Organic phosphorus removal using an integrated advanced oxidation-ultrafiltration process

Non-reactive phosphorus (nRP) contains condensed phosphates and organic phosphorus (OP) species that are recalcitrant in secondary wastewater treatment and tend to remain in final effluents. To meet ultra-low effluent P discharge limits, persistent nRP must be removed. The objective of this study was to evaluate the use of an advanced oxidation process (AOP) which couples TiO₂/UV photolysis with ultrafiltration to oxidize and remove nRP species. Initial tests utilized OP model compounds, adenosine triphosphate (ATP) and aminoethylphosphonate (AEP), in a binary mixture to evaluate AOP treatment and to elucidate possible mechanisms of phosphorus removal. The results were consistent with a model of preferential ATP binding to the TiO₂ surface compared to AEP. On UV light exposure, AEP was removed from solution due to the photooxidation of ATP freeing up binding sites for AEP adsorption and subsequent oxidation. Orthophosphate released during AOP treatment was retained on the TiO₂ solids. The AOP was applied to three municipal wastewaters and one automotive industry effluent for P removal. In all cases, phosphorus removal was found to occur through filtration, surface complexation and UV oxidation. Total phosphorus removal efficiencies between 90 and 97% were observed for the municipal wastewater effluents and 44% removal was observed in the industrial effluent after treatment using AOP.

Developmental cascades of social competence, achievement in school, and achievement on standardized assessments during the transition to adolescence and secondary school

INTRODUCTION

Social and academic functioning are cornerstones of positive youth development and important to later educational and health outcomes. Yet, little is known about how the timing and direction of relationships between social and academic functioning vary by the type of achievement assessed and how the transition to adolescence influences these relationships.

METHOD

This study employs longitudinal structural equation modeling to examine the interrelationships of children's social competence, teacher ratings of school achievement, and standardized assessments of cognitive achievement in a cohort of 1048 children in the United States.

RESULTS

& Conclusions: Results identify 1) direct and indirect pathways from children's social competence in grades three and five to their school achievement in grades five and six; 2) significant pathways between school and cognitive achievement across all assessment points that decline in magnitude as students enter high school; 3) the magnitude of pathways between social competence and school achievement far exceed those between social competence and cognitive achievement; and 4) social and maturational factors account for variation in these functions but do not confound the timing and direction of the pathways from one to the other function. Given the importance of social competence and academic achievement to positive development, these findings demonstrate elementary school as an optimal and foundational period to implement universal interventions to optimize social functioning and prevent later academic difficulties in secondary school.

Disability, depression and suicide ideation in people with multiple sclerosis

INTRODUCTION

Depressive symptoms occur frequently in people with Multiple Sclerosis (MS) and rates of suicide ideation are higher than the general population. There is evidence for a direct association between disability and depression, disability and suicide ideation, and depression and suicide ideation in MS. However, the relationship between all three, i.e. the mediating role of depression between disability and suicidal ideation, has not been investigated. Exploring this relationship could highlight risk factors, alerting clinicians to the need for timely intervention.

METHOD

Seventy five people with progressive MS attending two out-patient clinics took part in this cross-sectional study. Participants completed the Beck Suicide Scale, Beck Depression Inventory, Multiple Sclerosis Impact Scale and Guy's Neurological Disability Scale.

RESULTS

Depressive symptoms mediated the relationship between perceived and actual disability and suicide ideation. Different types of disability were associated with suicidality, including: 'tremors' and 'taking longer to do things'. A small sub-group of participants were identified who reported suicide ideation in the presence of only mild levels of depression.

LIMITATIONS

There may be a sample bias in this study as all participants were attending out-patient clinics and receiving support which may not be available to everyone with MS.

CONCLUSION

It is important for clinicians to screen regularly for both depression and suicide ideation, to be alert to specific types of disability for which a higher level of suicide ideation might be present and to consider the possibility of suicidal thoughts being present in people who show minimal or no depressive symptoms.

The value of routine MR myelography at MRI of the lumbar spine

Purpose: To determine whether a commercially available automated MR myelogram sequence improves the interpretation and diagnostic yield at MRI of the lumbar spine.

Material and Methods: A total of 207 consecutive patients referred for MR examination of the lumbar spine for evaluation of low back pain or spinal radicular symptoms were included for study. All patients had initial imaging with sagittal T1-W and T2-W scans, followed by axial T2-W images. Subsequently an MR myelogram was acquired in each case in coronal, sagittal and oblique planes. MR myelogram images were evaluated initially and a diagnosis was established and recorded. Subsequently, a diagnosis was established by review of conventional images of the lumbar spine in sagittal and axial planes, in conjunction with the MR myelogram. The utility of the MR myelogram in establishing the diagnosis was graded on a 4-point scale, where grade 0 indicated that it contributed no additional information and grade 3 indicated that it was essential for diagnosis. Analysis of the additional value of myelography in patients with multilevel disease was made.

Results: Primary diagnoses were disc herniation in 69 cases (33%), degenerative disc disease in 51 cases (26%), spinal stenosis in 19 cases (9%), isolated lateral recess stenosis in 5 cases (2%), or other diagnoses, including facet degeneration in 48 cases (23%). Scans were normal in 15 cases (7%). MR myelography was graded as grade 0 in 151 cases (73%), grade 1 in 44 cases (21%) and grade 2 in 12 cases (6%). In no case was MR myelography essential for diagnosis (grade 3). In patients with multilevel disease (n = 27), in 17 cases MR myelography was graded as grade 1 (63%) and in 8 cases grade 2 (30%).

Conclusion: MR myelography when employed in routine practice was of limited value, assisting in establishing a diagnosis in a minority of cases (6%). The technique was of limited additional value in patients with multilevel pathology and to a lesser extent in patients with scoliosis, where it helped to establish the level most likely to account for pathology.

Acute neuromedical and neurosurgical admissions: Standard and ultrafast MR imaging of the brain compared with cranial CT

Purpose: To evaluate the role of standard and ultrafast MR brain imaging and compare the information with CT.

Material and Methods: This was a prospective study of 114 patients with acute neurological symptoms and signs. CT brain examinations consisted of axial non-enhanced images. MR imaging consisted of standard spin-echo/fast spin-echo sequences and a series of rapid techniques including echoplanar and single shot fast spin-echo sequences.

Results: Using standard MR methods, 41% of the patients had all five sequences of good technical quality, while using ultrafast methods 81% of the patients had good technical quality examinations in all five sequences. In 3% of the cases, ischaemic stroke was incorrectly reported on CT. In 24% of the cases, MR gave extra diagnostic information not reported on CT and in a further 8%, one neuroradiologist reported the abnormality in agreement with the MR, whilst the other neuroradiologist reported the CT as normal. In 2 cases, subarachnoid haemorrhage was missed on MR. Subarachnoid haemorrhage was not shown on the ultrafast sequences.

Conclusion: MR can be used to image acute neurological admissions with a high success rate, particularly using ultrafast methods. In many cases, MR provided extra information of direct clinical relevance not shown on CT.

IFPA meeting 2015 workshop report III: nanomedicine applications and exosome biology, xenobiotics and endocrine disruptors and pregnancy, and lipid

Workshops are an important part of the IFPA annual meeting, as they allow for discussion of specialized topics. At the IFPA meeting 2015 there were twelve themed workshops, three of which are summarized in this report. These workshops were related to various aspects of placental biology but collectively covered areas of pregnancy pathologies and placental metabolism: 1) nanomedicine applications and exosome biology; 2) xenobiotics and endocrine disruptors and pregnancy; 3) lipid mediators and placental function.

IFPA meeting 2015 workshop report I: placental mitochondrial function, transport systems and epigenetics

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialized topics. At IFPA meeting 2015 there were twelve themed workshops, three of which are summarized in this report. These workshops covered areas of placental regulation and nutrient handling: 1) placental epigenetics; 2) placental mitochondrial function; 3) placental transport systems.

A pilot study quantifying the shape of tidal breathing waveforms using centroids in health and COPD

During resting tidal breathing the shape of the expiratory airflow waveform differs with age and respiratory disease. While most studies quantifying these changes report time or volume specific metrics, few have concentrated on waveform shape or area parameters. The aim of this study was to derive and compare the centroid co-ordinates (the geometric centre) of inspiratory and expiratory flow-time and flow-volume waveforms collected from participants with or without COPD. The study does not aim to test the diagnostic potential of these metrics as an age matched control group would be required. Twenty-four participants with COPD and thirteen healthy participants who underwent spirometry had their resting tidal breathing recorded. The flow-time data was analysed using a Monte Carlo simulation to derive the inspiratory and expiratory flow-time and flow-volume centroid for each breath. A comparison of airflow waveforms show that in COPD, the breathing rate is faster (17 ± 4 vs 14 ± 3 min(-1)) and the time to reach peak expiratory flow shorter (0.6 ± 0.2 and 1.0 ± 0.4 s). The expiratory flow-time and flow-volume centroid is left-shifted with the increasing asymmetry of the expired airflow pattern induced by airway obstruction. This study shows that the degree of skew in expiratory airflow waveforms can be quantified using centroids.

IFPA Meeting 2011 workshop report I: Placenta: Predicting future health; roles of lipids in the growth and development of feto-placental unit; placental nutrient sensing; placental research to solve clinical problems--a translational approach

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialized topics. At IFPA meeting 2011 there were twelve themed workshops, four of which are summarized in this report. These workshops related to both basic science and clinical research into placental growth and nutrient sensing and were divided into 1) placenta: predicting future health; 2) roles of lipids in the growth and development of feto-placental unit; 3) placental nutrient sensing; 4) placental research to solve clinical problems: a translational approach.

Demonstration of combined zero-valent iron and electrical resistance heating for in situ trichloroethene remediation

The effectiveness of in situ treatment using zero-valent iron (ZVI) for nonaqueous phase or significant sediment-associated contaminant mass can be limited by relatively low rates of mass transfer to bring contaminants in contact with the reactive media. For a field test in a trichloroethene (TCE) source area, combining moderate-temperature subsurface electrical resistance heating with in situ ZVI treatment was shown to accelerate TCE treatment by a factor of about 4 based on organic daughter products and a factor about 8 based on chloride concentrations. A mass-discharge-based analysis was used to evaluate reaction, dissolution, and volatilization processes at ambient groundwater temperature (~10 °C) and as temperature was increased up to about 50 °C. Increased reaction and contaminant dissolution were observed with increased temperature, but vapor- or aqueous-phase migration of TCE out of the treatment zone was minimal during the test because reactions maintained low aqueous-phase TCE concentrations.

Evaluation of a novel sputum clearance technique--hydro-acoustic therapy (HAT) in adult patients with cystic fibrosis: a feasibility study

This study was designed to investigate the efficacy, safety and patients' acceptance of a novel system for sputum clearance--Hydro Acoustic Therapy (HAT) in patients with cystic fibrosis (CF). This is a prospective crossover study where 18 patients received 6 sessions of physiotherapy over 6 separate days. These consisted of 2 sessions of either HAT, flutter valve or and sitting in the bath with sounds without vibration (placebo) for 30 minutes each. The efficacy was investigated by measuring the weight of wet and dry sputum after each session and by change in spirometry values. The preference was assessed by a questionnaire completed by patients at the end of the study about their preference of which type of physiotherapy received. The weight of both dry and wet sputum produced was similar in the 3 arms of the study. Spirometry values but not oxygen saturation were reduced after HAT and flutter therapy sessions. HAT therapy was preferred to flutter and placebo in terms of breathlessness, ease of sputum production and relaxation. Of the patients, 70% stated that they would choose HAT as their preferred physiotherapy method compared to 0% for flutter (χ(2) = 20.3, p < 0.0001). There were no procedure-related complications in any of the 3 arms of the study. HAT was found to be safe, well tolerated and favoured by the majority of CF patients. The effect of HAT, however, on sputum production was not superior to flutter or placebo.

MRI appearance of the pancreas in patients with cystic fibrosis: a comparison of pancreas volume in diabetic and non-diabetic patients

We investigated differences in the volume of the pancreas in cystic fibrosis (CF) patients with and without diabetes using MRI to study the natural history of CF-related diabetes (CFRD). We investigated 29 pancreas-insufficient adult CF patients, 13 with CFRD and 16 without diabetes. Patients with CFRD were receiving insulin therapy at the time of study. None of the non-diabetic CF patients had evidence of impaired glucose tolerance. Pancreas volume was estimated by MRI scans using T₁ weighted fat-suppression sequences and assessed by an examiner who was unaware of the patients' diabetes status. Pancreas volume of CF patients was measured and subsequently compared with that of non-CF age-matched Type 1 diabetes (T1DM) patients and healthy controls previously investigated. The two CF groups were matched for age and gender. There were no differences in spirometry values, body mass index or pancreatic exocrine function. The pancreas was visible by MRI in only 3 of 13 (23.1%) patients with CFRD and in 5 of 16 (31.3%) patients without diabetes (p-value = 0.7). In total, the pancreas was not detected by MRI as an anatomical entity in 21 of 29 (72.4%) CF patients, irrespective of their diabetes status. When comparing the four study groups, the pancreas was significantly smaller in CF patients than in T1DM patients and healthy controls.

The size of the spleen by magnetic resonance imaging in patients with cystic fibrosis; with and without diabetes--a novel observational study

BACKGROUND

Magnetic resonance imaging (MRI) has been shown to be a useful tool to evaluate the volume of the pancreas. There is currently no information about the size of the spleen in cystic fibrosis (CF) patients.

PATIENTS AND METHODS

We investigated 51 adult volunteers: 28 pancreatic insufficient CF patients [13 with CF-related diabetes (CFRD) and 15 non-diabetic] and 23 male non-CF patients [12 with type 1 diabetes mellitus (T1DM) and 11 healthy control subjects]. Patients with known liver cirrhosis or portal hypertension were excluded. The size of the spleen was measured in all subjects by an investigator unaware of patients' clinical status. For comparison of spleen size in the four study groups only male CF patients were included. For CF patients, spleen size was compared with forced expiratory volume in 1 s (FEV(1)), body mass index (BMI), total number of days of intravenous (IV) antibiotic treatment for pulmonary exacerbations in year previous to study, levels of circulating white blood cells, glycosylated haemoglobin A1c (HbA1c), and exocrine function of the pancreas, as assessed by daily requirement of oral lipase.

RESULTS

Amongst the four study groups, spleen size was greatest in the male non-diabetic CF patients (P = 0.01). For CF patients, spleen size was greater in male compared to female patients (P = 0.012). For patients with CFRD, there was an inverse correlation between the spleen size and HbA1c (r = -0.59, P = 0.04) and the daily intake of supplementary lipase (r = -0.63, P = 0.02). The size of the spleen in patients with CFRD, but not in CF patients without CFRD, inversely correlated with the days of IV antibiotic treatment received in the year previous to the study (r = -0.67, P = 0.012). There was no correlation between spleen size and BMI, FEV1 and white blood cell counts in any group.

CONCLUSION

On MRI, the spleen size was greatest in male non-diabetic CF patients in comparison with other groups. The size of the spleen in CFRD patients was smaller when diabetes was poorly controlled, when exocrine pancreatic function was greatly impaired and in those with greater need for IV antibiotics in the year prior to the study.

A review of high frequency oscillation ventilation in the neonate

In this study the use of high frequency oscillation (HFO) to treat neonates with respiratory failure is analysed. The theories behind gas exchange during HFO are reviewed and its specific application to neonatal care discussed. The mechanical performance of three HFO ventilators currently in use is compared with the views of medical staff operating them on a regular basis. The complex interactions between initial ventilator settings have led to difficulties in accurately comparing performance characteristics and ventilation strategies; each ventilator is seen to have its own strengths and weaknesses that contribute to the ventilator selection made. These interactions together with the specific HFO modes available on each ventilator should be taken into account when using a HFO for the first time or when switching from an alternative ventilation method. Medical staff who care for neonates suggest staff education and training into the variations of HFO will greatly improve its use in neonatal medicine.

Glucocorticoids as an adjuvant treatment to intravenous antibiotics for cystic fibrosis pulmonary exacerbations: a UK Survey

Oral glucocorticoids are widely used to treat exacerbations of asthma and COPD. A role for their use in treating exacerbations in Cystic Fibrosis (CF) is not proven. We describe the current practice, amongst UK adult CF physicians, of oral glucocorticoid use as an adjuvant to intravenous (IV) antibiotic treatment during CF pulmonary exacerbation (P EX). The survey also examined whether physicians thought a randomised controlled trial (RCT) was necessary and their willingness to participate patients in such a trial. Eighty one percent of physicians replied. All of them used corticosteroids with P EX. Most physicians supported the need for a RCT and would be willing to enroll consenting patients in the trial. This survey highlighted the need for a RCT which would examine the role of adjuvant corticosteroids to IV antibiotics in CF P EX.

17beta-estradiol potentiates the cardiac cystic fibrosis transmembrane conductance regulator chloride current in guinea-pig ventricular myocytes

There is a well-characterized membrane chloride current (ICl,cAMP) in the heart that can be activated by beta-adrenergic agonists and is due to expression of the cardiac isoform of the epithelial cystic fibrosis transmembrane conductance regulator (CFTR). We have investigated whether 17beta-estradiol (E2) modulates ICl,cAMP in single ventricular myocytes. Under whole-cell tight-seal voltage-clamp conditions, ICl,cAMP was evoked by exposing cells to 20 nM isoprenaline. On the addition of 30 microM E2, membrane slope conductance, measured at potentials near 0 mV, increased over that induced by isoprenaline alone by 2.46 +/- 0.16 (p < 0.001). The effects of E2 were concentration-dependent and described by a Hill Plot with an EC50 of 8.2 microM and a Hill coefficient of 1.63. The application of membrane-impermeant E2 conjugated to bovine serum albumin (E2-BSA) potentiated isoprenaline-evoked ICl,cAMP by approximately the same degree as that for the equivalent level of free E2. Cell surface binding was observed with confocal microscopy by using BSA-FITC tagged E2. This binding was inhibited by nonlabeled, nonconjugate E2, the specific E2 antagonist ICl 182,780, and incubation of E2coBSA with a specific anti-E2 antibody (E2885). ICl 182,780 (100 microM) significantly reduced the increase in ICl,cAMP evoked by 10 microM E2 to 1.46 +/- 0.10 (p < 0.02). The preincubation of myocytes with the NOS inhibitor N-omega-nitro-arginine (L-NNA, 1 mM) reduced the potentiation of ICl,cAMP by 30 microM E2, to 1.93 +/- 0.06 (p < 0.02), and for 10 microM E2, to 1.32 +/- 0.05 (p < 0.002). E2 also increased ICl,cAMP evoked by bath application of 0.5 microM Forskolin. These experiments demonstrate that, under our experimental conditions, E2 dramatically increases ICl,cAMP in ventricular myocytes by mechanisms involving a contribution by NOS, but that can be only partially accounted for through binding to classical plasma membrane estrogen receptor sites. This potentiation of ICl,cAMP by E2 may play a significant role in the observed clinical actions of E2 on the incidence of cardiac arrhythmias and hypertrophy.

Purinergic receptor expression and activation in first trimester and term human placenta

Intracellular calcium concentration ([Ca(2+)](i)) is an important signalling molecule in the human placenta and regulation of [Ca(2+)](i) must be tightly controlled to ensure normal cell function and in order to meet the changing demand for calcium with increased fetal growth over gestation. Little is known about the receptors and mechanisms involved in intracellular calcium signalling in the human placenta but in isolated cytotrophoblast cells members of the P2 purinergic receptor family have been shown to mediate an ATP-stimulated rise in [Ca(2+)](i). In this study we examined activation and expression of several of the purinergic receptor subtypes in human placental villous fragments at two stages of gestation, first trimester and term. We demonstrate mRNA and protein expression of the P2X(4), P2X(7) and P2Y(2) subtypes but found no evidence of P2Y(4) protein in the placenta. Using fluorescent calcium imaging we demonstrate that 300 microM ATP, 450 microM UTP and 300 microM BzATP significantly elevate [Ca(2+)](i) in villous fragments with a significant increase in agonist-induced response seen in the term compared to the first trimester fragments (ATP, P<0.0001; UTP, P=0.018; BzATP, P=0.015). The roles of the purinergic receptors within the human placenta are not known but it seems likely for this study that calcium handling through these receptors is altered with advancing gestation. This may be due to the need to meet increased fetal Ca(2+) requirements due to growth or as a secondary function to alterations in placental [Ca(2+)](i) signalling.

Laparoscopic renal cryotherapy: biology, techniques and outcomes

AIM

The development of minimally invasive approaches to renal cell carcinoma (RCC) over the last 10 years has given rise to newer therapies such as renal cryotherapy. Patients with significant comorbidities who are not suitable for open surgery may be candidates for this procedure. Herein, we review the biology, techniques and outcomes of laparoscopic renal cryotherapy as performed at our institution.

METHODS

We present our initial experience with laparoscopic cryotherapy for the treatment of small, peripheral renal lesions and provide a review of the literature. A retrospective review was performed on our first 25 patients treated with transperitoneal laparoscopic cryotherapy for small peripheral renal lesions by a single surgeon between 2002 and 2003.

RESULTS

We treated 25 patients, average age of 65 years (range 32-83) with transperitoneal laparoscopic renal cryotherapy for small, enhancing, peripheral lesions suspicious for RCC. Mean pretreatment creatinine of 1.06 was unchanged after treatment. Mean tumor size was 2.4 cm (range 1.5-3.6 cm), with a mean EBL of 80 mL. Pathology revealed 72% RCC, 2 oncocytomas, one each arterio-nephrosclerosis, inflammatory tissue, focal-segmental glomerulosclerosis, angiomyolipoma and one normal tissue specimen. Average tumor grade was 2.3 (range 2-4). Mean hospital stay was 2.3 days (range 1-5). Three cases were converted to open. Two complications included transfusion and hydronephrosis, both managed conservatively. Mean follow-up is 16.2 months (range 6-36 months). There have been no recurrences to date despite a rigorous surveillance protocol.

CONCLUSIONS

Renal cryotherapy is a viable option for nephron sparing surgery in small, peripheral, renal lesions. The procedure is well tolerated, may be considered in patients who are not good candidates for open surgical approaches, results in minimal morbidity, and has very encouraging treatment results. Close surveillance post-treatment is essential. Longer follow-up data will be necessary to establish the durability of laparoscopic renal cryotherapy.

Intracellular Ca(2+) dynamics and sarcomere length in single ventricular myocytes

The measurements of the sarcomere length in dissociated cardiac ventricular myocytes are discussed using mainly our own experimental data. The striation periodicity of these unloaded cells was found to be that which is to be expected of a myocyte free of the ultrastructural constraints imposed upon it by the normal syncytial matrix of the ventricular wall. The sarcomere length and [Ca(2+)] relationship was consistent as expected from the intact tissue, when it was measured soon after partial rupturing the cell membrane. Miniature fluctuations of individual sarcomere length were demonstrated during rest, which was augmented by the Ca(2+) overload. The [Ca(2+)] could be estimated from the measurements of sarcomere length during the positive staircase of contraction. The usefulness of the optical measurement of sarcomere pattern was indicated.