15 Structured Geriatric Liaison Services in Mental Health Inpatient Facilities

Introduction

Older people admitted to mental health facilities may be at increased risk of deterioration in the physical co-morbidities and increased rates of mortality when admitted in acute medical settings. Our model of care focuses on intervening in the physical aspect of patients admitted in the mental health unit addressing their comorbidities and polypharmacy and offering staff support during the admission process. Our Older Mental Health Unit is based in the district hospital with a total of 22 beds for people over 65 years old distributed in two areas: dementia with behavioral and psychological symptoms (BPS) and functional disorders.

Methods

Allocated geriatrician once a week to attend MDT and medical ward rounds. 5 working days telephone consultations for advice and supporting trainees in teaching and research. We measure the impact of our intervention comparing the data predating our intervention comparing 20 patients in each period 2016 and 2018.

Results

Mean age increased from 74.3 to 77.8 in a two year period with an average of 3.5 medical co-morbidities. Reduction in polypharmacy from 7.15 to 5.5 number of medication, 58% reduction in the number of hospital transfers and 90% reduction in specialty referrals.

Conclusions

Structured Geriatric Liaison Services in Mental Health in inpatient facilities are shown to be effective in reducing acute hospital and outpatient clinic attendances minimising the challenges of management of these patients in non-mental health facilities.

Drought response of Mucuna pruriens (L.) DC. inoculated with ACC deaminase and IAA producing rhizobacteria

Drought is one of the major constraints limiting agricultural production worldwide and is expected to increase in the future. Limited water availability causes significant effects to plant growth and physiology. Plants have evolved different traits to mitigate the stress imposed by drought. The presence of plant growth-promoting rhizobacteria (PGPR) could play an important role in improving plant performances and productivity under drought. These beneficial microorganisms colonize the rhizosphere of plants and increase drought tolerance by lowering ethylene formation. In the present study, we demonstrate the potential to improve the growth of velvet bean under water deficit conditions of two different strains of PGPR with ACCd (1-Aminocyclopropane-1-Carboxylate deaminase) activity isolated from rainfed farming system. We compared uninoculated and inoculated plants with PGPR to assess: a) photosynthetic performance and biomass; b) ACC content and ethylene emission from leaves and roots; c) leaf isoprene emission. Our results provided evidence that under drought conditions inoculation with PGPR containing the ACCd enzyme could improve plant growth compared to untreated plants. Ethylene emission from roots and leaves of inoculated velvet bean plants was significantly lower than uninoculated plants. Moreover, isoprene emission increased with drought stress progression and was higher in inoculated plants compared to uninoculated counterparts. These findings clearly illustrate that selected PGPR strains isolated from rainfed areas could be highly effective in promoting plant growth under drought conditions by decreasing ACC and ethylene levels in plants.

Fluoroquinolones (FQs) in the environment: A review on their abundance, sorption and toxicity in soil

The use of fluoroquinolones (FQs) antibiotics as therapeutic agents and growth promoters is increasing worldwide; however their extensive uses are also resulting in antibiotic resistance among world communities. FQs have also become one of the major contaminants in the waste water bodies, which are not even completely removed during the treatment processes. Furthermore, their abundance in agricultural resources, such as the irrigation water, the bio-solids and the livestock manure can also affect the soil micro-environment. These antibiotics in soil tend to interact in several different ways to affect soil flora and fauna. The current review endeavors to highlight the some critical aspects of FQs prevalence in the environment. The review presents a detailed discussion on the pathways and abundance of FQs in soil. The discussion further spans the issue of sorption and FQs transformation into the soil better understand of their behavior and their toxicity to soil flora and fauna.

Application of leaching tests on phosphogypsum by infiltration-percolation

The phosphoric acid production obtained by attacking phosphate rock by sulphuric acid cogenerates considerable quantities of phosphogypsum. The world cogeneration is estimated about 100-280 Mt per year. In another context of sustainable development, the phosphate chemical industry develops different ways of phosphogypsum valorization, which makes its storage stack in a suitable way for its potential use as an industrial by-product. Although, this storage can cause an environmental impact largely due to the transfer of trace elements (TEs) to groundwater by leaching. It is therefore important to evaluate the impact linked to the storage in order to limit this transfer. The evaluation is usually performed through leaching tests in columns or reactor. In this work, leaching tests were performed in columns by infiltration-percolation on two filter mediums: phosphogypsum and synthetic sandy soils. The results showed that the phosphogypsum is acting as a filter, which retains and releases the TEs. Most of these TEs (Pb, Se, Ag, Zn and Cu) were highly retained in the synthetic soils surfaces and their contents in waters were considerably lower than the maximum contaminant levels (MCLs). Although As, Cd, Cr and Ni were strongly transferred to groundwater, their respective contents were higher than the MCLs.

Synergistic effect of co-digestion to enhance anaerobic degradation of catering waste and orange peel for biogas production

Catering waste and orange peel were co-digested using an anaerobic digestion process. Orange peel is difficult to degrade anaerobically due to the presence of antimicrobial agents such as limonene. The present study aimed to examine the feasibility of anaerobic co-digestion of catering waste with orange peel to provide the optimum nutrient balance with reduced inhibitory effects of orange peel. Batch experiments were conducted using catering waste as a potential substrate mixed in varying ratios (20-50%) with orange peel. Similar ratios were followed using green vegetable waste as co-substrate. The results showed that the highest organic matter degradation (49%) was achieved with co-digestion of catering waste and orange peel at a 50% mixing ratio (CF4). Similarly, the soluble chemical oxygen demand (sCOD) was increased by 51% and reached its maximum value (9040 mg l^-1) due to conversion of organic matter from insoluble to soluble form. Biogas production was increased by 1.5 times in CF4 where accumulative biogas was 89.61 m³ t^-1_substrate compared with 57.35 m³ t^-1_substrate in the control after 80 days. The main reason behind the improved biogas production and degradation is the dilution of inhibitory factors (limonene), with subsequent provision of balanced nutrients in the co-digestion system. The tCOD of the final digestate was decreased by 79.9% in CF4, which was quite high as compared with 68.3% for the control. Overall, this study revealed that orange peel waste is a highly feasible co-substrate for anaerobic digestion with catering waste for enhanced biogas production.

Physiological and antioxidant response of wheat (Triticum aestivum) seedlings to fluoroquinolone antibiotics

Combinations of antibiotics occur in terrestrial environments due to excessive prescription, consumption, and disposal and have adverse effects, including crop toxicity. We examined short-term (20-d) toxicity of the fluoroquinolone antibiotics ciprofloxacin, enrofloxacin, levofloxacin, and their mixture in a germination and a greenhouse sand culture study with wheat. We tested the hypothesis that oxidative stress plays a role in toxicity by examining stress products and antioxidants involved in detoxifying reactive oxygen species (ROS) during stress. Germination was unaffected by any antibiotic concentration or mixture used. The highest antibiotic concentrations, 100 and 300 mg L^-1, significantly decreased wheat growth. In 20 days exposure the maximum malondialdehyde production (2.45 μmol g^-1 fresh weight), total phenols (16.40 mg g^-1 of extract), and total antioxidant capacity (17.74 mg of Vitamin C g^-1 of extract) and maximum activities of superoxide dismutase (7.99 units mg^-1 protein min^-1) and ascorbate peroxidase (0.69 μmol ascorbate mg^-1 protein min^-1) significantly increased compared to the control. In contrast, catalase (0.45 mmol H₂O₂ mg^-1 protein min^-1) and peroxidase (0.0005 units mg^-1 protein min^-1) activity significantly decreased compared to the control. We conclude that high antibiotic concentrations in the plant growth medium reduced wheat growth by causing oxidative stress. The capacity to respond to oxidative stress was compromised by increasingly higher antibiotic concentrations in some enzyme systems. This stress damaged the physiological structure of the young plants and could reduce crop productivity in the long term. Consequently, fluoroquinolone-contaminated water challenges developing countries with constraints on available water for irrigation.

Use of RSM modeling for optimizing decolorization of simulated textile wastewater by Pseudomonas aeruginosa strain ZM130 capable of simultaneous removal of reactive dyes and hexavalent chromium

Remediation of colored wastewater loaded with dyes and metal ions is a matter of interest nowadays. In this study, 220 bacteria isolated from textile wastewater were tested for their potential to decolorize each of the four reactive dyes (reactive red-120, reactive black-5, reactive yellow-2, and reactive orange-16) in the presence of a mixture of four different heavy metals (Cr, Zn, Pb, Cd) commonly found in textile effluents. Among the tested bacteria, the isolate ZM130 was found to be the most efficient in decolorizing reactive dyes in the presence of the mixture of heavy metals and was identified as Pseudomonas aeruginosa strain ZM130 by 16S rRNA gene analysis. The strain ZM130 was highly effective in simultaneously removing hexavalent chromium (25 mg L(-1)) and the azo dyes (100 mg L(-1)) from the simulated wastewater even in the presence of other three heavy metals (Zn, Pb, Cd). Simultaneous removal of chromium and azo dyes ranged as 76.6-98.7 % and 51.9-91.1 %, respectively, after 180 h incubation. On the basis of quadratic polynomial equation and response surfaces given by the response surface methodology (RSM), optimal salt content, pH, carbon co-substrate content, and level of multi-metal mixtures for decolorization of reactive red-120 in a simulated textile wastewater by the strain ZM130 were predicted to be 19.8, 7.8, and 6.33 g L(-1) and a multi-metal mixture (Cr 13.10 mg L(-1), Pb 26.21 mg L(-1), Cd 13.10 mg L(-1), Zn 26.21 mg L(-1)), respectively. Moreover, the strain ZM130 also exhibited laccase and nicotinamide adenine dinucleotide (reduced)-dichlorophenolindophenol reductase (NADH-DCIP reductase) activity during the decolorization of reactive red-120. However, the laccase activity was found to be maximum in the presence of 300 mg L(-1) of the dye as compared to other concentrations. Hence, the isolation of this strain might serve as a potential bio-resource required for developing the strategies aiming at bioremediation of the wastewater contaminated with dyes and heavy metals.

Early Pregnancy Ultrasound and Management: Effect of a Multifaceted Training on Physician Knowledge

Vaginal bleeding is a common event in early pregnancy, with 20-40% of pregnancies affected. Prompt diagnosis and management of bleeding is important, both to reduce morbidity and to avoid excessive emotional distress. This was a prospective study of an educational programme aimed at Obstetrics and Gynaecology BST trainees in the National Maternity Hospital, Dublin. The educational programme consisted of didactic lectures, and simulation and practical sessions. A questionnaire reviewing early pregnancy complications was used to assess participant knowledge. Six trainees participated in the programme, with five (83%) answering the questionnaire. The pre-education questionnaire showed a generally poor level of knowledge of early pregnancy complications with 8/50 (16%) questions answered correctly. Following the educational intervention there was a statistically significant increase in participant knowledge with 45/50 (90%) questions answered correctly. A significant increase in participant knowledge of early pregnancy complications followed our multifaceted educational programme. Study limitations exist, however we have shown the potential value of our educational programme.

Intrinsic fluorescence of selenium nanoparticles for cellular imaging applications

Nanoparticles hold great potential in contributing to high-resolution bioimaging as well as for biomedical applications. Although, selenium (Se) nanoparticles (NPs) have been investigated owing to their potential roles in therapeutics, the imaging capability of these NPs has never been explored. This manuscript identifies the intrinsic fluorescence of Se NPs, which is highly beneficial for nanoscale imaging of biological structures. The emission of individual NPs and its evolution with time is explored. The photoluminescence spectra has revealed visible to near infrared emission for Se NPs. The work finally reflects on the role of this intrinsic fluorescence for in vitro imaging and tracking in fibroblast cells, without the need of any additional tags. This technique would overcome the limitations of the conventionally used methods of imaging with tagged fluorescent proteins and dyes, preventing possible adverse cellular effects or phototoxicity caused by the added fluorescent moieties.

Yeast extract promotes decolorization of azo dyes by stimulating azoreductase activity in Shewanella sp. strain IFN4

Biological treatment of azo dyes commonly requires a combined anaerobic-aerobic process in which initial decolorization is achieved by reductive cleavage of azo bonds on the parent molecule. The present study was conducted to examine the relative importance of co-substrates for driving reductive decolorization of azo dyes by Shewanella sp. strain IFN4 using whole cells and enzyme assays. Results showed that the dye decolorization by strain IFN4 was faster in medium containing 1gL(-1) yeast extract (YE) as compared to nine other co-substrates. Moreover, only YE stimulated azoreductase activity (increased from 1.32 to 4.19U/mg protein). Increasing the level of YE up to 8gL(-)(1) resulted into 81% decolorization of the dye in 1h along with an increase in azoreductase activity up to 6.16U/mg protein. Among the components of YE, only riboflavin stimulated the decolorization process as well as enzyme activity. Moreover, strain IFN4 demonstrated flavin reductase activity, and a significant correlation (r(2)=0.98) between flavin reduction and dye reduction by this strain emphasized the involvement of flavin compounds in the decolorization process. The results of this study show that YE serves both as a source of reducing equivalents and an electron shuttle for catalyzing dye reduction.

Effect of trace metals and electron shuttle on simultaneous reduction of reactive black-5 azo dye and hexavalent chromium in liquid medium by Pseudomonas sp

This study demonstrates the role of electron shuttles and trace metals in the biotransformation of azo dye reactive black-5 and hexavalent chromium (CrVI) that are released simultaneously in tannery effluent. Previously isolated bacterial strain Pseudomonas putida KI was used for the simultaneous reduction of the dye (100 mg L(-1)) and CrVI (2 mg L(-1)) in a mineral salts medium (MSM). Among various trace metals, only Cu(II) had a stimulating effect on the bacterial-mediated reduction process. Application of electron shuttles such as hydroquinone and uric acid at a low concentration (1mM) had a positive effect on the reduction process and caused simultaneous reduction of 100% dye and 97% CrVI in 12-18 h. Mannitol, EDTA and sodium benzoate at all concentrations (ranging from 1 to 9 mM) showed an inhibitory effect on the reduction of reactive black-5 and CrVI. An inverse linear relationship between the velocity of reaction (V) and the concentration [S] of electron shuttles was observed. The results imply that both types and concentration of an electron shuttle and trace metals can affect the simultaneous reduction of reactive black-5 and CrVI.

The stability of textile azo dyes in soil and their impact on microbial phospholipid fatty acid profiles

The aim of this study was to examine the stability of structurally different azo dyes in soil and their impact on the microbial community composition by analyzing phospholipid fatty acid (PLFA) profiles. Sterile and non-sterile soils were amended with three azo dyes, including: Direct Red 81, Reactive Black 5 and Acid Yellow 19 at 160mgkg(-1) soil. The results showed that the azo dyes were quite stable and that large amounts of these dyes ranging from 17.3% to 87.5% were recoverable from the sterile and non-sterile soils after 14 days. The maximum amount of dye was recovered in the case of Direct Red 81. PLFA analysis showed that the azo dyes had a significant effect on microbial community structure. PLFA concentrations representing Gram-negative bacteria in dye-amended soil were substantially less as compared to the PLFA concentration of Gram-positive bacteria. Acid Yellow 19 dye had almost similar effects on the PLFA concentrations representing bacteria and fungi. In contrast, Reactive Black 5 had a greater negative effect on fungal PLFA than that on bacterial PLFA, while the opposite was observed in the case of Direct Red 81. To our knowledge, this is the first study reporting the stability of textile azo dyes in soil and their effects on soil microbial community composition.

Decolorization of Reactive Black-5 by Shewanella sp. in the Presence of Metal Ions and Salts

In this study, effect of various metal ions and salts on biodecolorization of Reactive black-5, azoreductase activity, and growth of Shewanella sp. strain IFN4 was evaluated. Among the tested metals, Cr²⁺, Pb(²⁺, Ni²⁺, Fe²⁺, and Mn²⁺ did not inhibit the biodecolorization of reactive black-5, azoreductase activity and bacterial growth. Three metals (Cu²⁺, Zn²⁺, and Co²⁺) delayed the decolorization process without completely inhibiting the reaction and also suppressed the bacterial growth. However, no dye decolorization was observed in the presence of Cd²⁺ (10 mg L⁻¹). Furthermore, bacterium decolorized the dye at high concentration (15 mg L⁻¹) of mixed metal ions. Strain IFN4 was also able to decolorize the dye at 50 g NaCl L⁻¹ and 60 g Na₂SO₄ L⁻¹. NaCl was found to be more inhibitory to bacterial growth than Na₂SO₄and the reverse was observed for azoreductase activity. These findings suggest that strain IFN4 could be used in designing a bioreactor for the treatment of textile effluent.

Mass burden and estimated flux of heavy metals in Pakistan coast: sedimentary pollution and eco-toxicological concerns

Heavy-metal contamination in coastal areas poses a serious threat to aquatic life and public health due to their high toxicity and bio-accumulation potential. In the present study, levels of different heavy metals (Cu, Cd, Cr, Ni, Co, Pb, Zn, and Mn), their spatial distribution, geochemical status, and enrichment indices (Cu, Cd, Cr, Ni, Co, Pb, Zn) were investigated in the sediment samples from 18 coastal sites of Pakistan. The analyses of coastal sediments indicated the presence of heavy metals in order such as Cr > Zn > Cu > Pb > Ni > Mn > Co > Cd. Geo-accumulation index (I geo), enrichment factor (EF), and contamination factor (CF) showed diverse range in heavy-metal enrichment site by site. Pollution load index (PLI) has shown that average pollution load along the entire coastal belt was not significant. Based on the mean effect range medium quotient, coastal sediments of Pakistan had 21% probability of toxicity. The estimated sedimentary load of selected heavy metals was recorded in the range of 0.3-44.7 g/cm(2)/year, while the depositional flux was in the range of 0.07-43.5 t/year. Heavy-metal inventories of 9.8 × 10(2)-3.8 × 10(5) t were estimated in the coastal sediments of Pakistan. The enrichment and contamination factors (EF and CF) suggested significant influence of anthropogenic and industrial activities along the coastal belt of Pakistan.

Biotreatment of simulated tannery wastewater containing Reactive Black 5, aniline and CrVI using a biochar packed bioreactor

Azo dyes and CrVI in tannery wastewater can be treated by redox active bacteria. Dye decolorization and CrVI reduction are simultaneous under anaerobic conditions. Biochar is an effective support matrix for packed bed bioreactors used to treat dyes and CrVI.