Elimination of transmission of onchocerciasis (river blindness) with long-term ivermectin mass drug administration with or without vector control in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

WHO has proposed elimination of transmission of onchocerciasis (river blindness) by 2030. More than 99% of cases of onchocerciasis are in sub-Saharan Africa. Vector control and mass drug administration of ivermectin have been the main interventions for many years, with varying success. We aimed to identify factors associated with elimination of onchocerciasis transmission in sub-Saharan Africa.

METHODS

For this systematic review and meta-analysis we searched for published articles reporting epidemiological or entomological assessments of onchocerciasis transmission status in sub-Saharan Africa, with or without vector control. We searched MEDLINE, PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, African Index Medicus, and Google Scholar databases for all articles published from database inception to Aug 19, 2023, without language restrictions. The search terms used were "onchocerciasis" AND "ivermectin" AND "mass drug administration". The three inclusion criteria were (1) focus or foci located in Africa, (2) reporting of elimination of transmission or at least 10 years of ivermectin mass drug administration in the focus or foci, and (3) inclusion of at least one of the following assessments: microfilarial prevalence, nodule prevalence, Ov16 antibody seroprevalence, and blackfly infectivity prevalence. Epidemiological modelling studies and reviews were excluded. Four reviewers (NM, AJ, AM, and TNK) extracted data in duplicate from the full-text articles using a data extraction tool developed in Excel with columns recording the data of interest to be extracted, and a column where important comments for each study could be highlighted. We did not request any individual-level data from authors. Foci were classified as achieving elimination of transmission, being close to elimination of transmission, or with ongoing transmission. We used mixed-effects meta-regression models to identify factors associated with transmission status. This study is registered in PROSPERO, CRD42022338986.

FINDINGS

Of 1525 articles screened after the removal of duplicates, 75 provided 282 records from 238 distinct foci in 19 (70%) of the 27 onchocerciasis-endemic countries in sub-Saharan Africa. Elimination of transmission was reported in 24 (9%) records, being close to elimination of transmission in 86 (30%) records, and ongoing transmission in 172 (61%) records. I2 was 83·3% (95% CI 79·7 to 86·3). Records reporting 10 or more years of continuous mass drug administration with 80% or more therapeutic coverage of the eligible population yielded significantly higher odds of achieving elimination of transmission (log-odds 8·5 [95% CI 3·5 to 13·5]) or elimination and being close to elimination of transmission (42·4 [18·7 to 66·1]) than those with no years achieving 80% coverage or more. Reporting 15-19 years of ivermectin mass drug administration (22·7 [17·2 to 28·2]) and biannual treatment (43·3 [27·2 to 59·3]) were positively associated with elimination and being close to elimination of transmission compared with less than 15 years and no biannual mass drug administration, respectively. Having had vector control without vector elimination (-42·8 [-59·1 to -26·5]) and baseline holoendemicity (-41·97 [-60·6 to -23·2]) were associated with increased risk of ongoing transmission compared with no vector control and hypoendemicity, respectively. Blackfly disappearance due to vector control or environmental change contributed to elimination of transmission.

INTERPRETATION

Mass drug administration duration, frequency, and coverage; baseline endemicity; and vector elimination or disappearance are important determinants of elimination of onchocerciasis transmission in sub-Saharan Africa. Our findings underscore the importance of improving and sustaining high therapeutic coverage and increasing treatment frequency if countries are to achieve elimination of onchocerciasis transmission.

FUNDING

The Bill & Melinda Gates Foundation and Neglected Tropical Diseases Modelling Consortium, UK Medical Research Council, and Global Health EDCTP3 Joint Undertaking.

TRANSLATIONS

For the Swahili, French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Spatial and temporal distribution of Taenia solium and its risk factors in Uganda

OBJECTIVES

The lack of subnational mapping of the zoonotic cestode Taenia solium in endemic countries presents a major challenge to achieving intensified T. solium control milestones, as outlined in the "World Health Organization neglected tropical disease roadmap by 2030". We conducted a mapping study in Uganda, considered to be endemic, to identify subnational high-risk areas.

METHODS

T. solium prevalence data, adjusted for diagnostic sensitivity and specificity in a Bayesian framework, were identified through a systematic review. Spatial autocorrelation and interpolation techniques were used to transform demographic and health survey cluster-level sanitation and poverty indicators, overlaid onto a pig density map for Uganda into modelled  porcine cysticercosis (PCC) risk maps.

RESULTS

A total of 16 articles (n = 11 PCC and n = 5 human cysticercosis (HCC) and/or human taeniasis) were included in the final analysis. The observed HCC prevalence ranged from 0.01% to 6.0% (confidence interval range: 0.004-11.4%), whereas the adjusted PCC ranged from 0.3 to 93.9% (uncertainty interval range: 0-99.8%). There was substantial variation in the modelled  PCC risk factors and prevalence across Uganda and over time.

CONCLUSION

The high PCC prevalence and moderate HCC exposure estimates indicate the need for urgent implementation of T. solium control efforts in Uganda.

Global variation in force-of-infection trends for human Taenia solium taeniasis/cysticercosis

Infection by Taenia solium poses a major burden across endemic countries. The World Health Organization (WHO) 2021–2030 Neglected Tropical Diseases roadmap has proposed that 30% of endemic countries achieve intensified T. solium control in hyperendemic areas by 2030. Understanding geographical variation in age-prevalence profiles and force-of-infection (FoI) estimates will inform intervention designs across settings. Human taeniasis (HTT) and human cysticercosis (HCC) age-prevalence data from 16 studies in Latin America, Africa, and Asia were extracted through a systematic review. Catalytic models, incorporating diagnostic performance uncertainty, were fitted to the data using Bayesian methods, to estimate rates of antibody (Ab)-seroconversion, infection acquisition and Ab-seroreversion or infection loss. HCC FoI and Ab-seroreversion rates were also estimated across 23 departments in Colombia from 28,100 individuals. Across settings, there was extensive variation in all-ages seroprevalence. Evidence for Ab-seroreversion or infection loss was found in most settings for both HTT and HCC and for HCC Ab-seroreversion in Colombia. The average duration until humans became Ab-seropositive/infected decreased as all-age (sero)prevalence increased. There was no clear relationship between the average duration humans remain Ab-seropositive and all-age seroprevalence. Marked geographical heterogeneity in T. solium transmission rates indicate the need for setting-specific intervention strategies to achieve the WHO goals.

Neurocysticercosis and HIV/AIDS co-infection: A scoping review

OBJECTIVES

Neurocysticercosis (NCC) and human immunodeficiency virus (HIV) have a high disease burden and are prevalent in overlapping low- and middle-income areas. Yet, treatment guidance for people living with HIV/AIDS (PLWH/A) co-infected with NCC is currently lacking. This study aims to scope the available literature on HIV/AIDS and NCC co-infection, focusing on epidemiology, clinical characteristics, diagnostics and treatment outcomes.

METHODS

The scoping literature review methodological framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of 16,969 records identified through database searching, and 45 additional records from other sources were reduced to 52 included studies after a standardised selection process.

RESULTS

Two experimental studies, ten observational studies, 23 case series/case reports and 17 reviews or letters were identified. Observational studies demonstrated similar NCC seroprevalence in PLWH/A and their HIV-negative counterparts. Of 29 PLWH/A and NCC co-infection, 17 (59%) suffered from epileptic seizures, 15 (52%) from headaches and 15 (52%) had focal neurological deficits. Eighteen (62%) had viable vesicular cysts, and six (21%) had calcified cysts. Fifteen (52%) were treated with albendazole, of which 11 (73%) responded well to treatment. Five individuals potentially demonstrated an immune-reconstitution inflammatory syndrome after commencing antiretroviral therapy, although this was in the absence of immunological and neuroimaging confirmation.

CONCLUSIONS

There is a paucity of evidence to guide treatment of PLWH/A and NCC co-infection. There is a pressing need for high-quality studies in this patient group to appropriately inform diagnostic and management guidelines for HIV-positive patients with NCC.

Taenia solium taeniasis/cysticercosis: From parasite biology and immunology to diagnosis and control

Infection with the pork tapeworm (Taenia solium) is responsible for a substantial global burden of disease, not only restricted to its impact on human health, but also resulting in a considerable economic burden to smallholder pig farmers due to pig cysticercosis infection. The life-cycle, parasitology and immunology of T. solium are complex, involving pigs (the intermediate host, harbouring the larval metacestode stage), humans (the definitive host, harbouring the adult tapeworm, in addition to acting as accidental intermediate hosts) and the environment (the source of infection with eggs/proglottids). We review the parasitology, immunology, and epidemiology of the infection associated with each of the T. solium life-cycle stages, including the pre-adult/adult tapeworm responsible for human taeniasis; post-oncosphere and cysticercus associated with porcine and human cysticercosis, and the biological characteristics of eggs in the environment. We discuss the burden associated, in endemic settings, with neurocysticercosis (NCC) in humans, and the broader cross-sectoral economic impact associated both with NCC and porcine cysticercosis, the latter impacting food-value chains. Existing tools for diagnostics and control interventions that target different stages of the T. solium transmission cycle are reviewed and their limitations discussed. Currently, no national T. solium control programmes have been established in endemic areas, with further work required to identify optimal strategies according to epidemiological setting. There is increasing evidence suggesting that cross-sectoral interventions which target the parasite in both the human and pig host provide the most effective approaches for achieving control and ultimately elimination. We discuss future avenues for research on T. solium to support the attainment of the goals proposed in the revised World Health Organisation neglected tropical diseases roadmap for 2021-2030 adopted at the 73rd World Health Assembly in November 2020.

How modelling can help steer the course set by the World Health Organization 2021-2030 roadmap on neglected tropical diseases

The World Health Organization recently launched its 2021-2030 roadmap, Ending the Neglect to Attain the Sustainable Development Goals , an updated call to arms to end the suffering caused by neglected tropical diseases. Modelling and quantitative analyses played a significant role in forming these latest goals. In this collection, we discuss the insights, the resulting recommendations and identified challenges of public health modelling for 13 of the target diseases: Chagas disease, dengue, gambiense human African trypanosomiasis (gHAT), lymphatic filariasis (LF), onchocerciasis, rabies, scabies, schistosomiasis, soil-transmitted helminthiases (STH), Taenia solium taeniasis/ cysticercosis, trachoma, visceral leishmaniasis (VL) and yaws. This piece reflects the three cross-cutting themes identified across the collection, regarding the contribution that modelling can make to timelines, programme design, drug development and clinical trials.

How modelling can help steer the course set by the World Health Organization 2021-2030 roadmap on neglected tropical diseases

The World Health Organization recently launched its 2021-2030 roadmap, Ending the Neglect to Attain the Sustainable Development Goals , an updated call to arms to end the suffering caused by neglected tropical diseases. Modelling and quantitative analyses played a significant role in forming these latest goals. In this collection, we discuss the insights, the resulting recommendations and identified challenges of public health modelling for 13 of the target diseases: Chagas disease, dengue, gambiense human African trypanosomiasis (gHAT), lymphatic filariasis (LF), onchocerciasis, rabies, scabies, schistosomiasis, soil-transmitted helminthiases (STH), Taenia solium taeniasis/ cysticercosis, trachoma, visceral leishmaniasis (VL) and yaws. This piece reflects the three cross-cutting themes identified across the collection, regarding the contribution that modelling can make to timelines, programme design, drug development and clinical trials.

Force-of-infection of Taenia solium porcine cysticercosis: a modelling analysis to assess global incidence and prevalence trends

The World Health Organization (WHO) called, in 2012, for a validated strategy towards Taenia solium taeniasis/cysticercosis control and elimination. Estimating pig force-of-infection (FoI, the average rate at which susceptible pigs become infected) across geographical settings will help understand local epidemiology and inform effective intervention design. Porcine cysticercosis (PCC) age-prevalence data (from 15 studies in Latin America, Africa and Asia) were identified through systematic review. Catalytic models were fitted to the data using Bayesian methods, incorporating uncertainty in diagnostic performance, to estimate rates of antibody seroconversion, viable metacestode acquisition, and seroreversion/infection loss. There was evidence of antibody seroreversion across 5 studies, and of infection loss in 6 studies measured by antigen or necropsy, indicating transient serological responses and natural resolution of infection. Concerted efforts should be made to collect robust data using improved diagnostics to better understand geographical heterogeneities in T. solium transmission to support post-2020 WHO targets.

Modelling for Taenia solium control strategies beyond 2020

The cestode Taenia solium is responsible for a considerable cross-sectoral health and economic burden due to human neurocysticercosis and porcine cysticercosis. The 2012 World Health Organization (WHO) roadmap for neglected tropical diseases called for the development of a validated strategy for control of T. solium; however, such a strategy is not yet available. In 2019, WHO launched a global consultation aimed at refining the post-2020 targets for control of T. solium for a new roadmap for neglected tropical diseases. In response, two groups working on taeniasis and cysticercosis mathematical models (cystiSim and EPICYST models), together with a range of other stakeholders organized a workshop to provide technical input to the WHO consultation and develop a research plan to support efforts to achieve the post-2020 targets. The workshop led to the formation of a collaboration, CystiTeam, which aims to tackle the population biology, transmission dynamics, epidemiology and control of T. solium through mathematical modelling approaches. In this paper, we outline developments in T. solium control and in particular the use of modelling to help achieve post-2020 targets for control of T. solium. We discuss the steps involved in improving confidence in the predictive capacities of existing mathematical and computational models on T. solium transmission, including model comparison, refinement, calibration and validation. Expanding the CystiTeam partnership to other research groups and stakeholders, particularly those operating in different geographical and endemic areas, will enhance the prospects of improving the applicability of T. solium transmission models to inform taeniasis and cysticercosis control strategies.

Zoonotic transmission of intestinal helminths in southeast Asia: Implications for control and elimination

Intestinal helminths are extremely widespread and highly prevalent infections of humans, particularly in rural and poor urban areas of low and middle-income countries. These parasites have chronic and often insidious effects on human health and child development including abdominal problems, anaemia, stunting and wasting. Certain animals play a fundamental role in the transmission of many intestinal helminths to humans. However, the contribution of zoonotic transmission to the overall burden of human intestinal helminth infection and the relative importance of different animal reservoirs remains incomplete. Moreover, control programmes and transmission models for intestinal helminths often do not consider the role of zoonotic reservoirs of infection. Such reservoirs will become increasingly important as control is scaled up and there is a move towards interruption and even elimination of parasite transmission. With a focus on southeast Asia, and the Philippines in particular, this review summarises the major zoonotic intestinal helminths, risk factors for infection and highlights knowledge gaps related to their epidemiology and transmission. Various methodologies are discussed, including parasite genomics, mathematical modelling and socio-economic analysis, that could be employed to improve understanding of intestinal helminth spread, reservoir attribution and the burden associated with infection, as well as assess effectiveness of interventions. For sustainable control and ultimately elimination of intestinal helminths, there is a need to move beyond scheduled mass deworming and to consider animal and environmental reservoirs. A One Health approach to control of intestinal helminths is proposed, integrating interventions targeting humans, animals and the environment, including improved access to water, hygiene and sanitation. This will require coordination and collaboration across different sectors to achieve best health outcomes for all.

Modelling the elimination of river blindness using long-term epidemiological and programmatic data from Mali and Senegal

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Onchocerciasis is earmarked for elimination in some African countries by 2020/2025.

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15+ years of ivermectin treatment drove infection prevalence to zero in areas of Mali & Senegal.

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Data-driven model projections are used to evaluate the risk of infection resurgence.

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Latent infections can initiate slow resurgence in communities with high transmission propensity.

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Highly sensitive and long-term surveillance will be necessary to verify elimination.

The onchocerciasis transmission models EPIONCHO and ONCHOSIM have been independently developed and used to explore the feasibility of eliminating onchocerciasis from Africa with mass (annual or biannual) distribution of ivermectin within the timeframes proposed by the World Health Organization (WHO) and endorsed by the 2012 London Declaration on Neglected Tropical Diseases (i.e. by 2020/2025). Based on the findings of our previous model comparison, we implemented technical refinements and tested the projections of EPIONCHO and ONCHOSIM against long-term epidemiological data from two West African transmission foci in Mali and Senegal where the observed prevalence of infection was brought to zero circa 2007–2009 after 15–17 years of mass ivermectin treatment. We simulated these interventions using programmatic information on the frequency and coverage of mass treatments and trained the model projections using longitudinal parasitological data from 27 communities, evaluating the projected outcome of elimination (local parasite extinction) or resurgence. We found that EPIONCHO and ONCHOSIM captured adequately the epidemiological trends during mass treatment but that resurgence, while never predicted by ONCHOSIM, was predicted by EPIONCHO in some communities with the highest (inferred) vector biting rates and associated pre-intervention endemicities. Resurgence can be extremely protracted such that low (microfilarial) prevalence between 1% and 5% can be maintained for 3–5 years before manifesting more prominently. We highlight that post-treatment and post-elimination surveillance protocols must be implemented for long enough and with high enough sensitivity to detect possible residual latent infections potentially indicative of resurgence. We also discuss uncertainty and differences between EPIONCHO and ONCHOSIM projections, the potential importance of vector control in high-transmission settings as a complementary intervention strategy, and the short remaining timeline for African countries to be ready to stop treatment safely and begin surveillance in order to meet the impending 2020/2025 elimination targets.

Assessing the impact of intervention strategies against Taenia solium cysticercosis using the EPICYST transmission model

BACKGROUND

The pork tapeworm, Taenia solium, and associated human infections, taeniasis, cysticercosis and neurocysticercosis, are serious public health problems, especially in developing countries. The World Health Organization (WHO) has set goals for having a validated strategy for control and elimination of T. solium taeniasis/cysticercosis by 2015 and interventions scaled-up in selected countries by 2020. Timely achievement of these internationally-endorsed targets requires that the relative benefits and effectiveness of potential interventions be explored rigorously within a quantitative framework.

METHODS

A deterministic, compartmental transmission model (EPICYST) was developed to capture the dynamics of the taeniasis/cysticercosis disease system in the human and pig hosts. Cysticercosis prevalence in humans, an outcome of high epidemiological and clinical importance, was explicitly modelled. A next generation matrix approach was used to derive an expression for the basic reproduction number, R 0. A full sensitivity analysis was performed using a methodology based on Latin-hypercube sampling partial rank correlation coefficient index.

RESULTS

EPICYST outputs indicate that chemotherapeutic intervention targeted at humans or pigs would be highly effective at reducing taeniasis and cysticercosis prevalence when applied singly, with annual chemotherapy of humans and pigs resulting, respectively, in 94 and 74% of human cysticercosis cases averted. Improved sanitation, meat inspection and animal husbandry are less effective but are still able to reduce prevalence singly or in combination. The value of R 0 for taeniasis was estimated at 1.4 (95% Credible Interval: 0.5-3.6).

CONCLUSIONS

Human- and pig-targeted drug-focussed interventions appear to be the most efficacious approach from the options currently available. The model presented is a forward step towards developing an informed control and elimination strategy for cysticercosis. Together with its validation against field data, EPICYST will be a valuable tool to help reach the WHO goals and to conduct economic evaluations of interventions in varying epidemiological settings.

Ecology of zoonoses: natural and unnatural histories

More than 60% of human infectious diseases are caused by pathogens shared with wild or domestic animals. Zoonotic disease organisms include those that are endemic in human populations or enzootic in animal populations with frequent cross-species transmission to people. Some of these diseases have only emerged recently. Together, these organisms are responsible for a substantial burden of disease, with endemic and enzootic zoonoses causing about a billion cases of illness in people and millions of deaths every year. Emerging zoonoses are a growing threat to global health and have caused hundreds of billions of US dollars of economic damage in the past 20 years. We aimed to review how zoonotic diseases result from natural pathogen ecology, and how other circumstances, such as animal production, extraction of natural resources, and antimicrobial application change the dynamics of disease exposure to human beings. In view of present anthropogenic trends, a more effective approach to zoonotic disease prevention and control will require a broad view of medicine that emphasises evidence-based decision making and integrates ecological and evolutionary principles of animal, human, and environmental factors. This broad view is essential for the successful development of policies and practices that reduce probability of future zoonotic emergence, targeted surveillance and strategic prevention, and engagement of partners outside the medical community to help improve health outcomes and reduce disease threats.

Comparative efficacies of three commercially available vaccines against West Nile Virus (WNV) in a short-duration challenge trial involving an equine WNV encephalitis model

We used a severe challenge model that produces clinical West Nile virus (WNV) disease to test the efficacy of three commercially available equine WNV vaccines in horses. Twenty-four healthy, WNV-seronegative horses of varying ages and genders were placed, in random and blind manner, into three trial groups consisting of eight horses each; two horses in each group received (i) an inactivated WNV vaccine (K-WN), (ii) a modified-live vaccine (CP-WN) containing the WNV prM and E proteins expressed by a canarypox vector, (iii) a live-chimera vaccine (WN-FV) containing WNV prM and E proteins expressed in a YF17D vector, or (iv) a diluent control. Challenge by this model caused grave neurological signs, viremia, moderate to severe histopathologic lesions in the brain and spinal cord, and an outcome of 0% survivorship in all six control horses. In contrast, challenge in horses at between 28 days postvaccination with the chimera vaccine and 56 days postvaccination with the commercial inactivated or modified-live vaccine resulted in 100% survivorship (protection from the onset of WNV encephalitis and viremia). Horses vaccinated with the live-chimera vaccine showed significantly fewer clinical signs than did the control horses (P </= 0.01) and the horses vaccinated with inactivated vaccine (P = 0.035). Mild residual inflammatory lesions were seen in a few of the vaccinated horses.

Inactivation of Escherichia coli O157:H7 and Salmonella on artificially or naturally contaminated mung beans (Vigna radiata L) using a stabilized oxychloro-based sanitizer

AIMS

To evaluate the efficacy of a stabilized oxychloro-based (SOC) sanitizer to decontaminate mung beans artificially or naturally contaminated with Escherichia coli O157:H7 or Salmonella.

METHODS AND RESULTS

Naturally contaminated beans were produced by introducing a five-strain cocktail of E. coli O157:H7 or Salmonella onto the flowers of growing mung bean plants. Escherichia coli O157:H7 was only sporadically recovered from sprout lots (three testing positive from 10 tested) derived from harvested beans. In contrast, Salmonella was recovered from 18 of 20 lots screened. Pathogens present on naturally contaminated seed could be successfully inactivated with SOC applied at 200 ppm for 24 h at 28 degrees C. SOC treatment could also decontaminate artificially inoculated mung bean batches containing different levels of contaminated seed. SOC inactivated E. coli O157:H7, but not Salmonella introduced onto damaged (scarified) beans.

CONCLUSIONS

SOC sanitizer could inactivate Salmonella or E. coli O157:H7 naturally or artificially introduced onto mung beans. However, the SOC treatment failed to inactivate Salmonella introduced onto damaged mung beans.

SIGNIFICANCE AND IMPACT OF THE STUDY

SOC sanitizer represents an effective method for decontaminating undamaged mung beans.

What is the role of medium-chain triglycerides in the management of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency?

Cardiomyopathy is common in infants with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency. Resolution of the cardiomyopathy can often be achieved by avoidance of fasting and changing from a conventional infant formula to one in which most long-chain fat is replaced by medium-chain triglycerides (MCT). It is uncertain whether the clinical improvement is due to the restriction of long-chain fat or whether the MCT have specific beneficial effects. To clarify this, the metabolic effects of MCT were examined in 5 patients. When given at around the level found in MCT-based infant formula, MCT had no effect on blood concentrations of ketone bodies, specific fatty acids or acylcarnitines. The present study cannot, however, exclude the possibility that MCT per se may have beneficial effects.

Plasma and erythrocyte fatty acid concentrations in long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency

Plasma and erythrocyte fatty acids have been measured in 9 patients with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency being treated with a low-fat diet. No significant abnormality was detected and in particular docosahexaenoic acid was not deficient.

The use of biofilters to improve indoor air quality: the removal of toluene, TCE, and formaldehyde

A biofilter composed of a scrubber, a hydroponic planting system, and an aquatic system with green plants as a base maintained air quality within part of a modern office building. The scrubber was composed of five parallel fiberglass modules with external faces of porous lava rock. The face, largely covered with mosses, was wetted by recirculating water. Air was drawn through the scrubber and the immediately adjacent hydroponic region by a dedicated air handling system. The system was challenged for 4 weeks with three common indoor organic pollutants and removed significant amounts of all compounds. A single pass through the scrubber removed 10% of the trichloroethylene and 50% of the toluene. A single pass lowered formaldehyde air concentrations to 13 micrograms m-3 irrespective of influent levels (ranging between 30 and 90 micrograms m-3). The aquatic system accumulated trichloroethylene but neither toluene nor formaldehyde, suggesting the rapid breakdown of these materials. The botanical components removed some pollutants.

The biofiltration of indoor air: air flux and temperature influences the removal of toluene, ethylbenzene, and xylene

An alternative approach to maintaining indoor air quality may be the biofiltration of air circulated within the space. A biofilter with living botanical matter as the packing medium reduced concentrations of toluene, ethylbenzene, and o-xylene concurrently present at parts per billion (volume) in indoor air. The greatest reduction in concentrations per pass was under the slowest influent air flux (0.025 m s(-1)); however, the maximum amount removed per unit time occurred under the most rapid flux (0.2 m s(-1)). There was little difference between the different compounds with removal capacities of between 1.3 and 2.4 micromol m(-3) biofilter s(-1) (between 0.5 and 0.9 g m(-3) biofilter h(-1)) depending on influent flux and temperature. Contrary to biofilters subjected to higher influent concentrations, the optimal temperatures for removal by this biofilter decreased to less than 20 degrees C at the most rapid flux for all three compounds. Microbial activity was decreased at these cooler temperatures suggesting the biofilter was not microbially limited but rather was limited by the availability of substrate. The cooler temperatures allowed greater partitioning of the VOCs into the water column which had a greater impact on removal than its reduction in microbial activity.

Resting energy expenditure in disorders of propionate metabolism

OBJECTIVES

During intercurrent illness children with methylmalonic acidemia were found to have increased resting energy expenditure (REE). We measured REE in children with disorders of propionate metabolism (methylmalonic and propionic acidemia) when they were well and compared the values with those predicted by the Schofield equation.

STUDY DESIGN

Prospective study in tertiary care facility. REE was measured with open-circuit indirect calorimetry under standardized conditions. Predicted REE values were calculated with the Schofield equation. Fourteen subjects with propionic acidemia (n = 3) and methylmalonic acidemia (n = 11) were studied.

RESULTS

The median REE was 690 kcal/d (range 186 to 1687 kcal/d), which is significantly reduced, representing 80% +/- 18% of that predicted by the Schofield height and weight equation (P <.01). REE was significantly lower in female compared with male patients for unknown reasons. There were no differences with age or neurologic state. REE was not further reduced in those with chronic renal failure.

CONCLUSION

REE in patients with disorders of propionate metabolism is reduced when they are well.

The biofiltration of indoor air: implications for air quality

An alternative method of maintaining indoor air quality may be through the biofiltration of air recirculating within the structure rather than the traditional approach of ventilation. This approach is currently being investigated. Prior to its acceptance for dealing with volatile organic compounds (VOCs) and CO2, efforts were made to determine whether the incorporation of this amount of biomass into the indoor space can have an (negative) impact on indoor air quality. A relatively large ecologically complex biofilter composed of a ca. 10 m2 bioscrubber, 30 m2 of plantings and a 3,500 litre aquarium were established in a 160 m2 'airtight' room in a recently constructed office building in downtown Toronto. This space maintained ca. 0.2 air changes per hour (ACH) compared to the 15 to 20 ACH (with a 30% refresh rate) of other spaces in the same building. Air quality parameters of concern were total VOCs (TVOCs), formaldehyde and aerial spore counts. TVOC and formaldehyde levels in the biofilter room were the same or significantly less than other spaces in the building despite a much slower refresh rate. Aerial spore levels were slightly higher than other indoor spaces but were well within reported values for 'healthy' indoor spaces. Levels appeared to be dependent on horticultural management practices within the space. Most genera of fungal spores present were common indoors and the other genera were associated with living or dead plant material or soil. From these results, the incorporation of a large amount of biomass associated with indoor biofilters does not in itself lower indoor air quality.

Sealed environment chamber for canopy light interception and trace hydrocarbon analyses

Two sealed chambers were constructed, each measuring approximately 4.5 m x 3 m x 2.5 m (LxWxH). Heat exchangers and air handling components were integrated within the sealed environment. Construction materials were chosen to minimize off-gassing and oxidation. Acceptable materials included stainless steel, Teflon (TM), glass and Heresite (TM) or baked enamel coated metal parts. The glass-topped chambers have externally mounted microwave powered light sources providing minimum PAR at canopy level of 1000 micrometers m-2 s-1. Major gases (CO2, O2) were monitored. Other environmental variables relevant to plant production (humidity, temperature, nutrient solution) were monitored and controlled continuously. Typical environment control capability and system specifications are presented. The facility is described as a venue ideally suited to address specific research objectives in plant canopy light interception, such as the roles of novel microwave powered overhead and inner-canopy light sources for dense plant canopies. In addition, control of recycled hydroponic nutrient solutions and analysis of trace atmospheric hydrocarbons in the context of sealed environment life support can be concurrently monitored.

Regulating plant/insect interactions using CO2 enrichment in model ecosystems

The greenhouse environment is a challenging artificial ecosystem in which it is possible to study selected plant/insect interaction in a controlled environment. Due to a combination of "direct" and "indirect" effects of CO2 enrichment on plant photosynthesis and plant development, canopy productivity is generally increased. In this paper, we discuss the effects of daytime and nighttime CO2 enrichment protocols on gas exchange of pepper plants (Capsicum annuum L, cv Cubico) grown in controlled environments. In addition, we present the effects of thrips, a common Insect pest, on the photosynthetic and respiratory activity of these plant canopies. Carbon dioxide has diverse effects on the physiology and mortality of insects. However, our data indicate that thrips and whiteflies, at least, are not killed "directly" by CO2 levels used to enhance photosynthesis and plant growth. Together the data suggest that the insect population is affected "indirectly" by CO2 and that the primary effect of CO2 is via its effects on plant metabolism.

An investigation of tactile and visual stimuli in the roadway environment

208 motorists were observed at Florida International University, in Miami, Florida as part of a study of the influence of speed humps on motorists' behavior at pedestrian crossings. It was hypothesized that the presence of a speed hump will affect motorists' behavior by compelling them either to yield or stop at a pedestrian crossing to enable a pedestrian to cross safely. A between-subjects experimental design was employed to measure motorists' reactions. Analysis indicated that the relationship is strong between drivers' behavior and the presence or absence of this roadway stimulus. There was also evidence that female drivers may take more precautionary actions than male drivers. This information is useful for roadway designers and traffic psychologists.

Uncooked cornstarch--efficacy in type I glycogenosis

Uncooked cornstarch (UCCS) loads in 14 patients with type 1 glycogenosis revealed that satisfactory glycaemia was achieved for a median of 4.25 hours (range 2.5 to 6). Length of glycaemia was related weakly to UCCS dose, but not to patient age or measures of metabolic control. Careful monitoring is required during UCCS treatment.

The spin dependent momentum density of hexagonal close packed cobalt

Directional-spin-dependent Compton profiles of ferromagnetic hexagonal close packed cobalt metal have been measured with 117 keV and 167 keV circularly polarized synchrotron radiation at the new ESRF high energy beamline. Significantly improved resolution was achieved at the higher energy. The results have been compared with the profile predicted from an augmented plane wave (APW) calculation of the electron momentum density in the hexagonal phase. No significant difference was found between the c-axis and the basal plane magnetic profiles. The experiments show that there is substantially more 3d spin density at high momentum than in the model calculation. After correcting for this deficiency we find that the 4s-p component of the momentum density remains significantly different than predicted.

Geriatric depression

In late life, depression is the most prevalent functional psychiatric disorder. Because the presentation may be multicausal and clinically complex, early assessment of biologic and psychosocial factors, diagnosis, and appropriate referral are important in ameliorating the associated morbidity and mortality. Nurses must have current knowledge and skills to assess mood states of elderly persons and to implement appropriate interventions. Successful management of depression in the elderly results in a reformulation of purpose and an enhanced quality of life.

Mechanisms of drought response in Thuja occidentalis L. I. Water stress conditioning and osmotic adjustment

We investigated the extent of osmotic adjustment and changes in transpiration rate that occur in response to repeated cycles of water deficit stress in 6-year-old Thuja occidentalis L. (eastern white cedar) trees. Groups of trees were water-stress conditioned by repeated exposure to predetermined thresholds of nonlethal water stress by withholding water until the predawn water potential fell to -0.9 (mild conditioning) or -1.4 MPa (moderate conditioning). Both the mild and moderate conditioning treatments resulted in a decrease in osmotic potential of 0.08 to 0.20 MPa and 0.11 to 0.28 MPa, respectively, relative to the well-watered controls. Mildly and moderately conditioned trees exhibited an approximately 35 and 50% reduction in cumulative transpiration, respectively, following at least two stress cycles. Transpiration rates of conditioned trees remained below those of the well-watered controls even when water potential integrals were similar. We conclude that the decrease in transpiration rate was more important than osmotic adjustment as a mechanism of response to repeated water stress.

Mechanisms of drought response in Thuja occidentalis L. II. Post-conditioning water stress and stress relief

We examined the extent of osmotic adjustment and the changes in relative water content (RWC) and transpiration rate (i.e., relative stomatal function) that occur in water-deficit-conditioned 6-year-old Thuja occidentalis L. (eastern white cedar) trees in response to a severe drought. Trees conditioned by successive cycles of mild or moderate nonlethal water stress (conditioning) and nonconditioned trees were exposed to drought (i.e., -2.0 MPa predawn water potential) to determine if water deficit conditioning enhanced tolerance to further drought stress. Following drought, all trees were well watered for 11 days to evaluate how quickly osmotic potential, RWC and transpiration rate returned to preconditioning values. Both nonconditioned trees and mildly conditioned trees exhibited similar responses to drought, whereas moderately conditioned trees maintained higher water potentials and transpiration rates were 38% lower. Both conditioned and nonconditioned trees exhibited a similar degree of osmotic adjustment (-0.39 MPa) in response to drought relative to the well-watered control trees. The well-watered control trees, nonconditioned trees and mildly conditioned trees had similar leaf RWCs that were about 3% lower than those of the moderately conditioned trees. Following the 11-day stress relief, there were no significant differences in osmotic potential between the well-watered control trees and any of the drought-treated trees. Daily transpiration rates and water potential integrals (WPI) of all drought-treated trees approached those of the well-watered control trees during the stress relief period. However, the relationship between cumulative transpiration and WPI showed that previous exposure to drought stress reduced transpiration rates. Leaf RWC of the moderately conditioned trees remained slightly higher than that of the nonconditioned and mildly conditioned trees.

Intercurrent illness in inborn errors of intermediary metabolism

Metabolic decompensation may occur in patients with disorders of intermediary metabolism during intercurrent illness. To prevent complications it is normal practice to change the diet to an 'emergency regimen'. The mainstay of this is a high carbohydrate intake, using soluble glucose polymer, given as frequent drinks by day and during the night. Additional therapy is given for some disorders. Practical details of the treatment are outlined.

A requirement for sucrose in xylem sap flow from dormant maple trees

The response of excised stem segments of several tree species to freezing and thawing cycles was studied. All species studied (Thuja occidentalis, Fagus grandifolia, and Betula papyrifera) except maple (Acer spp.) exuded sap while freezing and absorbed on thawing. Maple stems absorbed sap while freezing and exuded sap during the thaw only when sucrose was present in the vessel solution. Increased concentration of sucrose in the vessel sap led to increased exudation. In the absence of sucrose, maple stems absorbed sap on thawing. The presence of sucrose enhanced sap absorption during freezing cycles in maples. In general, large sugars, disaccharides and larger, could substitute for sucrose in the maple exudation response while sugar hexoses could not. The results are discussed in relation to the O'Malley-Milburn model (1983 Can J Bot 61: 3100-3106) of sap flow in maples.

Detection of Xylem Cavitation in Corn under Field Conditions

We report the detection of cavitation events in corn (Zea mays) plants growing under field conditions in Greeley, CO. To our knowledge this study reports the first successful attempt to monitor continuously for long periods the cavitation events of a crop plant using acoustic detection techniques. Cavitation events occur in corn plants using acoustic detection techniques. Cavitation events occur in corn plants irrigated daily when the xylem pressure potentials fall below about -1.0 megapascals. In unirrigated corn we estimate that approximately half of all vessels cavitate on any one day when xylem pressure potentials fall below about -1.8 megapascals. We postulate that root pressure developed every night in irrigated and unirrigated corn is adequate to rejoin cavitated water columns.

Families of adolescent clients and nonclients: their environments and help-seeking behaviors

Family demographic characteristics, family structure, family environment, and help-seeking variables were explored through interviews with two groups of Afro-American adolescents, including 52 clients and 52 nonclients. One parent of each adolescent was also interviewed. The ratio of single-parent families in the two groups differed significantly. Using one-way analysis of variance, significant differences were found between the means of the groups on five of the ten Family Environment Scale (FES) subscales. The family groups differed significantly on only one help-seeking variable, use of formal helpers. Adolescent client families reported using formal helpers more than did adolescent nonclient families (F = 2.69; df 102; p less than 0.05).

Ultrasonic acoustic emissions from the sapwood of cedar and hemlock : an examination of three hypotheses regarding cavitations

Measurements are reported of ultrasonic acoustic emissions (AEs) measured from sapwood samples of Thuja occidentalis L. and Tsuga canadensis (L.) Carr. during air dehydration. The measurements were undertaken to test the following three hypotheses: (a) Each cavitation event produces one ultrasonic AE. (b) Large tracheids are more likely to cavitate than small tracheids. (c) When stem water potentials are >-0.4 MPa, a significant fraction of the water content of sapwood is held by ;capillary forces.' The last two hypotheses were recently discussed at length by M. H. Zimmermann. Experimental evidence consistent with all three hypotheses was obtained. The evidence for each hypothesis respectively is: (a) the cumulative number of AEs nearly equals the number of tracheids in small samples; (b) more water is lost per AE event at the beginning of the dehydration process than at the end, and (c) sapwood samples dehydrated from an initial water potential of 0 MPa lost significantly more water before AEs started than lost by samples dehydrated from an initial water potential of about -0.4 MPa. The extra water held by fully hydrated sapwood samples may have been capillary water as defined by Zimmerman.We also report an improved method for the measurement of the ;intensity' of ultrasonic AEs. Intensity is defined here as the area under the positive spikes of the AE signal (plotted as voltage versus time). This method was applied to produce a frequency histogram of the number of AEs versus intensity. A large fraction of the total number of AEs were of low intensity even in small samples (4 mm diameter by 10 mm length). This suggests that the effective ;listening distance' for most AEs was less than 5 to 10 mm.

Ultrasonic Acoustic Emissions from the Sapwood of Thuja occidentalis Measured inside a Pressure Bomb

An improved method of counting acoustic emission (AE) events from water-stressed stems of cedar (Thuja occidentalis L.) is presented. Amplified AEs are analyzed on a real time basis by a microcomputer. The instrumentation counts AE events in a fashion nearly analogous to scintillation counting of radioactive materials.The technique was applied to measuring ultrasonic AEs from the stems of cedar inside a pressure bomb. The shoots were originally fully hydrated. When the shoots are dehydrated in the bomb by application of an overpressure very few AEs were detected. When the bomb pressure is reduced after dehydration of the shoot, AE events could be detected. We conclude that ultrasonic AEs are caused by cavitation events (= structural breakdown of water columns in the tracheids of cedar) and not by the breaking of cellulose fibers in the wood.

Cavitation Events in Thuja occidentalis L.? : Utrasonic Acoustic Emissions from the Sapwood Can Be Measured

Ultrasonic acoustic emissions (AE) in the frequency range of 0.1 to 1 megahertz appear to originate in the sapwood of Thuja occidentalis L. The AE are vibrations of an impulsive nature. The vibrations can be transduced to a voltage waveform and amplified. The vibrations of each AE event begin at a large amplitude which decays over 20 to 100 microseconds. Strong circumstantial evidence indicates that the ultrasonic AE result from cavitation events because: (a) they occur only when the xylem pressure potential Psi(xp) is more negative than a threshold level of about -1 megapascal; (b) the rate of AE events increases as Psi(xp) decreases and when the net rate of water loss increases; (c) the AE can be stopped by raising Psi(xp) above -1 megapascal. Ultrasonic AE have been measured in whole terminal shoots allowed to dry in the laboratory, in isolated pieces of sapwood as they dried in the laboratory, and in whole terminal shoots in a pressure bomb when Psi(xp) was decreased by lowering the gas pressure in the pressure bomb.