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Literature review identified seven principal pathways of plastic debris entry into river systems: waste water treatment plants; combined sewer overflows; on-site wastewater treatment systems; road and rail transport systems; agriculture; industrial sources; and diffuse litter. A further category of 'microplastics' reflects their multiple potential sources, including microplastic breakdown within rivers. Regulatory and management bodies necessarily make operational decisions based on resource limitations and significant uncertainty due to sparse or missing data, requiring a substantial degree of inference. To support this need, we develop a rapid, desk-based approach based on risk criteria to 'fingerprint' likely pathways of plastic pollution based on catchment characteristics. Characteristics of the River Wye system in the UK are reviewed identifying a risk-based 'fingerprint' of potential pathways of plastic entry or accumulation of plastic debris, represented graphically as a colour-coded 'traffic lights' classification. This 'fingerprinting' approach is based on desk-based inference from published materials as a rapid and resource-efficient alternative to intensive data collection, supporting prioritization of further investigation or response measures. We recommend replication of this 'fingerprinting' approach in other river catchments to support operational management of plastic pollution. Where feasible, it may also be down-scaled where sub-catchment or major river reach properties differ significantly. HIGHLIGHTS Unique catchment characteristics influence likely sources of plastics in rivers Seven potential plastic sources were identified, with a residual microplastics category Literature, interviews and surveys can rapidly 'fingerprint' likely plastic sources Fingerprinting can prioritize management and investigations in specific catchments [ABSTRACT FROM AUTHOR]

Native fish species provide significant ecosystem services, including as food (provisioning services), as organisms with specific cultural and spiritual importance (cultural services), and contributions to supporting and regulatory services across the Indian Himalayan biodiversity hotspot. Fisheries in the Himalayan midhills and foothills, including in the Shivalik Hills and parts of the Terai (between the lower Himalayan foothills and the plains), provide livelihood security and cultural values for millions of people. Multiple anthropogenic stressors compounded by climate change have significantly depleted native fish populations over recent decades. Literature survey, focus group discussions and semi-structured interviews reveal that the decrease in native fish species undermines freshwater-dependent livelihood security in the region with 'knock-on' impacts on downstream ecosystem functions and services. Better understanding of the current distribution, habitat requirement and dispersal of native fish species important from a local perspective is essential to manage the growing threats to livelihoods in the Indian Himalayan region. [ABSTRACT FROM AUTHOR]

Hybridization of 'green' and engineered infrastructure, informed by protecting or restoring catchment processes, can resolve interconnected demands on catchment ecosystems, potentially also reversing historic degradation of socio-ecological systems. Pressures are acute in water-scarce, developing regions with episodic rainfall, exacerbated by historic presumptions favouring engineered management. Comparing conditions, histories and emerging approaches in contrasting regions – the Central Plateau of Burkina Faso, Rajasthan State (India) and Ayacucho Region (Peru) – reveals similar yet distinct approaches reflecting different starting regimes. Transferrable learning about hybridizing localized, nature-based solutions and engineered technology informs the necessary transition towards a sustainable approach in these and other regions. [ABSTRACT FROM AUTHOR]

Locally nuanced community-based shallow groundwater management interventions have proven important in saline and sodic monsoonal regions. A mixed methods approach characterizes achievement of regeneration of the formerly degraded socio-ecological system of Laporiya village in the semi-arid Salt Lake region of Rajasthan state (India), with a focus on locally adapted chauka systems. Local people are key participants and agents as well as principal beneficiaries of innovative nature-based management interventions. Technological innovations and governance are adapted to environmental processes and local livelihood priorities, resisting imposed engineered solutions. Findings are transferrable to dryland areas facing similar challenges of declining water and livelihood security. [ABSTRACT FROM AUTHOR]

Anthropogenic activities impose major threats to global biodiversity, compounded by changing climatic variables. Freshwater ecosystems are amongst the most vulnerable habitats, integrating multiple pressures across catchment landscapes. Introduction of non-native fish species exerts multiple direct and indirect impacts on native species and the ecosystems of which they are part, with further impacts on the socio-economic wellbeing of communities. Field studies and an in-depth literature survey have recorded 15 non-native freshwater fish species from the Indian Himalaya. Three of these species (common carp, brown trout and rainbow trout, all highly invasive fish species globally) were documented from multiple locations between 2010 and 2017, raising environmental concern among scientists. In the wake of changing climatic variables and a range of linked population, land use and river impoundment and conversion pressures across the Indian Himalaya, there is an urgent need to understand the behaviour of these non-native fish species and identify factors which provide them an ecological advantage over native fish species. This can support a case for cessation of stocking with alien species. Further collection of long-term field data, integrative quantitative models, public awareness and education programmes could greatly assist in addressing these knowledge gaps and identification of effective control measures. [ABSTRACT FROM AUTHOR]

Rivers and their catchments support multiple human needs, necessitating integrated management of land and water resources. Agricultural land use, specifically the impacts of riparian cattle trampling, potentially significantly contributes to damage to river systems. This study addresses a knowledge gap stemming from the paucity of prior research correlating generation of pollutants with cattle activity locally and in 'real time'. Turbidity, soluble reactive phosphorus and faecal coliforms were analysed at upstream control and downstream impact sites correlated with cattle activity over a 65 m river margin throughout a two-month summer period. Riparian cattle trampling impacted water quality, specifically turbidity and faecal coliform levels. Average turbidity increased by more than 90% between upstream and downstream sites during cattle activity, whilst average faecal coliform counts almost doubled. Findings for phosphorus concentrations were less conclusive, perhaps due to filtration of suspended sediment-bound phosphorus prior to analysis. Illustrative cost--benefit assessment of potential buffer zone installation to exclude cattle from the river margin at the study site, based on values transferred from a relevant published study, found that investment in a buffer zone would achieve a benefit-to-cost ratio of approximately 38:1 with a distribution of broad societal benefits to the farmer, local people and wider publics. [ABSTRACT FROM AUTHOR]

The concept of sustainable development evolved from growing awareness of the interdependence of social and economic progress with the limits of the supporting natural environment, becoming progressively integrated into global agreements and transposition into local regulatory and implementation frameworks. We argue that transposition of the concept into regulation and supporting tools reduced the focus to minimal environmental and social standards, perceived as imposing constraints rather than opportunities for innovation to meet human needs. The aspirational ‘half’ of the concept of sustainable development specifically addressing human needs was thus lost in transposing high ideals into regulatory instruments. The Sustainable Development Goals (SDGs) restore focus on interlinked human needs, stimulating innovation of products and processes to satisfy them. Through three case studies – PVC water pipes, river quality management in England, and UK local air quality management – we explore the current operationalisation of the concept in diverse settings, using the SDG framework to highlight the broader societal purposes central to sustainable development. Partnerships involving civil society support evolution of regulatory instruments and their implementation, optimising social and ecological benefits thereby serving more human needs. Restoring the visionary ‘lost half’ of sustainable development – meeting human needs in sustainable ways – creates incentives for innovation and partnership; an innovation framework rather than a perceived constraint. [ABSTRACT FROM AUTHOR]

Much of the developing world and areas of the developed world suffer water vulnerability. Engineering solutions enable technically efficient extraction and diversion of water towards areas of demand but, without rebalancing resource regeneration, can generate multiple adverse ecological and human consequences. The Banas River, Rajasthan (India), has been extensively developed for water diversion, particularly from the Bisalpur Dam from which water is appropriated by powerful urban constituencies dispossessing local people. Coincidentally, abandonment of traditional management, including groundwater recharge practices, is leading to increasingly receding and contaminated groundwater. This creates linked vulnerabilities for rural communities, irrigation schemes, urban users, dependent ecosystems and the multiple ecosystem services that they provide, compounded by climate change and population growth. This paper addresses vulnerabilities created by fragmented policy measures between rural development, urban and irrigation water supply and downstream consequences for people and wildlife. Perpetuating narrowly technocentric approaches to resource exploitation is likely only to compound emerging problems. Alternatively, restoration or innovation of groundwater recharge practices, particularly in the upper catchment, can represent a proven, ecosystem-based approach to resource regeneration with linked beneficial socio-ecological benefits. Hybridising an ecosystem-based approach with engineered methods can simultaneously increase the security of rural livelihoods, piped urban and irrigation supplies, and the vitality of river ecosystems and their services to beneficiaries. A renewed policy focus on local-scale water recharge practices balancing water extraction technologies is consistent with emerging Rajasthani policies, particularly Jal Swavlamban Abhiyan (‘water self-reliance mission’). Policy reform emphasising recharge can contribute to water security and yield socio-economic outcomes through a systemic understanding of how the water system functions, and by connecting goals and budgets across multiple, currently fragmented policy areas. The underpinning principles of this necessary paradigm shift are proven and have wider geographic relevance, though context-specific research is required to underpin robust policy and practical implementation. [ABSTRACT FROM AUTHOR]

One of the keys to high quality paediatric asthma management is the provision of age appropriate information regarding the disease and its management. In order to determine whether the generation of a minimum dataset of information which can be translated into a wide range of languages might be used to assist children and their parents around the world, we undertook a survey of national Member Societies of the World Allergy Organization (WAO) to determine what educational material on asthma for children and their families already exists. A questionnaire was developed using Survey Monkey and distributed in 2014 to 263 representatives of the WAO member Societies from 95 countries. Thirty-three replies were received from thirty-one countries. The survey highlighted a considerable disparity in availability of material among the responding countries, with some countries reporting that information was freely available in hard copy and online and others reporting a lack of suitable material locally. The results highlight the need to develop a core set of simple, clear and consistent age appropriate information that can be easily translated and delivered in a cultural and educationally effective format. [ABSTRACT FROM AUTHOR]

Fluvial geomorphological forms and processes exert a fundamental influence on riverine processes and functions. They thereby contribute significantly to beneficial services for humanity, yet remain largely undervalued. Major ecosystem service studies to date tend to overlook the contribution of geodiversity and geomorphological processes, particularly of fluvial geomorphology, to human well-being. Yet, management of the water environment which overlooks fundamental driving processes, such as those encompassed by fluvial geomorphology, is inherently unsustainable. Inferences from the literature highlight a broad range of contributions of fluvial processes and forms to the four ecosystem service categories of the Millennium Ecosystem Assessment, contributing to system functioning, resilience and human well-being. Fluvial geomorphologists can help society better address sustainability challenges by raising the profile of fluvial forms and processes to continuing human well-being and system resilience. To achieve this, we identify three challenges: (1) cross-disciplinary collaboration, addressing interrelations between biodiversity and geodiversity as well as broader scientific disciplines; (2) quantification to an appropriate level and, where possible, mapping of service generation and benefit realization; and (3) persuasive demonstration projects emphasizing how investment in this aspect of the natural environment can enhance service provision and net human benefits. We explore lessons learnt from case studies on river rehabilitation, floodplain management, and mapping ecosystem services. We contend that linking fluvial geomorphology to societal well-being outcomes via the language of ecosystem services provides a pathway towards social and economic recognition of relevance, influencing policy-makers about their importance and facilitating their ‘mainstreaming’ into decision-making processes. We also advance a prototype conceptual model, guiding fluvial geomorphologists better to articulate the contribution to a sustainable flow of services through better characterization of: (1) interactions between anthropogenic pressures and geomorphology; (2) how forms and processes contribute to ecosystem services; and (3) guidance on better management reflecting implications for service provision. [ABSTRACT FROM PUBLISHER]

Aim Acute bronchiolitis is the commonest cause for hospitalisation in infancy. Supportive care remains the cornerstone of current management and no other therapy has been shown to influence the course of the disease. It has been suggested that adding nebulised hypertonic saline to usual care may shorten the duration of hospitalisation. To determine whether hypertonic saline does have beneficial effects we undertook an open, multi-centre parallel-group, pragmatic RCT in ten UK hospitals. Methods Infants admitted to hospital with a clinical diagnosis of acute bronchiolitis and requiring oxygen therapy were randomised to receive usual care alone or nebulised 3% hypertonic saline (HS) administered 6-hourly. Randomisation was within 4 h of admission. The primary outcome was time to being assessed as 'fit' for discharge with secondary outcomes including time to discharge, incidence of adverse events together with follow up to 28 days assessing patient centred health related outcomes. Results A total of 317 infants were recruited to the study. 158 infants were randomised to HS (141 analysed) and 159 to standard care (149 analysed). There was no difference between the two arms in time to being declared fit for discharge (hazard ratio: 0-95, 95% CI: 0.75-1.20) nor to actual discharge (hazard ratio: 0.97, 95% CI: 0.76-1.23). There was no difference in adverse events. One infant in the HS group developed bradycardia with desaturation. Conclusion This study does not support the use of nebulised HS in the treatment of acute bronchiolitis over usual care with minimal handlings. [ABSTRACT FROM AUTHOR]

Adherence to inhaled steroids is suboptimal in many children with asthma and can lead to poor disease control. Many previous studies in paediatric populations have used subjective and inaccurate adherence measurements, reducing their validity. Adherence studies now often use objective electronic monitoring, which can give us an accurate indication of the extent of non-adherence in children with asthma. A review of the studies using electronic adherence monitoring shows that half of them report mean adherence rates of 50% or below, and the majority report rates below 75%. Reasons for non-adherence are both intentional and non-intentional, incorporating illness perceptions, medication beliefs and practical adherence barriers. Interventions to improve adherence in the paediatric population have had limited success, with the most effective containing both educational and behavioural aspects. [ABSTRACT FROM AUTHOR]

The water cycle is a contiguous system interconnected with human activities. Management has tended to be fragmented across anthropocentrically defined disciplines, potentially generating unintended negative consequences. The ecosystem approach and the ecosystem services framework emphasise interlinked, albeit often overlooked, benefits that the natural environment provides for people. This enables recognition and avoidance of potential 'negative externalities', identification of solutions optimising benefits across multiple services, and participation of wider constituencies of stakeholders. Systemic, outcome-based approaches are inherently economically efficient, yielding greater cumulative benefits for lower transaction costs by working with natural processes. The ecosystem approach establishes geographical and socio-economic contexts for management ecosystem service outcomes, providing a broader context in which to nest established water resource management methods. The ecosystem approach can also be applied at different scales and to diverse societal activities, internalising into them the value of natural processes. It is amenable to integration into catchment-scale considerations, yet does not present these activities as subsidiary to river basin planning. The addition of ecosystem services for options appraisal in pre-existing decision-support tools adapts them to better address multi-benefit goals. Shifts are required in the policy and economic environment, but engineers have an important role in promoting, applying and innovating multi-benefit solutions. [ABSTRACT FROM AUTHOR]

Background: The Easyhaler® (EH) device-metered dry powder inhaler containing budesonide and formoterol is being developed for asthma and chronic obstructive pulmonary disease (COPD). As a part of product optimization, a series of in vitro and in vivo studies on flow rate dependency were carried out. Methods: Inspiratory flow parameters via EH and Symbicort® Turbuhaler® (TH) inhalers were evaluated in 187 patients with asthma and COPD. The 10th, 50th, and 90th percentile flow rates achieved by patients were utilized to study in vitro flow rate dependency of budesonide/formoterol EH and Symbicort TH. In addition, an exploratory pharmacokinetic study on pulmonary deposition of active substances for budesonide/formoterol EH in healthy volunteers was performed. Results: Mean inspiratory flow rates through EH were 64 and 56 L/min in asthmatics and COPD patients, and through TH 79 and 72 L/min, respectively. Children with asthma had marginally lower PIF values than the adults. The inspiratory volumes were similar in all groups between the inhalers. Using weighted 10th, 50th, and 90th percentile flows the in vitro delivered doses (DDs) and fine particle doses (FPDs) for EH were rather independent of flow as 98% of the median flow DDs and 89%-93% of FPDs were delivered already at 10th percentile air flow. Using±15% limits, EH and TH had similar flow rate dependency profiles between 10th and 90th percentile flows. The pharmacokinetic study with budesonide/formoterol EH in healthy subjects ( n=16) revealed a trend for a flow-dependent increase in lung deposition for both budesonide and formoterol. Conclusions: Comparable in vitro flow rate dependency between budesonide/formoterol EH and Symbicort TH was found using the range of clinically relevant flow rates. The results of the pharmacokinetic study were in accordance with the in vitro results showing only a trend of flow rate-dependant increase in lung deposition of active substances with EH. [ABSTRACT FROM AUTHOR]

Abstract: The environmental and financial costs of inputs to, and unintended consequences arising from narrow consideration of outputs from, water and environmental management technologies highlight the need for low-input solutions that optimise outcomes across multiple ecosystem services. Case studies examining the inputs and outputs associated with several ecosystem-based water and environmental management technologies reveal a range from those that differ little from conventional electro-mechanical engineering techniques through methods, such as integrated constructed wetlands (ICWs), designed explicitly as low-input systems optimising ecosystem service outcomes. All techniques present opportunities for further optimisation of outputs, and hence for greater cumulative public value. We define ‘systemic solutions’ as “…low-input technologies using natural processes to optimise benefits across the spectrum of ecosystem services and their beneficiaries”. They contribute to sustainable development by averting unintended negative impacts and optimising benefits to all ecosystem service beneficiaries, increasing net economic value. Legacy legislation addressing issues in a fragmented way, associated ‘ring-fenced’ budgets and established management assumptions represent obstacles to implementing ‘systemic solutions’. However, flexible implementation of legacy regulations recognising their primary purpose, rather than slavish adherence to detailed sub-clauses, may achieve greater overall public benefit through optimisation of outcomes across ecosystem services. Systemic solutions are not a panacea if applied merely as ‘downstream’ fixes, but are part of, and a means to accelerate, broader culture change towards more sustainable practice. This necessarily entails connecting a wider network of interests in the formulation and design of mutually-beneficial systemic solutions, including for example spatial planners, engineers, regulators, managers, farming and other businesses, and researchers working on ways to quantify and optimise delivery of ecosystem services. [Copyright &y& Elsevier]

Chronic cough is common in the paediatric population, yet the true prevalence of this condition remains difficult to define. Protracted bacterial bronchitis (PBB) is a disease caused by the chronic infection of the conducting airways. In many children the condition appears to be secondary to impaired mucociliary clearance that creates a niche for bacteria to become established, probably in the form of biofilms. In others, immunodeficiencies, which may be subtle, appear to be a factor. PBB causes persistent coughing and disturbed sleep, and affects exercise tolerance, causing significant levels of morbidity. PBB has remained largely unrecognised and is often misdiagnosed as asthma. [ABSTRACT FROM AUTHOR]

Many thousands of articles relating to asthma appear in medical and scientific journals each year, yet there is still no consensus as to how the condition should be defined. Some argue that the condition does not exist as an entity and that the term should be discarded. The key feature that distinguishes it from other respiratory diseases is that airway smooth muscles, which normally vary little in length, have lost their stable configuration and shorten excessively in response to a wide range of stimuli. The lungs' and airways' limited repertoire of responses results in patients with very different pathologies experiencing very similar symptoms and signs. In the absence of objective verification of airway smooth muscle (ASM) lability, over and underdiagnosis are all too common. Allergic inflammation can exacerbate symptoms but given that worldwide most asthmatics are not atopic, these are two discrete conditions. Comorbidities are common and are often responsible for symptoms attributed to asthma. Common amongst these are a chronic bacterial dysbiosis and dysfunctional breathing. For progress to be made in areas of therapy, diagnosis, monitoring and prevention, it is essential that a diagnosis of asthma is confirmed by objective tests and that all co-morbidities are accurately detailed. [ABSTRACT FROM AUTHOR]

Catchments constitute logical units for management of the water cycle. Patterns of development uninformed by sustainability concerns have degraded catchment integrity and associated ecosystem functions, imposing largely unquantified costs. Ecosystem functions are central to sustainable social and economic progress; their protection or restoration may be the only sustainable form of investment in catchments. Despite growing use of catchment functions in some policy areas, a shortfall in awareness and pragmatic tools limits progress with policies and practical tools to support sustainable development in catchments, perpetuating damaging practices. This paper reviews methods of economic valuation of riverine systems. Valuation of ecosystem functions is revealed as particularly pertinent to sustainable development, as an indicator of the benefits of ecological processes to social and economic progress. A range of practical projects, targeted at restoration of riverine habitat in the UK with the intent of improving both river ecology and the social and economic advantages that flow from it, is also reviewed. Emerging principles and themes are discussed in terms of their potential contribution to policies and practices that promote sustainability. Review of these projects highlights the importance of planning at adequately broad scales—spatial, temporal and disciplinary—to identify integrated solutions, and to maximise community ‘buy-in’ and total benefits. In several cases, economic analyses demonstrate strongly positive benefit–cost ratios stemming from habitat improvement. However, major reform of regulatory and economic instruments is needed to promote sustainable catchment development, since prevalent ‘perverse’ incentives continue to degrade ecosystem functions. Measures to recognise and reward ecosystem service as legitimate outputs from agricultural land use constitute a particular priority. There is a need simultaneously to address both ‘big picture’ structural adjustments and locally-appropriate solutions, from which clear local benefits flow. Pragmatic measures that contribute to systemic outcomes must also be attractive to local decision-makers and land managers, and yield benefits that ensure they are sustained once intervention ceases. Cost need not be a barrier, as current environmentally-damaging subsidies may instead be redirected towards sensitive land use and/or measures to protect biodiversity and ecosystem functioning, particularly where targeted upon habitat of disproportionate importance to functioning of catchments as whole systems. Internalisation of the costs of damage to ecosystem functioning will promote valuation of the natural capital of catchments as a primary resource for social and economic progress. [Copyright &y& Elsevier]

Delivering aerosolised drugs to infants poses a number of challenges. It is clear that drug delivery is possible via the inhaled route but to date it has been difficult to demonstrate clearly therapeutic benefit from the use of any conventional therapy in the vast majority of infants. This is probably related to the nature of pulmonary disease in this age group. While most aerosol scientists focus on factors such as aerosol size and airways geometry drug delivery, as in all age groups, is most dependent upon patient behaviour. A small amount of drug reaches the lungs of distressed infants. Consideration of patient device interactions is vital if successful drug delivery is to be achieved and this includes consideration of mask design. Doses reaching the lungs are generally very low when considered in terms of the nominal dose but when considered in terms of dose delivered per kilogram body weight drug delivery to the lungs is generally similar to or greater than in adults. Upper airways deposition is relatively greater than in older subjects, in large part because of nasal breathing, and this will affect the ‘therapeutic index’ of some drugs. [Copyright &y& Elsevier]

The rate of technological improvement continues to accelerate. Regulators in every field dealing with consumer products continue to set ever higher standards to protect consumers from adverse events and use 'recalls' to remove products that prove to be harmful from the market. In the field of medical products in general the issues of 'human factors' and 'usability' are now, quite rightly, a major issue at least among regulators in the USA. The elephant in the inhaled therapy room is of course the continued use of obsolete, portable inhalers which few patients can use effectively for the treatment of asthma. Countless studies have demonstrated that the inability of patients to use these devices effectively is a major factor in perpetuating unnecessarily high levels of morbidity. They fail to meet basic usability standards and do not incorporate the facility to provide feedback to patient and clinician. More than 20 years ago regulators deemed that pressurised metered dose inhalers containing chlorofluorocarbons should be removed from the market on environmental grounds even though their use accounted for less than 0.5% of chlorofluorocarbon use. Surely asthmatic patients require the same level of protection. Unfortunately regulators appear determined to fossilise the field in a 19500s time warp by ensuring that the failings of obsolete technology are perpetuated in any 'generic' device. The time has come for regulators to meet their obligations to 'protect the public health by assuring the safety, effectiveness, and security of drugs, vaccines and other biological products, medical devices....' and mandate the phasing out of these antiquated devices within the next decade in order to reduce the unacceptably high burden of preventable morbidity and death associated with their use. [ABSTRACT FROM AUTHOR]

Bhojtal, a large man-made lake bordering the city of Bhopal (Madhya Pradesh state, central India), is important for the city's water supply, connoted the lifeline of the city. Despite the dry though not arid and markedly seasonal climate, soil impermeability hampers infiltration into the complex geology underlying the Bhojtal catchment. Rural communities in the catchment are nonetheless high dependent on underlying aquifers. This paper develops baseline understanding of trends in the ecology, water quality and uses of Bhojtal, discussing their implications for the long-term wellbeing of the Bhopal city region. It highlights increasing dependency on water diverted from out-of-catchment sources, and also abstraction across the Bhojtal catchment in excess of replenishment that is depressing groundwater and contributing to reported declining lake level and water quality. Despite some nature-based management initiatives, evidence suggests little progress in haltering on-going groundwater depression and declines in lake water level and quality. Significant declines in ecosystem services produced by Bhojtal are likely without intervention, a major concern given the high dependency of people in the Bhopal region on Bhojtal for their water supply and socio-economic and cultural wellbeing. Over-reliance on appropriation of water from increasingly remote sources is currently compensating for lack of attention to measures protecting or regenerating local resources that may provide greater resilience and regional self-sufficiency. Improved knowledge of catchment hydrogeology on a highly localised scale could improve the targeting and efficiency of water harvesting and other management interventions in the Bhojtal catchment, and their appropriate hybridisation with engineered solutions, protecting the catchment from unintended impacts of water extraction or increasing its carrying capacity, and also providing resilience to rising population and climate change. Ecosystem service assessment provides useful insights into the breadth of benefits of improved management of Bhojtal and its catchment. NBS in Bhopal GRAPHIC (ME 2020-02-28). Unlabelled Image • Bhojtal contributes significantly to Bhopal's water supply, but is degrading. • Despite adequate rainfall, soil impermeability and complex geology hamper recharge. • Increasing abstraction across the Bhojtal catchment is depressing groundwater. • Declines in ecosystem services are likely without appropriate interventions. • Localised knowledge of hydrogeology can optimise catchment management interventions. [ABSTRACT FROM AUTHOR]

• Alien invasive eucalyptus trees consume more water than native neem trees in India. • Replacing eucalypts with neem may make a substantial contribution to water security. • Multiple ecosystem service benefits may also stem from replacement neem trees. • There is a case for integrating alien tree management into water security policy. • Biodiversity benefits were unquantifiable due to paucity of published information. Arid and semi-arid regions of central India receive scarce and episodic precipitation during the short monsoon season, and also experience substantial evaporation. Traditional and innovative water harvesting and governance practices improve water stewardship, or abate some impacts of intensive mechanised water extraction. However, significant numbers of alien trees, in particular Eucalyptus species with high water demands, populate some regions practicing progressive water stewardship. The water demands of these trees can potentially undermine efforts to achieve water security. Through interviews with community leaders in Indian villages with differing eucalyptus tree densities, water loss through evapotranspiration compared with livelihood demands was approximated. Literature review of the water demands and ecosystem services provided respectively by alien eucalypts and native, culturally valued neem trees supports assessment of the likely benefits and acceptability of a replacement programme favouring native trees. Although data limitations mean that the findings of this study are necessarily uncertain, they nonetheless illustrate the likely scale of impact, substantiating the case for alien tree management as an important contribution to water security. Alien vegetation management practices as a contribution to water security are already firmly established in South Africa, and are likely to yield equivalent benefits if translated to dryland India. [ABSTRACT FROM AUTHOR]

Abstract The aim of this study was to provide a simple, cost-effective, risk-based map of terrestrial areas in Ireland where environmental quality may be at risk from atmospheric ammonia. This risk-based approach identifies Natura 2000 sites in Ireland at risk from agricultural atmospheric ammonia, collating best available data using Geographical Information Systems (GIS). In mapping ammonia risk on sensitive habitats (MARSH), the method identifies sources of ammonia, classifying them on a scale of risk from 0 to 5. These sources are subsequently summed based on a weighting determined by their contribution to national emissions divided by their potentially impacted area. A Pearson's correlation coefficient of 0.72 allows for concentrations from United Kingdom's FRAME modelling to be applied to the MARSH model, which are corrected based on recent monitoring. Applying Designation Weighted Indicators (DWI), the MARSH model predicts that 80.7, 34.3 and 5.9% of Natura 2000 sites in Ireland may exceed ambient concentrations of 1, 2, and 3 μg/m3, respectively. A Nitroindex map of Ireland based on available lichen records was also developed and is presented as part of this study. This Nitroindex was used to identify areas where impacts have already been recorded, thus informing the classification of sites "at-risk". The combination of both the MARSH and Nitroindex models ascertains which Natura 2000 sites are most at risk, thereby providing valuable data to relevant authorities. The MARSH model acts as a first step towards screening and assessing Natura 2000 sites most at risk from atmospheric ammonia, providing a tool to demonstrate compliance with the National Emissions Ceilings Directive. Graphical abstract Unlabelled Image Highlights • A GIS risk-based approach gauges atmospheric NH 3 impacts in Ireland • Integrates best available agricultural data to identify "at-risk" areas in Ireland • Provides stakeholders with an atmospheric ammonia risk map for Ireland • 80.7% of Natura 2000 sites likely to exceed critical level of 1 μg/m3 • 5.9% of Natura 2000 sites likely to exceed critical level of 3 μg/m3 [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) causes annual epidemics of infections affecting the whole population. In vitro, it has been shown to infect and persist in human dendritic cells (DCs) for prolonged periods. Initially persistence is associated with low levels of replication before the virus becomes dormant. Reactivation of viral replication can be triggered many months later. Infection of DCs is likely to influence the host's ability to generate effective long-term memory responses. A well-established animal was utilized to confirm that RSV both infects and persists in pulmonary DCs in vivo. Mice were infected with a modified strain of RSV expressing red fluorescent protein (RSV-RFP) when replicating. Clinical symptoms of infection were monitored using weight change and inflammatory cell counts from bronchoalveolar lavage, which correlated with the RSV viral titer (quantitative polymerase chain reaction). Lung tissues were collected at 3, 5, 7, and 21 days postinfection (dpi) to assess leukocyte populations by flow cytometry. Clinical symptoms and RSV viral load peaked at 5 dpi. RSV-RFP was most prevalent in macrophages at 3 dpi and also observed in B cells and DCs. At 21 dpi, RSV-RFP remained evident in a subset of conventional DCs (CD103+CD11b+) even though both clinical symptoms and pulmonary inflammation had resolved. These results confirm that in this well-established mouse model, RSV persists in lung conventional DCs following resolution of the acute infection. Further work is required to explore whether the virus continues with low-level replication before becoming dormant in vivo, as has been described in vitro. [ABSTRACT FROM AUTHOR]

Focuses on the respiratory syncytial virus (RSV). RSV as a cause of bronchiolitis and other forms of lower respiratory tract infection in infancy; Reference to a study by Renato Stein et al in this issue; Role of RSV in the induction of atopic asthma.

Opinion. Considers how, despite the considerable morbidity associated with acute bronchiolitis, therapy has remained essentially unaltered for more than 30 years. Reference to study in the same issue by Roosevelt et al on the use of steroids to treat acute bronchiolitis, despite the lack of evidence to support their use; Results of various studies on treatments for acute bronchiolitis; Lack of an effective respiratory syncytial virus (RSV) vaccine.

Background: Persistent bacterial bronchitis (PBB) seems to be under-recognised and often misdiagnosed as asthma. In the absence of published data relating to the management and outcomes in this patient group, a review of the outcomes of patients with PBB attending a paediatric respiratory clinic was undertaken. Methods: A retrospective chart review was undertaken of 81 patients in whom a diagnosis of PBB had been made. Diagnosis was based on the standard criterion of a persistent, wet cough for >1 month that resolves with appropriate antibiotic treatment. Results: The most common reason for referral was a persistent cough or difficult asthma. In most of the patients, symptoms started before the age of 2 years, and had been present for >1 year in 59% of patients. At referral, 59% of patients were receiving asthma treatment and 11% antibiotics. Haemophilus inuluenzae and Streptococcus pneumoniae were the most commonly isolated organisms. Over half of the patients were completely symptom free after two courses of antibiotics. Only 13% of patients required ⩾6 courses of antibiotics. Conclusion: PBB is often misdiagnosed as asthma, although the two conditions may coexist. In addition to eliminating a persistent cough, treatment may also prevent progression to bronchiectasis. Further research relating to both diagnosis and treatment is urgently required. [ABSTRACT FROM AUTHOR]

With growing global demand for food, the agriculture sector worldwide is under pressure to intensify and expand, risking acceleration of existing negative biodiversity impacts. Agriculture is the dominant source of ammonia (NH 3) emissions, which can impact biodiversity directly through dry deposition as NH 3 and by wet deposition following conversion to ammonium (NH 4) in the atmosphere. Nitrogen deposition is one of the leading causes of global decline in biodiversity alongside changing land use and climate. Natura 2000 sites which are intended to protect important habitats and species across Europe, require strict levels of protection to ensure designated features achieve favourable conservation status. Many of these sites are nitrogen-limited, and/or contain sensitive species such as lichens or mosses. This project carried out ambient NH 3 monitoring on selected Irish Natura 2000 sites, in order to establish potential impacts from agricultural NH 3. Monitoring on twelve Natura 2000 sites observed concentrations ranging from 0.47 to 4.59 μg NH 3 m−3, from which dry deposition was calculated to be 1.22–11.92 kg N ha−1 yr−1. European Monitoring and Evaluation Programme (EMEP) was used to quantify wet deposited NH 4 and nitrogen oxides (NOx), in addition to dry deposited NOx on monitored sites. Estimated total nitrogen deposition ranged between 5.93 and 17.78 kg N ha−1 yr−1. On average across all monitored sites, deposition was comprised of 50.4%, 31.7%, 7.5%, and 10.3% dry NH 3 , wet NH 4 , dry NOx and wet NOx respectively. Implications for Irish agriculture are discussed in the light of both this monitoring and the European Commission Dutch Nitrogen Case (C 293/17 & C 294/17), highlighting a number of recommendations to aid compliance with the EU Habitats Directive (92/43/EEC). [Display omitted] • Ambient ammonia across twelve Natura 2000 sites was 0.47–4.59 μg NH 3 m−3. • Nitrogen deposition across twelve Natura 2000 sites was 5.93–17.78 kg N ha−1 yr−1. • Average nitrogen deposition comprised of 50.4% dry NH 3 & 31.7% wet NH 4. • Average nitrogen deposition comprised of 7.5% dry NOx & 10.3% wet NOx. • Agriculture is the primary source of biodiversity impacts from the more harmful NH 3. [ABSTRACT FROM AUTHOR]

Aim: With progressive impairment of lung function, deposition of inhaled drug in the lungs becomes progressively more central, limiting its effectiveness. This pilot study explored the possibility that long slow inhalations might improve delivery of aerosol to the lung periphery in cystic fibrosis patients with moderate lung disease. Methods: Five subjects aged 12–18 years (mean FEV1 72%; range 63–80%) inhaled a radiolabelled aerosol from a jet nebuliser on two occasions. Two inhalation techniques were compared: breathing tidally from a standard continuous output nebuliser and using long slow inhalations from the AKITA® JET system. Results: Long slow breaths resulted in much lower oropharyngeal deposition with higher lung doses. Importantly, the peripheral lung increased proportionately. The increased lung dose is attributable to more of the larger inhaled droplets passing into the lower airways. This would be expected to increase the central deposition unless significantly more of the smaller droplets were able to penetrate deeper into the lungs. The data support improved delivery of drug to the distal lung when compared with tidal breathing. Conclusion: These pilot data suggest that this approach may prove to be clinically relevant in improving the efficacy of inhaled medication in those with moderate‐severe lung disease. [ABSTRACT FROM AUTHOR]

Agriculture is responsible for 98% of atmospheric ammonia (NH 3) in Ireland, of which pigs and poultry produce 7%; with laying hens specifically contributing 0.6%. Though a small proportion of the national NH 3 total emissions, the ecological impacts on sensitive sites attributed to laying hen farms can be substantial. NH 3 emission monitoring was conducted in Spring (February to March) and Summer (July to August) 2016 to account for seasonal variation. The total average emission and ventilation rate was 0.25 g bird−1 day−1 and 931 cm3 s−1 bird−1. This is lower than the previously used emission factor for the Irish national inventory of 0.5 g bird−1 day−1, but broadly similar to factors reported in the United Kingdom (UK) and the European Union (EU). Dispersion modelling using monitored data indicated potentially acute effects within 84 m, critical level exceedance within 312 m and exceedance of 0.3 kg N ha−1 year−1 deposition within 2.9–5.2 km. The sensitivity of the model was tested using SCAIL-Agriculture emission and ventilation rates which showed P-values for one tailed critical level below 0.01 for all models, indicating that when normalised the maximum extents modelled by AERMOD were significantly different. This analysis showed emission rate having more influence than ventilation rate. Both parameters combined had the greatest increase in dispersion extent, on average 55.8% greater than the use of monitored rates. A deposition rate of 0.3 kg N ha−1 year−1 was modelled to occur within 5.1–7.7 km when using SCAIL-Agriculture rates. Indicating that the use of SCAIL-Agriculture recommended emission and ventilation rates would have been sufficiently precautionary to assess negative ecological effects on a Natura 2000 site under the Habitats Directive (92/43/EEC). In relation to Appropriate Assessment (AA) screening, the use of any contribution from a source within a set distance may be an appropriate full AA trigger. Image 1 • Monitored average NH 3 emission rate of 0.25 g bird−1 day−1. • Monitored average ventilation rate of 931 cm3 s−1 bird−1. • Potential critical level exceedance within 312 m of farm border from source alone. • 0.3 kg N ha−1 year−1 exceeded within 2.9–5.2 km of farm border from source alone. • Modelled dispersion using SCAIL-Agriculture rates was 55.8% greater than monitored. [ABSTRACT FROM AUTHOR]

The mahseer fishes (Tor spp.) represent an iconic genus of large-bodied species of the Cyprinidae family. Across the 16 recognised species in the genus, individual fish can attain weights over 50 kg, resulting in some species being considered as premier sport fishes. Tor species also generally have high religious and cultural significance throughout South and Southeast Asia. Despite their economic and cultural importance, the status of Tor fishes has been increasingly imperilled through their riverine habitats being impacted by anthropogenic activities, such as hydropower dam construction and exploitation. Moreover, conservation efforts have been constrained by knowledge on the genus being heavily skewed towards aquaculture, with considerable knowledge gaps on their taxonomy, autecology, distribution and population status. Whilst taxonomic ambiguity has been a major constraint on conservation efforts, this has been partially overcome by recent, robust taxonomic revisions. This has enabled revision of the IUCN Red List status of Tor fishes; three species are now assessed as 'Near Threatened', one 'Vulnerable', three 'Endangered' and one 'Critically Endangered'. However, eight species remain 'Data deficient'. Here, information on these 16 Tor fishes is synthesised for the first time, outlining the current state of knowledge for each species, including their known distributions and population status. For each species, the outstanding gaps in knowledge are also identified, and their population threats and conservation prospects outlined. Consequently, this review provides the basis for researchers to challenge and enhance the knowledge base necessary to conserve these freshwater icons in an era of unprecedented environmental changes. [ABSTRACT FROM AUTHOR]

Introduction: Persistent bacterial bronchitis (PBB) is a leading cause of chronic wet cough in young children. This study aimed to characterise the respiratory bacterial microbiota of healthy children and to assess the impact of the changes associated with the development of PBB. Blind, protected brushings were obtained from 20 healthy controls and 24 children with PBB, with an additional directed sample obtained from PBB patients. DNA was extracted, quantified using a 16S rRNA gene quantitative PCR assay prior to microbial community analysis by 16S rRNA gene sequencing. Results: No significant difference in bacterial diversity or community composition (R2 = 0.01, P = 0.36) was observed between paired blind and non-blind brushes, showing that blind brushings are a valid means of accessing the airway microbiota. This has important implications for collecting lower respiratory samples from healthy children. A significant decrease in bacterial diversity (P < 0.001) and change in community composition (R2 = 0.08, P = 0.004) was observed among controls, in comparison with patients. Bacterial communities within patients with PBB were dominated by Proteobacteria, and indicator species analysis showed that Haemophilus and Neisseria were significantly associated with the patient group. In 15 (52.9%) cases the dominant organism by sequencing was not identified by standard routine clinical culture. Conclusion: The bacteria present in the lungs of patients with PBB were less diverse in terms of richness and evenness. The results validate the clinical diagnosis, and suggest that more attention to bacterial communities in children with chronic cough may lead to more rapid recognition of this condition with earlier treatment and reduction in disease burden. [ABSTRACT FROM AUTHOR]

Background: Human respiratory syncytial virus (RSV) remains the most common cause of severe lower respiratory tract disease amongst infants, and continues to cause annual epidemics of respiratory disease every winter worldwide. Demonstrating placental transmission of viable RSV in human samples is a major paradigm shift in respiratory routes considered likely for RSV transmission. Methods: Droplet digital PCR (ddPCR) was used to identify RSV present in cord blood mononucleocytes (CBM). CBMs testing positive for RSV were treated with phytohemagglutinin (PHA), PHA and nitric oxide (NO) or PHA, NO and palivizumab, and co-cultured with HeLa cell monolayers. Subsequent immuno-staining for RSV was used to visualize infective viral plaques. Results: RSV was detected in 26 of 45 samples (57.7%) by ddPCR. CBM’s collected in winter were more likely to test positive for RSV (17/21 samples, risk = 80%, OR = 7.08; 95% CI 1.80–27.80; p = 0.005) compared to non-winter months (9/24 samples, 37.5%). RSV plaques were observed in non-treated and treated co-cultured HeLa monolayers. Conclusions: Demonstrating active RSV in CBMs suggests in utero transmission of infective virus to the fetus without causing overt disease. This is likely to have an important impact on immune development as well as future virus-host interactions, thereby warranting further investigation. [ABSTRACT FROM AUTHOR]

Social valuation of ecosystem services and public policy alternatives is one of the greatest challenges facing ecological economists today. Frameworks for valuing nature increasingly include shared/social values as a distinct category of values. However, the nature of shared/social values, as well as their relationship to other values, has not yet been clearly established and empirical evidence about the importance of shared/social values for valuation of ecosystem services is lacking. To help address these theoretical and empirical limitations, this paper outlines a framework of shared/social values across five dimensions: value concept, provider, intention, scale, and elicitation process. Along these dimensions we identify seven main, non-mutually exclusive types of shared values: transcendental, cultural/societal, communal, group, deliberated and other-regarding values, and value to society. Using a case study of a recent controversial policy on forest ownership in England, we conceptualise the dynamic interplay between shared/social and individual values. The way in which social value is assessed in neoclassical economics is discussed and critiqued, followed by consideration of the relation between shared/social values and Total Economic Value, and a review of deliberative and non-monetary methods for assessing shared/social values. We conclude with a discussion of the importance of shared/social values for decision-making. [ABSTRACT FROM AUTHOR]

We have previously shown that the respiratory syncytial virus [RSV] can productively infect monocyte derived dendritic cells [MoDC] and remain dormant within the same cells for prolonged periods. It is therefore possible that infected dendritic cells act as a reservoir within the airways of individuals between annual epidemics. In the present study we explored the possibility that sub-epithelial DCs can be infected with RSV from differentiated bronchial epithelium and that in turn RSV from DCs can infect the epithelium. A dual co-culture model was established in which a differentiated primary airway epithelium on an Air Liquid Interface (ALI) was cultured on a transwell insert and MoDCs were subsequently added to the basolateral membrane of the insert. Further experiments were undertaken using a triple co-culture model in which in which macrophages were added to the apical surface of the differentiated epithelium. A modified RSV [rr-RSV] expressing a red fluorescent protein marker of replication was used to infect either the MoDCs or the differentiated epithelium and infection of the reciprocal cell type was assessed using confocal microscopy. Our data shows that primary epithelium became infected when rr-RSV infected MoDCs were introduced onto the basal surface of the transwell insert. MoDCs located beneath the epithelium did not become infected with virus from infected epithelial cells in the dual co-culture model. However when macrophages were present on the apical surface of the primary epithelium infection of the basal MoDCs occurred. Our data suggests that RSV infected dendritic cells readily transmit infection to epithelial cells even when they are located beneath the basal layer. However macrophages appear to be necessary for the transmission of infection from epithelial cells to basal dendritic cells. [ABSTRACT FROM AUTHOR]

The article discusses a study on serotypes of Streptococcus pneumoniae and nontypable Haemophilus influenzae (NTHi) in children with bacterial bronchitis. In this study, samples were collected from children with chronic cough from Athens, Greece and Sheffield, England. The majority of English children had received pneumococcal-conjugate vaccines 7 (PCV-7) in contrast with Greek children. The study shows that S. pneumoniae serotypes possibly play a role in protracted bacterial bronchitis.

Background: A number of studies have suggested that the non-antimicrobial actions of macrolide antibiotics may be valuable in treating patients with cystic fibrosis. The use of long-term macrolide antibiotics for the management of CF patients colonised by Pseudomonas aeruginosa and progressive pulmonary disease was introduced into our clinic in 1997. A retrospective study was undertaken to assess of the impact of this therapy. Methods: Twenty patients with progressive pulmonary disease (>10% fall in FEV1 over 12 months despite optimising conventional therapy) were commenced on Azithromycin, 250 mg daily during a 21-month period. At the time of assessment they had remained on therapy for a mean of 0.9 years. Changes in lung function, weight, body mass index (BMI) and frequency of pulmonary exacerbations were assessed. A group of 20 patients with stable lung function and matched as far as possible for age and sex was identified for comparison. Results: Pulmonary function increased significantly in the Azithromycin group with FEV1% predicted increasing from a mean of 50.2–59.1% (P=0.001) while FVC% predicted increase from 64.5 to 76.1% (P=0.002). There was small but non-significant fall in lung function in the comparison group. Body mass index increased by a mean of 1.1 in the Azithromycin group but remained unchanged in the comparison group. The number of pulmonary exacerbations requiring intravenous antibiotics declined by 48.3% in macrolide treated subjects compared to the pre-treatment period (P<0.025); frequency of exacerbations in the control group was unchanged. Conclusion: Long-term Azithromycin treatment in patients with progressive deterioration in lung function appears to have led to an improvement in pulmonary function, increased body mass index and decreased the frequency of pulmonary exacerbations requiring intravenous antibiotics. [Copyright &y& Elsevier]

H-type tracheoesophageal fistula is rare. Although symptoms are present from birth, its rarity and overlap of symptoms with other respiratory conditions makes diagnosis difficult and delayed. We report a case of H-type fistula in a 13-year-old girl that was detected incidentally during investigations for achalasia cardia. [ABSTRACT FROM AUTHOR]