Response surface methodology and artificial neural network modelling for the performance evaluation of pilot-scale hybrid nanofiltration (NF) & reverse osmosis (RO) membrane system for the treatment of brackish ground water

Artificial neural network (ANN) and response surface methodology (RSM) were employed to develop models for process optimisation of pilot scale nanofiltration (NF) and reverse osmosis (RO) membrane filtration system for the treatment of brackish groundwater. The process variables for this study were feed concentration, temperature, pH and pressure. The performance of NF/RO was assessed in terms of permeate flux, water recovery, salt rejection and specific energy consumption, which were considered as responses. The experimental design was employed to develop both RSM and ANN models. RSM model was validated for the whole range of experimental levels, while the ANN model was considered for the whole range of experimental design. RSM and ANN models were statistically analysed using analysis of variance (ANOVA). Further, the models were graphically compared for its predictive capacity. Numerical optimisation of NF and RO pilot plant to determine the optimum conditions were verified. Finally, using the optimum conditions, three hybrid configurations of NF and RO were studied to determine the best mode for the treatment of brackish groundwater. It was found that parallel NF-RO had a recovery of 57.18% and rejection of 44.89%, for RO-concentrate-NF (RO-C-NF) recovery was 49.55% and rejection of 38.64% & for NF-concentrate-RO (NF-C-RO), the recovery of 39.53% and rejection of 49.66% was obtained. Results obtained also suggested that the mode of configurations and the feed concentration affect the performance of the hybrid system.

Zooplankton-based reactors for tertiary wastewater treatment: A pilot-scale case study

Nature-based wastewater treatments are an economic and sustainable alternative to intensive technologies in rural areas, although their efficiency needs to be improved. This study explores technological co-operation between zooplankton (e.g., Daphnia magna) and bacterial and algal biofilms in a 1.5 m³ zooplankton-based reactor for the on-site treatment of secondary urban wastewater. The efficiency of the reactor was evaluated over a 14-month period without any maintenance. The results suggest a low seasonality effect on nutrient polishing (organic matter and nitrogen) and the removal of solids (TSS and turbidity). The best performance, involving a decrease in organic carbon, nitrogen, E. coli loads, and solid content was achieved in winter when operating the reactor at 750 L d^-1. Under these conditions, the quality of the effluent water was suitable for its reuse for six different purposes in conformance with Spanish legislation. These results demonstrate that the zooplankton-based reactor presented here can be used as an eco-sustainable tertiary treatment to provide water suitable for reuse. On-site research revealed that the robustness of the reactor against temperature and oxygen fluctuations needs to be improved to ensure good performance throughout the year.

Efficacy of orchard terrace measures to minimize water erosion caused by extreme rainfall in the hilly region of China: Long-term continuous in situ observations

Terracing and rainfall characteristics notably influence the water erosion processes. However, an extensive long term in situ quantitative evaluation of the approaches to control the water erosion in different orchard terraces has not yet been performed, especially considering the increasing frequency and severity of extreme rainfall events due to the global climate change. In this study, six types of orchard terraces, including slope land as the control (SLck), level terrace with bare (LTb) and vegetation taluses (LTv), outward (OTv) and inward terrace (ITv) with vegetation taluses and level terrace having front mounds and back ditches with vegetation taluses (MDLTv), were used to analyze the effects of extreme and ordinary rainfall events on the surface runoff and soil erosion. According to the measured data for twelve consecutive years, 356 natural rainfall events were divided into extreme and ordinary rainfall, based on the World Meteorological Organization standard. The results indicated that more severe surface runoff and sediment loss occurred under extreme rainfall: the runoff coefficient and soil loss under extreme rainfall were 2.6 and 11.5 times those under ordinary rainfall, respectively. The sediment yield (contribution rate, 42.9%) exhibited a higher sensitivity to extreme rainfall events compared to that of the surface runoff generation (contribution rate, 16.4%). Moreover, the reduction in the surface runoff and sediment in the extreme rainfall case differed for different orchard terraces. The average surface runoff coefficient and soil loss amount decreased in the following order: SLck>LTb>OTv>LTv>ITv>MDLTv. Nevertheless, the highest and lowest contributions of the extreme rainfall to the sediment yield occurred in the LTb (64.8%) and MDLTv (21.7%) plots, respectively. Therefore, severe talus erosion caused by extreme rainfall should be monitored, and a combination of vegetation taluses and front mounds and back ditches on the platforms is recommended as a sustainable strategy to prevent extreme water erosion when transforming slope land into orchard terraces.

Exploring the structural factors of resilience in urban drainage systems: a large-scale stochastic computational experiment

The focus of infrastructure design and management has turned from a reliability-based approach to a resilience-based one. Resilience is a system's ability to maintain its function and minimize failure consequences when faced with exceptional conditions. This study carries out a large-scale computational experiment to study how resilience is affected by system's structure in a combined sewer system. We build a stochastic generation model, involving a random sampling of facility locations and a graph-based random walk sampling algorithm to generate various layouts of pipelines. The performance of these virtual systems are assessed in the Storm Water Management Model. We apply statistical techniques on these samples to study the relation between resilience and system structure. Results show that the number of combined sewer overflow (CSO) outfalls is a more important factor of resilience compared to the number of wastewater treatment plants (WWTPs). Some locations are found more preferable for WWTP or CSO outfall placement, while adding WWTPs or outfalls at other locations might even lower the system's resilience. Size of the sub-catchments of the CSO outfalls also affects resilience. Although this effect is statistically significant, the extent is not remarkable compared to other factors. We further study the structural features of the cost-effective systems. The highest achievable resilience level increases as the number of CSO outfalls decreases and so does system's cost. This results from the difference in CSO quantity, therefore this dilemma can be cut off by end-of-pipe storage or treatment which specifically tackles CSO. The conclusion of this study provides an insight into the structural factors of combined sewer systems' resilience and can provide guidance for system's planning.

Impact assessment of a large panel of organic and inorganic micropollutants released by wastewater treatment plants at the scale of France

Micropollutants emitted by Human activities represent a potential threat to our health and aquatic environment. Thousands of active substances are used and go to WWTP through wastewaters. During water treatment, incomplete elimination occurs. Effluents released to the environment still contain part of the micropollutants present in the influents. Here, we studied the potential impacts on Human health and aquatic environment of the release of 261 organic micropollutants and 25 inorganic micropollutants at the scale of France. Data were gathered from national surveys, reports, papers and PhD works. The USEtox ® model was used to assess potential impacts. The impacts on Human health were estimated for 94 organic and 15 inorganic micropollutants and on aquatic environment for 88 organic and 19 inorganic micropollutants highlighting lack of concentration and toxicological data in literature. Some Polycyclic Aromatic Hydrocarbons and pesticides as well as As and Zn showed highest potential impacts on Human health. Some pesticides, PCB 101, βE2, Al, Fe and Cu showed highest potential impacts on aquatic environment.

Positive matrix factorization receptor model and dynamics in fingerprinting of potentially toxic metals in coastal ecosystem sediments at a large scale (Persian Gulf, Iran)

Effective pollution control and remediation strategies are the key to providing a major progress in conservation of coastal and marine biodiversity. For the development of such strategies, quantitative assessment of potentially toxic metals (PTMs) and the accurate identification of the pollutant sources are essential. In this study, we seek to find out spatial PTMs distribution in the coastal sediments of the Persian Gulf (Iran), to assess the potential eco-environmental risks and to identify the metal pollution sources. Total and fraction analysis indicated considerable metal (Zn, Cu, Mn, Fe, Al, Hg, Pb, Cd, As, Cr, Co, Ni and V) pollution levels, albeit in most cases PTMs were predominantly associated with the oxidizable and residual fractions. The obtained PTMs concentrations were in the range of 22.8 - 156.3, 16.6 - 161.9; 2.7 - 88; 10.4 - 107.3; 1.1 - 35.8; 0.8 - 27.9; 0.1 - 1.3; 1.1 - 21.3; 0.04 - 1.9 mg.kg^-1 for V, Ni, Cu, Zn, Cr, Co, Hg, Pb, and Cd, respectively. The combined PTM-PCA-PMF modeling approach identified four main metal sources (anthropogenic, vehicle-related, agricultural and lithogenic) in the study area. Several recognizable 'hot-spots' with extremely high metal concentrations were observed in the spatial metal pollution patterns. Some of those locations were predominantly affected by the nearby industrial activities, while others have demonstrated contributions from several sources - not only anthropogenic, but also agricultural and vehicle-related. The same spots of elevated pollution were found to demonstrate higher potential eco-environmental risk. Various indexes indicated more or less similar trends: the eco-environmental risk was gradually increasing towards the northwestern part of the study area with several peaks in the central and eastern parts directly affected by the nearby industrial activities.

Contrast-associated acute kidney injury: An update of risk factors, risk factor scores, and preventive measures

As lifespans lengthen, age-related diseases such as cardiovascular disease and diabetes are becoming more prevalent. Correspondingly, the use of contrast agents for medical imaging is also becoming more common, and there is increasing awareness of contrast-associated acute kidney injury (CA-AKI). There is no specific treatment for CA-AKI, and clinicians currently focus on prevention, interventions that alter its pathogenesis, and identification of risk factors. Although the incidence of CA-AKI is low in the general population, the risk of CA-AKI can reach 20% to 30% in patients with multiple risk factors. Many models have been applied in the clinic to assess the risk factors for CA-AKI, enable identification of high-risk groups, and improve clinical management. Hypotonic or isotonic contrast media are recommended to prevent CA-AKI in high-risk patients. Patients with risk factors should avoid using contrast media multiple times within a short period of time. All nephrotoxic drugs should be stopped at least 24 h before the administration of contrast media in high-risk populations, and adequate hydration is recommended for all patients. This review summarizes the pathophysiology of CA-AKI and the progress in diagnosis and differential diagnosis; updates the risk factors and risk factor scoring systems; reviews the latest advances related to prevention and treatment; discusses current problems in epidemiological studies; and highlights the importance of identifying high-risk subjects to control modifiable risk factors and use of a rating scale to estimate the risk and implement appropriate prevention strategies.

Persistent organic pollutants exposure in newborn dried blood spots and infant weight status: A case-control study of low-income Hispanic mother-infant pairs

Persistent organic pollutants (POPs) are believed to alter metabolic homeostasis during fetal development, leading to childhood obesity. However, limited studies have explored how fetal chemical exposures relate to birth and infant weight outcomes in low-income Hispanic families at the highest risk of obesity. Therefore, we sought to determine associations between neonatal POPs exposure measured in newborn dried blood spots (DBS) and prenatal diet quality, birth weight, and overweight status at 18 months old. We conducted a case-control study nested within the Starting Early Program randomized controlled trial comparing POPs concentrations in infants with healthy weight (n = 46) and overweight status (n = 52) at age 18 months. Three categories of POPs, organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs) and perfluoroalkyl substances (PFASs) were measured in archived newborn DBS. We assessed correlations between prenatal diet quality and neonatal POPs concentrations. Multivariable regression analyses examined associations between POPs (dichotomized at the mean) and birth weight z-score and weight status at 18 months, controlling for confounders. Seven of eight chemicals had detectable levels in greater than 94% of the sample. Higher protein, sodium and refined grain intake during pregnancy were correlated with lower POPs in newborn DBS. We found that high concentrations of perfluorooctanesulfonate (unstandardized coefficient [B]: -0.62, 95% confidence interval [CI]: -0.96 to -0.29) and perfluorohexanesulfate (B: -0.65, 95% CI: -0.99 to -0.31) were related to lower birth weight z-scores compared to those with low concentrations. We did not find associations between PBDEs, OCPs, and the other PFASs with birth weight z-scores, or between any POPs and weight status at 18 months. In conclusion, two PFASs were associated with lower birth weight, an important indicator of child health and growth, although direct associations with infant overweight status were not found. Whether neonatal POPs exposures contribute to economic and ethnic disparities in early obesity remains unclear.

Comparison of 4 sinus augmentation techniques for implant placement with residual alveolar bone height ≤3 mm

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Local and Landscape-Scale Features Influence Bumble Bee (Hymenoptera: Apidae) Bycatch in Bertha Armyworm Mamestra configurata (Lepidoptera: Noctuidae) Pheromone-Baited Monitoring Traps

The bertha armyworm (BAW) Mamestra configurata Walker is a significant pest of canola Brassica napus L. (Brassicales: Brassicaceae) in western Canada. Its activity is monitored through a large network of pheromone-baited monitoring traps as a part of the Prairie Pest Monitoring Network across the Canadian Prairies. The unintentional bycatch of bee pollinators in pheromone-baited traps targeting moth pests occurs in many agroecosystems and may have repercussions for biodiversity and pollination services of wild plants and managed crops. We conducted field experiments to determine the abundance and diversity of bees attracted to green-colored BAW pheromone-baited traps across the canola growing regions of Alberta, Canada. A higher species diversity and more bumble bees were captured in BAW pheromone-baited than in unbaited control traps. Bombus rufocinctus Cresson (Hymenoptera: Apidae) was the most commonly captured species. Few other wild bees or honey bees Apis mellifera L. (Hymenoptera: Apidae) were captured during this study. Additionally, we evaluated the influence of local and landscape-level habitat features on bee bycatch. Local flowering plant abundance improved overall model fit but did not directly impact bee bycatch. The proportion of natural and seminatural habitat, and especially forested area, in the area surrounding monitoring traps affected bee bycatch. Both local and landscape-scale factors were important in this study and often have combined effects on bee communities. This study provides recommendations to reduce the bycatch of beneficial bee pollinators in a large-scale pheromone-baited monitoring network.

The German Multi-Dimensional Perceived Autonomy Support Scale for Physical Education: Adaption and Validation in a Sample of Lower Track Secondary School Students

Teachers' autonomy support (AS) in physical education (PE) has positive effects on students' affective and behavioral outcomes in PE. Even though the existence of three different dimensions of AS, namely cognitive, organizational and procedural AS has been suggested in educational settings, there is a lack of multidimensional instruments for the assessment of autonomy-supportive teaching in PE. The aim of this study was to validate the German Multi-Dimensional Perceived Autonomy Support Scale for Physical Education (MD-PASS-PE). The sample comprised 1030 students of grades 6 through 10. Internal consistency was used to test the reliability of the assumed subscales. Factorial validity and measurement invariance across gender and age were examined by confirmatory factor analyses. Structural equation modeling was used to evaluate criterion validity. The subscales exhibited acceptable to good internal consistency. The assumed three-factor structure was confirmed within a bi-factor model including a general factor and three specific group factors. Results strongly supported measurement invariance across gender while tentatively suggesting measurement invariance across age. Criterion validity was supported as the MD-PASS-PE explained 15% and 14% of the variance in the constructs of self-efficacy and intrinsic value, respectively. The German MD-PASS-PE provides PE teachers with deeper insights into their autonomy-supportive teaching behavior, helping them to support their students' autonomy in a holistic way.

Neighborhood Socioeconomic Deprivation Associated with Fat Mass and Weight Status in Youth

(1) Background: Few studies have examined the relationship between neighborhood socioeconomic deprivation (SED) and weight-related outcomes in youth, controlling for weight-related behaviors. Hence, the purpose of this study was to examine the association between neighborhood SED, weight status, and fat mass in a diverse sample of youth, before and after controlling for physical activity and diet. (2) Methods: The sample included 828 youth from the Transitions and Activity Changes in Kids study. Neighborhood SED was expressed as an index score at the census tract of residence. Height, weight, and body composition were measured and used to calculate fat mass index (FMI) and weight status. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior (min/h) were measured via accelerometry. Diet quality was assessed via the Block Food Screener for Kids. Multilevel regression models were employed to examine these relationships. (3) Results: Neighborhood SED was significantly associated with FMI and weight status before and after controlling for MVPA, sedentary behavior, and diet. Notably, youth residing in the most deprived neighborhoods had significantly higher FMI and were 30% more likely to be overweight/obese (OR = 1.30; 95% CI = 1.03-1.65). (4) Conclusions: Greater neighborhood SED was consistently and significantly associated with higher fat mass index and increased likelihood of overweight/obesity among youth.

Viscoelastic legs for open-loop control of gram-scale robots

Gram-scale insects, such as cockroaches, take advantage of the mechanical properties of the musculoskeletal system to enable rapid and robust running. Engineering gram-scale robots, much like their biological counterparts, comes with inherent constraints on resources due to their small sizes. Resource-constrained robots are generally limited in their computational complexity, making controlled, high-speed locomotion a challenge, especially in unstructured environments. In this paper we show that embedding control into the leg mechanics of robots, similarly to cockroaches, results in predictable dynamics from an open-loop control strategy that can be modified through material choice. Tuning the mechanical properties of gram-scale robot legs promotes high-speed, stable running, reducing the need for active control. We utilize a torque-driven damped spring-loaded inverted pendulum model to explore the behavior and the design space of a spring-damper leg at this scale. The resulting design maps show the trade-offs in performance goals, such as speed and efficiency, with stability, as well as the sensitivity in performance to the leg properties and the control input. Finally, we demonstrate experimental results with magnetically actuated quadrupedal gram-scale robots, incorporating viscoelastic legs and demonstrating speeds up to 11.7 body lengths per second.

Long-term effects of medical management on growth and weight in individuals with urea cycle disorders

Low protein diet and sodium or glycerol phenylbutyrate, two pillars of recommended long-term therapy of individuals with urea cycle disorders (UCDs), involve the risk of iatrogenic growth failure. Limited evidence-based studies hamper our knowledge on the long-term effects of the proposed medical management in individuals with UCDs. We studied the impact of medical management on growth and weight development in 307 individuals longitudinally followed by the Urea Cycle Disorders Consortium (UCDC) and the European registry and network for Intoxication type Metabolic Diseases (E-IMD). Intrauterine growth of all investigated UCDs and postnatal linear growth of asymptomatic individuals remained unaffected. Symptomatic individuals were at risk of progressive growth retardation independent from the underlying disease and the degree of natural protein restriction. Growth impairment was determined by disease severity and associated with reduced or borderline plasma branched-chain amino acid (BCAA) concentrations. Liver transplantation appeared to have a beneficial effect on growth. Weight development remained unaffected both in asymptomatic and symptomatic individuals. Progressive growth impairment depends on disease severity and plasma BCAA concentrations, but cannot be predicted by the amount of natural protein intake alone. Future clinical trials are necessary to evaluate whether supplementation with BCAAs might improve growth in UCDs.

Weight of epidemiological evidence for titanium dioxide risk assessment: current state and further needs

We address here the importance of epidemiological evidence in risk assessment and decision-making in Europe. To illustrate this, titanium dioxide (TiO₂) was used as a model compound. TiO₂ is widely used as an odorless white pigment and opacifying agent. A recent systematic review assessing the weight of evidence on the relationship between exposure to TiO₂ (all forms) and cancer in humans questions the assumptions that TiO₂ is an inert material of low toxicity. Based on this new data, France submitted a proposal to classify TiO₂ as a possible human carcinogen under the European regulation. The European Chemicals Agency Risk assessment committee concluded that TiO₂ (all forms) warrants a classification as a suspected human carcinogen via inhalation (Category-2) under the CLP regulation (for Classification, Labeling and Packaging of chemicals). No considerations was given to TiO₂ particle size, which may affect human health effects. Consequently, further epidemiological studies are needed to assess possible associations between different physical-chemical characteristics of TiO₂ exposures and their impact on human health. This would allow strengthening the evidence on which to build the most appropriate regulation and to guaranty safe use given any exposure route of any TiO₂ particle shape or size.

Changes in inner retinal layer thickness in patients with exudative age-related macular degeneration during treatment with anti-vascular endothelial growth factor

The aim of this study was to identify any changes that occur in the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with exudative age-related macular degeneration (AMD) during treatment with anti-vascular endothelial growth factor (VEGF) injections.Patients were enrolled in this retrospective study if they had exudative AMD, had received at least 3 injections of ranibizumab or aflibercept, and had a minimum of 12 months of follow-up. We analyzed the changes in the RNFL and GC-IPL using spectral-domain optical coherence tomography in rescan mode.Fifty-two eyes of 52 patients who had been treated with repeated anti-VEGF injections for exudative AMD were included. At the final visit, there was no significant between-group difference in best-corrected visual acuity or intraocular pressure. There was a significant decrease in central macular thickness in all groups (P < .05). There was a decrease in RNFL thickness that was only statistically significant in the ranibizumab group and when the ranibizumab or aflibercept groups were combined (P = .036 and .044, respectively). The thickness of the GC-IPL layer was significantly decreased in the aflibercept and total group (P = .035 and P = .048, respectively).The thicknesses of the RNFL and GC-IPL decreased in patients with exudative AMD who underwent repeated anti-VEGF injections.

Is 'heavy' up or down? Testing the vertical spatial representation of weight

Smaller numbers are typically responded to faster with a bottom than a top key, whereas the opposite occurs for larger numbers (a vertical spatial-numerical association of response codes: i.e. the vertical SNARC effect). Here, in four experiments, we explored whether a vertical spatial-magnitude association can emerge for lighter vs. heavier items. Participants were presented with a central target stimulus that could be a word describing a material (e.g. 'paper', 'iron': Experiment 1), a numerical quantity of weight (e.g. '1 g', '1 kg': Experiment 2) or a picture associated with a real object that participants weighed before the experiment (Experiments 3a/3b). Participants were asked to respond either to the weight (Experiments 1-3a) or to the size (i.e. weight was task-irrelevant; Experiment 3b) of the stimuli by pressing vertically placed keys. In Experiments 1 and 2, faster responses emerged for the lighter-bottom/heavier-top mapping-in line with a standard SNARC-like effect-whereas in Experiment 3a the opposite mapping emerged (lighter-top/heavier-bottom). No evidence of an implicit weight-space association emerged in Experiment 3b. Overall, these results provide evidence indicating a possible context-dependent vertical spatial representation of weight.

Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care

BACKGROUND

Pain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties.

METHODS

This two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach's α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI).

RESULTS

This study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414.

CONCLUSION

This study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.

Pilot-scale production of xylo-oligosaccharides and fermentable sugars from Miscanthus using steam explosion pretreatment

This study investigated pilot-scale production of xylo-oligosaccharides (XOS) and fermentable sugars from Miscanthus using steam explosion (SE) pretreatment. SE conditions (200 °C; 15 bar; 10 min) led to XOS yields up to 52 % (w/w of initial xylan) in the hydrolysate. Liquid chromatography-mass spectrometry demonstrated that the solubilised XOS contained bound acetyl- and hydroxycinnamate residues, physicochemical properties known for high prebiotic effects and anti-oxidant activity in nutraceutical foods. Enzymatic hydrolysis of XOS-rich hydrolysate with commercial endo-xylanases resulted in xylobiose yields of 380 to 500 g/kg of initial xylan in the biomass after only 4 h, equivalent to ~74 to 90 % conversion of XOS into xylobiose. Fermentable glucose yields from enzymatic hydrolysis of solid residues were 8 to 9-fold higher than for untreated material. In view of an integrated biorefinery, we demonstrate the potential for efficient utilisation of Miscanthus for the production of renewable sources, including biochemicals and biofuels.

A pilot-scale study on the treatment of landfill leachate by a composite biological system under low dissolved oxygen conditions: Performance and microbial community

In this work, a pilot-scale low dissolved oxygen (DO) composite biological system (LDOCBS) composed of an anoxic rotating biological contactor (RBC) and four aeration tanks with gradient aeration was used to treat landfill leachate for 88 d. The maximum removals of 85.65%, 99.92% and 84.06% for chemical oxygen demand (COD), ammonia (NH₄⁺-N) and total nitrogen (TN) were achieved, respectively. The three-dimensional exaction and emission matrix (3D-EEM) fluorescence spectroscopy revealed that the biodegradability of leachate was significantly improved by the LDOCBS. Mass balance calculations showed that the COD removal and denitrification process mainly occurred in RBC while 1# contributed primarily to nitrification. High-throughput sequencing analysis indicated that denitrifying bacteria with highly relative abundances of 46.45%-53.81% played key roles in organic degradation and nitrogen removal. This work could add some guiding insights into the cost-efficient treatment of landfill leachate by the composite biological system.

A Simple Method for Estimating Hand Hygiene Use Among Anesthesia Personnel: Development, Validation, and Use in a Quality Improvement Project

BACKGROUND

Frequent hand hygiene by anesthesia personnel may be an important factor in reducing contamination of IV lines and medication access ports and may reduce hospital-acquired infections. Measurement of hand hygiene frequency at the individual clinician level by direct observation or electronic devices is cumbersome and expensive. We developed and validated a simple method for estimating hand hygiene frequency by individual anesthesia providers and utilized it in a quality improvement initiative to increase hand hygiene use.

METHODS

Pump-style, alcohol-based hand hygiene container weight at the anesthesia work station was measured before and after each surgical operation and converted to estimated number of accesses (pumps) per hour. Video observation was used to validate the estimated hand hygiene use. A quality improvement initiative utilized periodic measurement of hand hygiene frequency via the validated method, and incorporated individual provider feedback, email reminders, monthly departmental performance reports, and reminders in the electronic anesthesia record. Segmented linear regression was used to evaluate the effect of the intervention on hand hygiene use.

RESULTS

Delivered product per pump was consistent for containers at least half-full and averaged (mean ± SD) 0.92 ± 0.13 g per pump. Video observation in 26 cases showed a strong correlation between observed hand hygiene episodes and estimated hand hygiene use frequency based on weight change of the container (linear regression, R = 0.97, P < .0001). Median hand hygiene frequency was near 0 at baseline but increased progressively throughout the intervention period (segmented linear regression, overall R = 0.76, P < .0001; change of intercept or mean hand hygiene after initiation of intervention [parameter estimate ± SE] [0.970 ± 0.29], P = .0008).

CONCLUSIONS

A low-cost, simple method for measuring individual anesthesia clinician use of hand hygiene intraoperatively based on container weight change is feasible and sufficiently accurate to support a quality improvement initiative to increase its use.

Differences in Select Measures of Health Care Access, Utilization, and Financial Burden by Urbanicity, 2017

Objective-This report examines select measures of health care access, utilization, and financial burden by metropolitan statistical area (MSA) status among adults aged 18-64. Methods-Data from the 2017 National Health Interview Survey were used to examine how a usual place to go for care, visits to a doctor or emergency room in the past year, unmet medical need due to cost, inability to afford prescription medications, and problems paying medical bills differed by MSA status among adults aged 18-64. Estimates are presented for adults living in a large MSA (population of 1 million or more), living in a small MSA (less than 1 million in population), and not living in an MSA. Results-In 2017, adults not living in an MSA generally had reduced access to or use of health care, and a higher financial burden associated with their care, compared with those in more populous areas. However, after controlling for selected sociodemographic and health characteristics, it was found that for the measures examined, adults not living in MSAs were more likely to have a usual place to go for care but less likely to have financial burden associated with their care compared with those in small or large MSAs. Conclusion-The unadjusted results show that adults not living in an MSA are more likely to have financial burden associated with their health care and reduced access to or use of health care services compared with those in large MSAs. However, the differences in the measures examined may be due to differential distributions of poverty levels, insurance coverage status, or other sociodemographic or health characteristics between the MSA status categories rather than MSA status itself.

A full-scale survey of sludge landfill: sludge properties, leachate characteristics and microbial community structure

In this study, a full-scale survey was conducted of a sludge landfill that had been sealed for 10 years to investigate sludge properties, leachate characteristics and microbial community structure. Vertical distribution of sludge and leachate pollutants in the landfill site showed that the sludge and soluble pollutants in the leachate were both distributed almost evenly even after long-term anaerobic digestion, and higher concentrations of soluble pollutants and richness of microbial community were observed at the middle layer. Compared to dewatered excess sludge generated from the activated sludge process before landfill, landfill sludge had a much lower organic content (28.1%), smaller particle size and worse dewaterability. Compared to municipal waste landfill, sludge landfill generated leachate with a lower concentration of organic substances, and comparable concentrations of nitrogenous and phosphorus pollutants. Bacterial community analysis by Illumina MiSeq sequencing showed that Proteobacteria, Firmicutes, Chloroflexi, Actinobacteria and Bacteroidetes were the major phyla, and some new genera (Methylocystaceae, Mariniphaga and Aminicenantes) were enriched in the sludge landfill. Archaeal community analysis showed that aceticlastic methanogenesis by Methanosaeta and Methanosarcina was the main pathway for methane production in the sludge landfill, in contrast to waste landfill with hydrogenotrophic methanogenesis as the main pathway.

A farm-scale grass biorefinery concept for combined pig feed and biogas production

This study assessed the nutrient flows and the economic viability of a farm-scale grass biorefinery concept for a pig farm. Grass silage was separated into liquid and solid fractions; the liquid fraction was used as pig feed and the solid fraction was directed to biogas production together with pig slurry. The addition of grass to the farm's crop rotation and its use in feed and biogas production slightly increased the share of nitrogen (N) circulating within the farm (by 2%), thus decreasing phosphorus circulation by 3%. Despite the positive effect on N balance, the economy of the farm-scale concept had challenges. However, upgrading biogas to vehicle fuel and selling it on farm was more economically viable than combined heat and power production. The proposed concept could be economically viable with a slight increase in the price of vehicle fuel, a moderate increase in the price of the grass liquid fraction, or better optimization of the system, starting with grass cultivation and processing. Moreover, profitable production could also be reached by increasing the scale of production by increasing farm size or by two or more farms working together.

Assessment of frailty syndrome using Edmonton frailty scale in Polish elderly sample

The aim of the study was to assess the incidence and severity of the frailty syndrome assessed with the Edmonton Frailty Scale. This is a cross-sectional study conducted among 382 patients (236 men and 146 women, mean age 71.9 years). The Edmonton Frailty Scale was administered during the patient's admission to the hospital. The Polish adaptation was performed using the standard methodology. The Cronbach's alpha coefficient for the whole Edmonton Frailty Scale was 0.709. The mean correlation between positions and the overall result was r = 0.180. There were no statistically significant differences between women and men in the area of Edmonton Frailty Scale mean score (p < 0.05). The socio-clinical analysis, showed statistically significant differences in the age of respondents, educational attainment, occupational activity, number of drugs taken and co-occurrence of chronic diseases. A higher values of the Edmonton Frailty Scale were indicated for individuals >70 years than for those <70 years (p < 0.001). The Edmonton Frailty Scale proved to be a reliable tool which may be used in the Polish population. The use of this questionnaire for frailty syndrome may be helpful in everyday clinical practice.

Pilot Evaluation of Aggregate Plate Waste as a Measure of Students' School Lunch Consumption

BACKGROUND

Weighing an individual's plate waste provides reliable estimates of food intake by physically weighing individual food components to the nearest gram before and after a meal. Weighing aggregate, school-level food waste may be an inexpensive and less time-consuming alternative. However, it has not been determined whether aggregate plate waste is an accurate measure of individually weighed plate waste.

OBJECTIVE

This pilot study aimed to evaluate the accuracy of aggregate plate waste for quantifying food waste in a school cafeteria setting in comparison with individually weighed plate waste.

DESIGN

A pilot validation study in which aggregate plate waste was compared against individually weighed plate waste in a school cafeteria setting.

PARTICIPANTS/SETTING

This study took place in an urban, low-income school district in Massachusetts in the spring of 2014. Four elementary schools with identical cafeterias and meals participated in the study. Approximately 1,700 students participated in this study.

MAIN OUTCOME MEASURES

For individually weighed plate waste, the percent discarded was calculated by dividing the weight of each discarded item by the average weight of the food item served and the percent consumed was calculated as the residual. For aggregate-level measurements, waste was separated by component (entrée, vegetable, fruit, and milk), and the weight discarded was calculated based on the weight of the cumulative amount remaining and an average weight for each food item served, with the percent consumed calculated as the residual.

STATISTICAL ANALYSES PERFORMED

Intraclass correlation coefficients (ICCs) were calculated to assess the agreement between aggregate plate waste and individual-level plate waste values.

RESULTS

Agreement was excellent for entrées (ICC=0.90) and vegetables (ICC=0.78), but poor for milk (ICC=0.22) and fruits (ICC=0.23). The overall agreement for all four components combined was excellent (ICC=0.75).

CONCLUSIONS

Results suggest that aggregate plate waste may provide a reasonable estimate of individually weighed plate waste, but additional research is warranted.

Endothelial keratoplasty: The relationship between recipient anterior chamber depth and endothelial cell loss

PURPOSE

To determine the relationship between anterior chamber depth (ACD) and percent endothelial cell loss (ECL) after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).

METHOD

In 78 eyes receiving triple procedure (DSAEK combined with cataract extraction and posterior chamber intraocular lens (PCIOL) implantation), ACD was measured preoperatively with an intraocular lens (IOL) Master and ECL was calculated with specular microscopy at 6 months, 1, 2, 3, and 4 years postoperatively. ACD and ECL from all 78 eyes were compared using correlation analysis and students t test. Eyes were then separated into 2 groups based on ACD, group 1 with ACD < 3mm and group 2 with ACD ≥ 3mm. Students t test was then performed to compare group 1 and group 2 ECL at 6 months, 1, 2, 3, and 4 years postoperative.

RESULTS

Mean ACD for all 78 eyes was 2.93 ± 0.43 mm. Mean ECL was 32.7%, 27.6%, 29.6%, 32.5%, and 37.2% at 6 months, 1, 2, 3, and 4 years. No significant correlation between ACD and ECL was observed at any time point for the combined analysis of 78 eyes (P > .05). At 2 and 4 years postoperative, mean ECL was 32.6% ± 16.1% and 43.0% ± 23.2% in eyes with ACD < 3mm and 25.3% ± 13.0% and 29.6% ± 18.2% in eyes with ACD ≥ 3 mm (P = .041 at 2 years and .008 at 4 years).

CONCLUSION

ACD and ECL were not directly correlated; however, there may be a threshold ACD in which shallower anterior chambers preoperatively result in greater donor ECL over time.

Association of a Beverage Tax on Sugar-Sweetened and Artificially Sweetened Beverages With Changes in Beverage Prices and Sales at Chain Retailers in a Large Urban Setting

IMPORTANCE

Policy makers have implemented beverage taxes to generate revenue and reduce consumption of sweetened drinks. In January 2017, Philadelphia, Pennsylvania, became the second US city to implement a beverage excise tax (1.5 cents per ounce).

OBJECTIVES

To compare changes in beverage prices and sales following the implementation of the tax in Philadelphia compared with Baltimore, Maryland (a control city without a tax) and to assess potential cross-border shopping to avoid the tax in neighboring zip codes.

DESIGN, SETTING, AND PARTICIPANTS

This study used a difference-in-differences approach and analyzed sales data to compare changes between January 1, 2016, before the tax, and December 31, 2017, after the tax. Differences by store type, beverage sweetener status, and beverage size were examined. The commercial retailer sales data included large chain store sales in Philadelphia, Baltimore, and the Pennsylvania zip codes bordering Philadelphia. These data reflect approximately 25% of the ounces of taxed beverages sold in Philadelphia.

EXPOSURES

Philadelphia's tax on sugar-sweetened and artificially sweetened beverages.

MAIN OUTCOMES AND MEASURES

Change in taxed beverage prices and volume sales.

RESULTS

A total of 291 stores (54 supermarkets, 20 mass merchandise stores, 217 pharmacies) were analyzed. The mean price per ounce of taxed beverages in Philadelphia increased from 5.43 cents in 2016 to 6.24 cents in 2017 at supermarkets; from 5.28 cents to 6.24 cents at mass merchandise stores, and from 6.60 cents to 8.28 cents at pharmacies. The mean price per ounce in Baltimore increased from 5.33 cents in 2016 to 5.50 cents in 2017 at supermarkets, from 6.34 cents to 6.52 cents at mass merchandise stores, and from 6.76 cents to 6.93 cents at pharmacies. The mean per-ounce difference in price between the 2 cities was 0.65 cents (95% CI, 0.60 cents-0.69 cents; P<.001) at supermarkets; 0.87 cents (95 % CI, 0.72 cents-1.02 cents; P<.001) at mass merchandise stores, and 1.56 cents (95% CI, 1.50 cents-1.62 cents; P<.001) at pharmacies. Total volume sales of taxed beverages in Philadelphia decreased by 1.3 billion ounces (from 2.475 billion to 1.214 billion) or by 51.0% after tax implementation. Volume sales in the Pennsylvania border zip codes, however, increased by 308.2 million ounces (from 713.1 million to 1.021 billion), offsetting the decrease in Philadelphia's volume sales by 24.4%. In Philadelphia, beverage volume sales in ounces per 4-week period between before and after tax periods decreased from 4.85 million to 1.99 million at supermarkets, from 2.98 million to 1.72 million at mass merchandise stores, and from 0.16 million to 0.13 million at pharmacies. In Baltimore, the beverage volume sales in ounces decreased from 2.83 million to 2.81 million at supermarkets, from 1.05 million to 1.00 million at mass merchandise stores, and from 0.14 million to 0.13 million at pharmacies. This was a 58.7% reduction at supermarkets (difference-in-differences, -2.85 million ounces; 95% CI, -4.10 million to -1.60 million ounces; P < .001), 40.4% reduction at mass merchandise stores (difference-in-differences, -1.20 million ounces; 95% CI, -2.04 million to -0.36 million ounces; P = .001), and 12.6% reduction in pharmacies (difference-in-differences, -0.02 million ounces; 95% CI, -0.03 million to -0.01 million ounces; P < .001).

CONCLUSIONS AND RELEVANCE

In Philadelphia in 2017, the implementation of a beverage excise tax on sugar-sweetened and artificially sweetened beverages was associated with significantly higher beverage prices and a significant and substantial decline in volume of taxed beverages sold. This decrease in taxed beverage sales volume was partially offset by increases in volume of sales in bordering areas.

Red cell distribution width predicts mid-term prognosis in patients hospitalized with acute heart failure: the RDW in Acute Heart Failure (RE-AHF) study

The aim of the study was to evaluate the prognostic role of red cell distribution width (RDW) in a broad population of patients hospitalized for acute heart failure (AHF). In a retrospective cohort observational study, 451 consecutive patients discharged for AHF were categorized in patients with low RDW (≤ 14.8%) and high RDW (> 14.8%). The rates of death from all causes or of hospital readmission for worsening heart failure and death were determined after a median follow-up of 18 months. The overall population has a median age of 80 years (IQR 72-85), 235 patients (52%) were males. Patients with a higher RDW have more comorbidities and a higher Charlson Index. At follow-up, 200 patients (44%) had died and 247 (54%) had died or were readmitted for HF: in the cohort with low RDW, 70 patients (36.4%) had died, whereas in the cohort with high RDW, 165 patients (63.7%) had died: the unadjusted risk ratio of patients with high RDW was 2.03 (log-rank test: p < 0.0001). In a multivariate Cox regression model, the hazard ratio for death from any cause in the 'high RDW' cohort is 1.73 (95% confidence interval 1.2-2.48; p = 0.003); the RDW adds prognostic information beyond that provided by conventional predictors, including age; etiology of HF; anemia; hyponatremia; estimated glomerular filtration rate; NT-proBNP levels; Charlson comorbidity score, atrial fibrillation, functional status, therapy with renin-angiotensin-aldosterone system inhibitors, beta-blockers. RDW is a powerful marker of worse long-term outcomes in patients with AHF, and its prognostic value is maintained beyond that provided by other well-established risk factors or biomarkers.

Variability in the spatial density of vacant properties contributes to background lead (Pb) exposure in children

BACKGROUND

Heightened blood lead levels (BLL) are associated with cognitive deficiencies and adverse behavioral outcomes. Lead-contaminated house dust is the primary source of exposure in U.S. children, and evidence suggests that even background (low-level) exposure has negative consequences. Identifying sources of background exposure is of great public health significance because of the larger number of children that can be affected.

METHODS

Blood lead was assessed in a bi-racial sample of children from Syracuse, NY, aged 9-11, using established biomonitoring methods. The spatial density of vacant properties was modelled from publicly available georeferenced datasets. Further, regression models were used to measure the impact of this spatial density variable on children's BLL.

RESULTS

In a sample of 221 children, with a mean BLL of 1.06 µg/dL (SD = 0.68), results showed increases in spatial density of vacant properties predict increases in median blood-PB levels, b = 0.14 (0.06-0.21), p < .001. This association held true even after accounting for demographic covariates, and age of individual housing. Further analysis showed spatial autocorrelation of the residuals changed from a clustered pattern to a random pattern once the spatial density variable was introduced to the model.

DISCUSSION

This study is the first to identify a background-lead exposure source using spatial density modelling. As vacant properties deteriorate, lead-contaminated dust likely disperses into the surrounding environment. High-density areas have an accumulation of lead hazards in environmental media, namely soil and dust, putting more children at risk of exposure.

Police Officer performance and perception using light, medium and heavy weight tactical batons

OBJECTIVE

Compare the effectiveness of light, medium and heavy weight Police expandable batons from a performance and a user perception perspective.

RATIONALE

Police Officers are required to control combative individuals using less lethal tactics in proportion to the threat they face. Officers need to deliver sufficient force quickly and accurately. As such, it is important to select batons that are optimal for both performance and user experience.

METHODS

Eleven active-duty New York Police Department Officers completed static and dynamic strike testing followed by a questionnaire. Six baton types were tested using different weights and lengths.

RESULTS

Peak force, dynamic task speed and accuracy were similar between baton types. Peak impulse, forearm muscle activity, and discomfort were higher with the heaviest baton.

CONCLUSIONS

Lighter batons can deliver sufficient force to control assailants while imposing lower ergonomic costs and being preferable to the user with no impact on speed or accuracy.

Placental weight in relation to maternal and paternal preconception and prenatal urinary phthalate metabolite concentrations among subfertile couples

INTRODUCTION

Phthalates are known reproductive toxicants that reduce placental and fetal weight in experimental animal studies. Although phthalate exposure has been associated with reduced birth weight in humans, there is limited epidemiologic evidence on whether the placenta is also affected.

OBJECTIVE

To assess whether maternal and paternal preconception and prenatal urinary phthalate metabolite concentrations are associated with placental weight, and the birth weight: placental weight (BW:PW) ratio among singletons conceived by subfertile couples.

METHODS

The present analysis included 132 mothers and 68 fathers, and their corresponding 132 singletons recruited in an academic hospital fertility center in Boston, Massachusetts. Urinary concentrations of eleven phthalate metabolites were measured and averaged in multiple paternal (n = 196) and maternal (n = 596) preconception, and maternal prenatal (n = 328) samples. Placental weight and birth weight (grams) were abstracted from delivery records, and the BW:PW was calculated. We estimated the association of natural log-phthalate metabolite concentrations across windows of exposure with placental weight and the BW:PW ratio using multivariable linear regression models, adjusting for a priori covariates.

RESULTS

In adjusted models, each log-unit increase in paternal urinary concentrations of the sum of di-(2-ethylhexyl) phthalate (ΣDEHP) metabolites was associated with a 24 g (95% CI: -48, -1) decrease in placental weight. We also observed a significant negative association between maternal preconception monoethyl phthalate (MEP) metabolite concentrations and the BW:PW ratio (β = -0.26; 95%CI: -0.49, -0.04). Additionally, each log-unit increase in prenatal MEP metabolite concentrations was associated with a 24 g (95% CI: -41, -7) decrease in placental weight.

CONCLUSIONS

Our results suggest that certain paternal and maternal urinary phthalate metabolites may affect placental weight and the BW:PW ratio. However, given the small sample size within a subfertile cohort and the novelty of these findings, more studies are needed to confirm the present results.

Vehicle registration year, age, and weight - Untangling the effects on crash risk

The aim of the present study was to investigate the effects of passenger cars' first year of registration, weight, and age on the number of killed or seriously injured (KSI) car drivers, pedestrians, and cyclists. Poisson regression models were developed of injury crashes involving passenger cars in Norway in 2000-2016, with the following predictor variables: The cars' first year of registration and weight, either crash year or car age, the drivers age and gender, and in models for car-car collisions the crash partner cars' weight and either registration year or age. The results show that there are fewer KSI car drivers in more recent, newer, and heavier cars. It is estimated that the number of KSI car drivers in all types of crashes on average decreases by 6.7% for each consecutive registration year (-7.2% in car-car collisions and -6.0% in single vehicle crashes), increases by 3.7% for each consecutive year of age (+2.1% in car-car collisions and +5.3% in single vehicle crashes), and decreases by 4.9% on average for each 100 kg weight increase (-11.1% in car-car collisions and -2.3% in single vehicle crashes). In car-car collisions there are fewer KSI car drivers when the crash partner car is more recent (-4.4% for each consecutive registration year), and more KSI car drivers when the crash partner car is older (+4.1% for each consecutive year of age), or heavier (+6.8% per 100 kg weight increase). In collisions with pedestrians or cyclists, there are fewer KSI pedestrians/cyclists when the car is more recent (-3.3% per consecutive registration year) and more KSI pedestrians/cyclists when the car is heavier (+4.6% per 100 kg weight increase). Due to the large effects of safety improvements in more recent cars, an increased renewal rate in the passenger car fleet can be expected to contribute to large safety improvements. The increasing weight of more recent cars may contribute to improved safety for those who drive heavier cars, but overall the effect of increasing weight is probably small or even negative because heavier vehicles impose greater risk on other car drivers, pedestrians, and cyclists.

Measurement and Outcomes of the Perceived Risk of Stroke: A Review

Stroke continues to be a public health problem, and risk perceptions are key to understanding people's thoughts about stroke risk and their preventive health behaviors. This review identifies how the perceived risk of stroke has been measured and outcomes in terms of levels, predictors, accuracy, and intervention results. Sixteen studies were included. The perceived risk of stroke has primarily been assessed with single-item measures; no multi-item surveys were found. In general, people tend to perceive a low-moderate risk of stroke; the most common predictors of higher stroke risk perceptions were having risk factors for stroke (hypertension, diabetes) and a higher number of risk factors. However, inaccuracies were common; at least half of respondents underestimated/overestimated their risk. Few studies have examined whether interventions can improve the perceived risk of stroke. Strategies to improve stroke risk perceptions should be explored to determine whether accuracy can promote healthy lifestyles to reduce stroke risk.

Mothers' Thoughts and Feelings About Using a Pediatric Scale in the Home to Monitor Weight Changes in Breastfed Newborns

OBJECTIVE

To document mothers' thoughts and feelings about using a pediatric digital scale in their homes to monitor the weights of their newborns.

DESIGN

Cross-sectional design.

SETTING

A community hospital in the northeastern region of the United States.

PARTICIPANTS

Women (N = 63) who gave birth between August 2015 and September 2016 to healthy, full-term singleton newborns who were exclusively or predominantly breastfed at the time of hospital discharge.

MEASUREMENTS

We used an online survey to document participants' thoughts and feelings about the use of a pediatric scale in their homes to monitor the weights of their newborns every day for 2 weeks after birth.

RESULTS

Most participants (81%) had positive responses about the use of a pediatric scale in their homes. The collection of daily weight provided valuable knowledge (67%) and elicited feelings of reassurance (32%) and increased confidence in breastfeeding (14%). For some women (14%), using the scale caused concern about neonatal weight. If a participant believed her newborn was not feeding or gaining weight well (n = 9), she was more likely to have mixed or negative feelings about the scale (67%).

CONCLUSION

Women who breastfeed may benefit from the use of a pediatric scale in their homes. They may gain valuable knowledge and have increased confidence in breastfeeding if they monitor neonatal weight changes. Use of the scale may also alert mothers to early problems with newborn feeding or growth.

Reliability of the sliding scale for collecting affective responses to words

Warriner, Shore, Schmidt, Imbault, and Kuperman, Canadian Journal of Experimental Psychology, 71; 71-88 (2017) have recently proposed a slider task in which participants move a manikin on a computer screen toward or further away from a word, and the distance (in pixels) is a measure of the word's valence. Warriner, Shore, Schmidt, Imbault, and Kuperman, Canadian Journal of Experimental Psychology, 71; 71-88 (2017) showed this task to be more valid than the widely used rating task, but they did not examine the reliability of the new methodology. In this study we investigated multiple aspects of this task's reliability. In Experiment 1 (Exps. 1.1-1.6), we showed that the sliding scale has high split-half reliability (r = .868 to .931). In Experiment 2, we also showed that the slider task elicits consistent repeated responses both within a single session (Exp. 2: r = .804) and across two sessions separated by one week (Exp. 3: r = .754). Overall, the slider task, in addition to having high validity, is highly reliable.

The Impact of Backpack Loads on School Children: A Critical Narrative Review

Background: Backpack loads of school students during school days have been suggested to range from 10% to as high as 25% of their body weight and may have a negative impact on their body. The aim of this review was to identify and review studies that have examined impacts of contemporary backpack loads on school children. Methods: A systematic search was conducted of the literature using key search terms. After relevant studies published in recent years were selected using strict inclusion and exclusion criteria, the studies were critically appraised and relevant data were extracted and tabulated prior to conducting a critical narrative synthesis of findings. Results: Twenty-one studies were included, ranging in methodological quality from poor to good (critical appraisal scores 22% to 77%). Students carried on average over 15% of their own body weight, which caused biomechanical and physiological adaptations that could increase musculoskeletal injury risk, fatigue, redness, swelling and discomfort. Conclusion: Considering the limited methodological quality and variations in foci across studies, further research is needed to elucidate: (1) the loads students carry around on a school day in their school backpacks and; (2) the biomechanical, physiological and physical effects of load carriage on students.

Using within-day hive weight changes to measure environmental effects on honey bee colonies

Patterns in within-day hive weight data from two independent datasets in Arizona and California were modeled using piecewise regression, and analyzed with respect to honey bee colony behavior and landscape effects. The regression analysis yielded information on the start and finish of a colony’s daily activity cycle, hive weight change at night, hive weight loss due to departing foragers and weight gain due to returning foragers. Assumptions about the meaning of the timing and size of the morning weight changes were tested in a third study by delaying the forager departure times from one to three hours using screen entrance gates. A regression of planned vs. observed departure delays showed that the initial hive weight loss around dawn was largely due to foragers. In a similar experiment in Australia, hive weight loss due to departing foragers in the morning was correlated with net bee traffic (difference between the number of departing bees and the number of arriving bees) and from those data the payload of the arriving bees was estimated to be 0.02 g. The piecewise regression approach was then used to analyze a fifth study involving hives with and without access to natural forage. The analysis showed that, during a commercial pollination event, hives with previous access to forage had a significantly higher rate of weight gain as the foragers returned in the afternoon, and, in the weeks after the pollination event, a significantly higher rate of weight loss in the morning, as foragers departed. This combination of continuous weight data and piecewise regression proved effective in detecting treatment differences in foraging activity that other methods failed to detect.

Development and validation of a Malawian version of the primary care assessment tool

BACKGROUND

Malawi does not have validated tools for assessing primary care performance from patients' experience. The aim of this study was to develop a Malawian version of Primary Care Assessment Tool (PCAT-Mw) and to evaluate its reliability and validity in the assessment of the core primary care dimensions from adult patients' perspective in Malawi.

METHODS

A team of experts assessed the South African version of the primary care assessment tool (ZA-PCAT) for face and content validity. The adapted questionnaire underwent forward and backward translation and a pilot study. The tool was then used in an interviewer administered cross-sectional survey in Neno district, Malawi, to test validity and reliability. Exploratory factor analysis was performed on a random half of the sample to evaluate internal consistency, reliability and construct validity of items and scales. The identified constructs were then tested with confirmatory factor analysis. Likert scale assumption testing and descriptive statistics were done on the final factor structure. The PCAT-Mw was further tested for intra-rater and inter-rater reliability.

RESULTS

From the responses of 631 patients, a 29-item PCAT-Mw was constructed comprising seven multi-item scales, representing five primary care dimensions (first contact, continuity, comprehensiveness, coordination and community orientation). All the seven scales achieved good internal consistency, item-total correlations and construct validity. Cronbach's alpha coefficient ranged from 0.66 to 0.91. A satisfactory goodness of fit model was achieved (GFI = 0.90, CFI = 0.91, RMSEA = 0.05, PCLOSE = 0.65). The full range of possible scores was observed for all scales. Scaling assumptions tests were achieved for all except the two comprehensiveness scales. Intra-class correlation coefficient (ICC) was 0.90 (n = 44, 95% CI 0.81-0.94, p < 0.001) for intra-rater reliability and 0.84 (n = 42, 95% CI 0.71-0.96, p < 0.001) for inter-rater reliability.

CONCLUSIONS

Comprehensive metric analyses supported the reliability and validity of PCAT-Mw in assessing the core concepts of primary care from adult patients' experience. This tool could be used for health service research in primary care in Malawi.

Validity and Interrater Reliability of the Visual Quarter-Waste Method for Assessing Food Waste in Middle School and High School Cafeteria Settings

BACKGROUND

Measuring food waste (ie, plate waste) in school cafeterias is an important tool to evaluate the effectiveness of school nutrition policies and interventions aimed at increasing consumption of healthier meals. Visual assessment methods are frequently applied in plate waste studies because they are more convenient than weighing. The visual quarter-waste method has become a common tool in studies of school meal waste and consumption, but previous studies of its validity and reliability have used correlation coefficients, which measure association but not necessarily agreement.

OBJECTIVE

The aims of this study were to determine, using a statistic measuring interrater agreement, whether the visual quarter-waste method is valid and reliable for assessing food waste in a school cafeteria setting when compared with the gold standard of weighed plate waste.

METHODS

To evaluate validity, researchers used the visual quarter-waste method and weighed food waste from 748 trays at four middle schools and five high schools in one school district in Washington State during May 2014. To assess interrater reliability, researcher pairs independently assessed 59 of the same trays using the visual quarter-waste method. Both validity and reliability were assessed using a weighted κ coefficient.

RESULTS

For validity, as compared with the measured weight, 45% of foods assessed using the visual quarter-waste method were in almost perfect agreement, 42% of foods were in substantial agreement, 10% were in moderate agreement, and 3% were in slight agreement. For interrater reliability between pairs of visual assessors, 46% of foods were in perfect agreement, 31% were in almost perfect agreement, 15% were in substantial agreement, and 8% were in moderate agreement.

CONCLUSIONS

These results suggest that the visual quarter-waste method is a valid and reliable tool for measuring plate waste in school cafeteria settings.

The Measurement of Palpebral Fissure Height Using the Intersection Angle (the Réal Angle) Between the Meeting Points of the Upper Eyelid and the Edge of the Cornea

BACKGROUND

We evaluated a new palpebral fissure height measurement to evaluate medial, lateral, and overall ptosis.

METHODS

We photographed 250 Koreans (44 males, 206 females) and evaluated their Réal 1 angle (angle between the meeting points of the upper eyelid and the corneal edge), Réal 2 angle (angle between the meeting point of the upper eyelid, medial corneal edge and a vertical line through the center of the pupil), Réal 3 angle (angle between the meeting point of the upper eyelid, lateral corneal edge and a vertical line through the center of the pupil), and Réal 4 angle (Réal 2-Réal 3). Angles were compared between sexes and age groups. We then evaluated the Réal angles of 13 Korean actresses.

RESULTS

Mean age was 31.85 ± 14.60 years; Réal 1 was 129.01° ± 14.23°, Réal 2 was 68.20° ± 7.49°, Réal 3 was 60.80° ± 9.65°. There was no significant difference between the sexes in Réal 1, Réal 2, and Réal 3 angles. Réal 1 increased with age, and Réal 4 decreased with age. All Réal angles were significantly different between age groups. The actresses' mean age was 30.66 ± 8.01 years; Réal 1 was 102.84° ± 10.16°, Réal 2 was 57.87° ± 6.10°, and Réal 3 was 44.97° ± 8.74°.

CONCLUSION

This simple measurement of palpebral fissure height using Réal angles consistently evaluated the amount of medial, lateral, and general ptosis. For average Korean eyes, the lateral portion of the upper eyelid is slightly higher than the medial portion; however, this lateral portion droops with age. Korean actresses have vertically higher eyes than average Korean women.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Overeat today, skip the scale tomorrow: An examination of caloric intake predicting nonadherence to daily self-weighing

OBJECTIVE

Daily self-weighing is an effective weight loss strategy. Little is known about "micro" factors influencing nonadherence to self-weighing (e.g., daily overeating). It was hypothesized that increased caloric intake on a given day would increase odds of not self-weighing the following day.

METHODS

Daily self-reports of weight and caloric intake were collected from 74 adults with overweight and obesity (mean BMI = 31.2 ± 4.5 kg/m² , age = 50.6 ± 10 years, 69% female, 87% Caucasian) throughout a 12-week Internet-based weight management intervention. Multilevel logistic regression investigated odds of nonadherence to self-weighing on a given day based on the previous day's caloric intake.

RESULTS

Self-monitoring adherence was high (weights: 87%; calories: 85%); adherence was associated with greater 12-week weight loss (weighing: r = -0.24, P = 0.04; calories: r = -0.26, P = 0.04). Increased caloric intake on a given day, relative to the individual's average intake, was associated with increased odds of nonadherence to self-weighing the next day (F_(1,5106)  = 12.66, P = 0.0004, β = 0.001). For example, following a day of eating 300 calories more than usual, odds of not self-weighing increased by 1.33.

CONCLUSIONS

Odds of nonadherence to self-weighing increased following a day with higher-than-usual caloric intake. Weight management interventions collecting daily self-monitoring data could provide support to participants who report increased caloric intake to prevent self-weighing nonadherence.

Measurement of parent satisfaction in the paediatric intensive care unit - Translation, cultural adaptation and psychometric equivalence for the French-speaking version of the EMPATHIC-65 questionnaire

INTRODUCTION

Within paediatric intensive care units (PICUs), only a few parent satisfaction instruments are validated and none are available for French-speaking parents. The aims of the study were to translate and culturally adapt the Dutch EMPATHIC-65 questionnaire into a French version and to test its psychometric equivalence.

METHODS

Two French-speaking PICUs in Switzerland and France participated. The questionnaire was translated using a standardised method and parents with PICU experience were interviewed to assess clarity of the translated version. Secondly, parents of children hospitalised for at least 24 hours and who were fluent in French, were invited to complete the French translated version of the EMPATHIC-65 questionnaire. Reliability and validity measures were used to examine its psychometric equivalence.

RESULTS

The overall mean clarity agreement reached 90.2% by 17 French-speaking parents. Eight unclear items have subsequently been reworded. One hundred seventy-two parents completed the French version questionnaire. Reliability and convergent validity have been confirmed by an adequate internal consistency (0.59-0.89) and convergent validity (r_s 0.25-0.63, p<0.01).

CONCLUSION

Psychometric equivalence of the French EMPATHIC-65 questionnaire highlights the appropriateness of relying on available valid instrument to expand the availability of health instrument measure in French.

[Determination of postoperative hemoglobin levels and their correlation with the weight of the transoperative textiles]

OBJECTIVE

To determine postsurgical hemoglobin levels and the correlation with trans-surgical textile weight.

MATERIALS AND METHODS

A cross-sectional study, including 120 patients who underwent gynecological surgery, was performed in the HGR 1 in Cd. Obregon Sonora, from June to July 2015; the account of textile weight blood loss estimation was carried out and subsequently became an association of hemoglobin levels in the postoperative period, performing the conversion of a gram to one milliliter. There was expected to be an association between blood loss with low levels of hemoglobin; for each lost 500 ml, the hemoglobin decreased by 1 g.

RESULTS

120 patients were evaluated; the average age was 48.65 years. The surgical events were divided in abdominal in 76.67%, breast surgery 19.17%, and vaginal 9.17%. There was a decrease in hemoglobin of 0.74 mg/dl and hematocrit of 1.93%. We found significant association between blood loss and the decrease in hemoglobin with relative risk of 3.01 (95% CI: 1.69-5.36).

CONCLUSIONS

The main conclusion of this study is to establish that a loss > 500 ml has a direct association with > 1.1 g postoperative hemoglobin decrease and hematocrit reduction > 6%.

Judgment of Volume from Photographs of Complex Shapes

Observers were asked to judge the volume reduction of 40 distorted metal containers from photographs. Hypotheses regarding the role of amount of information provided by photographs, complexity of damage to the container, past experience of the observer, and memory for visual forms were tested in a study using 279 college students. Findings revealed judgment accuracy to vary as a complex function of angular disparity between photographs, number of photographs, type of object, stimulus characteristics of individual containers, and degree of distortion. Volume reduction of “square” objects was judged more accurately than that of “round” objects. Individual observers were found to be reasonably consistent from one type of object to another in over- or underestimating volume reduction.

SI Units: How Systematic and How International are They?

Despite the fact that the use of SI units should standardize the reporting of results in chemical pathology, there is still considerable confusion in some areas about the accepted conventions. This confusion is particularly rife in reporting results of thyroxine, and, to a lesser extent, of lipid assays.

50 years of amino acid hydrophobicity scales: revisiting the capacity for peptide classification

BACKGROUND

Physicochemical properties are frequently analyzed to characterize protein-sequences of known and unknown function. Especially the hydrophobicity of amino acids is often used for structural prediction or for the detection of membrane associated or embedded β-sheets and α-helices. For this purpose many scales classifying amino acids according to their physicochemical properties have been defined over the past decades. In parallel, several hydrophobicity parameters have been defined for calculation of peptide properties. We analyzed the performance of separating sequence pools using 98 hydrophobicity scales and five different hydrophobicity parameters, namely the overall hydrophobicity, the hydrophobic moment for detection of the α-helical and β-sheet membrane segments, the alternating hydrophobicity and the exact ß-strand score.

RESULTS

Most of the scales are capable of discriminating between transmembrane α-helices and transmembrane β-sheets, but assignment of peptides to pools of soluble peptides of different secondary structures is not achieved at the same quality. The separation capacity as measure of the discrimination between different structural elements is best by using the five different hydrophobicity parameters, but addition of the alternating hydrophobicity does not provide a large benefit. An in silico evolutionary approach shows that scales have limitation in separation capacity with a maximal threshold of 0.6 in general. We observed that scales derived from the evolutionary approach performed best in separating the different peptide pools when values for arginine and tyrosine were largely distinct from the value of glutamate. Finally, the separation of secondary structure pools via hydrophobicity can be supported by specific detectable patterns of four amino acids.

CONCLUSION

It could be assumed that the quality of separation capacity of a certain scale depends on the spacing of the hydrophobicity value of certain amino acids. Irrespective of the wealth of hydrophobicity scales a scale separating all different kinds of secondary structures or between soluble and transmembrane peptides does not exist reflecting that properties other than hydrophobicity affect secondary structure formation as well. Nevertheless, application of hydrophobicity scales allows distinguishing between peptides with transmembrane α-helices and β-sheets. Furthermore, the overall separation capacity score of 0.6 using different hydrophobicity parameters could be assisted by pattern search on the protein sequence level for specific peptides with a length of four amino acids.