The examination of population‐specific adaptations of introduced salmonids to the wide range of environments found in Patagonia (southern South America) can help unveil some of the genetic and environmental contributions to life history variation. The rainbow trout Oncorhynchus mykiss introduced into Argentina originated from a few parental stocks. Although some of these stocks were anadromous, all of the dozens of established populations described until now have been freshwater resident. In this paper we provide the first documentation of the presence of an anadromous run of rainbow trout in the Santa Cruz River, the second largest river of Argentinean Patagonia. Microsatellite analysis revealed that anadromous and resident fish from the Santa Cruz River are genetically indistinguishable, probably representing alternative life histories within the same population. Both wild types are very different from the fish of Danish origin that were reared in a local hatchery, suggesting that they are descended more directly from California stocks or that they have been affected by strong drift or selection. Marine growth and freshwater residence are comparable to those of California steelhead. River entrance peaks in early fall. Population age structure and scale pattern analysis indicate that fish enter the river at age 3 but that most do not spawn until their next river entry as 4‐year‐olds. An unusual aspect of Santa Cruz anadromous fish is that they are long‐lived and highly iteroparous. For instance, 20% of the fish analyzed had experienced as many as five spawning events.

Medication use at the end of life varies widely by setting, both for potentially appropriate and inappropriate medications. Combining experts' opinion and current medication use resulted in the identification of 16 medications that might be used to assess the quality of cancer care at the end of life.

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In the present study, profiles of stable isotope composition were characterized for two species with partially migratory populations in rivers along the latitudinal gradient of Patagonia, brown trout Salmo trutta and rainbow trout Oncorhynchus mykiss. The effects of factors (e.g. ontogeny of fishes, location, species and fasting) that may influence the stable isotope analysis (SIA) were evaluated, as was SIA evaluated as a tool to assign individual fish to their corresponding ecotype. Anadromous fishes exhibited enriched d 15 N (15Á2 AE 1Á0%; mean AE S.D.) and d 13 C (À19Á2 AE 1Á3%) relative to resident fishes' d 15 N (8Á8 AE 1Á1%) and d 13 C (À23Á2 AE 2Á5%). For both species, the difference in d 15 N was larger between resident (range 6Á8-10Á7%) and anadromous (range 14Á3-17Á8%) fishes than that in d 13 C. Values of d 13 C, while not as dramatically contrasting in rainbow trout, provided a powerful anadromy marker for brown trout in the region. Increases were found in both d 15 N and d 13 C during the spawning migration of anadromous rainbow trout, most likely due to fasting. Differences in stable isotopes between location, size and species were found, suggesting different stable isotopes base levels in freshwater environments and different trophic levels and feeding location of anadromous populations. The SIA was demonstrated as a powerful tool for ecotype discrimination in Patagonian Rivers, overriding any effect of sampling location, size or species.

Small intestine contrast ultrasonography (SICUS) has emerged as a valuable tool in the detection of intestinal damage in Crohn's disease (CD). Our aim was to develop a numerical index quantitating small bowel damage as detected by SICUS in patients with an established diagnosis of CD. One hundred and ten patients with ileal or ileocolonic CD were prospectively enrolled and followed up for one year. Disease activity was assessed by CDAI and CRP levels. Study variables included bowel wall thickness, lumen diameter, lesion length and number of lesion site. Fistula, mesenteric adipose tissue alteration, abscess and lymphnodes were also considered. Bowel segments were considered as a hollow cylinder. Standardized variations of variables were combined into a statistical and mathematical model to create an algorithm scoring an index value ranging from 0 to 200. Index was subdivided into a severity scale with 5 classes from the lower (A) to the higher score (E). Median lesion index value was significantly higher (p<0.005) in patients with a CDAI>150 and in patients with CRP>5 mg/l (p=0.003). Patients classified in class E and D at SICUS underwent surgery within one year follow up more frequently than those in class C, B and A (p<0.0001). We propose a new index for assessment of small bowel lesions in CD (SLIC: sonographic lesion index for CD) developed by using SICUS. This index may turn ultrasonography in CD from a descriptive qualitative assessment to a quantitative numerical index suitable for comparison studies.

Background and aimsDespite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality.Methods and resultsThe framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included ‘coverage’, ‘waiting list time’, ‘dosage’ and ‘availability in prisons’. For the specific NSP indicators, the priority indicators included ‘coverage’, ‘number of needles/syringes distributed/collected’, ‘provision of other drug use paraphernalia’ and ‘availability in prisons’. Among the generic or cross-cutting indicators the priority indicators were ‘infectious diseases counselling and care’, ‘take away naloxone’, ‘information on safe use/sex’ and ‘condoms’. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries.ConclusionsThe establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

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Chinook salmon spawning was first reported in the 1980s in the Caterina River tributary of the Santa Cruz River basin of Patagonia, which drains into the Atlantic Ocean. A naturalized population now persists and its source has been debated. Chinook salmon from California populations was directly released into the Santa Cruz River in the early twentieth century, but ocean ranching experiments on the Pacific coast of Patagonia (Chile) also released Chinook salmon of lower Columbia River origin (University of Washington hatchery stock) in the late twentieth century. We used genetic stock identification with single nucleotide polymorphisms to explore the origin of this Chinook salmon population. The genotypes of salmon that invaded the Santa Cruz River were compared with those derived from 69 known populations from the Northern Hemisphere. Chinook Salmon of the Santa Cruz River were found to be most similar to those from the lower Columbia River. This supports the hypothesis that the Santa Cruz River population was founded from the ocean ranching in southern Chile and the river was invaded by fish straying from Pacific coast basins. Moreover, we find that the life history of these naturalized fish, as inferred from scale analysis, was similar to that of the progenitor stock. We suggest that the successful invasion of the Caterina River in Patagonia by Chinook salmon was aided by pre-adaptations of some of the stocks used in the ocean ranching experiments to conditions in the new environment, rather than a post-colonization adaptation.