Nano zerovalent Fe did not reduce metal(loid) leaching and ecotoxicity further than conventional Fe grit in contrasting smelter impacted soils: A 1-year field study

The majority of the studies on nanoscale zero-valent iron (nZVI) are conducted at a laboratory-scale, while field-scale evidence is scarce. The objective of this study was to compare the metal(loid) immobilization efficiency of selected Fe-based materials under field conditions for a period of one year. Two contrasting metal(loid) (As, Cd, Pb, Zn) enriched soils from a smelter-contaminated area were amended with sulfidized nZVI (S-nZVI) solely or combined with thermally stabilized sewage sludge and compared to amendment with microscale iron grit. In the soil with higher pH (7.5) and organic matter content (TOC = 12.7 %), the application of amendments resulted in a moderate increase in pH and reduced As, Cd, Pb, and Zn leaching after 1-year, with S-nZVI and sludge combined being the most efficient, followed by iron grit and S-nZVI alone. However, the amendments had adverse impacts on microbial biomass quantity, S-nZVI being the least damaging. In the soil with a lower pH (6.0) and organic matter content (TOC = 2.3 %), the results were mixed; 0.01 M CaCl2 extraction data showed only S-nZVI with sludge as remaining effective in reducing extractable concentrations of metals; on the other hand, Cd and Zn concentrations were increased in the extracted soil pore water solutions, in contrast to the two conventional amendments. Despite that, S-nZVI with sludge enhanced the quantity of microbial biomass in this soil. Additional earthworm avoidance data indicated that they generally avoided soil treated with all Fe-based materials, but the presence of sludge impacted their preferences somewhat. In summary, no significant differences between S-nZVI and iron grit were observed for metal(loid) immobilization, though sludge significantly improved the performance of S-nZVI in terms of soil health indicators. Therefore, this study indicates that S-nZVI amendment of soils alone should be avoided, though further field evidence from a broader range of soils is now required.

Evaluating the effectiveness of sulfidated nano zerovalent iron and sludge co-application for reducing metal mobility in contaminated soil

Sewage sludge has long been applied to soils as a fertilizer yet may be enriched with leachable metal(loid)s and other pollutants. Sulfidated nanoscale zerovalent iron (S-nZVI) has proven effective at metal sorption; however, risks associated with the use of engineered nanoparticles cannot be neglected. This study investigated the effects of the co-application of composted sewage sludge with S-nZVI for the stabilization of Cd, Pb, Fe, Zn. Five treatments (control, Fe grit, composted sludge, S-nZVI, composted sludge and S-nZVI), two leaching fluids; synthetic precipitation leaching procedure (SPLP) and toxicity characteristic leaching procedure (TCLP) fluid were used, samples were incubated at different time intervals of 1 week, 1, 3, and 6 months. Fe grit proved most efficient in reducing the concentration of extractable metals in the batch experiment; the mixture of composted sludge and S-nZVI was the most effective in reducing the leachability of metals in the column systems, while S-nZVI was the most efficient for reducing about 80% of Zn concentration in soil solution. Thus, the combination of two amendments, S-nZVI incorporated with composted sewage sludge and Fe grit proved most effective at reducing metal leaching and possibly lowering the associated risks. Future work should investigate the longer-term efficiency of this combination.

School Health Programme in Sri Lanka: Assessment using WHO’s ‘4S’ Framework

Background

Sri Lanka has one of the oldest school health programmes (SHP) in the region, which was started in 1918, and at present caters for 70% of adolescents in the country. This study assessed the implementation status of the Sri Lankan SHP.

Methods

This review was conducted by a panel of experts adopting a participatory approach. Policies and supporting documents were collected from the relevant sectors of the Ministry of Health and Ministry of Education using electronic and manual search and by visiting institutions/resource persons. The WHO’s ’4S’ Framework; consisting of strategic information (S1), supportive evidence-informed policies (S2), strengthening services for adolescents (S3) and strengthening collaboration with other sectors (S4); was used as the guiding framework to analyse the strengths and weaknesses of the SHP.

Results

Having a comprehensive national health information system was the main strength on S1, gaps in timeliness, completeness and accuracy of the data, and the lack of evidence on perceived health needs of school children were the main weaknesses. On S2, Sri Lanka has a strong unifying policy platform supportive of the SHP, but the timeliest need is to finalise the School Health Policy. More than 90% island-wide coverage of school medical inspection was the main strength on S3, while focusing more on physical health and less emphasis on promoting mental health in the existing service package and gaps in the referral/follow-up were the weaknesses. On S4, school staff focusing more on achieving academic-related outcomes and focusing less on health-related activities, undue media and industry influence hindering the promotion of healthy behaviours in school settings were the main challenges.

Conclusions

Despite several emerging challenges, the SHP in Sri Lanka is one of the best school health programmes in the region with more than 90% island-wide coverage of health services.

Key messages

The SHP in Sri Lanka, which is one of the oldest and the best school health programmes in the region, caters for 70% of adolescents in the country. Assessment of Sri Lankan SHP according to the WHO’s ‘4S’ Framework revealed multiple strengths such as comprehensive national health information system and high island-wide coverage.

Assessment of Adolescent and Youth Friendly Health Services in Sri Lanka using WHO’s ‘4S’ Framework

Background

The Adolescent and Youth Friendly Health Services (AYFHS) in Sri Lanka (SL) are provided via three service models, viz., hospital-based, field-based and centre-based. This study assessed the implementation status of AYFHS in SL.

Methods

A panel of experts conducted the review by adopting a participatory approach. Policies and supporting documents were collected from the relevant sectors of the Ministry of Health using electronic and manual search and by visiting institutions/resource persons. The strengths and weaknesses of the AYFHS were identified using the WHO’s ’4S’ Framework consisting strategic information (S1), supportive evidence-informed policies (S2), strengthening services for adolescents (S3) and strengthening collaboration with other sectors (S4).

Results

While recent development of guidelines, standards and protocols in line with WHO/UNAIDS ’Global Standards for Quality Health-care Services for Adolescents’ was the main strength on S1, gaps in timeliness, completeness and accuracy of the data; and the gaps in effective utilization of sub-national level data addressing area specific problems were the main weaknesses. On S2, SL has a strong, supportive policy environment to promote adolescent health. Lack of coherence in existing health related policies was the main gap. A comprehensive health care package was a strength on S3, while difficulty in reaching the vulnerable groups, curative service oriented service package and underutilization of the health services by adolescents were the weaknesses. On S4, lack of sustained political commitment identifying adolescent health as a priority development issue across multi-stakeholders and their silo mentality to maintain the accountability/ownership of cross-cutting programmatic activities were the weaknesses.

Conclusions

Despite numerous imposing challenges, with mainstreaming and constructive monitoring, the AYFHS in SL will remain as one of the best adolescent health programmes in the region.

Key messages

Assessment of Sri Lankan AYFHS according to the WHO’s ’4S’ Framework revealed multiple strengths such as updated guidelines, supportive policy environment and comprehensive care package. Despite numerous imposing challenges, with mainstreaming and constructive monitoring, the AYFHS in SL will remain as one of the best adolescent health programmes in the region.

Relationship between burnout and work engagement among Sri Lankan collegiate cycle students

Background

Keeping on par with the emerging trend towards positive psychology focusing on optimal functioning, burnout research is also associated with a shift towards its positive antipode; work engagement. This study was aimed at determining the relationship between burnout and work engagement among collegiate cycle students in Sri Lanka.

Methods

A school-based, cross-sectional study was conducted among 872 grade thirteen students in 15 government schools in the Kegalle district, Sri Lanka. The validated Sinhala versions of the 15-item Maslach Burnout Inventory-Student Survey and the 16-item Utrecht Work Engagement Scale-Student Version were used to assess burnout and work engagement respectively. The relationship between subscales of burnout; viz., exhaustion (EX), cynicism (CY) and reduced professional efficacy (rPE); and subscales of work engagement; viz., vigor (VI), dedication (DE) and absorption (AB); were assessed using Pearson product-moment correlation coefficient.

Results

The response rate was 91.3%. The EX subscale of burnout had strong negative correlations with VI (r=-0.699) and AB (r=-0.642) subscales and a moderate negative correlation (r=-0.475) with DE subscale of work engagement. The CY subscale of burnout had a strong negative correlation with AB subscale (r=-0.577), a moderate negative correlation with VI subscale (r=-0.391) and a weak negative correlation (r=-0.195) with DE subscale. The rPE subscale of burnout had weak negative correlations with DE subscale (r=-0.218), AB subscale (r=-0.206) and VI subscale (r=-0.128). All these correlations between the subscales of burnout and work engagement were statistically significant (p < 0.001).

Conclusions

Given the significant negative correlation between burnout and work engagement, exploring student work engagement may allow identification of their positive psychological characteristics that can be incorporated in formulating packages for preventing burnout.

Key messages

Bivariate correlation revealed that all three subscales of burnout had statistically significant negative correlations with all three subscales of work engagement. Exploring student work engagement may allow identification of their positive psychological characteristics that can be incorporated in formulating packages for preventing burnout.

Expansion of highly activated invariant natural killer T cells with altered phenotype in acute dengue infection

Invariant natural killer T (iNKT) cells are capable of rapid activation and production of cytokines upon recognition of antigenic lipids presented by CD1d molecules. They have been shown to play a significant role in many viral infections and were observed to be highly activated in patients with acute dengue infection. In order to characterize further their role in dengue infection, we investigated the proportion of iNKT cells and their phenotype in adult patients with acute dengue infection. The functionality of iNKT cells in patients was investigated by both interferon (IFN)-γ and interleukin (IL)-4 ex-vivo enzyme-linked immunospot (ELISPOT) assays following stimulation with alpha-galactosyl-ceramide (αGalCer). We found that circulating iNKT cell proportions were significantly higher (P = 0·03) in patients with acute dengue when compared to healthy individuals and were predominantly of the CD4(+) subset. iNKT cells of patients with acute dengue had reduced proportions expressing CD8α and CD161 when compared to healthy individuals. The iNKT cells of patients were highly activated and iNKT activation correlated significantly with dengue virus-specific immunoglobulin (Ig)G antibody levels. iNKT cells expressing Bcl-6 (P = 0·0003) and both Bcl-6 and inducible T cell co-stimulator (ICOS) (P = 0·006) were increased significantly in patients when compared to healthy individuals. Therefore, our data suggest that in acute dengue infection there is an expansion of highly activated CD4(+) iNKT cells, with reduced expression of CD161 markers.

Dengue NS1 antigen contributes to disease severity by inducing interleukin (IL)-10 by monocytes

Both dengue NS1 antigen and serum interleukin (IL)-10 levels have been shown to associate with severe clinical disease in acute dengue infection, and IL-10 has also been shown to suppress dengue-specific T cell responses. Therefore, we proceeded to investigate the mechanisms by which dengue NS1 contributes to disease pathogenesis and if it is associated with altered IL-10 production. Serum IL-10 and dengue NS1 antigen levels were assessed serially in 36 adult Sri Lankan individuals with acute dengue infection. We found that the serum IL-10 levels correlated positively with dengue NS1 antigen levels (Spearman's r = 0·47, P < 0·0001), and NS1 also correlated with annexin V expression by T cells in acute dengue (Spearman's r = 0·63, P = 0·001). However, NS1 levels did not associate with the functionality of T cell responses or with expression of co-stimulatory molecules. Therefore, we further assessed the effect of dengue NS1 on monocytes and T cells by co-culturing primary monocytes and peripheral blood mononuclear cells (PBMC), with varying concentrations of NS1 for up to 96 h. Monocytes co-cultured with NS1 produced high levels of IL-10, with the highest levels seen at 24 h, and then declined gradually. Therefore, our data show that dengue NS1 appears to contribute to pathogenesis of dengue infection by inducing IL-10 production by monocytes.

How workflow management systems enable the achievement of value driven healthcare delivery

Healthcare institutions globally are currently having major problems accessing and maintaining the large amounts of data that are continuously being generated. Examination of the clinical procedures relating to patient management reveals that many of these activities are repetitive. Workflow Management Systems (WFMS) can automate these repeated activities. Moreover, the introduction of WFMS would enable healthcare institutions to face this challenge of transforming large amounts of medical data into contextually relevant clinical information and knowledge. In order to emphasise the dynamic connection between healthcare, workflow and internet technologies, the intelligence continuum is introduced.

Integrating knowledge workers and the organization: the role of IT

Agency theory is primarily concerned with the relationship between the principal (employer/purchaser) and the agent (employee/contractor) in the issue of goal-aligned behavior. Jensen and Meckling and others were not referring to a knowledge worker agent in their conceptualization of the principal/agent relationship. The significance of having a knowledge worker agent is that the decision rights are no longer located with the principal but with the agent. This in turn has a tremendous bearing on goal alignment and agency problems. We propose that information systems/information technology (IS/IT), in particular enterprise wide systems, can alleviate these agency problems. We illustrate this through a case example from health care, an industry with a high proportion of knowledge worker agents.