conducted an intensive survey for the United States nearshore of Lake Huron along a continuous shoreline transect (523 km) from Port Huron, Michigan, to Detour Passage. A depth contour of 20 m was towed with a conductivity-temperature depth profiler, fluorometer, transmissometer, and laser optical plankton counter. Multiple cross-contour tows (10-30 m) on the cruise dates were used to characterize the variability across a broader range of the nearshore. The cross-contour tows were comparable with the alongshore contour indicating that the 20-m contour does a good job of representing the nearshore region (10-30 m). Strong correlations were observed between water quality and spatially associated watershed land use. A repeat tow separated by several weeks investigated temporal variability in spatial patterns within a summer season. Strong correlations were observed across each variable for the temporal repeat across broad- and fine-scale spatial dimensions. The survey results for Lake Huron nearshore are briefly compared with a similar nearshore survey in Lake Superior. The biomass concentrations of lower food web components of Lake Huron were notably approximately 54-59 % of those in Lake Superior. The towed instrumentation survey supported the recent view of a change in Lake Huron to an ultra-oligotrophic state, which has been uncharacteristic in recent history.

We characterized stable isotope mixing along a river-Great Lake transition zone in the St. Louis River, an important fish nursery inwestern LakeSuperior, and useditto identify food web linkages supporting young fish production. We observed a broad, spatial pattern in the carbon stable isotope ratio (δ 13 C); downriver enrichment in particulate organic carbon and aquatic vegetation δ 13 C, as well as pelagic, benthic and littoral invertebrate δ 13 C, reflected isotope mixing along the river-lake transition zone. Fishes with similarly enriched δ 13 C were used to identify bentho- pelagic and littoral trophic pathways. River and Lake Superior organic matter (OM) sources contributed to both pathways. Differences between the δ 13 C in fishes and invertebrate prey revealed that fish production was supported at multiple spatial scales. The result was that the food web specific to any location along the transition zone incorporat- ed multiple OM sources from across the watershed.

Despite the recognized importance of wetlands as habitat for fishes and the growing need to assess and manage human impacts on that habitat, there is little information on patterns and variability of habitat within Great Lakes coastal wetlands. Our goal was to describe wetland aquatic habitat patterns and the natural factors that organize them as a step towards developing habitat assessment schemes and identifying experimental design elements for future synoptic surveys. We analyzed data on aquatic vegetation structure, water chemistry, and water movement (inferred from gypsum plug dissolution) in relation to hydrology and morphology in inundated segments of ten relatively un-impacted coastal marshes of western Lake Superior. Spatial differences in aquatic habitat within wetlands were as large or larger than differences among wetlands, and habitat patterns were strongly associated with morphology and hydrology. Back-bay segments tended to have greater vegetation cover and structural complexity and lower levels of water movement, and they were prone to high water temperatures and low dissolved oxygen levels in wetlands having little seiche activity. Increasing seiche inputs tended to homogenize habitat elements among wetland segments, while increasing tributary inputs tended to increase spatial variability. Patterns in emergent vegetation differed from patterns in submerged/floating vegetation, and different assessment metrics may be needed for different plant zones. Segment-scale sampling schemes like those used in this study have the potential to elucidate habitat patterns within inundated portions of wetlands with a reasonable level of effort. Human impacts on coastal wetland fish habitat must be interpreted in the context of natural spatial heterogeneity as structured by wetland morphology and magnitude of seiche and tributary inputs.

Most Great River ecosystems (GREs) are extensively modified and are not receiving adequate protection to prevent further habitat degradation and loss of biotic integrity. In the United States, ecological monitoring and assessment of GREs has lagged behind streams and estuaries, and the management of GREs is hampered by the lack of unbiased data at appropriate spatial scales. Properties of GREs that make them challenging to monitor and assess include difficult sample logistics and high habitat diversity. The U.S. Environmental Protection Agency's Environmental Monitoring and Assessment Program (EMAP) has developed a comprehensive, regional-scale, survey-based monitoring approach to assessment of streams and estuaries, but has not yet conducted research on applying these tools to GRE monitoring. In this paper we present an overview of an EMAP research project on the Upper Missouri River (UMR). We summarize the assessment objectives for the study, the design for selecting sample locations, the indicators measured at these sites and the tools used to analyze data. We present an example of the type of statements that can be made with EMAP monitoring data. With modification, the set of methodologies developed by EMAP may be well suited for assessment of GREs in general.

Understanding the relationship between human disturbance and ecological response is essential to the process of indicator development. For large-scale observational studies, sites should be selected across gradients of anthropogenic stress, but such gradients are often unknown for a population of sites prior to site selection. Stress data available from public sources can be used in a geographic information system (GIS) to partially characterize environmental conditions for large geographic areas without visiting the sites. We divided the U.S. Great Lakes coastal region into 762 units consisting of a shoreline reach and drainage-shed and then summarized over 200 environmental variables in seven categories for the units using a GIS. Redundancy within the categories of environmental variables was reduced using principal components analysis. Environmental strata were generated from cluster analysis using principal component scores as input. To protect against site selection bias, sites were selected in random order from clusters. The site selection process allowed us to exclude sites that were inaccessible and was shown to successfully distribute sites across the range of environmental variation in our GIS data. This design has broad applicability when the goal is to develop ecological indicators using observational data from large-scale surveys.

An optical plankton counter (OPC) potentially provides an assessment tool for zooplankton condition in ecosystems that is rapid, economical, and spatially extensive. We collected zooplankton data with an OPC in 20 near-shore regions of 4 of the Laurentian Great Lakes. The zooplankton size information was used to compute mean size, biomass density, and size-spectra parameters for each location. The resulting metrics were analyzed for their ability to discriminate among the Great Lakes. Biomass density provided discrimination among lakes, as did several parameters describing spectra shape and distribution. A proposed zooplankton indicator, mean size (determined with OPC measurements in this study), was found to provide discrimination among lakes. Size-spectra-related parameters added increased ability to discriminate in conjunction with the biomass density (or mean size) metric. A discriminant function analysis of the multiple metrics (mean size, biomass density, and distribution parameters) suggests that a multi metric size-based approach might be used to classify communities among lakes improving a mean-size metric. The feasibility OPCs and size-based metrics for zooplankton assessment was found to have potential for further development as assessment tools for the biological condition of zooplankton communities in the Great Lakes.

This article summarizes the views of aquatic scientists who gathered to assess the ability of stream ecosystem theory to predict recovery from disturbance. Two views of disturbance were evident: a discrete removal of organisms vs an unusual deviation from normal. These were perceived as applying to different scales and/or objectives. Long-term information is required from both points of view to define recovery. Recovery also may be defined in different ways, but it is clear that recovery has both spatial and temporal components, and includes both physical and biological processes. Consensus was very strong that a major role (and challenge) for theory lies in the understanding of spatial aspects, temporal scales, coupling of physics and biology, and the interaction of these features in recovery processes. Some progress is evident in the articles of this volume, but among the topics identified as critical for further theoretical contributions were: homogeneous vs heterogeneous distribution of disturbance, local extent of disturbance relative to a regional context, critical vs noncritical patches (size and location) of disturbance at different spatial scales and temporal frequencies, delineation of reversible and nonreversible processes, and physical and biological constraints on the time frame for recovery. Such concepts need attention across different types of lotic ecosystems. Thus, there was strong consensus that a national monitoring system of representative lotic ecosystems within ecological regions be established. The purpose of this monitoring system would be to acquire long-term data on natural variability, to establish viable indicators of spatial and temporal aspects of recovery, and to develop and test emerging theoretical developments.

Assessment of ecological changes relative to disturbance, either natural or human-induced, confronts a fundamental problem. Ecosystems are complex, variable, and diverse in nature; consequently, the need for simplification to essential features that would characterize ecosystems adequately is generally acknowledged. Yet there is no firm prescription for what to measure in order to describe the response and recovery of ecosystems to stress. Initial focus is provided by identifying relevant ecological endpoints, i.e., ecological changes of particular relevance to humans. Furthermore, we suggest generic purposes and criteria to be considered in making choices of ecological indicators that relate to those endpoints. Suites of indicators, with variety of purposes, are required to assess response and recovery of most ecosystems and most stresses. We suggest that measures of certain ecosystem processes may provide special insight on the early stages of recovery; the use of functional indicators as complimentary to other biotic indicators is highlighted in an extended example for lotic ecosystems.

Sediment denitrification is a microbial process that converts dissolved inorganic nitrogen in sediment porewaters to N2 gas, which is subsequently lost to the atmosphere. In coastal waters, it represents a potentially important loss pathway for fixed nitrogen which might otherwise be available to primary producers. Currently, data are lacking to adequately assess the role of denitrification in reducing or remediating the effects of large anthropogenic nitrogen loads to the coastal zone. This study describes the results of 88 individual measurements of denitrification (as a direct flux of N2 gas) in sediment cores taken over a 3-yr period (1991–1994) from six stations in Boston Harbor, nine stations in Massachusetts Bay, and two stations in Cape Cod Bay. The dataset is unique in its extensive spatial and temporal coverage and includes the first direct measurements of denitrification for North Atlantic shelf sediments. Results showed that rates of denitrification were significantly higher in Boston Harbor (mean=54, range

This paper summarizes evidence that most of the considerable nitrogen loading (∼8, 470 mmol total N m−2 yr−1) to Boston Harbor (Massachusetts, USA) is expelled to shallow shelf waters of Massachusetts Bay, where it strongly influences ecological dynamics. Examination of nitrogen concentrations in the harbor, compared with loading, indicated that removal processes are active in the harbor. Comparison to other estuarine systems showed that the harbor’s nitrogen concentrations are consistent with its loading, if they are corrected for tidal flushing effects on the water residence time. Furthermore, extensive measurements of sediment denitrification confirmed that rates of N2 gas loss are high in an absolute sense (∼600–800 mmol N m−2 yr−1) but nonetheless remove only a small portion (

Flow-through seagrass core microcosms were used to examine responses of species and processes to a logarithmic gradient of dosing with14C-labeled tributyltin-chloride (TBT-CI). Experiments involved delivery of TBT-CI to the water column of replicate cores of a treatment (n=16) once per week; one-half of the cores were sacrificed after 3 wk of dosing, the others were dosed for 6 wk. Initial water column concentrations for the three treatments averaged 0.205, 2.23, and 22.21 μg I−1, expressed as the TBT+ cation, but these concentrations dropped rapidly. Retained14C tracer, an estimate of total organotin species, was distributed to sediments, plants, and other biological tissues, all of whose tracer concentrations increased with time. Measures to indicate responses of both autotrophic and heterotrophic organisms were made; in general, treatment effects were demonstrable statistically only at the highest dose level. Accumulation of chlorophyll and biomass on glass slides was highest when suspended for the entire experiment in the water of the highest treatment; this unexpected result was perhaps an indirect effect related to reduced grazing activity in the microcosms. The highest dose of TBT-CI resulted in virtual population mortality of a few macrobenthic species and decreased loss of plant material in litter bags, both demonstrated within the first 3 wk of dosing. Reduced litter loss was coincident with mortality of an amphipod (Cymadusa compta) capable of shredding plant material, and a causal relation between the two effects is plausible. Thus, if concentrated to similar levels in aThalassia bed, TBT+ may have direct species-level effects and process-level effects, potentially causing ecosystem change via disruption of a species-process linkage influential in seagrass detrital food web dynamics.

Potential effects of oil drilling fluid discharges uponThalassia seagrass ecosystems were examined using seagrass core microcosms. Observed experimental effects, summarized in this article, included changes in both autotrophic (Thalassia and epiphyte) and heterotrophic (dominant benthic macroinvertebrates) species, and the processes of primary productivity and decomposition. The physical disturbance related to greater turbidity and sedimentation caused some effects, while others seemed a direct response to the toxic constituents of drilling fluids. Using these experimental results and the case ofThalassia and drilling fluids as a case study, we explore general methodological and philosophical issues for ecotoxicology and, furthermore, focus upon the challenge of providing a scientific basis for judging acceptability of environmental changes likely to ensue from human activities.