Credible knowledge: A pilot evaluation of a modified GRADE method using parent-implemented interventions for children with autism

Abstract Background Decision-making in child and youth mental health (CYMH) care requires recommendations that are developed through an efficient and effective method and are based on credible knowledge. Credible knowledge is informed by two sources: scientific evidence, and practice-based evidence, that reflects the "real world" experience of service providers. Current approaches to developing these recommendations in relation to CYMH will typically include evidence from one source or the other but do not have an objective method to combine the two. To this end, a modified version of the Grading Recommendations Assessment, Development and Evaluation (GRADE) approach was pilot-tested, a novel method for the CYMH field. Methods GRADE has an explicit methodology that relies on input from scientific evidence as well as a panel of experts. The panel established the quality of evidence and derived detailed recommendations regarding the organization and delivery of mental health care for children and youth or their caregivers. In this study a modified GRADE method was used to provide precise recommendations based on a specific CYMH question (i.e. What is the current credible knowledge concerning the effects of parent-implemented, early intervention with their autistic children?). Results Overall, it appeared that early, parent-implemented interventions for autism result in positive effects that outweigh any undesirable effects. However, as opposed to overall recommendations, the heterogeneity of the evidence required that recommendations be specific to particular interventions, based on the questions of whether the benefits of a particular intervention outweighs its harms. Conclusions This pilot project provided evidence that a modified GRADE method may be an effective and practical approach to making recommendations in CYMH, based on credible knowledge. Key strengths of the process included separating the assessments of the quality of the evidence and the strength of recommendations, transparency in decision-making, and the objectivity of the methods. Most importantly, this method combined the evidence and clinical experience in a more timely, explicit and simple process as compared to previous approaches. The strengths, limitations and modifications of the approach as they pertain to CYMH, are discussed

Linkages between household wealth, bushmeat and other animal protein consumption are not invariant: evidence from Rio Muni, Equatorial Guinea

Bushmeat consumption is affected by household wealth. However, how household wealth impacts bushmeat eaten in different environmental and social settings (i.e. whether urban, rural, coastal or forest) is poorly understood. In this study, we sampled households in six contrasting localities in Rio Muni, Equatorial Guinea, in coastal (Bata, Cogo), central (Niefang, Evinayong) and eastern parts of the territory (Ebebiyin, Nsork). On average, 32.3 g of bushmeat per adult male equivalent per day were consumed, though this varied widely between sites and most households ate no bushmeat on the survey day. Fish was the most frequently recorded source of protein and in a coastal site, Cogo, significantly more fish was consumed than in the other localities. Overall, average protein consumption was correlated with household wealth, but the strength of this effect varied among sites. At the site where average wealth was highest (Bata, the most urban site), bushmeat was more expensive, and wealthier households ate more of it. Elsewhere bushmeat consumption was not associated with wealth, and the cost of bushmeat was a higher proportion of household wealth. In Bata, wealthier households reported consumption of more than one meat type (most frequently bushmeat and either domestic meat or fish), and diversity of dietary items also increased with wealth. In all sites, wealthier households ate less fish. We demonstrate distinct differences in relationships between urban versus rural areas, and between coastal versus inland sites. We therefore caution that general patterns of wealth-wild meat consumption must be evaluated taking account the circumstances of wild meat consumers. © 2009 The Authors. Journal compilation © 2009 The Zoological Society of London

Effects of constructed wetland system on the removal of dibutyl phthalate (DBP)

Phthalic acid esters (PAEs) have become widely diffused in the environment via the manufacturing process. Numerous experiments have shown that the bioaccumulation of PAEs occurred in the aquatic and terrestrial food chain; meanwhile, it was found that some of PAEs were considered as potential carcinogens, teratogens and mutagens. In this research, two vertical/reverse-vertical flow constructed wetland systems were set up to study its removal efficiency of dibutyl, phthalate (DBP) pollution. The results showed that the constructed wetland system could remove DBP effectively, and the removal rates reached nearly 100%. Substrate microorganism and enzymatic activities probably played key roles during DBP removal, and the removal of DBP probably mainly took place in the upper layer of chamber A in the constructed wetland systems. (C) 2007 Elsevier GmbH. All rights reserved.Phthalic acid esters (PAEs) have become widely diffused in the environment via the manufacturing process. Numerous experiments have shown that the bioaccumulation of PAEs occurred in the aquatic and terrestrial food chain; meanwhile, it was found that some of PAEs were considered as potential carcinogens, teratogens and mutagens. In this research, two vertical/reverse-vertical flow constructed wetland systems were set up to study its removal efficiency of dibutyl, phthalate (DBP) pollution. The results showed that the constructed wetland system could remove DBP effectively, and the removal rates reached nearly 100%. Substrate microorganism and enzymatic activities probably played key roles during DBP removal, and the removal of DBP probably mainly took place in the upper layer of chamber A in the constructed wetland systems. (C) 2007 Elsevier GmbH. All rights reserved

Root zone microbial populations, urease activities, and purification efficiency for a constructed wetland

In order to investigate the effects of microorganisms and their urease activities in macrophytic root zones on pollutant removal, four small-scale plots (SSPs) of vertical/reverse-vertical flow wetlands were set up to determine: a) the relationship between the abundance of microorganisms in the root zones and water purification efficiency; and b) the relationship between urease activities in the root zones and pollutant removal in a constructed wetland system. Total numbers of the microbial population (bacteria, fungi, and actinomyces) along with urease activities in the macrophytic root zones were determined. In addition, the relationships between microbial populations and urease activities as well as the wastewater purification efficiencies of total phosphorus (TP), total Kjeldahl nitrogen (TKN), biochemical oxygen demand in 5 days (BOD5), and chemical oxygen demand (COD) were also analyzed. The results showed that there was a highly significant positive correlation (r = 0.9772, P < 0.01) between the number of bacteria in the root zones and BOD5 removal efficiency and a significant negative correlation (r = -0.9092, P < 0.05) between the number of fungi and the removal efficiency of TKN. Meanwhile, there was a significant positive correlation (r = 0.8830, P < 0.05) between urease activities in the root zones and the removal efficiency of TKN. Thus, during wastewater treatment in a constructed wetland system, microorganism and urease activities in the root zones were very important factors