WaterNSW

Pathogens present in animal fecal deposits excreted to land undergo a poorly defined process of dispersion, transport or attenuation, and inactivation. The transport of pathogens overland in surface runoff is clearly responsible for event-related increases in the concentrations of in-stream waterborne pathogens in many watersheds. However, there are significant knowledge gaps concerning the precise mechanisms of pathogen transport. This article reviews the fate and transport of pathogens in watersheds supplying drinking water, from their deposition in feces and septic seepages on land to their dispersion in major tributaries. Pathogens considered representative of those associated with waterborne disease included enteric viruses derived from human fecal contamination, bacterial pathogens represented by Escherichia coli O157:H7, and the protozoan pathogens Cryptosporidium and Giardia. References to suitable model and index organisms for these pathogens are described. The key processes determining the fate and transport of pathogens within watersheds are discussed in the context of changing agricultural practices, climate, and scale factors. A generic conceptual model for watershed processes is described in light of the knowledge gaps identified from this review. Future areas for fundamental research were identified and included: (1) inactivation kinetics of pathogens in soil and fecal matrices; (2) characterization of the particle sizes with which pathogens are transported; (3) characterization of pathogen properties and watershed-specific features that affect terrestrial transport and attenuation; and (4) the inactivation and sedimentation of pathogens during their initial introduction to the aquatic environment. Such information is critical to advance the assessment of pathogen total maximum daily loads (TMDL), determining management priorities and appropriate control points, as well as integrating pathogens within the broader watershed hydrologic models.

BACKGROUND: Hyperparathyroidism is a common endocrinopathy characterised by the formation of parathyroid tumours. In this study, we determine the role of the recently identified gene, HRPT2, in parathyroid tumorigenesis. METHODS: Mutation analysis of HRPT2 was undertaken in 60 parathyroid tumours: five HPT-JT, three FIHP, three MEN 1, one MEN 2A, 25 sporadic adenomas, 17 hyperplastic glands, two lithium associated tumours, and four sporadic carcinomas. Loss of heterozygosity at 1q24-32 was performed on a subset of these tumours. RESULTS: HRPT2 somatic mutations were detected in four of four sporadic parathyroid carcinoma samples, and germline mutations were found in five of five HPT-JT parathyroid tumours (two families) and two parathyroid tumours from one FIHP family. One HPT-JT tumour with germline mutation also harboured a somatic mutation. In total, seven novel and one previously reported mutation were identified. "Two-hits" (double mutations or one mutation and loss of heterozygosity at 1q24-32) affecting HRPT2 were found in two sporadic carcinomas, two HPT-JT-related and two FIHP related tumours. CONCLUSIONS: The results in this study support the role of HRPT2 as a tumour suppressor gene in sporadic parathyroid carcinoma, and provide further evidence for HRPT2 as the causative gene in HPT-JT, and a subset of FIHP. In light of the strong association between mutations of HRPT2 and sporadic parathyroid carcinoma demonstrated in this study, it is hypothesised that HRPT2 mutation is an early event that may lead to parathyroid malignancy and suggest intragenic mutation of HRPT2 as a marker of malignant potential in both familial and sporadic parathyroid tumours.

BACKGROUND: The main aim of this study is to evaluate the antioxidant and anti-inflammatory properties of forty four traditional Chinese medicinal herbal extracts and to examine these activities in relation to their antioxidant content. METHODS: The antioxidant activities were investigated using DPPH radical scavenging method and yeast model. The anti-inflammatory properties of the herbal extracts were evaluated by measuring their ability to inhibit the production of nitric oxide and TNF-α in RAW 264.7 macrophages activated by LPS and IFN- γ, respectively. The cytotoxic effects of the herbal extracts were determined by Alomar Blue assay by measuring cell viability. In order to understand the variation of antioxidant activities of herbal extracts with their antioxidant contents, the total phenolics, total flavonoids and trace metal (Mg, Mn, Cu, Zn, Se and Mo) quantities were estimated and a correlation analysis was carried out. RESULTS: Results of this study show that significant levels of phenolics, flavonoids and trace metal contents were found in Ligustrum lucidum, Paeonia suffuticosa, Salvia miltiorrhiza, Sanguisorba officinalis, Spatholobus suberectus, Tussilago farfara and Uncaria rhyncophylla, which correlated well with their antioxidant and anti-inflammatory activities. Some of the plants displayed high antioxidant and anti-inflammatory activities but contained low levels of phenolics and flavonoids. Interestingly, these plants contained significant levels of trace metals (such as Zn, Mg and Se) which are likely to be responsible for their activities. CONCLUSIONS: The results indicate that the phenolics, flavonoids and trace metals play an important role in the antioxidant activities of medicinal plants. Many of the plants studied here have been identified as potential sources of new antioxidant compounds.

Abstract This paper examines whether the perceived risk of online purchasing by consumers varies with the frequency of previous purchases, satisfaction with previous purchase experiences, the good/service orientation of an intended purchase and the level of purchase decision involvement required. No association was found between the frequency of online purchasing and perceived risk, although satisfaction with prior internet purchases was negatively associated with the perceived risk of intended purchases, but only for low‐involvement products. Differences in perceived risk were associated with whether the intended purchase was a good or service and whether it was a high or low‐involvement product. Analysis of consumer perceived risks, disaggregated by type of risk and purchase situation, provides insight into impediments that may hinder the expansion of consumer purchasing using the internet. Copyright © 2004 Henry Stewart Publications.

Global environmental change has influenced lake surface temperatures, a key driver of ecosystem structure and function. Recent studies have suggested significant warming of water temperatures in individual lakes across many different regions around the world. However, the spatial and temporal coherence associated with the magnitude of these trends remains unclear. Thus, a global data set of water temperature is required to understand and synthesize global, long-term trends in surface water temperatures of inland bodies of water. We assembled a database of summer lake surface temperatures for 291 lakes collected in situ and/or by satellites for the period 1985-2009. In addition, corresponding climatic drivers (air temperatures, solar radiation, and cloud cover) and geomorphometric characteristics (latitude, longitude, elevation, lake surface area, maximum depth, mean depth, and volume) that influence lake surface temperatures were compiled for each lake. This unique dataset offers an invaluable baseline perspective on global-scale lake thermal conditions as environmental change continues.

BACKGROUND: A subgroup of patients undergoing TKA is unhappy with the outcome of surgery and preoperative psychological factors may play a role in their dissatisfaction. QUESTIONS/PURPOSES: We asked whether (1) psychological factors, as measured by preoperative self-reported questionnaires, predicted poor outcome after TKA, and (2) whether certain psychological factors examined predicted poor outcome better than others. METHODS: We performed a systematic review and meta-analysis of prospective observational studies published in MEDLINE, CINAHL®, EMBASE™, and PsycINFO® databases from their date of inception to October 2013, augmented with a manual search of bibliographies. Study eligibility was performed according to an a priori protocol. Included studies were assessed for quality according to the Newcastle-Ottawa scale. Two reviewers independently performed the search, identified eligible studies, assessed their methodologic quality, and extracted data. Outcomes of interest included postoperative dissatisfaction, pain, or limited function of the patients. RESULTS: A total of 19 studies (17 cohort studies and two cross-sectional surveys) containing data on 9046 TKAs performed in 8704 adult patients were included in the review. Mean patient age was 68 years and followup ranged from 6 to 60 months (mean study followup, 14 months). Clinical and methodologic heterogeneity in study design prevented the statistical pooling of data and subsequent meta-analysis. Dissatisfaction rates with TKA ranged from 7.5% to 28.3%. Psychological health was deemed a significant predictor of satisfaction, pain, or function at a minimum of 6 months after TKA in 16 studies. The remaining three studies did not find this relationship. Baseline mental health factors may affect patient satisfaction, their long-term perception of pain, and their motivation to return to the desired level of function. We were unable to determine the most relevant psychological states or the most appropriate way to assess them with our systematic review. CONCLUSIONS: The preoperative psychological state of a patient may affect the outcome after a TKA. A comprehensive psychological assessment of patients is required to examine the long-term effect of such psychological factors on the eventual outcomes of TKA once the recovery phase is complete and to assess the effect that treatment for these psychological conditions may have on decreasing the dissatisfaction rate with TKA in this population.

The frequency of freshwater cyanobacterial blooms is at risk of increasing as a consequence of climate change and eutrophication of waterways. It is increasingly apparent that abiotic data are insufficient to explain variability within the cyanobacterial community, with biotic factors such as heterotrophic bacterioplankton, viruses and protists emerging as critical drivers. During the Australian summer of 2012-2013, a bloom that occurred in a shallow ephemeral lake over a 6-month period was comprised of 22 distinct cyanobacteria, including Microcystis, Dolichospermum, Oscillatoria and Sphaerospermopsis. Cyanobacterial cell densities, bacterial community composition and abiotic parameters were assessed over this period. Alpha-diversity indices and multivariate analysis were successful at differentiating three distinct bloom phases and the contribution of abiotic parameters to each. Network analysis, assessing correlations between biotic and abiotic variables, reproduced these phases and assessed the relative importance of both abiotic and biotic factors. Variables possessing elevated betweeness centrality included temperature, sodium and operational taxonomic units belonging to the phyla Verrucomicrobia, Planctomyces, Bacteroidetes and Actinobacteria. Species-specific associations between cyanobacteria and bacterioplankton, including the free-living Actinobacteria acI, Bacteroidetes, Betaproteobacteria and Verrucomicrobia, were also identified. We concluded that changes in the abundance and nature of freshwater cyanobacteria are associated with changes in the diversity and composition of lake bacterioplankton. Given this, an increase in the frequency of cyanobacteria blooms has the potential to alter nutrient cycling and contribute to long-term functional perturbation of freshwater systems.

Summary 1. A common goal of many environmental flow regimes is to maintain and/or enhance the river’s native fish community by increasing the occurrence of successful spawning and recruitment events. However, our understanding of the flow requirements of the early life history of fish is often limited, and hence predicting their response to specific managed flow events is difficult. To overcome this uncertainty requires the use of adaptive management principles in the design, implementation, monitoring and adjustment of environmental flow regimes. 2. The Barmah‐Millewa Forest, a large river red gum forest on the Murray River floodplain, south‐east Australia, contains a wide variety of ephemeral and permanent aquatic habitats suitable for fish. Flow regulation of the Murray River has significantly altered the natural flood regime of the Forest. In an attempt to alleviate some of the effects of river regulation, the Forest’s water regime is highly managed using a variety of flow control structures and also receives targeted Environmental Water Allocations (EWA). In 2005, the largest environmental flow allocated to date in Australia was delivered at the Forest. 3. This study describes the adaptive management approach employed during the delivery of the 2005 EWA, which successfully achieved multiple ecological goals including enhanced native fish spawning and recruitment. Intensive monitoring of fish spawning and recruitment provided invaluable real‐time and ongoing management input for optimising the delivery of environmental water to maximise ecological benefits at Barmah‐Millewa Forest and other similar wetlands in the Murray‐Darling Basin. 4. We discuss possible scenarios for the future application of environmental water and the need for environmental flow events and regimes to be conducted as rigorous, large‐scale experiments within an adaptive management framework.

Using pre- and post-fire satellite imagery from SPOT2, we examined the fire severity and intensity of the Christmas 2001 wildfires in the greater Sydney Basin, Australia. We computed a Normalised Difference Vegetation Index (NDVI) from the two satellite images captured before (November 2001) and after (January 2002) the wildfires, then subtracted the later from the former to produce a difference image (NDVIdiff) which was subsequently classified into six fire severity classes (unburnt, low, moderate, high, very high and extreme severity). We then tested the fire severity classification on 342 sample sites within the 225 000ha fire affected area using a qualitative visual assessment guide. We found that the NDVIdiff classification produced an accuracy of at least 88% (Khat = 0.86), with the greatest discrepancy being between the low and moderate classification. Knowledge of rate of spread over some of the affected area, coupled with a complete knowledge of fuel loads, was used to retrospectively model fire intensity, which in areas of extreme fire intensity, produced heat energy levels exceeding 70 000 kW m–1. Importantly, we found no positive effect of topography on fire severity, in fact finding an inverse relationship between slope and fire severity and no effect due to aspect. Further analysis showed that flat to moderate slopes less than 18° across all aspects suffered the greatest vegetal destruction, and there was no relationship between north-westerly aspects and fire severity. We also introduce a relatively simple method for estimating fuel load biomass using a combination of satellite image and rapid field assessment. We found 79% accuracy for this method based on 125 sample sites. It is postulated that this type of analysis can greatly improve our understanding of the spatial impact of fire, how natural areas within the fire ground were impacted, and how remote sensing and GIS technologies can be efficiently used in fire management planning and post-fire analysis.

Summary 1. Diatoms were sampled in the spring of 1994 and the autumn of 1995 at 137 pristine or near‐pristine reference sites on large and small streams at various altitudes in eastern New South Wales and Victoria. Scrapings were taken from five firm substrata across a range of microhabitat conditions at each site on each occasion. For each substratum, 100 valves were identified to genus level. 2. Multivariate statistical models were constructed to predict the probability of occurrence of each genus at a given site under near‐pristine conditions on the basis of physical features of the site that are not affected by human activity. Model predictions were compared with the flora observed at the reference sites and at 55 test sites affected by varying degrees of human disturbance. 3. Test sites were characterized more by the presence of genera not predicted by the model than by the absence of predicted genera. The degree of departure from model predictions was related mainly to increasing alkalinity, electrical conductivity, hardness and pH of river water. We therefore conclude that the main effect of human activity on the composition of diatom communities in the rivers of coastal south‐eastern Australia has been to increase genus richness through enrichment with alkaline salts. 4. The models did not perform as well as similar models applied to river macroinvertebrates at the family level, perhaps because of greater temporal variability in diatom communities and differences in the environmental variables to which diatoms and macroinvertebrates respond. Means of improving the current models are discussed.

Rainwater harvesting (RWH) plays an important role in increasing water security for individuals and governments. The demand for tools to enable technical and economic analysis of RWH systems has led to a substantial body of research in the recent past. This paper focuses on the economic aspects of domestic RWH in urban and peri-urban environments. In this regard, key issues are identified and discussed including quality and quantity of harvested water, the water demand profile, the scale of installation, interest rates, the period of analysis, real estate value, and the water-energy-food nexus. Kenya and Australia are used as reference points having different economies and opposing RWH policies. It has been found that the previous studies on financial aspects of RWH systems often had conflicting results. Most of the economic analyses have ignored the full benefits that a RWH system can offer. In view of the varying and conflicting results, there is a need to standardize the methods of economic analysis of RWH systems.

A fecal analysis survey was undertaken to quantify animal inputs of pathogenic and indicator microorganisms in the temperate watersheds of Sydney, Australia. The feces from a range of domestic animals and wildlife were analyzed for the indicator bacteria fecal coliforms and Clostridium perfringens spores, the pathogenic protozoa Cryptosporidium and Giardia, and the enteric viruses adenovirus, enterovirus, and reovirus. Pathogen and fecal indicator concentrations were generally higher in domestic animal feces than in wildlife feces. Future studies to quantify potential pathogen risks in drinking-water watersheds should thus focus on quantifying pathogen loads from domestic animals and livestock rather than wildlife.

Abstract Freshwater ecosystems play a major role in global carbon cycling through the breakdown of organic material and release of greenhouse gases ( GHG s). Carbon dioxide ( CO 2 ) and methane ( CH 4 ) emissions from lakes, wetlands, reservoirs and small natural ponds have been well studied, however, the GHG emissions of highly abundant, small‐scale (<0.01 km 2 ) agricultural dams (small stream and run‐off impoundments) are still unknown. Here, we measured the diffusive CO 2 and CH 4 flux of 77 small agricultural dams within south‐east Australia. The GHG emissions from these waterbodies, which are currently unaccounted for in GHG inventories, amounted to 11.12 ± 2.59 g CO 2 ‐equivalent m 2 /day, a value 3.43 times higher than temperate reservoir emissions. Upscaling these results to the entire state of Victoria, Australia, resulted in a farm dam CO 2 ‐equivalent/day emission rate of 4,853 tons, 3.1 times higher than state‐wide reservoir emissions in spite of farm dams covering only 0.94 times the comparative area. We also show that CO 2 and CH 4 emission rates were both significantly positively correlated with dissolved nitrate concentrations, and significantly higher in livestock rearing farm dams when compared to cropping farm dams. The results from this study demonstrate that small agricultural farm dams can be a major source of greenhouse gas emissions, thereby justifying their inclusion in global carbon budgets.

OBJECTIVES: Defecation proctography is the standard method used in the investigation of obstructed defecation. Translabial ultrasound has recently been shown to demonstrate rectocele, enterocele and rectal intussusception. We performed a comparative clinical study to determine agreement between the two methods. METHODS: Thirty-seven women scheduled to undergo defecation proctography for obstructed defecation were recruited. Using both proctography and translabial ultrasound, we determined the anorectal angle, presence of a rectocele and rectocele depth, rectal intussusception and prolapse. Measurements were obtained by operators blinded to all other data. All patients rated discomfort on a scale of 0-10. RESULTS: Six women did not attend defecation proctography, leaving 31 cases for comparison. The mean age was 53 years. Patients rated discomfort at a median of 1 (range 0-10) for ultrasound and 7 (range 0-10) for defecation proctography (P < 0.001). Defecation proctography suggested rectocele and rectal intussusception/prolapse more frequently than did ultrasound. While the positive predictive value of ultrasound (considering defecation proctography to be the definitive test) was 0.82 for rectocele and 0.88 for intussusception/prolapse, negative predictive values were only 0.43 and 0.27, respectively. Cohen's kappa values were 0.26 and 0.09, respectively. There was poor agreement between ultrasound and defecation proctography measurements of anorectal angle and rectocele depth. CONCLUSIONS: Translabial ultrasound can be used in the initial investigation of defecatory disorders. It is better tolerated than defecation proctography and also yields information on the lower urinary tract, pelvic organ prolapse and levator ani. Agreement between ultrasound and defecation proctography in the measurement of quantitative parameters was poor, but when intussusception or rectocele was diagnosed on ultrasound these results were highly predictive of findings on defecation proctography.

Summary 1. RIVPACS‐type predictive models were developed at a relatively large spatial scale for the Australian state called New South Wales (NSW, 801 428 km 2 ). Aquatic macroinvertebrate samples and physical and chemical data were collected from 250 reference sites (little affected by human activities) and 23 test sites (with known human impacts) throughout NSW in autumn and spring 1995 and identified mostly to family level. Reference sites were grouped based on their macroinvertebrate data using classification (UPGMA) and ordination techniques. Relationships between macroinvertebrate and environmental data were established using principal axis correlations and stepwise multiple discriminant function analysis. models for predicting invertebrate assemblages were developed separately for edge and riffle habitats for autumn and spring data sets and for combined autumn and spring data sets. 2. Sites in the lowland sections of the western flowing rivers were characterized by low taxonomic richness and were distinct from the sites in the eastern part of the state. Sites on the western slopes of the Great Dividing Range in southern and northern NSW mostly fell into separate groups. In eastern NSW, site groups did not represent a north, central and south division. Sites on highland streams, coastal fringe streams and large rivers mostly formed distinct groups, but most of the sites on east‐flowing rivers fell into large site groups that did not have clear geographic boundaries. 3. Environmental variables that were strongly correlated with ordinations of macroinvertebrate presence/absence at sites were water temperature, altitude, longitude and maximum distance from source. The predictor variables determined by DFA for the six models created included alkalinity, altitude, location (longitude and/or latitude), stream size and substratum composition. These are generally in common with the variables determined for other large geographic areas in Australia and the United Kingdom. 4. Model outputs from reference sites suggest that, among the six models, the riffle model combining autumn and spring is likely to give the most reliable predictions. The combined edge model also performed well but refinements are needed for single season models to provide reliable outputs. 5. Combined season models both for riffles and for edges detected biological impairment at all but one of the test sites. Single season riffle models also detected impairment while single season edge models characterized sites as unimpaired despite other models’ indications of impaired fauna. Riffle models may be more sensitive than edge models but the sampling of riffles is often limited by flow. Edge habitats are available at most sites but there may be few riffles in floodplain rivers. Available resources, desired model sensitivity, and river type should be considered jointly to determine the most useful habitat to sample.

This study investigated whether a psychotic illness was associated with posttraumatic stress disorder (PTSD) symptomatology in 45 subjects recovering from hospitalization for a psychotic episode. Previous studies have suggested that the experience of psychosis and hospitalization is distressing and that PTSD may be a useful paradigm for the psychological response. Subjects were given questionnaires to evaluate PTSD symptoms, anxiety symptoms, and distress and intrusive memories associated with aspects of treatment and psychosis. Treatment, especially experiences involving a loss of control such as detention, and psychotic symptoms, particularly persecutory delusions, passivity phenomena, and visual hallucinations, were perceived as highly distressing. Twenty-two subjects (52%) met the criteria for a postpsychotic PTSD, with implications for recognition and management of secondary morbidity related to psychosis.

AIM: This paper is a report of a study conducted to explore the reasons behind the decision to blow the whistle and provide insights into nurses' experiences of being whistleblowers. BACKGROUND: Whistleblowing is a stigmatized and hidden activity that carries considerable ramifications to all concerned. In the health sector, when episodes of poor practice or service provision are identified, it is frequently nurses who are the whistleblowers. Despite this, there is remarkably limited literature that explores nurses' experiences of whistleblowing. METHODS: Qualitative narrative inquiry design. Data were collected in 2008 from 11 nurse whistleblowers using in-depth semi-structured interviews. FINDINGS: Participants were drawn from a range of general and specialty clinical areas and experienced whistleblowing as highly stressful. The findings were clustered into three main themes, namely: (i) Reasons for whistleblowing: I just couldn't advocate, (ii) Feeling silenced: Nobody speaks out, and (iii) Climate of fear: You are just not safe. CONCLUSION: The whistleblowing nurses believed they were acting in accordance with a duty of care. There is a need for greater clarity about the role nurses have as patient advocates. Furthermore, there is need to develop clear guidelines that create opportunities for nurses to voice concerns and to ensure that healthcare systems respond in a timely and appropriate manner, and a need to foster a safe environment in which to raise issues of concern.

The dispersion and initial transport of Cryptosporidium oocysts from fecal pats were investigated during artificial rainfall events on intact soil blocks (1,500 by 900 by 300 mm). Rainfall events of 55 mm h(-1) for 30 min and 25 mm h(-1) for 180 min were applied to soil plots with artificial fecal pats seeded with approximately 10(7) oocysts. The soil plots were divided in two, with one side devoid of vegetation and the other left with natural vegetation cover. Each combination of event intensity and duration, vegetation status, and degree of slope (5 degrees and 10 degrees ) was evaluated twice. Generally, a fivefold increase (P < 0.05) in runoff volume was generated on bare soil compared to vegetated soil, and significantly more infiltration, although highly variable, occurred through the vegetated soil blocks (P < 0.05). Runoff volume, event conditions (intensity and duration), vegetation status, degree of slope, and their interactions significantly affected the load of oocysts in the runoff. Surface runoff transported from 10(0.2) oocysts from vegetated loam soil (25-mm h(-1), 180-min event on 10 degrees slope) to up to 10(4.5) oocysts from unvegetated soil (55-mm h(-1), 30-min event on 10 degrees slope) over a 1-m distance. Surface soil samples downhill of the fecal pat contained significantly higher concentrations of oocysts on devegetated blocks than on vegetated blocks. Based on these results, there is a need to account for surface soil vegetation coverage as well as slope and rainfall runoff in future assessments of Cryptosporidium transport and when managing pathogen loads from stock grazing near streams within drinking water watersheds.

Abstract Background Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50 years or more; acute episodes of delirium; and the outcomes of intensive care and hospital stay were explored. Results During the 6-month baseline period, 997 patients, aged 50 years or more, were included in this study. The average age was 71 years (IQR, 63–79); 55% were male ( n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% ( n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio ( adj RR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adj RR = 2.54, 95% CI 1.72–3.75, p &lt; 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.

Abstract Nontidal wetlands are estimated to contribute significantly to the soil carbon pool across the globe. However, our understanding of the occurrence and variability of carbon storage between wetland types and across regions represents a major impediment to the ability of nations to include wetlands in greenhouse gas inventories and carbon offset initiatives. We performed a large‐scale survey of nontidal wetland soil carbon stocks and accretion rates from the state of Victoria in south‐eastern Australia—a region spanning 237,000 km 2 and containing &gt;35,000 temperate, alpine, and semi‐arid wetlands. From an analysis of &gt;1,600 samples across 103 wetlands, we found that alpine wetlands had the highest carbon stocks (290 ± 180 Mg C org ha −1 ), while permanent open freshwater wetlands and saline wetlands had the lowest carbon stocks (110 ± 120 and 60 ± 50 Mg C org ha −1 , respectively). Permanent open freshwater sites sequestered on average three times more carbon per year over the last century than shallow freshwater marshes (2.50 ± 0.44 and 0.79 ± 0.45 Mg C org ha −1 year −1 , respectively). Using this data, we estimate that wetlands in Victoria have a soil carbon stock in the upper 1 m of 68 million tons of C org , with an annual soil carbon sequestration rate of 3 million tons of CO 2 eq. year −1 —equivalent to the annual emissions of about 3% of the state's population. Since European settlement (~1834), drainage and loss of 260,530 ha of wetlands may have released between 20 and 75 million tons CO 2 equivalents (based on 27%–90% of soil carbon converted to CO 2 ). Overall, we show that despite substantial spatial variability within wetland types, some wetland types differ in their carbon stocks and sequestration rates. The duration of water inundation, plant community composition, and allochthonous carbon inputs likely play an important role in influencing variation in carbon storage.