The impact of rainfall events on dissolved oxygen concentrations in a subtropical urban reservoir

Understanding controls of dissolved oxygen (DO) concentrations in reservoirs is important as they are important for fisheries and a significant driver of greenhouse gas emissions. The latter is of global significance as IPCC inventories now require greenhouse gas emissions from artificial reservoirs to be included. Declines in dissolved oxygen (DO) concentrations in lakes and reservoirs have been linked to climate change and human activity. However, these effects can vary widely in any given region under various meteorological conditions. There is a clear need to know how changes in weather patterns affect DO in reservoirs by changing internal processes. Based on a six-year (2016-2021) high-frequency (twice a week) dataset from a shallow urban reservoir (Xinglinwan Reservoir) in subtropical China, the long-term (six years) and short-term (8-72-h) drivers of DO concentrations in surface waters were evaluated. Over the past six years, the concentration of DO has gradually decreased in the reservoir from 2016 to 2021. Multivariate adaptive regression spline (MARS) models were developed to identify the key factors explaining variability in DO and partial least squares path models (PLS-PM) were used to explore the short-term relationships between DO and environmental variables in rainy and dry (non-rain) periods, separately. We identified three key drivers operating on different time scales. First, the long-term decline of DO in Xinglinwan Reservoir from 2016 to 2021 was best explained by anthropogenic nutrient inputs. Second, rainy periods prior to sampling reduced DO concentrations indirectly by affecting the algal biomass and nutrient concentrations. This effect varied in complexity with the duration of the rainfall period. Third, water temperature best explained DO concentrations during dry periods, while wind reduced DO by reducing algal biomass. We conclude that anthropogenic nutrient and organic matter inputs drive long-term oxygen declines in urban subtropical reservoirs, while meteorological factors determine short-term variability in DO concentrations.

Lake browning counteracts cyanobacteria responses to nutrients: Evidence from phytoplankton dynamics in large enclosure experiments and comprehensive observational data

Lakes worldwide are affected by multiple stressors, including climate change. This includes massive loading of both nutrients and humic substances to lakes during extreme weather events, which also may disrupt thermal stratification. Since multi-stressor effects vary widely in space and time, their combined ecological impacts remain difficult to predict. Therefore, we combined two consecutive large enclosure experiments with a comprehensive time-series and a broad-scale field survey to unravel the combined effects of storm-induced lake browning, nutrient enrichment and deep mixing on phytoplankton communities, focusing particularly on potentially toxic cyanobacterial blooms. The experimental results revealed that browning counteracted the stimulating effect of nutrients on phytoplankton and caused a shift from phototrophic cyanobacteria and chlorophytes to mixotrophic cryptophytes. Light limitation by browning was identified as the likely mechanism underlying this response. Deep-mixing increased microcystin concentrations in clear nutrient-enriched enclosures, caused by upwelling of a metalimnetic Planktothrix rubescens population. Monitoring data from a 25-year time-series of a eutrophic lake and from 588 northern European lakes corroborate the experimental results: Browning suppresses cyanobacteria in terms of both biovolume and proportion of the total phytoplankton biovolume. Both the experimental and observational results indicated a lower total phosphorus threshold for cyanobacterial bloom development in clearwater lakes (10-20 μg P L-1 ) than in humic lakes (20-30 μg P L-1 ). This finding provides management guidance for lakes receiving more nutrients and humic substances due to more frequent extreme weather events.

Late-onset postoperative angioedema triggered by angiotensin-converting enzyme inhibitor: An emergent airway forethought

Angioedema is a potentially life-threatening condition due to the risk of airway compromise leading to deterioration of respiratory function, hypoxia, and ultimately, cardiopulmonary arrest. It can be either unprovoked or triggered by pharmaceutical agents, emotional or physiologic factors, upper airway trauma, or surgical stress. A 46-year-old man previously prescribed perindopril developed angioedema of the tongue 4 h after being discharged from the Post Anesthesia Care Unit (PACU). A multidisciplinary team was called and they outlined an airway management strategy to use in the event of worsening. The strategy consisted of either fiberoptic intubation by an anesthesiologist or surgical tracheostomy performed by the surgical team, both performed with the patient awake and in spontaneous ventilation. The aim of this case report is to raise awareness that angioedema is a potentially life-threatening condition. For optimal management, it is important to prepare in advance a detailed airway management strategy to be implemented by a multidisciplinary team.

The benefits of restoring urban lakes in the tropics

Lake restoration in developing economies, particularly in the tropics, is a major challenge given the severe levels of pollution from untreated wastewater and the warm climate conducive to microbial and algal growth. Restoration goals are often ill-defined or unachievable. Here we describe the successes that can be achieved through a control, compared with intervention case study of the two urban lakes in Bengaluru, India, one of the world's largest and fastest growing mega-cities. The unrestored control, Bellandur Lake, was severely polluted by 231 million litres per day (MLD) of untreated wastewater. The restoration site, Jakkur Lake, receives 10 MLD of treated wastewater and also receives some tertiary treatment by circulating the effluent through a constructed wetland before it enters the lake. The water quality of Bellandur Lake can only be described as extremely bad. Organic pollution levels in the main inflow were high (BOD5 of 199 mg/l, faecal coliforms 6.9 Log MPN/100 ml, total suspended solids (TSS) of 285 mg/l) leading to the complete deoxygenation of lake even at the surface. The levels exceeded use-base standards for bathing water and fisheries. The high levels of organic pollution and low oxygen conditions also led to extreme levels of methane emissions that occasionally led to the lake surface catching fire. Total nitrogen (TN) and total phosphorus (TP) concentrations in the lake were extremely high (47 mg/l and 6.3 mg/l) respectively with low Secchi depth (SD). Despite the high nutrient levels, very little phytoplankton growth occurred (chlorophyll-a of 0 mg/l), most likely due to the high TSS loads which restricted light availability. In comparison, the wastewater treatment and wetland at Jakkur Lake markedly reduced organic pollution of the main inflow (BOD5 of 32 mg/l, faecal coliforms 4.1 Log MPN/100 ml, TSS of 48 mg/l). Levels of coliforms in the lake were above the standards for bathing waters. Total nitrogen (TN) and total phosphorus (TP) concentrations in the lake reduced (10.5 mg/l, 2.4 mg/l) but still classify the lake as extremely hypereutrophic. The lower TSS levels did, however, enable dense phytoplankton blooms to develop (max chlorophyll-a of 600 µg/l) which are in part responsible for the higher levels of dissolved oxygen in the lake water, albeit and as expected with large diurnal fluctuations. The comparison highlights the benefits that standard wastewater treatment provides to restore urban tropical lakes in context of rapidly urbanising catchments, and even though Jakkur Lake is by no means fully restored, it sustains water quality that allow propagation of fisheries and shore-based recreation. It also greatly contributes to greenhouse gas emission reductions. Further restoration measures are likely needed for urban tropical lakes, particularly to tackle pollutant loads in monsoon periods, but restoring community pride in the uses of a lake is an important milestone of the restoration efforts.

Real-world EGFR testing practices for non-small-cell lung cancer by thoracic pathology laboratories across Europe

BACKGROUND

Testing for epidermal growth factor receptor (EGFR) mutations is an essential recommendation in guidelines for metastatic non-squamous non-small-cell lung cancer, and is considered mandatory in European countries. However, in practice, challenges are often faced when carrying out routine biomarker testing, including access to testing, inadequate tissue samples and long turnaround times (TATs).

MATERIALS AND METHODS

To evaluate the real-world EGFR testing practices of European pathology laboratories, an online survey was set up and validated by the Pulmonary Pathology Working Group of the European Society of Pathology and distributed to 64 expert testing laboratories. The retrospective survey focussed on laboratory organisation and daily EGFR testing practice of pathologists and molecular biologists between 2018 and 2021.

RESULTS

TATs varied greatly both between and within countries. These discrepancies may be partly due to reflex testing practices, as 20.8% of laboratories carried out EGFR testing only at the request of the clinician. Many laboratories across Europe still favour single-test sequencing as a primary method of EGFR mutation identification; 32.7% indicated that they only used targeted techniques and 45.1% used single-gene testing followed by next-generation sequencing (NGS), depending on the case. Reported testing rates were consistent over time with no significant decrease in the number of EGFR tests carried out in 2020, despite the increased pressure faced by testing facilities during the COVID-19 pandemic. ISO 15189 accreditation was reported by 42.0% of molecular biology laboratories for single-test sequencing, and by 42.3% for NGS. 92.5% of laboratories indicated they regularly participate in an external quality assessment scheme.

CONCLUSIONS

These results highlight the strong heterogeneity of EGFR testing that still occurs within thoracic pathology and molecular biology laboratories across Europe. Even among expert testing facilities there is variability in testing capabilities, TAT, reflex testing practice and laboratory accreditation, stressing the need to harmonise reimbursement technologies and decision-making algorithms in Europe.

Radiotherapy skin marking with lancets versus electric marking pen - Comfort, satisfaction, effectiveness and cosmesis results from the randomized, double-blind COMFORTATTOO trial

INTRODUCTION

Set-up skin markings are performed, in several centers, for radiotherapy (RT) treatments. This study aimed to compare two permanent methods: lancets and an electric marking pen, the Comfort Marker 2.0® (CM).

METHODS

This was a prospective, unicentric, randomized study. Patients aged 18 years or older referred to our department to receive RT were recruited. Patients were randomly assigned, in a 1:1 ratio, to receive set-up markings using lancets or CM. The markings arrangement followed our departmental protocols. The coprimary endpoints were patients' comfort and effectiveness. Secondary endpoints included radiation therapists (RTTs) satisfaction and cosmesis.

RESULTS

Between October 2021 and January 2022, 100 patients were enrolled (50 received lancets and 50 CM) and assessed for the comfort and satisfaction outcomes. CM was significantly less painful than the lancets, with 44% and 16% of the patients, respectively, considering the tattooing process painless (RR = 2.75; 95% IC: 1.36 - 5.58). On the RTT-reported satisfaction, CM had significantly easier processes than lancets (98.0% vs. 78.0%, respectively; RR = 1.26; 95% CI: 1.08 - 1.46). For effectiveness and cosmesis assessment, 98 patients were analyzed (48 received lancets and 50 CM). Patients receiving CM had a significantly higher proportion of markings graded as good and excellent compared to those receiving lancets (98.0% and 50.0%, respectively, had ≥75% of the tattoos assessed as good/excellent, RR = 1.96; 95% CI: 1.47 - 2.61). On the cosmetic evaluation, patients receiving CM had significantly better cosmetic markings, with a median score of 4.4 (vs. 3.5 for lancets, p <0.001).

CONCLUSION

The trial results demonstrated that tattooing with the CM is significantly less painful, more effective, easier to apply, and cosmetically superior to tattooing with lancets.

IMPLICATIONS FOR PRACTICE

Tattooing with CM allows for better results regarding pain, quality, ease and cosmesis.

Short-term rainfall limits cyanobacterial bloom formation in a shallow eutrophic subtropical urban reservoir in warm season

The global increase in dominance of toxic blooms of cyanobacteria has severely impacted aquatic ecosystems and threatened human health for decades. Although it has been shown that high levels of rainfall may inhibit the growth of bloom-forming cyanobacteria, it is still unclear how cyanobacteria respond to short-term rainfall events. Based on five-year (2016-2020) high-frequency (half-week) sampling data from a shallow eutrophic urban reservoir in subtropical China, we explored the short-term effects of rainfall events on cyanobacterial biomass (CBB) by constructing generalized additive models of CBB in rainy periods during warm (April to September) and cool (December and January) months, respectively. We find evidence in support of the hypotheses that short-term rainfall events significantly reduce CBB in warm months, but the opposite response was observed in the cool months. We also highlight a difference in the factors explaining CBB decreases in warm months (precipitation, air temperature, relative humidity, dissolved oxygen and total phosphorus) compared with factors explaining the response of CBB in cool months (sunshine hours, pH and total carbon). In particular, meteorological factors (precipitation, wind speed and sunlight) might drive changes in water temperature and hydro-dynamics of the reservoir, thereby causing a rapid reduction of CBB after rainfall events in warm months. This varying response of cyanobacteria to short-term rainfall events in the shallow eutrophic subtropical reservoir may also be expected in temperate or cool lakes as climate change effects become stronger.

The production costs of Haemonchus contortus and other nematode parasites in pre-weaned beef calves in New Zealand

Haemonchus contortus can frequently be found infecting pre-weaned beef calves on sheep and beef farms around the North Island of New Zealand. The purpose of this study was to consider whether the presence of this parasite alone, or as part of a mixed infection, could be impacting growth rates of young animals, on three commercial farms in the North Island of New Zealand. Trials were conducted on commercial sheep and beef farms in each of the Northland, King Country and Gisborne regions, in late summer/autumn (February to April) of 2016 to measure the effect of treatment with narrow and broad spectrum anthelmintics on liveweight gain of spring-born calves pre-weaning. Each farm was chosen based on the presence of Haemonchus and that it was a beef cow/calf system with the cows and calves grazing the same pastures as sheep at some stage. Three sampling visits were made to each farm with the animals being weighed, faecal sampled and treated with one of two anthelmintics (Closantel alone to remove only Haemonchus or a triple combination containing moxidectin, levamisole and oxfendazole to remove all nematodes) or left untreated, on each of the first two visits. There was no significant difference in liveweight gain between any of the treatment groups, hence there was no evidence for an impact of Haemonchus alone, or a mixed nematode infection, on pre-weaned calf growth rates on these farms. It remains unclear whether there may be a justification to consider treatment of calves should they constitute a significant source of pasture larval infestation with H. contortus, in an integrated cattle-sheep system.

Phytoplankton and cyanobacteria abundances in mid-21st century lakes depend strongly on future land use and climate projections

Land use and climate change are anticipated to affect phytoplankton of lakes worldwide. The effects will depend on the magnitude of projected land use and climate changes and lake sensitivity to these factors. We used random forests fit with long-term (1971-2016) phytoplankton and cyanobacteria abundance time series, climate observations (1971-2016), and upstream catchment land use (global Clumondo models for the year 2000) data from 14 European and 15 North American lakes basins. We projected future phytoplankton and cyanobacteria abundance in the 29 focal lake basins and 1567 lakes across focal regions based on three land use (sustainability, middle of the road, and regional rivalry) and two climate (RCP 2.6 and 8.5) scenarios to mid-21st century. On average, lakes are expected to have higher phytoplankton and cyanobacteria due to increases in both urban land use and temperature, and decreases in forest habitat. However, the relative importance of land use and climate effects varied substantially among regions and lakes. Accounting for land use and climate changes in a combined way based on extensive data allowed us to identify urbanization as the major driver of phytoplankton development in lakes located in urban areas, and climate as major driver in lakes located in remote areas where past and future land use changes were minimal. For approximately one-third of the studied lakes, both drivers were relatively important. The results of this large scale study suggest the best approaches for mitigating the effects of human activity on lake phytoplankton and cyanobacteria will depend strongly on lake sensitivity to long-term change and the magnitude of projected land use and climate changes at a given location. Our quantitative analyses suggest local management measures should focus on retaining nutrients in urban landscapes to prevent nutrient pollution from exacerbating ongoing changes to lake ecosystems from climate change.

Greenhouse gas budgets of severely polluted urban lakes in India

Inland waters are important sources of greenhouse gases and emissions from polluted subtropical systems may be contributing to the observed global increase in atmospheric methane concentrations. Here we detail a scoping study where dissolved concentrations of greenhouse gases methane (CH₄), carbon dioxide (CO₂) and nitrous oxide (N₂O) were measured in two contrasting urban lakes in Bangalore (Bengaluru), Karnataka, India, from June 2018 to February 2020. Bellandur Lake is a severely polluted system whilst Jakkur Lake has been subject to partial restoration via treatment of organic matter inputs. Methane concentrations in Bellandur Lake were three orders of magnitude higher than in Jakkur Lake, with a mean concentration of 3.02 ± 1.57 mg CH₄-C L^-1 compared to 1.72 ± 1.22 μg CH₄-C L^-1. At Bellandur Lake, dissolved CO₂ concentrations were of the same order of magnitude as for CH₄, whereas at Jakkur Lake dissolved CO₂ concentrations were two orders of magnitude greater than for CH₄. Concentrations of N₂O were negligible in both lakes. Extrapolating our data to estimate greenhouse gas fluxes, mean daily methane fluxes from Bellandur Lake were consistently in excess of 1000 mg CH₄ m² d^-1, rendering the lake a source of GHGs to the order of 148,350 ± 21,790 ton yr^-1 CO₂-e yr^-1, compared to 100 ± 37 ton CO₂-e yr^-1 from Jakkur Lake, with CH₄ contributing primarily to this difference. We propose that the contribution of severely polluted urban lakes to global CH₄ production warrants further investigation, particularly as our evidence suggests that standard secondary wastewater treatment to support restoration of these systems has the potential to significantly reduce CH₄ emissions.

Integrating Inland and Coastal Water Quality Data for Actionable Knowledge

Water quality measures for inland and coastal waters are available as discrete samples from professional and volunteer water quality monitoring programs and higher-frequency, near-continuous data from automated in situ sensors. Water quality parameters also are estimated from model outputs and remote sensing. The integration of these data, via data assimilation, can result in a more holistic characterization of these highly dynamic ecosystems, and consequently improve water resource management. It is becoming common to see combinations of these data applied to answer relevant scientific questions. Yet, methods for scaling water quality data across regions and beyond, to provide actionable knowledge for stakeholders, have emerged only recently, particularly with the availability of satellite data now providing global coverage at high spatial resolution. In this paper, data sources and existing data integration frameworks are reviewed to give an overview of the present status and identify the gaps in existing frameworks. We propose an integration framework to provide information to user communities through the the Group on Earth Observations (GEO) AquaWatch Initiative. This aims to develop and build the global capacity and utility of water quality data, products, and information to support equitable and inclusive access for water resource management, policy and decision making.

Making waves. Bridging theory and practice towards multiple stressor management in freshwater ecosystems

Despite advances in conceptual understanding, single-stressor abatement approaches remain common in the management of fresh waters, even though they can produce unexpected ecological responses when multiple stressors interact. Here we identify limitations restricting the development of multiple-stressor management strategies and address these, bridging theory and practice, within a novel empirical framework. Those critical limitations include that (i) monitoring schemes fall short of accounting for theory on relationships between multiple-stressor interactions and ecological responses, (ii) current empirical modelling approaches neglect the prevalence and intensity of multiple-stressor interactions, and (iii) mechanisms of stressor interactions are often poorly understood. We offer practical recommendations for the use of empirical models and experiments to predict the effects of freshwater degradation in response to changes in multiple stressors, demonstrating this approach in a case study. Drawing on our framework, we offer practical recommendations to support the development of effective management strategies in three general multiple-stressor scenarios.

The role of sheep (Ovis aries) in maintaining Theileria orientalis Ikeda type infection

Theileria orientalis is a tick‒borne intracellular parasite of red blood cells that causes severe and mild infections in various ruminants worldwide. To date there have been 11 types identified within this species, of which 4 types are presently found in New Zealand cattle. Since 2012, New Zealand has suffered a substantial epidemic of infectious bovine anaemia in both dairy and beef cattle associated with the Ikeda type. The speed at which the disease spread through the North Island suggested that other species could have been involved in transmission. The aim of a series of related experiments was to test the null hypothesis that sheep cannot maintain T. orientalis Ikeda type infection or infect ticks that feed on them. Several studies were conducted over 2 years to address this hypothesis which together showed that sheep can have detectable levels of T. orientalis Ikeda type infection in both the acute and chronic phase and that Haemaphysalis longicornis larvae can become infected when feeding on sheep. No anaemia, weight loss or clinical disease was recorded in the sheep in the acute phase of infection. The levels of infection recorded in the sheep were much lower than those found in cattle, consistent with the sheep being asymptomatic carriers of T. orientalis Ikeda type infection.

Ecological health and water quality of village ponds in the subtropics limiting their use for water supply and groundwater recharge

Ponds are a typical feature of many villages in the subtropics, and have been widely used as important sources of water for agriculture, aquaculture and groundwater recharge, as well as enhancing village resilience to floods and drought. Currently many village ponds are in a very poor state and in dire need of rejuvenation. This paper assesses the current water quality status and ecological health of twelve sub-tropical village ponds, situated in western Uttar Pradesh, India. This assessment is used to evaluate their wastewater treatment needs in relation to potential village uses of the water. Physico-chemical (Secchi depth, Total phosphorus and Total nitrogen) and biological (Phytoplankton chlorophyll-a) indicators highlight hypertrophic conditions in all the ponds. The study indicates that the status of village ponds requires significant investments in wastewater treatment to restore their use for many purposes, including aquaculture, although some may still be acceptable for irrigation purposes, as long as pathogenic bacteria are not abundant. We propose increased implementation of decentralised systems for wastewater treatment, such as septic tanks and constructed wetlands, to reduce the organic and nutrient loads entering village ponds and allow their use for a wider range of purposes.

Clinical and molecular practice of European thoracic pathology laboratories during the COVID-19 pandemic. The past and the near future

Background

This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases.

Materials and methods

A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019.

Results

Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples.

Conclusions

The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe.

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Biosafety measures used in the first wave of the COVID-19 crisis were heterogeneous in 53 European pathology laboratories.

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A dramatic decrease of the workload in pathology laboratories was noted.

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No case of healthcare workers contaminated with SARS-CoV-2 associated with samples handling was identified.

Association between genetic polymorphisms in the promoter region of the defensin beta 1 gene and persistent apical periodontitis

AIM

To evaluate the association between the promoter region of defensin beta 1 (DEFB1) genetic polymorphisms and persistent apical periodontitis (PAP) in Brazilian patients.

METHODOLOGY

Seventy-three patients with post-treatment PAP (PAP group) and 89 patients with root filled teeth with healed and healthy periradicular tissues (healed group) were included (all teeth had apical periodontitis lesions at the beginning of the treatment). Patients who had undergone at least 1 year of follow-up after root canal treatment were recalled, and their genomic DNA was extracted from saliva. Two single nucleotide polymorphisms (SNPs) in DEFB1 at the g. -52G>A (rs1799946) and g. -20G>A (rs11362) positions were analysed using real-time polymerase chain reaction. The chi-squared test was performed, and the odds ratios were calculated using Epi Info 3.5.2. Logistic regression analysis in the codominant model, using the time of follow-up as a variable, was used to evaluate the SNP-SNP interaction. All tests were performed with an established alpha of 0.05 (P = 0.05).

RESULTS

For the rs11362 polymorphism in the codominant and recessive models, patients who carried two copies of the T allele had a significantly lower risk of developing PAP (P = 0.040 and P = 0.031, respectively). For the rs1799946 polymorphism in DEFB1 in the codominant and recessive models, carrying one copy of the T allele significantly increased the risk of developing PAP (P = 0.007 and P = 0.031, respectively). In the logistic regression, both polymorphisms were associated with PAP as well as the SNP-SNP interaction (P < 0.0001).

CONCLUSIONS

Polymorphisms in DEFB1 genes were associated with the development of post-treatment persistent apical periodontitis.

Validation of hair type diversification for recruiting shampoo panelists without losing data relevance

A sensory descriptive method is used by the industries to characterize their various products under development. The sensory panelists are recruited through some general criteria suggested in International Standard Sensory Analysis - General guidelines for the selection, training and monitoring of selected assessors and expert sensory assessors [5] but for hair product evaluation, some hair criteria should also be considered, as a major challenge lied in the difficulty to recruit panelists. Such an issue led us to find practical solutions to make this recruitment easier. Among others, one possible solution was to restrict some requirements in the characteristics of hair. This study aimed at checking if a hair type diversification on either sensitization or curliness could influence the sensory perception of shampoos, and, if so, to which extent. This study demonstrates that, for a shampoo trained panel, the evaluation is impacted by the hair curliness but is not impacted by the hair sensitization level.

Storm impacts on phytoplankton community dynamics in lakes

In many regions across the globe, extreme weather events such as storms have increased in frequency, intensity, and duration due to climate change. Ecological theory predicts that such extreme events should have large impacts on ecosystem structure and function. High winds and precipitation associated with storms can affect lakes via short-term runoff events from watersheds and physical mixing of the water column. In addition, lakes connected to rivers and streams will also experience flushing due to high flow rates. Although we have a well-developed understanding of how wind and precipitation events can alter lake physical processes and some aspects of biogeochemical cycling, our mechanistic understanding of the emergent responses of phytoplankton communities is poor. Here we provide a comprehensive synthesis that identifies how storms interact with lake and watershed attributes and their antecedent conditions to generate changes in lake physical and chemical environments. Such changes can restructure phytoplankton communities and their dynamics, as well as result in altered ecological function (e.g., carbon, nutrient and energy cycling) in the short- and long-term. We summarize the current understanding of storm-induced phytoplankton dynamics, identify knowledge gaps with a systematic review of the literature, and suggest future research directions across a gradient of lake types and environmental conditions.

Capacity challenges in water quality monitoring: understanding the role of human development

Monitoring the qualitative status of freshwaters is an important goal of the international community, as stated in the Sustainable Development Goal (SDGs) indicator 6.3.2 on good ambient water quality. Monitoring data are, however, lacking in many countries, allegedly because of capacity challenges of less-developed countries. So far, however, the relationship between human development and capacity challenges for water quality monitoring have not been analysed systematically. This hinders the implementation of fine-tuned capacity development programmes for water quality monitoring. Against this background, this study takes a global perspective in analysing the link between human development and the capacity challenges countries face in their national water quality monitoring programmes. The analysis is based on the latest data on the human development index and an international online survey amongst experts from science and practice. Results provide evidence of a negative relationship between human development and the capacity challenges to meet SDG 6.3.2 monitoring requirements. This negative relationship increases along the course of the monitoring process, from defining the enabling environment, choosing parameters for the collection of field data, to the analytics and analysis of five commonly used parameters (DO, EC, pH, TP and TN). Our assessment can be used to help practitioners improve technical capacity development activities and to identify and target investment in capacity development for monitoring.

Response of cyanobacteria and phytoplankton abundance to warming, extreme rainfall events and nutrient enrichment

Cyanobacterial blooms are an increasing threat to water quality and global water security caused by the nutrient enrichment of freshwaters. There is also a broad consensus that blooms are increasing with global warming, but the impacts of other concomitant environmental changes, such as an increase in extreme rainfall events, may affect this response. One of the potential effects of high rainfall events on phytoplankton communities is greater loss of biomass through hydraulic flushing. Here we used a shallow lake mesocosm experiment to test the combined effects of: warming (ambient vs. +4°C increase), high rainfall (flushing) events (no events vs. seasonal events) and nutrient loading (eutrophic vs. hypertrophic) on total phytoplankton chlorophyll-a and cyanobacterial abundance and composition. Our hypotheses were that: (a) total phytoplankton and cyanobacterial abundance would be higher in heated mesocosms; (b) the stimulatory effects of warming on cyanobacterial abundance would be enhanced in higher nutrient mesocosms, resulting in a synergistic interaction; (c) the recovery of biomass from flushing induced losses would be quicker in heated and nutrient-enriched treatments, and during the growing season. The results supported the first and, in part, the third hypotheses: total phytoplankton and cyanobacterial abundance increased in heated mesocosms with an increase in common bloom-forming taxa-Microcystis spp. and Dolichospermum spp. Recovery from flushing was slowest in the winter, but unaffected by warming or higher nutrient loading. Contrary to the second hypothesis, an antagonistic interaction between warming and nutrient enrichment was detected for both cyanobacteria and chlorophyll-a demonstrating that ecological surprises can occur, dependent on the environmental context. While this study highlights the clear need to mitigate against global warming, oversimplification of global change effects on cyanobacteria should be avoided; stressor gradients and seasonal effects should be considered as important factors shaping the response.

Protecting and restoring Europe's waters: An analysis of the future development needs of the Water Framework Directive

The Water Framework Directive (WFD) is a pioneering piece of legislation that aims to protect and enhance aquatic ecosystems and promote sustainable water use across Europe. There is growing concern that the objective of good status, or higher, in all EU waters by 2027 is a long way from being achieved in many countries. Through questionnaire analysis of almost 100 experts, we provide recommendations to enhance WFD monitoring and assessment systems, improve programmes of measures and further integrate with other sectoral policies. Our analysis highlights that there is great potential to enhance assessment schemes through strategic design of monitoring networks and innovation, such as earth observation. New diagnostic tools that use existing WFD monitoring data, but incorporate novel statistical and trait-based approaches could be used more widely to diagnose the cause of deterioration under conditions of multiple pressures and deliver a hierarchy of solutions for more evidence-driven decisions in river basin management. There is also a growing recognition that measures undertaken in river basin management should deliver multiple benefits across sectors, such as reduced flood risk, and there needs to be robust demonstration studies that evaluate these. Continued efforts in 'mainstreaming' water policy into other policy sectors is clearly needed to deliver wider success with WFD goals, particularly with agricultural policy. Other key policy areas where a need for stronger integration with water policy was recognised included urban planning (waste water treatment), flooding, climate and energy (hydropower). Having a deadline for attaining the policy objective of good status is important, but even more essential is to have a permanent framework for river basin management that addresses the delays in implementation of measures. This requires a long-term perspective, far beyond the current deadline of 2027.

Response to Comment on "Tropical forests are a net carbon source based on aboveground measurements of gain and loss"

The Hansen et al critique centers on the lack of spatial agreement between two very different datasets. Nonetheless, properly constructed comparisons designed to reconcile the two datasets yield up to 90% agreement (e.g., in South America).

Wooden-Breast, White Striping, and Spaghetti Meat: Causes, Consequences and Consumer Perception of Emerging Broiler Meat Abnormalities

Ten years ago, the occurrence of macroscopic defects in breasts muscles from fast-growing broilers challenged producers and animal scientists to label and characterize myopathies wholly unknown. The distinctive white striations in breasts affected by white striping disorder, the presence of out-bulging and pale areas of hardened consistency in the so-called wooden breast, and the separation of the fiber bundles in breasts labelled as spaghetti meat, made these myopathies easily identified in chicken carcasses. Yet, the high incidence of these myopathies and the increasing concern by producers and retailers led to an unprecedented flood of questions on the causes and consequences of these abnormal chicken breasts. This review comprehensively collects the most relevant information from studies aimed to understand the pathological mechanisms of these myopathies, their physicochemical and histological characterization and their impact on meat quality and consumer's preferences. Today, it is known that the occurrence is linked to fast-growth rates of the birds and their large breast muscles. The muscle hypertrophy along with an unbalanced growth of supportive connective tissue leads to a compromised blood supply and hypoxia. The occurrence of oxidative stress and mitochondrial dysfunction leads to lipidosis, fibrosis, and overall myodegeneration. Along with the altered appearance, breast muscles affected by the myopathies display poor technological properties, impaired texture properties, and reduced nutritional value. As consumer's awareness on the occurrence of these abnormalities and the concerns on animal welfare arise, efforts are made to inhibit the onset of the myopathies or alleviate the severity of the symptoms. The lack of fully effective dietary strategies leads scientists to propose whether "slow" production systems may alternatively provide with poultry meat free of these myopathies.

Effects of multiple stressors on cyanobacteria abundance vary with lake type

Blooms of cyanobacteria are a current threat to global water security that is expected to increase in the future because of increasing nutrient enrichment, increasing temperature and extreme precipitation in combination with prolonged drought. However, the responses to multiple stressors, such as those above, are often complex and there is contradictory evidence as to how they may interact. Here we used broad scale data from 494 lakes in central and northern Europe, to assess how cyanobacteria respond to nutrients (phosphorus), temperature and water retention time in different types of lakes. Eight lake types were examined based on factorial combinations of major factors that determine phytoplankton composition and sensitivity to nutrients: alkalinity (low and medium-high), colour (clear and humic) and mixing intensity (polymictic and stratified). In line with expectations, cyanobacteria increased with temperature and retention time in five of the eight lake types. Temperature effects were greatest in lake types situated at higher latitudes, suggesting that lakes currently not at risk could be affected by warming in the future. However, the sensitivity of cyanobacteria to temperature, retention time and phosphorus varied among lake types highlighting the complex responses of lakes to multiple stressors. For example, in polymictic, medium-high alkalinity, humic lakes cyanobacteria biovolume was positively explained by retention time and a synergy between TP and temperature, while in polymictic, medium-high alkalinity, clear lakes only retention time was identified as an explanatory variable. These results show that, although climate change will need to be accounted for when managing the risk of cyanobacteria in lakes, a "one-size fits-all" approach is not appropriate. When forecasting the response of cyanobacteria to future environmental change, including changes caused by climate and local management, it will be important to take this differential sensitivity of lakes into account.

Improving outcome in congenital diaphragmatic hernia - experience of a tertiary center without ECMO

BACKGROUND

Congenital diaphragmatic hernia (CDH) has a high mortality rate, representing a therapeutic challenge. Prenatal diagnosis (PND) is essential in defining optimal perinatal strategy, particularly delivery planning. Hospital Pediátrico de Coimbra is the referral centre for all neonatal surgery, particularly CDH, for the central region of Portugal. The aim was to evaluate clinical management and outcome of newborns with CDH.

METHODS

An exploratory retrospective study made up of newborns admitted to PICU with CDH was undertaken between January 1995 and December 2014. Two groups were formed based on their year of admission: group A (1995- 2004) and group B (2005- 2014) and were compared.

RESULTS

The mean birth weight of the 69 newborns admitted was 2.762 ± 696 g; the median of the gestational age was 38 weeks. Associated malformations were observed in 28 (40.5%) and 15 (21.7%) had a right-sided diaphragm defect. The global mortality was 13.0%; in group A was significantly higher than in group B (22.2 vs 3.0%; p = 0.029). A reduction in mortality throughout the years was confirmed after adjusting for POS score (OR = 0.77; 95% CI: 0.62- 0.96, p = 0.021). PND was made in 30.6% of cases in the group A and 66.7% in the group B (p = 0.03). Tertiary perinatal hospital birth was achieved in 60% of newborns in the group A versus 84.8% in group B (p = 0.022). Maximum fraction of inspired oxygen showed a statistically significant difference between the two study groups (60% vs 40%; p = 0.009).

CONCLUSIONS

A significant decrease in mortality was observed throughout the study. The authors highlight the increase in prenatal diagnosis and an improvement in perinatal care with planning delivery as important contributors to these results.

Evaluation of a single extraction test to estimate the human oral bioaccessibility of potentially toxic elements in soils: Towards more robust risk assessment

Intake of soil by children and adults is a major exposure pathway to contaminants including potentially toxic elements (PTEs). However, only the fraction of PTEs released in stomach and intestine are considered as bioaccessible and results from routine analyses of the total PTE content in soils, therefore, are not necessarily related to the degree of bioaccessibility. Experimental methods to determine bioaccessibility usually are time-consuming and relatively complicated in terms of analytical procedures which limits application in first tier assessments. In this study we evaluated the potential suitability of a recently developed single extract method (ISO-17586:2016) using dilute (0.43M) nitric acid (HNO₃) to mimic the bioaccessible fraction of PTEs in soils. Results from 204 soils from Portugal, Brazil and the Netherlands including all major soil types and a wide range of PTEs' concentrations showed that the extraction efficiency using 0.43M HNO₃ of Ba, Cd, Cu, Ni, Pb and Zn in soils is related to that of in vitro methods including the Simple Bioaccessibility Extraction Test (SBET) and Unified BARGE Method (UBM). Also, differences in the degree of bioaccessibility resulting from differences in parent material, geology and climate conditions did not affect the response of the 0.43M HNO₃ extraction which is a prerequisite to be able to compare results from different soils. The use of 0.43M HNO₃ as a first screening of bioaccessibility therefore offers a robust and representative way to be included in first tier standard soil tests to estimate the oral bioaccessibility.

CAPSULE

The single dilute (0.43M) nitric acid extraction can be used in first tier soil risk assessment to assess both geochemical reactivity and oral bioaccessibility of PTEs.

Hepatitis C Virus Eradication in Kidney Transplant Recipients: A Single-Center Experience in Portugal

INTRODUCTION

Hepatitis C (HCV) is a major cause of liver impairment post-kidney transplantation (KT). Anti-HCV direct-acting antivirals (DAA) made viral eradication possible.

METHODS

We performed a retrospective review of KT patients (n = 23) who received DAA at our hospital. Sustained viral response (SVR) was defined as absence of viral detection 12 weeks after cessation of therapy.

RESULTS

From 1985 to September 2017, 1440 patients underwent transplantation at Hospital Santa Cruz. From a total of 32 HCV RNA+ KT recipients on follow-up, we describe the first 23 patients treated with DAA. They were 56.7 ± 9.1 years old; 22 were white, 52.2% were males, they underwent transplantation 18.8 ± 9.0 years ago, and 13 had genotype 1B, 21 were naïve, and 9 had stages F3/F4. All but 2 patients, treated with grazoprevir/elbasvir, received sofosbuvir (18 with ledispasvir, 2 with daclastavir, and 4 with simultaneous ribavirin). Pretreatment, intra-treatment, and post-treatment creatinine clearances were 61.4, 60.6, and 60.7 mL/min/1.73 m², respectively (not significant [NS]). Cyclosporine A was the basis of immunosuppression in the majority [(n = 14); pretreatment and intra-treatment levels were 79.5 ± 23.0 and 91.8 ± 26.0 ng/mL, respectively (P = .08)]; tacrolimus (n = 8) and mammalian target of rapamycin (mTOR) levels (n = 5) were also similar. One patient interrupted ribavirin after 7 weeks due to anemia; all other patients completed the treatment course without major side effects. Only 3 patients presented positive viral RNA at the fourth week of treatment and SVR was achieved in 100% of the patients 12 weeks after treatment.

CONCLUSIONS

DAA therapy was well tolerated and effective in 100% of our treated patients, without significant impact on the renal function or on the immunosuppression.

Proteostasis in epicardial versus subcutaneous adipose tissue in heart failure subjects with and without diabetes

BACKGROUND

Cardiovascular diseases (CVDs) are leading cause of death and primary cause of morbidity and mortality in diabetic population. Epicardial adipose tissue (EAT) covers the heart's surface and is a source of biomolecules regulating heart and blood vessel physiology. The protective activation of the unfolded protein response (UPR) and autophagy allows the cardiomyocyte reticular network to restore energy and/or nutrient homeostasis and to avoid cell death. However, an excessive or prolonged UPR activation can trigger cell death. UPR activation is an early event of diabetic cardiomyopathies and deregulated autophagy is associated with CVDs.

RESULTS

An upregulation of UPR markers (glucose-regulated protein 78 KDa, glucose-regulated protein 94 KDa, inositol-requiring enzyme 1α, protein kinase RNA-like ER kinase and CCAAT/-enhancer-binding protein homologous protein (CHOP) gene) in EAT compared to subcutaneous adipose tissue (SAT), was observed as well as the UPR-related apoptosis marker caspase-4/procaspase-4 ratio but not in CHOP protein levels. Additionally, levels of ubiquitin and ubiquitinated proteins were decreased in EAT. Moreover, upregulation of autophagy markers (5' adenosine monophosphate-activated protein kinase, mechanistic target of rapamycin, Beclin 1, microtubule-associated protein light chain 3-II, lysosome-associated membrane protein 2, and PTEN-induced putative kinase 1) was observed, as well as an increase in the apoptotic Bim but not the ratio between Bim and the anti-apoptotic Bcl-2 in EAT. Diabetic patients show alterations in UPR activation markers but not in autophagy or apoptosis markers.

CONCLUSION

UPR and autophagy are increased in EAT compared to SAT, opening doors to the identification of early biomarkers for cardiomyopathies and novel therapeutic targets.

Practical application of spatial ecosystem service models to aid decision support

Ecosystem service (ES) spatial modelling is a key component of the integrated assessments designed to support policies and management practices aiming at environmental sustainability. ESTIMAP ("Ecosystem Service Mapping Tool") is a collection of spatially explicit models, originally developed to support policies at a European scale. We based our analysis on 10 case studies, and 3 ES models. Each case study applied at least one model at a local scale. We analyzed the applications with respect to: the adaptation process; the "precision differential" which we define as the variation generated in the model between the degree of spatial variation within the spatial distribution of ES and what the model captures; the stakeholders' opinions on the usefulness of models. We propose a protocol for adapting ESTIMAP to the local conditions. We present the precision differential as a means of assessing how the type of model and level of model adaptation generate variation among model outputs. We then present the opinion of stakeholders; that in general considered the approach useful for stimulating discussion and supporting communication. Major constraints identified were the lack of spatial data with sufficient level of detail, and the level of expertise needed to set up and compute the models.