Phosphorus Removal from Dirty Farmyard Water by Activated Anaerobic-Digestion-Derived Biochar

The management of anaerobic digestate is important to realize the value of the waste and enhance the whole system sustainability of anaerobic digestion. In this study, the phosphorus treatment of dirty irrigation water by biochar samples derived from digestate of anaerobic digestion were investigated. The biochars were further activated by steam activation with different duration time and KOH activation with different introducing ratios; the textural properties of biochars were optimized after activation from the aspect of biochar characterization. Notably, AD-N2 demonstrates a remarkable adsorption effect of phosphorus, with an adsorption efficiency of 8.99 mg g-1. Besides the effect of biochar dosage on phosphorus removal, adsorption kinetics and thermodynamic isotherms are studied. According to the adsorption kinetics, the adsorption of phosphorus from dirty water fits the Elovich equation (R2 = 0.95). Furthermore, the thermodynamic isotherm results illustrate the process of phosphorus removal by biochar is endothermic (ΔH0 = 17.93 kJ mol-1) and spontaneous (ΔS = 96.24 J mol-1 K-1). Therefore, this work suggests a promising solution to phosphorus-related environmental challenges in industry and agriculture.

Development and validation of a prognostic model for death 30 days after adult emergency laparotomy

The probability of death after emergency laparotomy varies greatly between patients. Accurate pre-operative risk prediction is fundamental to planning care and improving outcomes. We aimed to develop a model limited to a few pre-operative factors that performed well irrespective of surgical indication: obstruction; sepsis; ischaemia; bleeding; and other. We derived a model with data from the National Emergency Laparotomy Audit for patients who had emergency laparotomy between December 2016 and November 2018. We tested the model on patients who underwent emergency laparotomy between December 2018 and November 2019. There were 4077/40,816 (10%) deaths 30 days after surgery in the derivation cohort. The final model had 13 pre-operative variables: surgical indication; age; blood pressure; heart rate; respiratory history; urgency; biochemical markers; anticipated malignancy; anticipated peritoneal soiling; and ASA physical status. The predicted mortality probability deciles ranged from 0.1% to 47%. There were 1888/11,187 deaths in the test cohort. The scaled Brier score, integrated calibration index and concordance for the model were 20%, 0.006 and 0.86, respectively. Model metrics were similar for the five surgical indications. In conclusion, we think that this prognostic model is suitable to support decision-making before emergency laparotomy as well as for risk adjustment for comparing organisations.

A comparative life-cycle assessment and cost analysis of biofilters amended with sludge-based activated carbon and commercial activated carbon for stormwater treatment

Environmental and economic issues resulting from the unsustainable management of sewage sludge from wastewater have necessitated the development of eco-friendly sewage sludge disposal methods, whereas stormwater effluent contains tremendous amounts of pollutants. This study compares the feasibility and environmental impacts associated with incorporating biofilters with sludge-based activated carbon (SBAC) versus commercial activated carbon (CAC) for stormwater treatment. The results demonstrate that the construction and disposal life-cycle stages are the dominant contributors to several environmental impact categories, including resource scarcity, carcinogenic toxicity, terrestrial ecotoxicity, and ozone formation indicators. Across multiple impact categories, the incorporation of biofilters with SBAC can reduce the negative environmental impacts associated with biofilter construction and disposal by 40% over a 50-year analysis period. In contrast, the most significant improvement is on construction-dominant indicators, where the decreased need for biofilter reconstruction results in a higher reduction in environmental impacts. Economically, amending the biofilter with SBAC can increase profits by up to 66% due to extending its lifespan. This study shows that SBAC has similar performance as CAC for lowering the negative environmental impacts resulting from biofilter construction, while increasing the overall net profits of the system. However, converting sewage sludge to an effective sorbent (SBAC) and incorporating SBAC into a biofilter to capture pollutants from stormwater is an economically and environmentally sustainable solution available to practitioners to manage sewage sludge and stormwater effluent. This solution protects the environment in a cost efficient, sustainable manner.

The effect of biochar and acid activated biochar on ammonia emissions during manure storage

Animal manure contains valuable plant nutrients which need to be stored until field application. A significant proportion of slurry nitrogen is volatilized in the form of ammonia (NH₃) during storage. This impacts human health, biodiversity, air and water quality and thus urgent action is needed to reduce NH₃ emissions. In this experiment, we evaluated the NH₃ emission mitigation potential of biochars derived from miscanthus (MB) and solid separated anaerobic digestate (DB), and orthophosphoric acid activated MB (AMB) and DB (ADB) as well as lightweight expanded clay aggregate (LECA) during four months of liquid manure storage. A slurry without amendment was included as a control (Ctrl). Acid activated and non-activated biochars were applied on top of the slurry maintaining a 7 mm thick surface layer, while LECA was applied in a 2 cm thick layer. NH₃ emissions were measured by photoacoustic analyzer. In comparison to Ctrl, acid activated biochar decreased (p < 0.05) NH₃ emissions during the slurry storage. Activated biochar reduced the emissions by 37-51% within the first month of slurry storage and achieved a 25-28% emissions reduction efficiency throughout the four month period due to the reduction in emission mitigation efficiency as the storage period progressed. LECA reduced NH₃ emissions by 21% during storage. Losses of NH₃ as a percentage of total ammoniacal N were 29-31% for activated biochars, 35-39% for non-activated biochars and 33% for LECA. In conclusion, acid activated biochars and LECA could be good floating-covers to mitigate NH₃ emissions during manure storage, but activated biochars may have better mitigation potential than LECA.

Snap-shot assessment of adult mosquito (Diptera: Culicidae) densities on the Turks and Caicos Islands, February 2022

In many of the small island communities of the Caribbean, much of the vector surveillance effort is focussed on house-to-house peri-focal surveys to collect data on larval indices. Adult mosquito trapping is not always routine or affordable and is usually focussed on ad hoc biting issues or small-scale investigations. This makes understanding the relative importance and densities of the common urban mosquitoes, such as Aedes aegypti and Culex quinquefasciatus, problematic. This snap-shot survey in February 2022 using BG-Sentinel traps at 30 different locations across five islands of the Turks and Caicos, aimed to provide the first island-wide assessment of urban mosquito densities. In total, 2,820 adult mosquitoes were collected over 285 trap nights. Aedes aegypti was most common on the island of Providenciales, with very low densities recorded on South Caicos, North and Middle Caicos, with Ae. aegypti most highly abundant in the main commercial centres. The highest densities of Cx. quinquefasciatus were trapped on North Caicos. Small numbers of other species were also collected, including the first record of Anopheles in TCI. This established framework of trapping and initial assessment provides a platform for continued monitoring of mosquitoes in TCI to better inform mosquito-borne disease risk assessment and future vector control efforts.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Modelling and experimental investigation of small-scale gasification CHP units for enhancing the use of local biowaste

Small-scale gasification Combined Heat and Power systems, fed by biowaste resources, have the potential to enhance local renewable energy production, reduce carbon emissions and address the challenges of waste disposal. However, there is a lack of understanding on the influence of challenging feedstocks, such as, for example, digestate, poultry litter and municipal solid waste, on the syngas quality and the incidence of the drying stage in the overall process. This paper addresses this gap by analysing and comparing 40 samples of the most common biowaste feedstocks. We developed a stoichiometric-thermodynamic one stage equilibrium model that was experimentally validated and calibrated by laboratory results, with a maximum error of 15% between real and predicted values. Simulation results show that the low heating value of the syngas produced from biowaste resources analysed ranges from 3.1 to 5.4 MJ/Nm³ on a dry basis. Working at the optimal equivalence ratio increases the electricity and thermal output by up to 20%. To achieve a feedstock moisture content of 10%, the drying process may require up to 60% of the heat produced. Furthermore, results show that downdraft gasification based combined heat and power, is a feasible and interesting option to deal with biowaste resources which can potentially avoid the cost, risk and externalities of landfilling while it contributes to the increase of local electricity and heat production from renewable energy sources, both for grid and off-grid applications.

Mosquito Magnet® traps as a potential means of monitoring blackflies of medical and veterinary importance

Mosquito Magnet® traps, deployed in widespread parts of England as part of nationwide mosquito surveillance projects, also caught blackflies. As many as 1242 blackflies were caught in a trapping session lasting 4 days. Principal among the species caught were Simulium equinum, Simulium lineatum and Simulium ornatum s.l. As S. ornatum s.l. is a vector that transmits Onchocerca linealis to cattle and S. equinum is responsible for dermatitis ('sweet itch') in cattle and horses, it is suggested that Mosquito Magnet® traps could be used to monitor and partially control these pests, as well as nuisance anthropophilic blackflies such as Simulium posticatum that can cause simuliidosis in southern England.

COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study

OBJECTIVE

Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.

DESIGN

Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed.

RESULTS

From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170).

CONCLUSIONS

Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

Investigations into the synthesis of a nucleotide dimer via mechanochemical phosphoramidite chemistry

Liquid-assisted mechanochemistry as a versatile approach for the coupling of a nucleoside phosphoramidite with a 5'-OH partially protected nucleoside has been investigated. Noted advantages over reported methods were a simplified reaction protocol, a drastic reduction in the use of toxic solvents, the facilitation of mechanochemical reactions through the improved mixing of solid reagents, and low hydrolytic product formation.

Phosphorus stocks and flows in an intensive livestock dominated food system

Current use and management of phosphorus (P) in our food systems is considered unsustainable and considerable improvements in the efficiency of P use are required to mitigate the environmental impact of poor P stewardship. The inherent low P use efficiency of food production from animals means food systems dominated by livestock agriculture can pose unique challenges for improving P management. This paper presents the results of a substance flow analysis for P in the Northern Ireland (NI) food system for the year 2017 as a case study for examining P stewardship in a livestock dominated agricultural system. Imported livestock feed was by far the largest flow of P into the NI food system in 2017 (11,700 t ± 1300 t) and P from livestock excreta the largest internal flow of P (20,400 ± 1900t). The P contained in livestock slurries and manures alone that were returned to agricultural land exceeded total crop and grass P requirement by 20% and were the largest contributor to an annual excess soil P accumulation of 8.5 ± 1.4 kg ha^-1. This current livestock driven P surplus also limits the opportunities for P circularity and reuse from other sectors within the food system, e.g. wastewater biosolids and products from food processing waste. Management of livestock P demand (livestock numbers, feed P content) or technological advancements that facilitate the processing and subsequent export of slurries and manures are therefore needed.

Health Care Workers and Patients as Trojan Horses: a COVID19 ward outbreak

Background

Transmission in healthcare settings can result in significant infections in healthcare workers and patients. Understanding infection dynamics has important implications for methods employed in hospitals to prevent nosocomial transmission events.

Methods

In this case series report we describe a cluster of COVID-19 (Coronavirus disease 2019) in a tertiary care university hospital, in the early phases of the epidemic, after hospital visiting had been stopped and when the UK lockdown was in place.

Findings

A 48 year old patient developed COVID-19 31 days post-admission and four days after admission to a medical ward from ITU. Infection was likely acquired from an asymptomatic or minimally symptomatic healthcare worker (HCW). Subsequent investigation over a 14 day period revealed symptoms in 23 staff members and five linked cases in patients on the same ward.

Nine of the 23 affected staff members provided care for and had direct exposure with the index case. Four staff reported caring for the index case without use of personal protective equipment. One was coughed on directly by the patient 24 hours prior to the onset of symptoms.

Conclusion

SARS CoV2 infection can be introduced to a ward area by asymptomatic and minimally symptomatic healthcare workers. Staff members and patients can act as Trojan horses carrying infection into and around the hospital, setting up unexpected transmission events.

Transmission of infection from pre-symptomatic, asymptomatic and minimally symptomatic individuals means that universal use of measures to prevent transmission is required for successful reduction of transmission events in the hospital setting.

Diagnostic accuracy of SUVmax in predicting malignancy of supraclavicular lymph nodes from primary oesophageal cancer

PURPOSE

To determine the diagnostic accuracy and optimum cut-off value of SUVmax on PET to predict malignancy of supraclavicular lymph nodes (SCLNs) in patients with oesophageal carcinoma.

MATERIAL AND METHODS

All diagnosed cases of oesophageal cancer were retrospectively reviewed (2010-2016). Patients that had a confirmed diagnosis of oesophageal cancer with avid SCLNs on staging PET were included in the study. 33 SCLNs that subsequently underwent ultrasound guided biopsy for staging were analysed. The maximum uptake values (SUVmax) of the SCLNs and primary tumours were measured. A receiver operating characteristic (ROC) analysis was performed to determine the optimum cut off of SUVmax in predicting malignancy.

RESULTS

24/33 PET-detected SCLNs were malignant. ROC analysis identified the best nodal SUVmax cut-off to be 3.0. The diagnostic accuracy of PET was 76.0 % (sensitivity = 78.9 %, specificity = 66.6 %). For SCLNs with SUVmax > 3.0, PET showed a positive predictor value of 88.2 %; for SCLNs < 3.0, PET showed a negative predictor value of 50 %. The median SUVmax of pathologically negative and positive nodes were 2.8 (range 1.8-6.0) and 5.3 (range 1.9-13.4). The median primary tumour SUVmax was 13.8 (range 3.7-30.0). The SUVmax of metastatic lymph nodes were significant higher than those of benign lesions (p < 0.05).

CONCLUSION

Our study revealed an accuracy rate of 76 % for PET detected SCLNs in patients with oesophageal carcinoma. For SCLNs with SUVmax > 3.0, PET had a high PPV (88 %), which can minimize the need for further diagnostic tests.

Co-activation during gait following anterior cruciate ligament reconstruction

BACKGROUND

Heightened co-activation of the quadriceps and hamstrings has been reported following anterior cruciate ligament reconstruction during various tasks, and may contribute to post-traumatic osteoarthritis risk. However, it is unclear if this phenomenon occurs during walking or how co-activation influences gait biomechanics linked to changes in joint health.

METHODS

Co-activation and gait biomechanics were assessed in 50 individuals with ACLR and 25 healthy controls. Biomechanical outcomes included knee flexion displacement, peak vertical ground reaction force magnitude and rate, peak internal knee extension and valgus moments and rates, sagittal knee stiffness, and the heelstrike transient. Co-activation was calculated for the flexors and extensors collectively (i.e. composite), the medial musculature, and the lateral musculature.

FINDINGS

Composite co-activation was greater in the ACLR limb compared to the contralateral limb and the control cohort during the preparatory and heelstrike phases of gait, and co-activation of the medial musculature was greater in the ACLR limb compared to the control cohort during the heelstrike phase. Greater co-activation in multiple gait phases was associated with less knee flexion displacement (r = -0.293 to -0.377), smaller peak vertical ground reaction force magnitude (r = -0.291), smaller peak internal knee extension moment (r = -0.291 to -0.328), and greater peak internal knee valgus moment (r = 0.317).

INTERPRETATION

Individuals with ACLR displayed heightened co-activation during walking which was associated with biomechanical outcomes that have been linked to negative changes in joint health following ACLR. These data suggest that excessive co-activation may contribute to the mechanical pathogenesis of post-traumatic osteoarthritis. ClinicalTrials.gov Identifier: NCT02605876.

Association between surgeon special interest and mortality after emergency laparotomy

Background

Approximately 30 000 emergency laparotomies are performed each year in England and Wales. Patients with pathology of the gastrointestinal tract requiring emergency laparotomy are managed by general surgeons with an elective special interest focused on either the upper or lower gastrointestinal tract. This study investigated the impact of special interest on mortality after emergency laparotomy.

Methods

Adult patients having emergency laparotomy with either colorectal or gastroduodenal pathology were identified from the National Emergency Laparotomy Audit database and grouped according to operative procedure. Outcomes included all-cause 30-day mortality, length of hospital stay and return to theatre. Logistic and Poisson regression were used to analyse the association between consultant special interest and the three outcomes.

Results

A total of 33 819 patients (28 546 colorectal, 5273 upper gastrointestinal (UGI)) were included. Patients who had colorectal procedures performed by a consultant without a special interest in colorectal surgery had an increased adjusted 30-day mortality risk (odds ratio (OR) 1·23, 95 per cent c.i. 1·13 to 1·33). Return to theatre also increased in this group (OR 1·13, 1·05 to 1·20). UGI procedures performed by non-UGI special interest surgeons carried an increased adjusted risk of 30-day mortality (OR 1·24, 1·02 to 1·53). The risk of return to theatre was not increased (OR 0·89, 0·70 to 1·12).

Conclusion

Emergency laparotomy performed by a surgeon whose special interest is not in the area of the pathology carries an increased risk of death at 30 days. This finding potentially has significant implications for emergency service configuration, training and workforce provision, and should stimulate discussion among all stakeholders.

Exploratory study on modification of sludge-based activated carbon for nutrient removal from stormwater runoff

Nutrients (P, N) in stormwater runoff are a major cause of eutrophication and algal blooms. A promising solution to this problem is to amend the rain garden growing medium (RGGM) with sewage sludge-based activated carbon (SBAC). To optimize the SBAC production process, different metals, pyrolysis conditions (temperature, heating time, carrier gas), and post-treatments were explored. When pyrolyzed at 400 °C for two hours, Zn-activated SBAC removed up to 41% of PO₄-P (initial concentration of 1 mg/L) and 72% of NO₃-N (initial concentration of 2 mg/L), at a dose of 1 g sorbent/L of nutrient-spiked distilled water. When the same dosage was applied to stormwater leachate made from RGGM and spiked with nutrients, the removal efficiencies were reduced to 20% for PO₄-P and 38% for NO₃-N. These reductions were probably caused by competition from other leachate components. Increasing the dosage to 3 g/L leachate improved PO₄-P removal to 31% and NO₃-N to 72%, while also resulting in the removal of 46% of total organic carbon. The major energy cost of producing such sorbents is estimated to be ∼$0.76 CAD/kg SBAC.

Outcomes of growing rod surgery for severe compared with moderate early-onset scoliosis: a matched comparative study

Aims

The aim of this study was to compare the outcomes of surgery using growing rods in patients with severe versus moderate early-onset scoliosis (EOS).

Patients and Methods

A review of a multicentre EOS database identified 107 children with severe EOS (major curve ≥ 90°) treated with growing rods before the age of ten years with a minimum follow-up of two years and three or more lengthening procedures. From the same database, 107 matched controls with moderate EOS were identified.

Results

The mean preoperative major curve was 101° (90 to 139) in the severe group and 67° (33° to 88°) in the moderate group (p < 0.001), which was corrected at final follow-up to 57° (10° to 96°) in the severe group and 40° (3° to 85°) in the moderate group (p < 0.001). T1-S1 height increased by a mean of 54 mm (-8 to 131) in the severe group and 27 mm (-4 to 131) in the moderate group at the initial surgery (p < 0.001), and by 50 mm (-17 to 200) and 54 mm (-11 to 212), respectively, during distraction (p = 0.84). The mean number of complications per patient was 2.6 (0 to 14) in the severe group and 1.9 (0 to 10) in the moderate group (p = 0.040). Five patients (4.7%) in the severe group and three (2.8%) in the moderate group developed a neurological deficit postoperatively (p = 0.47).

Conclusion

Severe EOS can be treated effectively using growing rods, but the risk of complications is high. Cite this article: Bone Joint J 2018;100-B:772-9.

Hyponatraemia and Moduretic-Grand Mal Seizures: A Review

Three cases are presented which emphasize the importance of hyponatraemia as a cause of grand mal seizures. The combination of hydrochlorothiazide and amiloride appears to increase the risk of hyponatraemia. We discuss the aetiology and treatment of hyponatraemia and review the necessity for such combination therapy. We recommend caution in prescribing diuretics and preparations such as Moduretic should be used only in those few patients shown to need potassium supplementation.

What do Key Stakeholders Think About HIV Self-Testing in Canada? Results from a Cross-Sectional Survey

Human immunodeficiency virus (HIV) self-testing presents an empowering alternative to facility-based testing for reaching undiagnosed HIV infected individuals, but is not currently available in Canada. We surveyed stakeholders (clinical providers, public health professionals, researchers) engaged in HIV testing initiatives nationwide to identify the concerns, opportunities and challenges to implementing HIV self-testing in Canada. An online cross-sectional survey was disseminated by the Canadian Institutes of Health Research Centre for REACH 2.0 National HIV & sexually transmitted and blood borne infections working group to stakeholders nationwide, with a target sample size of 200. Quantitative and qualitative data were analyzed using a mixed-methods, respondent-informed approach, to inform subsequent HIV self-testing in a country where self-testing is not yet accessible. A total of 183 responses were received. A majority (70.7%) (128/181) felt that self-testing was a necessary investment to reach the undiagnosed. 64.6% (117/181) felt that self-tests should be made available to their clients and 71.5% (128/179) of respondents agreed that self-test instructions required improvements. However, 50% (90/180) felt that self-testing will pose an economic challenge to current HIV testing models. Regardless, 21% urged for timely action and availability of HIV self-tests. Thematic analyses reflected the following concerns: (a) need for affordable self-tests, (b) need for expedited, customized, and accessible linkages to counselling, (c) concern for patients to cope with positive self-test results, (d) accuracy of self-tests to detect acute HIV and (e) liability in the context of non-disclosure. Stakeholders agreed to the provision of an option of HIV self-testing to reach the undiagnosed individuals. Concerns regarding costs and accuracy of self-tests, expedited linkages to counselling, and integration of self-test within prevailing HIV testing models, will need to be addressed before their widespread implementation.

Parent Reports of the Psychosocial Functioning of Children with Cleft Lip and/or Palate

Objectives:

(1) to determine the opinion of parents regarding the psychosocial functioning of their child with cleft lip and/or palate (CLP); (2) to identify predictors of psychosocial functioning; and (3) to determine the level of agreement between children with CLP and their parents.

Participants:

One hundred twenty-nine parents of children with CLP and 96 parents of children without CLP participated in this cross-sectional study.

Outcome measures:

Parental opinion of the child's self-esteem, anxiety, happiness, and problems caused by facial appearance were assessed using visual analogue scales. Parents completed the Child Behavior Checklist and were interviewed.

Results:

Children with CLP were more anxious (p < 0.05), less happy with their appearance (p < 0.001), and in general (p < 0.05) had lower self-esteem (p < 0.05) and greater behavioral problems (p < 0.001) compared with non-CLP children. Parents reported that their child with CLP was teased more often (p < 0.001) and was less satisfied with his/her speech (p < 0.01) compared with reports of parents in the control group. A number of factors affected parents’ ratings of their child's psychosocial functioning (presence of CLP, appearance happiness, previous history of CLP, and visibility of scar). Children who had been teased were more anxious (p ≤ 0.01), less happy with their appearance (p < 0.001) and had greater behavioral problems (p < 0.001).

Conclusions:

Parents of children with CLP reported various psychosocial problems among their children. Parents considered children who had been teased to have greater psychosocial problems.

Self-Reports of Psychosocial Functioning among Children and Young Adults with Cleft Lip and Palate

Objective:

A cross-sectional study was employed to determine the psychosocial effects of cleft lip and/or palate among children and young adults, compared with a control group of children and young adults without cleft lip and palate.

Participants:

The study comprised 160 children and young adults with cleft lip and/or palate and 113 children and young adults without cleft lip and/or palate. All participants were between 8 and 21 years of age.

Outcome measures:

Psychological functioning (anxiety, self-esteem, depression, and behavioral problems) was assessed using validated psychological questionnaires. Happiness with facial appearance was rated using a visual analog scale. Social functioning, including experience of teasing/bullying and satisfaction with speech, was assessed using a semistructured interview.

Results:

Participants with cleft lip and/or palate reported greater behavioral problems (p < .001) and more symptoms of depression (p < .01); they were teased more often (p < .001) and were less happy with their facial appearance (p < .01) and speech (p < .001), compared with controls. There were no significant difference between subjects with cleft lip and/or palate and subjects without cleft lip and/or palate in terms of anxiety (p > .05) or self-esteem (p > .05). Having been teased was a significant predictor of poor psychological functioning, more so than having a cleft lip and/or palate per se (p < .001).

Conclusions:

Teasing was greater among participants who had cleft lip and/ or palate and it was a significant predictor of poorer psychosocial functioning. Children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as part of their routine cleft care.

Stakeholders' views of the introduction of assistive technology in the classroom: How family-centred is Australian practice for students with cerebral palsy?

BACKGROUND

With family-centred care widely recognized as a cornerstone for effective assistive technology service provision, the current study was undertaken to investigate to what extent such approaches were used by schools when assistive technology assessments and implementation occurred in the classroom.

METHOD

In this cross-sectional study, we compare survey results from parents (n = 76), school staff (n = 33) and allied health professionals (n = 65) with experience in the use of high-tech assistive technology. Demographic characteristics and the stakeholders' perceived helpfulness and frequency attending assessment and set-up sessions were captured. To evaluate how family-centred the assistive technology services were perceived to be, the parents filled out the Measure of Processes of Care for Caregivers, and the professionals completed the Measure of Processes of Care for Service Providers. Descriptive statistics and one-way analysis of variance were used to conduct the data analysis.

RESULTS

Findings show that parents are more involved during the assessment stage than during the implementation and that classroom teachers are often not involved in the initial stage. Speech pathologists in particular are seen to be to a great extent helpful when implementing assistive technology in the classroom. This study found that family-centred service is not yet fully achieved in schools despite being endorsed in early intervention and disability services for over 20 years. No statistically significant differences were found with respect to school staff and allied health professionals' roles, their years of experience working with students with cerebral palsy and the scales in the Measure of Processes of Care for Service Providers.

CONCLUSION

To enhance the way technology is matched to the student and successfully implemented, classroom teachers need to be fully involved in the whole assistive technology process. The findings also point to the significance of parents' involvement, with the support of allied health professionals, in the process of selecting and implementing assistive technology in the classroom.

Broad autism spectrum and obsessive-compulsive symptoms in adults with the fragile X premutation

OBJECTIVE

Clinical observations and a limited number of research studies provide evidence that the fragile X premutation may confer risk for autism, executive dysfunction, and psychopathology. The link to autism spectrum symptoms and social cognition deficits with the premutation remains uncertain, and thus was the focus of the present investigation.

METHOD

Our sample included 131 individuals, 42 men/22 women with the FMR1 premutation (mean age = 31.83 ± 8.59 years) with a normal neurological exam, and 48 men/19 women healthy age-matched controls (mean age = 29.48 ± 7.29 years). Individuals completed a comprehensive neuropsychological battery with additional assessments for social cognition, broad autism spectrum, and obsessive-compulsive (OC) symptoms.

RESULTS

Premutation carriers self-reported higher rates of autism-related symptoms (Autism Quotient; p = .001). Among males only, premutation carriers showed more atypical social interaction (p < .001) and stereotyped behavior (p = .014) during standardized clinical examination on the Autism Diagnostic Observation Schedule (ADOS) relative to controls. Female premutation carriers reported significantly higher rates of OC symptoms compared to control females (p = .012). Molecular measures defining the expanded premutation (FMR1 CGG repeat length and/or mRNA) were significantly associated with a measure of theory of mind (Reading the Mind in the Eyes Task).

CONCLUSIONS

The results of this study indicate a higher rate of broad autism spectrum symptoms in some males with the premutation and provide evidence for an obsessive-compulsive subtype in female premutation carriers.

BASEBALL PLAYERS WITH ULNAR COLLATERAL LIGAMENT TEARS DEMONSTRATE DECREASED ROTATOR CUFF STRENGTH COMPARED TO HEALTHY CONTROLS

BACKGROUND

Ulnar Collateral Ligament (UCL) tears are common in baseball players. Alterations in rotator cuff strength are believed to be associated with injury to the shoulder and/or elbow in baseball players.

HYPOTHESIS/PURPOSE

Baseball players diagnosed with a UCL tear will demonstrate decreased internal (IR) and external rotation (ER) force as an indication of isometric muscular strength in the throwing arm compared to IR and ER force of the throwing arm in healthy baseball players. The purpose of this study was to examine isometric IR and ER strength of the shoulder in baseball players with UCL tears at the time of injury compared to healthy baseball players.

STUDY DESIGN

Case-control study design.

METHODS

Thirty-three of the participants were diagnosed with a UCL tear and thirty-three were healthy, age- and positioned-matched controls. All of the participants played baseball at either the high school or collegiate level and volunteered for the study. Isometric rotator cuff strength measurements for internal (IR) and external rotation (ER) were performed with the arm held to the side at 0 ° of shoulder abduction. All measurements were taken bilaterally and the means of the throwing and non-throwing arms for IR and ER in the UCL group were compared to the means of the throwing and non-throwing arms in the healthy group. One-way ANOVAs were used to calculate differences between groups (p < 0.05).

RESULTS

Baseball players with UCL tears demonstrated significant rotator cuff strength deficits on their throwing arm IR (p < .001) and ER (p < .001) compared to throwing arm IR and ER in the Healthy (UCL IR = 131.3 ± 31.6 N; Healthy IR = 174.9 ± 20.7 N) (UCL ER = 86.4 ± 18.3 N; Healthy ER = 122.3 ± 18.3 N). On the non-throwing arm, the UCL group was weaker in both IR (135.0 ± 31.1 N; p < .001) and ER (93.4 ± 22.8 N; p < .001) than IR (172.1 ± 24.1 N) and ER (122.3 ± 19.1 N) in the Healthy group.

CONCLUSION

Participants with a UCL tear exhibit lower force values as an indication of isometric rotator cuff strength in both the throwing and non-throwing arms than a healthy cohort.

LEVEL OF EVIDENCE

Level 4.

A role for helminth parasites in achieving immunological tolerance in transplantation

BACKGROUND

Helminths infect more than a quarter of the world's population. Their success as parasites is the result of active immunomodulation of the host immune response, which can have benefits for the host, particularly in suppressing harmful allergic and autoimmune responses. Accordingly, we tested the hypothesis that helminth infection reduces the immune response to allograft transplantation.

METHODS

C57BL/6 mice were implanted with a subcutaneous minipump that delivered a continuous infusion of secreted products from the model mouse intestinal parasite, Heligmosomoides polygyrus (equivalent to 7 μg of protein per day). Simultaneously, fully allogeneic skin grafts from BALB/c donors were performed. 7 days later, lymphocytes were isolated from allograft draining lymph nodes and analysed by flow cytometry.

FINDINGS

Flow cytometric analysis showed a 41·7% increase in the mean percentage of CD4+CD25+Foxp3+ regulatory T cells (of total CD4 cells) from a baseline of 8·1% (95% CI 7·4-8·8) in untreated mice to 11·5% (8·8-14·2) in the treatment group (p=0·0085). Treatment with parasite products also increased mean expression of the regulatory cell surface receptor PD1 by 62·2% in the effector CD4 T-cell population from a baseline of 7·7% (5·7-9·6) to 12·5% (7·5-17·4) (p=0·03).

INTERPRETATION

The results show that helminth-derived products can powerfully induce regulatory immunological mechanisms in the presence of a fully allogeneic transplant. Identification of the specific mechanisms involved in suppression of allograft rejection by helminth parasites could lead towards development of safe and effective novel therapeutic strategies.

FUNDING

Wellcome Trust.

Naturally occurring heavy radioactive elements in the geothermal microcosm of the Los Azufres (Mexico) volcanic complex

The Los Azufres geothermal complex of central Mexico is characterized by fumaroles and boiling hot-springs. The fumaroles form habitats for extremophilic mosses and ferns. Physico-chemical measurements of two relatively pristine fumarolic microcosms point to their resemblance with the paleo-environment of earth during the Ordovician and Devonian periods. These geothermal habitats were analysed for the distribution of elemental mass fractions in the rhizospheric soil (RS), the native volcanic substrate (VS) and the sediments (S), using the new high-sensitivity technique of polarized x-ray energy dispersive fluorescence spectrometry (PEDXRF) as well as instrumental neutron activation analysis (INAA) for selected elements. This work presents the results for the naturally occurring heavy radioactive elements (NOHRE) Bi, Th and U but principally the latter two. For the RS, the density was found to be the least and the total organic matter content the most. Bi was found to be negligibly present in all substrate types. The average Th and U mass fractions in the RS were higher than in the VS and about equal to their average mass fractions in the S. The VS mass fraction of Th was higher, and of U lower, than the mass fractions in the earth's crust. In fact for the fumaroles of one site, the average RS mass fractions of these elements were higher than the averaged values for S (without considering the statistical dispersion). The immobilization of the NOHRE in the RS is brought about by the bio-geochemical processes specific to these extremophiles. Its effectiveness is such that despite the small masses of these plants, it compares with, or may sometimes exceed, the immobilization of the NOHRE in the S by the abiotic and aggressive chemical action of the hot-springs. These results indicate that the fumarolic plants are able to transform the volcanic substrate to soil and to affect the NOHRE mass fractions even though these elements are not plant nutrients. Mirrored back to the paleo times when such plant types were ubiquitous, it would mean that the first plants contributed significantly to pedogenesis and the biogeochemical recycling of even the heaviest and radioactive elements. Such plants may potentially be useful for the phytostabilisation of soil moderately contaminated by the NOHRE. Furthermore where applicable, geochronology may require taking into account the influence of the early plants on the NOHRE distributions.

Value of CT–PET after neoadjuvant chemoradiation in the prediction of histological tumour regression, nodal status and survival in oesophageal adenocarcinoma

Background

The role of CT–PET after neoadjuvant chemoradiation (nCRT) for prediction of pathological response and oncological outcome in oesophageal and junctional adenocarcinoma (OAC) is unclear. The relationship between complete metabolic response (cMR), pathological complete response (pCR) and nodal status has not been clarified.

Methods

Patients with locally advanced OAC selected to receive nCRT and surgery with curative intent, on the basis of staging that included CT–PET positivity, were included. Repeat scanning (PET2) with an identical protocol was performed 2–4 weeks after completion of nCRT (cisplatin and 5-fluorouracil plus 44 Gy radiation). Changes in [18F]fluorodeoxyglucose uptake, considered as either a maximum standardized uptake value (SUVmax) or a relative reduction (%ΔSUVmax), and PET-predicted nodal status following nCRT were compared with histopathological response, histological node positivity and survival.

Results

One hundred consecutive patients with PET-positive OAC were studied. Following nCRT, PET2 identified M1 disease in 2·0 per cent of patients. There were no significant associations between PET2 SUVmax or %ΔSUVmax with respect to primary tumour stage (ypT) (P = 0.216 and P = 0·975 respectively), tumour regression grade (P = 0·109 and P = 0·232), pCR (P = 0·633 and P = 0·870) or complete resection (R0) (P = 0·440 and P = 0·235). The sensitivity of PET2 for ypN was 10 per cent. %ΔSUVmax was not associated with disease-free or overall survival (P = 0·162 and P = 0·154 respectively). Of 46 patients with a cMR on PET2, 37 (80 per cent) had histological evidence of residual tumour in the resected specimen, and cMR was not associated with overall survival benefit (P = 0·478).

Conclusion

CT–PET following nCRT for OAC has poor prognostic and discriminatory value for clinical application.