TMET-34. RADIATION METABOLOMICS IN PRIMARY HUMAN MENINGIOMA AND SCHWANNOMA: EARLY EXPERIENCE AND INITIAL RESULTS

Introduction

Meningiomas and schwannomas account for 45% of primary CNS tumors. Yet when surgery and radiation fail, no further treatments exist. Metabolomics has been used to discover new cancer therapies; however, to date few have used metabolomics to study meningiomas and schwannomas. Here we present initial results and lessons learned from this novel endeavor.

METHODS

Primary tumors were obtained from patients during surgery and immediately taken for culturing or xenograft implantation. Upon reaching >90% confluence, cultures were treated with 0gy, 3gy, 10gy, or 20gy gamma radiation, then flash frozen 6 or 72 hours post-treatment. Xenograft tumors were implanted in nude mice. MRI 4 weeks post-implantation confirmed tumor viability. Mice were then given 10gy, 20gy, or sham radiation treatment. Xenografts were harvested 72 hours post-treatment. Metabolites were measured with a ThermoISQ gas chromatography-mass spectrometer.

RESULTS

Eleven meningiomas and nine schwannomas were successfully cultured. Unsupervised hierarchical clustering of cultures demonstrated greater influence from tumor of origin than from radiation. Univariate analysis of schwannoma xenografts demonstrated elevated ornithine following radiation (fold change 1.62; P = 0.008). However, principal component analysis did not show significant between-group differentiation. Orthotopic meningioma xenografts did not produce sufficient tissue for metabolomics; however, subsequent subcutaneous implants have been successful (data forthcoming).

CONCLUSION

Standard cell cultures did not reveal significant metabolic changes following radiation; it is unclear whether this was due to culture technique or inter-tumor heterogeneity. In radiated schwannoma xenografts, elevated ornithine may implicate related pathways such as ornithine decarboxylase-mediated polyamide synthesis for DNA double-strand break repair. Compared to other ‘-omics’ studies, metabolomics requires more tissue per sample ( >10mg) and is more sensitive to environmental conditions. Thus, large sample sizes are needed to detect significant changes, and xenografts are likely superior to cell culture. Future plans include increased xenograft sample size and stable isotope tracing for pathway analysis.

A novel method for automatic classification of Parkinson gait severity using front-view video analysis

BACKGROUND

Gait impairment is an essential symptom of Parkinson's disease (PD).

OBJECTIVE

This paper introduces a novel computer-vision framework for automatic classification of the severity of gait impairment using front-view motion analysis.

METHODS

Four hundred and fifty-six videos were recorded from 19 PD patients using an RGB camera during clinical gait assessment. Gait performance in each video was rated by a neurologist using the unified Parkinson's disease rating scale for gait examination (UPDRS-gait). The proposed algorithm detects and tracks the silhouette of the test subject in the video to generate a height signal. Gait features were extracted from the height signal. Feature analysis was performed using the Kruskal-Wallis rank test. A support vector machine was trained using the features to classify the severity levels according to UPDRS-gait in 10-fold cross-validation.

RESULTS

Features significantly (p< 0.05) differentiated between median-ranks of UPDRS-gait levels. The SVM classified the levels with a promising area under the ROC of 80.88%.

CONCLUSION

Findings support the feasibility of this model for Parkinson's gait assessment in the home environment.

Explore the sludge stabilization process in sludge drying bed by modeling study from mesocosm experiments

Sludge drying bed (SDB) treatment is a valuable alternative to conventional sludge treatment methods. However, changes in sludge hydrotexture during dewatering present a barrier for direct modeling of the SDB process. This study proposes a modeling strategy to simulate the sludge stabilization process in SDB treatment by separating sludge dewatering and sludge solids stabilization into independent processes. Two cell decay theories widely used by activated sludge models (ASM), death-regeneration concept and endogenous respiration theory, are compared to describe the biokinetic processes of sludge digestion. Both cell decay theories are found to adequately describe effluent total COD, NH₄-N, NO₃-N, and sludge layer composition, but have pronounced differences in describing effluent COD compositions. Results show that natural aeration does not maintain adequate aerobic/anoxic sludge digestion within the sludge layer to fully nitrify NH₄-N released by cell decay. Results also indicate that the kinetics of sludge digestion are adaptable over time, indicating the need to adopt lumped values for biokinetic simulations. While lowered sludge dewatering rates (outflow) can increase biodegradable COD for cell metabolism, increased sludge loading rates (inflow) lead to higher effluent COD and NH₄-N concentrations. Contrary to conventional judgement, this study demonstrates the merit of sludge layer formation to reduce leaching loss of biodegradable COD. Overall, the proposed modeling strategy is proven capable of simulating deposited sludge digestion processes in an SDB.

Managing biofilm growth and clogging to promote sustainability in an intermittent sand filter (ISF)

The sustainability of rural sanitation includes the long-term welfare of both rural and urban societies. As a commonly used rural sanitation technology, operation of intermittent sand filters (ISF) is impacted by biofilm clogging inside the ISF. In this study ISF performance is studied at low hydraulic loading rates (HLR) to explore the interaction between biofilm growth and wastewater treatment efficiency. CW2D/HYDRUS, a simulation model which does not include media hydraulic property changes caused by biofilm growth, is utilized as a numerical control to contrast the effects of biofilm growth inside an experimental ISF. A paired experiment with simulation demonstrate that biofilm clogging comprised dominantly of heterotrophs occurred in the top layers of the ISF. Lowered HLR slows clogging development but not final clogging extent. The biofilm clogging development zone offers adequate removal of applied biodegradable COD and NH₄⁺ - N. However, the spatial distribution of heterotrophs and biodegradable COD does not match the denitrification requirement of the resulting NO₃^- - N. A simultaneous nitrification and denitrification (SND) potential is manifested in the clogging development zone, but lowered HLR reduces media moisture level to a less favorable level for denitrification. Furthermore, slowed water movement under lower HLR aggravates the accumulation of NO₃^- - N, which can potentially result in counterproductive salt accumulation. Since biofilm growth is a natural and self-adaptive response to wastewater application, this study suggests accepting limited, managed biofilm growth and clogging in ISFs. In addition, this study calls for further research to manage biofilm growth and clogging for long-term ISF sustainability.

Numerical assessment of a soil moisture controlled wastewater SDI disposal system in Alabama Black Belt Prairie

To promote the environmental sustainability of rural sanitation, a soil moisture controlled wastewater subsurface drip irrigation (SDI) dispersal system was field tested in the Black Belt Prairie of Alabama, USA. The soil moisture control strategy was designed to regulate wastewater disposal timing according to drain field conditions to prevent hydraulic overloading and corresponding environmental hazard. CW2D/HYDRUS simulation modeling was utilized to explore difficult-to-measure aspects of system performance. While the control system successfully adapted hydraulic loading rate to changing drain field conditions, saturated field conditions during the dormant season presented practical application challenges. The paired field experiment and simulation model demonstrate that soil biofilm growth was stimulated in the vicinity of drip emitters. Although biofilm growth is critical in maintaining adequate COD and NH₄⁺-N removal efficiencies, the efficient removal of biodegradable COD itself by soil biofilm limits denitrification of formed NO₃^--N . Furthermore, stimulated soil biofilm growth can create soil clogging around drip emitters, which was discerned in the field experiment along with salt accumulation, both of which were verified by simulation. Comparable modeling of system performance in sand and clay media demonstrate that the placement of soil moisture sensors within the drain field can have pronounced impacts on system hydraulic performance, depending on the soil permeability. Overall, the soil moisture control strategy tested is shown as a viable supplemental technology to promote the environmental sustainability of rural sanitation systems.

RRNPP-type quorum-sensing systems regulate solvent formation, sporulation and cell motility in Clostridium saccharoperbutylacetonicum

BACKGROUND

Clostridium saccharoperbutylacetonicum N1-4 (HMT) is a strictly anaerobic, spore-forming Gram-positive bacterium capable of hyper-butanol production through the well-known acetone-butanol-ethanol fermentation process. Recently, five putative RRNPP-type QSSs (here designated as QSS1 to QSS5) were predicted in this bacterial strain, each of which comprises a putative RRNPP-type regulator (QssR1 to QssR5) and a cognate signaling peptide precursor (QssP1 to QssP5). In addition, both proteins are encoded by the same operon. The functions of these multiple RRNPP-type QSSs are unknown.

RESULTS

To elucidate the function of multiple RRNPP-type QSSs as related to cell metabolism and solvent production in N1-4 (HMT), we constructed qssR-deficient mutants ΔR1, ΔR2, ΔR3 and ΔR5 through gene deletion using CRISPR-Cas9 and N1-4-dcas9-R4 (with the QssR4 expression suppressed using CRISPR-dCas9). We also constructed complementation strains by overexpressing the corresponding regulator gene. Based on systematic characterization, results indicate that QSS1, QSS2, QSS3, and QSS5 positively regulate the sol operon expression and thus solvent production, but they likely negatively regulate cell motility. Consequently, QSS4 might not directly regulate solvent production, but positively affect cell migration. In addition, QSS3 and QSS5 appear to positively regulate sporulation efficiency.

CONCLUSIONS

Our study provides the first insights into the roles of multiple RRNPP-type QSSs of C. saccharoperbutylacetonicum for the regulation of solvent production, cell motility, and sporulation. Results of this study expand our knowledge of how multiple paralogous QSSs are involved in the regulation of essential bacterial metabolism pathways.

Infectious Diseases Specialty Intervention Is Associated With Better Outcomes Among Privately Insured Individuals Receiving Outpatient Parenteral Antimicrobial Therapy

BACKGROUND

Outpatient parenteral antimicrobial therapy (OPAT) can be managed by specialists in infectious diseases (ID) or by other physicians. Better management of OPAT can reduce the likelihood of readmission or emergency department (ED) use. The relative success of ID specialists and other physicians in managing OPAT has received little study.

METHODS

We analyzed a national database of insurance claims for privately insured individuals under age 65, locating inpatient acute-care stays in 2013 and 2014 that were followed by OPAT. Through propensity scoring, patients who received outpatient ID intervention (ID-led OPAT) were matched 1-to-1 with those who did not (Other OPAT). We estimated regression models of hospital and ED admissions and of total healthcare payments over the first 30 days after discharge.

RESULTS

The final analytic sample of 8200 observations was well balanced on clinical and demographic characteristics. Soft-tissue infection and osteomyelitis were the most common infections in the index event, each affecting more than 40% of individuals. Relative to those with Other OPAT, people with ID-led OPAT had lower odds of an ED admission (odds ratio [OR] 0.449, 95% confidence interval [CI] 0.311-0.645) or hospitalization (OR 0.661, 95% CI 0.557-0.791) over 30 days, and they accumulated $1488 less in total healthcare payments (95% CI -2 688.56--266.58).

CONCLUSIONS

Among privately insured individuals below age 65, ID consultations during OPAT are associated with large and significant reductions in the rates of ED admission and hospital admission in the 30 days after index events, as well as lower total healthcare spending.

Something Old, Something New, Something Borrowed, Something Blue: Part 3 – An Elephant Never Forgets

Forgetting is an oft-forgotten art. Many artificial intelligence (AI) systems deliver good performance when first implemented; however, as the contextual environment changes, they become out of date and their performance degrades. Learning new knowledge is part of the solution, but forgetting outdated facts and information is a vital part of the process of renewal. However, forgetting proves to be a surprisingly difficult concept to either understand or implement. Much of AI is based on analogies with natural systems, and although all of us have plenty of experiences with having forgotten something, as yet we have only an incomplete picture of how this process occurs in the brain. A recent judgment by the European Court concerns the “right to be forgotten” by web index services such as Google. This has made debate and research into the concept of forgetting very urgent. Given the rapid growth in requests for pages to be forgotten, it is clear that the process will have to be automated and that intelligent systems of forgetting are required in order to meet this challenge.

A Novel Method for the Treatment of Bilateral Hypogastric Aneurysms Using Hybrid Polytetrafluoroethylene Graft

Open aortic aneurysm repair in the setting of bilateral hypogastric aneurysms is technically challenging. We present a novel technique for open surgical repair for bilateral hypogastric aneurysms using the Gore hybrid vascular graft (GVHG; W. L. Gore and Associates Inc, Flagstaff, Arizona). The GVHG is an expanded polytetrafluoroethylene graft with a nitinol stent at 1 end designed for hemodialysis access. The GVHG has been also been used for aortic debranching and treatment of occlusive disease. We describe the first report using GVHG to repair hypogastric aneurysms.

Multifaceted signaling regulators of chondrogenesis: Implications in cartilage regeneration and tissue engineering

Defects of articular cartilage present a unique clinical challenge due to its poor self-healing capacity and avascular nature. Current surgical treatment options do not ensure consistent regeneration of hyaline cartilage in favor of fibrous tissue. Here, we review the current understanding of the most important biological regulators of chondrogenesis and their interactions, to provide insight into potential applications for cartilage tissue engineering. These include various signaling pathways, including: fibroblast growth factors (FGFs), transforming growth factor β (TGF-β)/bone morphogenic proteins (BMPs), Wnt/β-catenin, Hedgehog, Notch, hypoxia, and angiogenic signaling pathways. Transcriptional and epigenetic regulation of chondrogenesis will also be discussed. Advances in our understanding of these signaling pathways have led to promising advances in cartilage regeneration and tissue engineering.

Machine Vision Approach for Automating Vegetation Detection on Railway Tracks

The presence of vegetation on railway tracks (amongst other issues) threatens track safety and longevity. However, vegetation inspections in Sweden (and elsewhere in the world) are currently being carried out manually. Manually inspecting vegetation is very slow and time consuming. Maintaining an even quality standard is also very difficult. A machine vision-based approach is therefore proposed to emulate the visual abilities of the human inspector. Work aimed at detecting vegetation on railway tracks has been split into two main phases. The first phase is aimed at detecting vegetation on the tracks using appropriate image analysis techniques. The second phase is aimed at detecting the rails in the image to determine the cover of vegetation that is present between the rails as opposed to vegetation present outside the rails. Results achieved in the current work indicate that the machine vision approach has performed reasonably well in detecting the presence/absence of vegetation on railway tracks when compared with a human operator.

Impact of a real-time controlled wastewater subsurface drip disposal system on the selected chemical properties of a vertisol

The operation of onsite septic effluent disposal without considering seasonal moisture changes in drain field conditions can be a major cause of the failure of conventional septic systems. This study addressed this issue from a soil hydraulic perspective by using real-time drain field soil moisture levels to limit septic effluent disposal in a vertisol via subsurface drip irrigation. A prototype system was field-tested in a Houston clay soil and results describe the subsequent impact on selected soil chemical properties. After one year of hydraulic dosing with a synthetic wastewater, soil total carbon and nitrogen concentrations increased, but no increase in soil total phosphorus concentration was observed. Soil NO3-N leaching potential was noted, but soil NH4-N concentrations decreased, which could be ascribed to NH4-N nitrification, fixation within clay sheets and NH3 volatilization. Soil K+, Mg2+ and Na+ concentrations increased in soil layers above the drip lines, but decreased in soil layers below drip lines. Soil electrical conductivity accordingly increased in soil layers above drip lines, but the range was significantly lower than the threshold for soil salinity. Although the moisture-controlled effluent disposal strategy successfully avoided hydraulic dosing during unfavourable wet drain field conditions and prevented accumulation of soil salts in the soil profile beneath the drip lines, soil salts tended to accumulate in top soil layers. These adverse effects warrant system corrections before large-scale implementation of subsurface drip irrigation of effluent in similar vertisols.

Something Old, Something New, Something Borrowed, Something Blue Part 2: From Frankenstein to Battlefield Drones; A Perspective on Machine Ethics

Intelligent systems are reaching the point where they can take very significant decisions on behalf of humans and society. The moral and ethical impact of such systems needs to be taken very seriously, both internally and externally in respect of such systems. Although some work into defining and systematizing machine ethics has begun, a great deal of work remains to be done and many research questions remain open.

Motion cue analysis for parkinsonian gait recognition

This paper presents a computer-vision based marker-free method for gait-impairment detection in Patients with Parkinson's disease (PWP). The system is based upon the idea that a normal human body attains equilibrium during the gait by aligning the body posture with Axis-of-Gravity (AOG) using feet as the base of support. In contrast, PWP appear to be falling forward as they are less-able to align their body with AOG due to rigid muscular tone. A normal gait exhibits periodic stride-cycles with stride-angle around 45o between the legs, whereas PWP walk with shortened stride-angle with high variability between the stride-cycles. In order to analyze Parkinsonian-gait (PG), subjects were videotaped with several gait-cycles. The subject's body was segmented using a color-segmentation method to form a silhouette. The silhouette was skeletonized for motion cues extraction. The motion cues analyzed were stride-cycles (based on the cyclic leg motion of skeleton) and posture lean (based on the angle between leaned torso of skeleton and AOG). Cosine similarity between an imaginary perfect gait pattern and the subject gait patterns produced 100% recognition rate of PG for 4 normal-controls and 3 PWP. Results suggested that the method is a promising tool to be used for PG assessment in home-environment.

Validation of a home environment test battery for supporting assessments in advanced Parkinson's disease

Test sequences in a test battery for Parkinson's disease patients, consisting of self-assessments and motor tests, were carried out repeatedly in a telemedicine setting, during week-long test periods and results were summarized in an 'overall score'. 35 patients in stable and fluctuating conditions (15 age- and gender-matched pairs) used the test battery for 1 week, and were then assessed with UPDRS and PDQ-39. This procedure was repeated 1 week later, without treatment changes. Reliability was assessed by intraclass correlation coefficients and Cronbach's alpha. Convergent validity was assessed by Spearman rank correlations and known-groups' validity, by the Mann-Whitney test. According to anonymous usability questionnaires, the patients could easily complete the tasks. Median compliance (93%) and test-retest reliability (0.88) were good. The correlations between overall score and total UPDRS (-0.64) and PDQ-39 (-0.72) were adequate. Median overall score was 18% better in the stable compared to the fluctuating group (p = 0.0014).

A web application for follow-up of results from a mobile device test battery for Parkinson's disease patients

This paper describes a web-based system for enabling remote monitoring of patients with Parkinson's disease (PD) and supporting clinicians in treating their patients. The system consists of a patient node for subjective and objective data collection based on a handheld computer, a service node for data storage and processing, and a web application for data presentation. Using statistical and machine learning methods, time series of raw data are summarized into scores for conceptual symptom dimensions and an "overall test score" providing a comprehensive profile of patient's health during a test period of about one week. The handheld unit was used quarterly or biannually by 65 patients with advanced PD for up to four years at nine clinics in Sweden. The IBM Computer System Usability Questionnaire was administered to assess nurses' satisfaction with the web application. Results showed that a majority of the nurses were quite satisfied with the usability although a sizeable minority were not. Our findings support that this system can become an efficient tool to easily access relevant symptom information from the home environment of PD patients.

Hydraulic management of a soil moisture controlled SDI wastewater dispersal system in an Alabama Black Belt soil

Rural areas represent approximately 95% of the 14000 km(2) Alabama Black Belt, an area of widespread Vertisols dominated by clayey, smectitic, shrink-swell soils. These soils are unsuitable for conventional onsite wastewater treatment systems (OWTS) which are nevertheless widely used in this region. In order to provide an alternative wastewater dosing system, an experimental field moisture controlled subsurface drip irrigation (SDI) system was designed and installed as a field trial. The experimental system that integrates a seasonal cropping system was evaluated for two years on a 500-m(2) Houston clay site in west central Alabama from August 2006 to June 2008. The SDI system was designed to start hydraulic dosing only when field moisture was below field capacity. Hydraulic dosing rates fluctuated as expected with higher dosing rates during warm seasons with near zero or zero dosing rates during cold seasons. Lower hydraulic dosing in winter creates the need for at least a two-month waste storage structure which is an insurmountable challenge for rural homeowners. An estimated 30% of dosed water percolated below 45-cm depth during the first summer which included a 30-year historic drought. This massive volume of percolation was presumably the result of preferential flow stimulated by dry weather clay soil cracking. Although water percolation is necessary for OWTS, this massive water percolation loss indicated that this experimental system is not able to effective control soil moisture within its monitoring zone as designed. Overall findings of this study indicated that soil moisture controlled SDI wastewater dosing is not suitable as a standalone system in these Vertisols. However, the experimental soil moisture control system functioned as designed, demonstrating that soil moisture controlled SDI wastewater dosing may find application as a supplement to other wastewater disposal methods that can function during cold seasons.

A new computer method for assessing drawing impairment in Parkinson's disease

A test battery, consisting of self-assessments and motor tests (tapping and spiral drawing tasks) was used on 9482 test occasions by 62 patients with advanced Parkinson's disease (PD) in a telemedicine setting. On each test occasion, three Archimedes spirals were traced. A new computer method, using wavelet transforms and principal component analysis processed the spiral drawings to generate a spiral score. In a web interface, two PD specialists rated drawing impairment in spiral drawings from three random test occasions per patient, using a modification of the Bain & Findley 10-category scale. A standardised manual rating was defined as the mean of the two raters' assessments. Bland-Altman analysis was used to evaluate agreement between the spiral score and the standardised manual rating. Another selection of spiral drawings was used to estimate the Spearman rank correlations between the raters (r=0.87), and between the mean rating and the spiral score (r=0.89). The 95% confidence interval for the method's prediction errors was +/-1.5 scale units, which was similar to the differences between the human raters. In conclusion, the method could assess PD-related drawing impairments well comparable to trained raters.

A home environment test battery for status assessment in patients with advanced Parkinson's disease

A test battery for assessing patient state in advanced Parkinson's disease, consisting of self-assessments and motor tests, was constructed and implemented on a hand computer with touch screen in a telemedicine setting. The aim of this work was to construct an assessment device, applicable during motor fluctuations in the patient's home environment. Selection of self-assessment questions was based on questions from an e-diary, previously used in a clinical trial. Both un-cued and cued tapping tests and spiral drawing tests were designed for capturing upper limb stiffnes, slowness and involuntary movements. The patient interface gave an audible signal at scheduled response times and was locked otherwise. Data messages in an XML-format were sent from the hand unit to a central server for storage, processing and presentation. In tapping tests, speed and accuracy were calculated and in spiral tests, standard deviation of frequency filtered radial drawing velocity was calculated. An overall test score, combining repeated assessments of the different test items during a test period, was defined based on principal component analysis and linear regression. An evaluation with two pilot patients before and after receiving new types of treatments was performed. Compliance and usability was assessed in a clinical trial (65 patients with advanced Parkinson's disease) and correlations between different test items and internal consistency were investigated. The test battery could detect treatment effect in the two pilot patients, both in self-assessments, tapping tests' results and spiral scores. It had good patient compliance and acceptable usability according to nine nurses. Correlation analysis showed that tapping results provided different information as compared to diary responses. Internal consistency of the test battery was good and learning effects in the tapping tests were small.

Municipal wastewater treatment through an aerobic biofilm SBR integrated with a submerged filtration bed

A biofilm reactor and a gravitational filtration bed were integrated as a sequencing batch reactor (SBR) to aerobically treat a municipal wastewater. Polyacrylonitrile balls (50 mm diameter, 90% porosity) were filled into the upper part of the SBR as biofilm attaching materials and anthracite coal (particle size approximately 1.17 mm) was placed into the lower part as filter media. The SBR was aerated during filling and reaction phases, followed by a 10 min discharge phase during which the wastewater went through the filtration bed without aeration. The SBR was tested with raw wastewater from a municipal WWTP in Wuhan, China from July 2006 to January 2007, during both a warm season and a cold season. The SBR showed a capability to accept COD and turbidity fluctuations in the receiving wastewater. Seasonal influence on COD and nitrogen removal by the biofilm reactor was significant. Nitrogen and phosphorus removals were limited by COD levels in the wastewater. The filtration process removed considerable COD, nitrogen, phosphorus, and turbidity. The overall SBR effluent quality consistently satisfied the national secondary effluent discharge standard of China, except for total phosphorus. An anaerobic phase before the aerobic reaction is proposed to improve phosphorus and nitrogen removal. The filter normally required a backwash every seven days and the water needed for backwash was less than 4% of the wastewater treated by the SBR. This experiment provides information needed for further investigation to improve performance of the SBR.

An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003

OBJECTIVE

The objective of this study was to obtain the best estimate of intrapartum-related perinatal mortality (IPPM) rates for booked home births.

DESIGN

A population-based cross-sectional study.

SETTING

England and Wales.

SUBJECTS

All births in England and Wales, including home births (intended or unintended) occurring between 1994 and 2003.

METHODS

All IPPM data were derived from the Confidential Enquiry into Maternal and Child Health. Denominators were derived by using unintended home births and transfer rates from home to hospital, from previous studies, with sensitivity analyses. IPPM rates were calculated for the three following subgroups: (a) the completed home birth group, (b) the transferred group and (c) the unintended home birth group.

OUTCOME

IPPM rate.

RESULTS

The overall IPPM rate for England and Wales improved between 1994 and 2003. However, data to obtain a precise estimate of IPPM rate for booked home birth were not available. The average IPPM rate for all births in the study period was 0.79 per 1000 births (95% CI 0.77-0.81), and the estimated IPPM rate for booked home births was 1.28 or 0.74 per 1000 births, depending on the method of calculation (range 0.49-1.47). The IPPM rates for the completed home birth group appeared to be lower throughout the study period compared with the unintended home birth groups. Those women who had booked for a home birth, but later needed to transfer their care for a hospital birth, appeared to have the highest risk of IPPM in the study period.

CONCLUSIONS

The results of this study need to be interpreted with caution due to inconsistencies occurring in the recorded data. However, the data do highlight two important features. First, they suggest that IPPM rates for home births do not appear to have improved over the study period examined, even though rates did so overall. Second, although the women who booked for home births and had their babies at home seemed to have a generally low IPPM rate, those who required their care to be transferred to hospital did not. Women who book for home births should be offered comprehensive evidence-based information about the potential benefits, risks and uncertainties associated with their choice of birthplace by the healthcare professional responsible for supporting their decision. It is of considerable concern that the data recorded nationally in England and Wales do not provide accurate information about when and why a transfer from home to hospital booking occurs and about their outcomes.

Water quality in a non-traditional off-stream polyethylene-lined reservoir

Annual water storage in a 5.3 ha, polyethylene-lined, off-stream irrigation reservoir in northern Alabama, USA, resulted in marked improvement in water quality. Results of three-year monitoring from June 1999 to May 2002 indicate that the relatively static conditions of the reservoir enhanced settling of suspended particles by 85% (from 14.4 to 2.1 mg TSS/L) that cleared the water and increased sunlight penetration. The organic and inorganic particles that settled to the bottom removed up to 88% of the nutrients and other chemical substances from the water. Nutrients remaining in the water column were rapidly assimilated by phytoplankton algae. With the basin sealed at the bottom and no runoff input there was limited opportunity for nutrients or other substances to enter the reservoir in quantities that would adversely affect water quality. Consequently, reservoir water was found to be of high quality and suitable as a raw water supply. Non-traditional, off-stream storage reservoirs such as described in this paper may be uniquely suited for agricultural irrigation and public water supply in regions such as southeastern US that experience relatively frequent drought conditions but have relatively abundant long-term annual rainfall.