Multi-omics for studying and understanding polar life

Polar ecosystems are experiencing amongst the most rapid rates of regional warming on Earth. Here, we discuss 'omics' approaches to investigate polar biodiversity, including the current state of the art, future perspectives and recommendations. We propose a community road map to generate and more fully exploit multi-omics data from polar organisms. These data are needed for the comprehensive evaluation of polar biodiversity and to reveal how life evolved and adapted to permanently cold environments with extreme seasonality. We argue that concerted action is required to mitigate the impact of warming on polar ecosystems via conservation efforts, to sustainably manage these unique habitats and their ecosystem services, and for the sustainable bioprospecting of novel genes and compounds for societal gain.

Development and External Validation of a Multivariable Prediction Model to Identify Nondiabetic Hyperglycemia and Undiagnosed Type 2 Diabetes: Diabetes Risk Assessment in Dentistry Score (DDS)

The aim of this study was to develop and externally validate a score for use in dental settings to identify those at risk of undiagnosed nondiabetic hyperglycemia (NDH) or type 2 diabetes (T2D). The Studies of Health in Pomerania (SHIP) project comprises 2 representative population-based cohort studies conducted in northeast Germany. SHIP-TREND-0, 2008 to 2012 (the development data set) had 3,339 eligible participants, with 329 having undiagnosed NDH or T2D. Missing data were replaced using multiple imputation. Potential covariates were selected for inclusion in the model using backward elimination. Heuristic shrinkage was used to reduce overfitting, and the final model was adjusted for optimism. We report the full model and a simplified paper-based point-score system. External validation of the model and score employed an independent data set comprising 2,359 participants with 357 events. Predictive performance, discrimination, calibration, and clinical utility were assessed. The final model included age, sex, body mass index, smoking status, first-degree relative with diabetes, presence of a dental prosthesis, presence of mobile teeth, history of periodontal treatment, and probing pocket depths ≥5 mm as well as prespecified interaction terms. In SHIP-TREND-0, the model area under the curve (AUC) was 0.72 (95% confidence interval [CI] 0.69, 0.75), calibration in the large was -0.025. The point score AUC was 0.69 (95% CI 0.65, 0.72), with sensitivity of 77.0 (95% CI 76.8, 77.2), specificity of 51.5 (95% CI 51.4, 51.7), negative predictive value of 94.5 (95% CI 94.5, 94.6), and positive predictive value of 17.0 (95% CI 17.0, 17.1). External validation of the point score gave an AUC of 0.69 (95% CI 0.66, 0.71), sensitivity of 79.2 (95% CI 79.0, 79.4), specificity of 49.9 (95% CI 49.8, 50.00), negative predictive value 91.5 (95% CI 91.5, 91.6), and positive predictive value of 25.9 (95% CI 25.8, 26.0). A validated prediction model involving dental variables can identify NDH or undiagnosed T2DM. Further studies are required to validate the model for different European populations.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

The impact of hydraulic retention time on the performance of two configurations of anaerobic pond for municipal sewage treatment

Anaerobic ponds have the potential to contribute to low carbon wastewater treatment, however are currently restricted by long hydraulic residence time (HRT) which leads to large land requirements. A two-stage anaerobic pond (SAP) design was trialled against a single-stage control (CAP) over four HRTs down to 0.5 days, to determine the lowest HRT at which the ponds could operate effectively. No statistical differences were observed in particulate removal between the ponds over all four HRTs, suggesting solids loading is not a critical factor in AP design. Significantly higher biogas production rates were observed in the SAP than the CAP at 1.5 d and 1.0 d HRT, and microbial community profiling suggests the two-stage design may be facilitating spatial separation of the anaerobic digestion process along reactor length. Hydrogenotrophic methanogensis dominated over aceticlastic, with acetate oxidisation a likely degradation pathway. Experimental tracer studies were compared to CFD simulations, with the SAP showing greater hydraulic efficiency, and differences more pronounced at shorter HRTs. Greater flow recirculation between baffles was observed in CFD velocity profiles, demonstrating baffles can dissipate preferential flow patterns and increase effective pond volume, especially at high flow rates. The study demonstrates the potential of APs to be operated at shorter HRTs in psychrophilic conditions, presenting an opportunity for use as pre-treatments (in place of septic tanks) and primary treatment for full wastewater flows. Two-stage designs should be investigated to separate the stages of the anaerobic digestion process by creating preferential conditions along the pond length.

POS0125 CALCULATING RISK OF HAND OSTEOARTHRITIS PROGRESSION AT TEN YEARS THROUGH A PREDICTION MODEL

Background:

Hand osteoarthritis (OA) is a chronic, progressive disease, commonly affecting middle aged women. OA at the interphalangeal joints (IPJs) or the thumb base are considered different disease subsets (1). Few studies have investigated individual risk factors for IPJ OA progression (2). Prediction models can be used to calculate overall disease risk from multiple risk factors. This can guide prevention and treatment options.

Objectives:

Develop and internally validate a prediction model for IPJ OA progression.

Methods:

Data from the Chingford 1000 Women Study (Chingford Study), the largest population-based cohort worldwide assessing hand OA, was used. It is representative of the middle-aged female population in the United Kingdom (3). At baseline, 1,003 women aged 45 to 64 years’ old were recruited, and 693 measurements taken. Hand radiographs were taken at baseline and after ten years, read using the Kellgren-Lawrence (KL) atlas (inter-observer correlation: ≥0.7 (4)).

For the current study, participants must have had OA (KL ≥2 in ≥1 IPJ) on baseline hand radiographs. Participants with KL 4 in all 16 IPJs at baseline were excluded. Risk factors from the Chingford Study at baseline were selected by biological plausibility, literature evidence (2), and hand surgeons‘ consensus (5): age (years), occupation (manual versus non manual), OA in ≥1 thumb base (KL ≥2 versus KL<2), body mass index (BMI) (kg/m2), family history of hand OA (yes versus no). The outcome was defined on an ordinal scale for the number of IPJs (up to >5 IPJs) with OA progression (increase by KL ≥1), at ten years’.

The prediction model was developed using a penalized proportional odds logistic regression. Odds ratios (95% confidence intervals) were reported for each risk factor. The model was internally validated using 2,000 bootstrap iterations. Model performance was assessed for discrimination (C-statistic), and calibration (C-slope). 3.5% of data was missing, and complete case analysis was used.

Results:

699 women had baseline hand radiographs: 38 were unreadable, 459 had no IPJ OA. Seven participants had missing data (occupation: 5, BMI: 1, family history: 1) and were excluded. 195 participants were included this study. Median age at baseline was 59 (interquartile range: 8) years.

181 (92.8%) participants had OA progression at 10 years (Figure 1). Thumb base OA (odds ratio: 1.32 (0.93 to 1.88)) was most strongly associated with IPJ OA progression (Table 1). C-statistic was 0.57, and calibration slope was 1.38 for the optimism-corrected model.

Table 1.

Odds ratios for risk factors

Risk factorOdds ratio (95% confidence interval)Age (years)1.02 (0.99 to 1.06)Occupation (manual versus non manual)0.88 (0.60 to 1.29)Thumb base OA (Kellgren-Lawrence grade ≥2 versus <2)1.32 (0.93 to 1.88)Family history of hand OA (yes versus no)1.03 (0.72 to 1.45)Body mass index (kg/m2)1.04 (0.99 to 1.09)

OA: Osteoarthritis

Conclusion:

More stringent cut-offs for OA progression would be clinically useful. It was only weakly possible to predict which participants with IPJ OA would progress. This suggests that other risk factors, such as gender, ethnicity and genetics, may be predominant.

Figure 1.

Hand interphalangeal joints with osteoarthritis progression (Kellgren-Lawrence grade ≥1) at 10 years’ follow up

References:

[1]Kloppenburg M, et al. Research in hand osteoarthritis: time for reappraisal and demand for new strategies. Ann Rheum Dis. 2007;66(9):1157-61.

[2]Shah K, et al. Risk factors for the progression of finger interphalangeal joint osteoarthritis: a systematic review. Rheumatol Int. 2020;40(11):1781-1792.

[3]Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol. 1993;20:331-335.

[4]Hart DJ, et al. Reliability and reproducibility of grading radiographs for osteoarthritis of the hand. Br J Rheum. 1993;32:S1.

[5]Shah K, et al. Delphi consensus of risk factors for development and progression of finger interphalangeal joint osteoarthritis. J Hand Surg Eur Vol. 2019;44(10):1089-1090.

Acknowledgements:

We would like to thank all of the participants of The Chingford 1000 Women Study, Professor Tim Spector, Dr Deborah Hart, Dr Alan Hakim, Maxine Daniels, Alison Turner, James van Santen and Julie Damnjanovic for their time and dedication.

Disclosure of Interests:

Karishma Shah: None declared, Garrett Bullock: None declared, Alan Silman: None declared, Dominic Furniss: None declared, Nigel Arden Consultant of: Receives personal fees from Pfizer/Lily for consultancy outside the scope of this work, Grant/research support from: Receives grant from Merck outside the scope of this work, Gary Collins: None declared

OP0280 TEMPORAL TRENDS OF OPIOID USE AMONG INCIDENT OSTEOARTHRITIS PATIENTS IN CATALONIA, 2007-2016: A POPULATION-BASED COHORT STUDY

Background:

Opioids are not recommended as first-line treatments for chronic pain management in osteoarthritis (OA), but recent data suggest they are commonly used in routine practice in North America and northern Europe.

Objectives:

To characterise the secular trends of opioid and strong opioids use in patients with incident OA from 2007 to 2016, and to explore the impact of patient characteristics on the use of opioid/s for OA.

Methods:

Data was obtained from the SIDIAP (The System for the Development of Research in Primary Care) database, which contains primary care records and pharmacy dispensing data for 80 % of the population in Catalonia (~ 6 million people). All persons aged 18 or older at the beginning of each calendar year with an incident OA diagnosis (including both peripheral and central joints) in the study period were included. Index date was the date of first OA diagnosis, and the observation period of opioid use was 1-year after index date. Opioids considered included codeine, tramadol, fentanyl, and morphine, with the latter three classified as strong opioids. The period prevalence of any opioid use was estimated in whole and sub-population stratified by sex, age, socio-economic status (U1 – U5, higher values of the indicator equivalent to deprivation) and residence area (rural/urban).

Results:

The 1-year prevalence of any opioid use among incident OA patients was around 15% from 2007 to 2012. After that, this figure grew by 10% approaching 25% in 2016. However, strong opioid use increased continuously to nearly triple, from 8% in 2007 to 20% in 2016. The different subgroups followed similar trends over time, with women 4% higher than men, oldest 10% higher than youngest, most deprived 6% higher than least deprived, and rural 1% higher than urban.

Conclusion:

The use of opioids (and especially strong opioids) has substantially increased in recent years among newly diagnosed OA patients in Catalonia. Our findings call for urgent action for safe opioid prescribing to avoid opioid abuse in OA patients especially amongst older women living in deprived areas.

Figure 1.

Trends of 1-year prevalence of opioid/s use among incident OA patients, whole and subgroup population.

Disclosure of Interests:

Junqing Xie: None declared, Aleksandra Turkiewicz: None declared, Gary Collins: None declared, Martin Englund Consultant of: Advisory Board 1 day (2019) Pfizer (Tanezumab)., Victoria Y Strauss: None declared, Carlen Reyes: None declared, Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen

The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients

BACKGROUND

Survival in mycosis fungoides (MF) is varied and may be poor. The PROCLIPI (PROspective Cutaneous Lymphoma International Prognostic Index) study is a web-based data collection system for early-stage MF with legal data-sharing agreements permitting international collaboration in a rare cancer with complex pathology. Clinicopathological data must be 100% complete and in-built intelligence in the database system ensures accurate staging.

OBJECTIVES

To develop a prognostic index for MF.

METHODS

Predefined datasets for clinical, haematological, radiological, immunohistochemical, genotypic, treatment and quality of life are collected at first diagnosis of MF and annually to test against survival. Biobanked tissue samples are recorded within a Federated Biobank for translational studies.

RESULTS

In total, 430 patients were enrolled from 29 centres in 15 countries spanning five continents. Altogether, 348 were confirmed as having early-stage MF at central review. The majority had classical MF (81·6%) with a CD4 phenotype (88·2%). Folliculotropic MF was diagnosed in 17·8%. Most presented with stage I (IA: 49·4%; IB: 42·8%), but 7·8% presented with enlarged lymph nodes (stage IIA). A diagnostic delay between first symptom development and initial diagnosis was frequent [85·6%; median delay 36 months (interquartile range 12-90)]. This highlights the difficulties in accurate diagnosis, which includes lack of a singular diagnostic test for MF.

CONCLUSIONS

This confirmed early-stage MF cohort is being followed-up to identify prognostic factors, which may allow better management and improve survival by identifying patients at risk of disease progression. This study design is a useful model for collaboration in other rare diseases, especially where pathological diagnosis can be complex.

Hydrogen sulfide oxidation in novel Horizontal-Flow Biofilm Reactors dominated by an Acidithiobacillus and a Thiobacillus species

Hydrogen Sulfide (H2S) is an odourous, highly toxic gas commonly encountered in various commercial and municipal sectors. Three novel, laboratory-scale, Horizontal-Flow Biofilm Reactors (HFBRs) were tested for the removal of H2S gas from air streams over a 178-day trial at 10°C. Removal rates of up to 15.1 g [H2S] m(-3) h(-1) were achieved, demonstrating the HFBRs as a feasible technology for the treatment of H2S-contaminated airstreams at low temperatures. Bio-oxidation of H2S in the reactors led to the production of H(+) and sulfate (SO(2-)4) ions, resulting in the acidification of the liquid phase. Reduced removal efficiency was observed at loading rates of 15.1 g [H2S] m(-3) h(-1). NaHCO3 addition to the liquid nutrient feed (synthetic wastewater (SWW)) resulted in improved H2S removal. Bacterial diversity, which was investigated by sequencing and fingerprinting 16S rRNA genes, was low, likely due to the harsh conditions prevailing in the systems. The HFBRs were dominated by two species from the genus Acidithiobacillus and Thiobacillus. Nonetheless, there were significant differences in microbial community structure between distinct HFBR zones due to the influence of alkalinity, pH and SO4 concentrations. Despite the low temperature, this study indicates HFBRs have an excellent potential to biologically treat H2S-contaminated airstreams.

Review article: acute severe ulcerative colitis - evidence-based consensus statements

BACKGROUND

Acute severe ulcerative colitis (ASUC) is a potentially life-threatening complication of ulcerative colitis.

AIM

To develop consensus statements based on a systematic review of the literature of the management of ASUC to improve patient outcome.

METHODS

Following a literature review, the Delphi method was used to develop the consensus statements. A steering committee, based in Australia, generated the statements of interest. Three rounds of anonymous voting were carried out to achieve the final results. Acceptance of statements was pre-determined by ≥80% votes in 'complete agreement' or 'agreement with minor reservation'.

RESULTS

Key recommendations include that patients with ASUC should be: hospitalised, undergo unprepared flexible sigmoidoscopy to assess severity and to exclude cytomegalovirus colitis, and be provided with venous thromboembolism prophylaxis and intravenous hydrocortisone 100 mg three or four times daily with close monitoring by a multidisciplinary team. Rescue therapy such as infliximab or ciclosporin should be started if insufficient response by day 3, and colectomy considered if no response to 7 days of rescue therapy or earlier if deterioration. With such an approach, it is expected that colectomy rate during admission will be below 30% and mortality less than 1% in specialist centres.

CONCLUSION

These evidenced-based consensus statements on acute severe ulcerative colitis, developed by a multidisciplinary group, provide up-to-date best practice recommendations that improve and harmonise management as well as provide auditable quality assessments.

Carbon amendment and soil depth affect the distribution and abundance of denitrifiers in agricultural soils

The nitrite reductase (nirS and nirK) and nitrous oxide reductase-encoding (nosZ) genes of denitrifying populations present in an agricultural grassland soil were quantified using real-time polymerase chain reaction (PCR) assays. Samples from three separate pedological depths at the chosen site were investigated: horizon A (0-10 cm), horizon B (45-55 cm), and horizon C (120-130 cm). The effect of carbon addition (treatment 1, control; treatment 2, glucose-C; treatment 3, dissolved organic carbon (DOC)) on denitrifier gene abundance and N2O and N2 fluxes was determined. In general, denitrifier abundance correlated well with flux measurements; nirS was positively correlated with N2O, and nosZ was positively correlated with N2 (P < 0.03). Denitrifier gene copy concentrations per gram of soil (GCC) varied in response to carbon type amendment (P < 0.01). Denitrifier GCCs were high (ca. 10(7)) and the bac:nirK, bac:nirS, bac:nir (T) , and bac:nosZ ratios were low (ca. 10(-1)/10) in horizon A in all three respective treatments. Glucose-C amendment favored partial denitrification, resulting in higher nir abundance and higher N2O fluxes compared to the control. DOC amendment, by contrast, resulted in relatively higher nosZ abundance and N2 emissions, thus favoring complete denitrification. We also noted soil depth directly affected bacterial, archaeal, and denitrifier abundance, possibly due to changes in soil carbon availability with depth.

Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013

Introduction

Hip arthroscopy is increasingly adopted for the treatment of intra-articular and extra-articular pathologies. Studies from USA demonstrate a 365% increase in the number of procedures performed between 2004 and 2009 and 250% increase between 2007 and 2011. There is limited evidence of long-term efficacy for this procedure and hip arthroscopy is not universally funded across England. The aim of this study is to describe temporal trends in the adoption of hip arthroscopy in England between 2002 and 2013 and to forecast trends for the next 10 years.

Methods

A search of the Hospital Episodes Database was performed for all codes describing arthroscopic hip procedures with patient age, sex and area of residence.

Results

11 329 hip arthroscopies were performed in National Health Service hospitals in England between 2002 and 2013. The number of hip arthroscopies performed increased by 727% (p<0.0001) during this period and is forecast to increase by 1388% in 2023. Females represent 60% of all patients undergoing hip arthroscopy (p<0.001). Median age category is 40–44 for females and 35–39 for males and average age decreased during the study period (p<0.0001). There is significant regional variation in procedure incidence. In the final year of this study the highest incidence was in the Southwest (8.63/100 000 population) and lowest in East Midlands (1.29/100 000 population).

Conclusions

The increase in number of hip arthroscopies performed in England reflects trends in USA and continued increases are forecast. Evidence from robust clinical trials is required to justify the increasing number of procedures performed and regional variation suggests potential inequality in the provision of this intervention.

Synthesis and catalytic properties of highly branched palladium nanostructures using seeded growth

In order to develop nanocatalysts with enhanced catalytic performance, it is important to be able to synthesize nanocrystals enclosed by high-index surface facets, due to their high density of low coordinated atoms at step, ledge and kink sites. Here, we report a facile seed-mediated route to the synthesis of highly branched Pd nanostructures with a combination of {113}, {115} and {220} high-index surface planes. The size of these nanostructures is readily controlled by a simple manipulation of the seed concentration. The selective use of oleylamine and oleic acid was also found to be critical to the synthesis of these structures, with Pd icosahedra enclosed by low-index {111} facets being produced when hexadecylamine was employed as capping ligand. The structure-property relationship of these nanostructures as catalysts in Suzuki-cross coupling reactions was then investigated and compared, with the high-index faceted branched Pd nanostructures found to be the most effective catalysts.

Factors associated with neurocognitive test performance at baseline: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

OBJECTIVES

We describe neuropsychological test performance (NP) in antiretroviral treatment (ART)-naïve HIV-positive individuals with CD4 cell counts above 500 cells/μL.

METHODS

In a neurology substudy of the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) Strategic Timing of AntiRetroviral Treatment (START) study, eight neurocognitive tests were administered. The primary measure of NP was the quantitative NP z-score (QNPZ-8), the average of the z-scores for the eight tests. Associations of baseline factors with QNPZ-8 scores were assessed by multiple regression. Mild neurocognitive impairment (NCI) was defined as z-scores < -1 in at least two of six cognitive domains.

RESULTS

A total of 608 participants had a median age of 34 years; 11% were women and 15% were black; the median time since HIV diagnosis was 0.9 years; the median CD4 cell count was 633 cells/μL; 19.9% had mild NCI. Better NP was independently associated with younger age, being white, higher body mass index (0.10 per 10 kg/m(2) higher), and higher haematocrit percentage (0.19 per 10% higher). Worse NP was associated with longer time since HIV diagnosis (-0.17 per 10 years), diabetes (-0.29) and higher Framingham risk score (-0.15 per 10 points higher). QNPZ-8 scores differed significantly between geographical locations, with the lowest scores in Brazil and Argentina/Chile.

CONCLUSIONS

This is the largest study of NP in ART-naïve HIV-positive adults with CD4 counts > 500 cells/μL. Demographic factors and diabetes were most strongly associated with NP. Unmeasured educational/sociocultural factors may explain geographical differences. Poorer NP was independently associated with longer time since HIV diagnosis, suggesting that untreated HIV infection might deleteriously affect NP, but the effect was small.

Pulmonary function in an international sample of HIV-positive, treatment-naïve adults with CD4 counts > 500 cells/μL: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

OBJECTIVES

The aim of the study was to describe the prevalence and correlates of chronic obstructive pulmonary disease (COPD) in a multicentre international cohort of persons living with HIV (PLWH).

METHODS

We performed a cross-sectional analysis of adult PLWH, naïve to HIV treatment, with baseline CD4 cell count > 500 cells/μL enrolled in the Pulmonary Substudy of the Strategic Timing of AntiRetroviral Treatment (START) trial. We collected standardized, quality-controlled spirometry. COPD was defined as forced expiratory volume in 1 s:forced vital capacity (FEV1 :FVC) ratio less than the lower limit of normal.

RESULTS

Among 1026 participants from 80 sites and 20 countries, the median age was 36 [interquartile range (IQR) 30, 44] years, 29% were female, and the median time since HIV diagnosis was 1.2 (IQR 0.4, 3.5) years. Baseline median CD4 cell count was 648 (IQR 583, 767) cells/μL, median viral load was 4.2 (IQR 3.5, 4.7) log10 HIV-1 RNA copies/mL, and 10% had a viral load ≤ 400 copies/mL despite lack of HIV treatment. Current/former/never smokers comprised 28%/11%/61% of the cohort, respectively. COPD was present in 6.8% of participants, and varied by age, smoking status and region. Forty-eight per cent of those with COPD reported lifelong nonsmoking. In multivariable regression, age and pack-years of smoking had the strongest associations with FEV1 :FVC ratio (P < 0.0001). There was a significant effect of region on FEV1 :FVC ratio (P = 0.010).

CONCLUSIONS

Our data suggest that, among PLWH who were naïve to HIV treatment and had CD4 cell counts > 500 cells/μL, smoking and age were important factors related to COPD. Smoking cessation should remain a high global priority for clinical care and research in PLWH.

An evaluation of the performance and optimization of a new wastewater treatment technology: the air suction flow-biofilm reactor

In this laboratory study, a novel wastewater treatment technology, the air suction flow-biofilm reactor (ASF-BR) - a sequencing batch biofilm reactor technology with a passive aeration mechanism - was investigated for its efficiency in removing organic carbon, nitrogen and phosphorus, from high-strength synthetic wastewaters. A laboratory-scale ASF-BR comprising 2 reactors, 350 mm in diameter and 450 mm in height, was investigated over 2 studies (Studies 1 and 2) for a total of 430 days. Study 1 lasted a total of 166 days and involved a 9-step sequence alternating between aeration, anoxic treatment and settlement. The cycle time was 12.1 h and the reactors were operated at a substrate loading rate of 3.60 g filtered chemical oxygen demand (CODf)/m2 media/d, 0.28 g filtered total nitrogen (TNf)/m2 media/d, 0.24 g ammonium-nitrogen (NH4-N)/m2 media/d and 0.07 g ortho-phosphate (PO4-P)/m2 media/d. The average removal rates achieved during Study 1 were 98% CODf, 88% TNf, 97% NH4-N and 35% PO4-P. During Study 2 (264 days), the unit was operated at a loading rate of 2.49 g CODf/m2 media/d, 0.24 g TNf/m2 media/d, 0.20 g NH4-N/m2 media/d and 0.06 PO4-P/m2 media/d. The energy requirement during this study was reduced by modifying the treatment cycle in include fewer pumping cycles. Removal rates in Study 2 averaged 97% CODf, 86% TNf, 99% NH4-N and 76% PO4-P. The excess sludge production of the system was evaluated and detailed analyses of the treatment cycles were carried out. Biomass yields were estimated at 0.09 g SS/g CODf, removed and 0.21 g SS/g CODf, removed for Studies 1 and 2, respectively. Gene analysis showed that the use of a partial vacuum did not affect the growth of ammonia-oxidizing bacteria. The results indicate that the ASF-BR and passive aeration technologies can offer efficient alternatives to existing technologies.

The changes in prostate cancer and its management in the North West of England over a 10-year period

Objectives:

Our aim was to evaluate changes in prostate cancer diagnosis and management and to examine changes in the stage and grade of newly diagnosed prostate cancer in the North West of England over a 10-year period.

Materials and methods:

Data was collected concerning the diagnosis (including stage and grade) and management of newly diagnosed prostate cancer in the North West of England. There were three time points: 2003, 2007 and 2011 including a total of 648 patients. For assessment of median time changes Spearman’s Rank correlation test was used, for the assessment of changes in Gleason grade and clinical stage Mann–Whitney U test was used, and assessment of positive margin rates was done with Fisher’s test.

Results:

Median time from management decision to surgery has reduced from 46 (2003), 34 (2007) to 27 days (2011) ( p=0.074). The proportion of patients managed with active surveillance has remained relatively constant over time (18%, 16% and 21% respectively). More minimally invasive, nerve-sparing prostatectomies are now performed, and positive margin rates have significantly reduced from 53% (2003) to 23% (2011) ( p<0.001). Gleason grade significantly increased over time ( p<0.001); Gleason 7 disease was diagnosed in 23% of patients in 2003, 32% in 2007 and 49% in 2011 ( p<0.001). There was an increase in Gleason 8 disease; 6% (2003) to 8.6% (2011), but this was not significant ( p=0.27). Increase in clinical stage was also noted over time; identification of T3 disease rose from 2% (2003 and 2007) to 5% (2011) ( p=0.045) (excluding cases with non-recorded stage).

Conclusion:

Prostate cancer management in the North West of England has evolved over the last decade, with overall improvements in management quality. We have demonstrated an increase in the presenting stage and grade of prostate cancer over a 10-year period.

Controlling alloy formation and optical properties by galvanic replacement of sub-20 nm silver nanoparticles in organic media

Galvanic replacement is a versatile synthetic strategy for the synthesis of alloy and hollow nanostructures.

Fate of Trace Metals in Anaerobic Digestion

A challenging, and largely uncharted, area of research in the field of anaerobic digestion science and technology is in understanding the roles of trace metals in enabling biogas production. This is a major knowledge gap and a multifaceted problem involving metal chemistry; physical interactions of metal and solids; microbiology; and technology optimization. Moreover, the fate of trace metals, and the chemical speciation and transport of trace metals in environments--often agricultural lands receiving discharge waters from anaerobic digestion processes--simultaneously represents challenges for environmental protection and opportunities to close process loops in anaerobic digestion.

Interface effects on the electronic transport properties in highly epitaxial LaBaCo2O(5.5+δ) films

Single-crystalline perovskite LaBaCo2O5.5+δ thin films were grown on a (110) NdGaO3 single-crystal substrate in order to systematically investigate the effect of lattice mismatch on the electrical transport properties in comparison to the films on LaAlO3, SrTiO3, and MgO substrates. Microstructure studies reveal that all of the LaBaCo2O5.5+δ films are of excellent quality with atomically sharp interface structures. The electrical and magnetic transport property studies indicate that the resistivity, magnetoresistance, and magnetic moment of the film are very sensitive to the substrate materials because of the lattice mismatch/interface strain. The Curie temperature, however, is almost independent of the strain imposed by the substrate, probably because of the strong coupling between the nanodomain boundary and interface strain.

Compliance and use of the World Health Organization checklist in UK operating theatres

Background

The World Health Organization (WHO) Surgical Safety Checklist is reported to reduce surgical morbidity and mortality, and is mandatory in the UK National Health Service. Hospital audit data show high compliance rates, but direct observation suggests that actual performance may be suboptimal.

Methods

For each observed operation, WHO time-out and sign-out attempts were recorded, and the quality of the time-out was evaluated using three measures: all information points communicated, all personnel present and active participation.

Results

Observation of WHO checklist performance was conducted for 294 operations, in five hospitals and four surgical specialties. Time-out was attempted in 257 operations (87·4 per cent) and sign-out in 26 (8·8 per cent). Within time-out, all information was communicated in 141 (54·9 per cent), the whole team was present in 199 (77·4 per cent) and active participation was observed in 187 (72·8 per cent) operations. Surgical specialty did not affect time-out or sign-out attempt frequency (P = 0·453). Time-out attempt frequency (range 42–100 per cent) as well as all information communicated (15–83 per cent), all team present (35–90 per cent) and active participation (15–93 per cent) varied between hospitals (P &lt; 0·001 for all).

Conclusion

Meaningful compliance with the WHO Surgical Safety Checklist is much lower than indicated by administrative data. Sign-out compliance is generally poor, suggesting incompatibility with normal theatre work practices. There is variation between hospitals, but consistency across studied specialties, suggesting a need to address organizational culture issues.

Optimization of a horizontal-flow biofilm reactor for the removal of methane at low temperatures

Three pilot-scale, horizontal-flow biofilm reactors (HFBRs 1-3) were used to treat methane (CH4)-contaminated air to assess the potential of this technology to manage emissions from agricultural activities, waste and wastewater treatment facilities, and landfills. The study was conducted over two phases (Phase 1, lasting 90 days and Phase 2, lasting 45 days). The reactors were operated at 10 degrees C (typical of ambient air and wastewater temperatures in northern Europe), and were simultaneously dosed with CH4-contaminated air and a synthetic wastewater (SWW). The influent loading rates to the reactors were 8.6 g CH4/m3/hr (4.3 g CH4/m2 TPSA/hr; where TPSA is top plan surface area). Despite the low operating temperatures, an overall average removal of 4.63 g CH4/m3/day was observed during Phase 2. The maximum removal efficiency (RE) for the trial was 88%. Potential (maximum) rates of methane oxidation were measured and indicated that biofilm samples taken from various regions in the HFBRs had mostly equal CH4 removal potential. In situ activity rates were dependent on which part of the reactor samples were obtained. The results indicate the potential of the HFBR, a simple and robust technology, to biologically treat CH4 emissions.

IMPLICATIONS

The results of this study indicate that the HFBR technology could be effectively applied to the reduction of greenhouse gas emissions from wastewater treatment plants and agricultural facilities at lower temperatures common to northern Europe. This could reduce the carbon footprint of waste treatment and agricultural livestock facilities. Activity tests indicate that methanotrophic communities can be supported at these temperatures. Furthermore, these data can lead to improved reactor design and optimization by allowing conditions to be engineered to allow for improved removal rates, particularly at lower temperatures. The technology is simple to construct and operate, and with some optimization of the liquid phase to improve mass transfer, the HFBR represents a viable, cost-effective solution for these emissions.