Clinical Audit of Assisting Renal Biopsy Procedure Performed in Nephrology Unit of a Tertiary Care Hospital with a View to Develop Standard Nursing Procedure Protocol.

Background: Renal biopsy is one of the most commonly performed diagnostic procedures in the nephrology unit. Nurses play a very important role in pre-biopsy preparation, assisting during procedure and post-biopsy care. Nursing care provided during or after renal biopsy is of utmost importance in reducing complications. The study aims to perform a clinical audit of nursing practices to find the gaps in existing practices for the procedure of assisting renal biopsy and to develop standard protocol. Materials and Methods: This descriptive observational study was conducted on 19 nurses who were working in the nephrology unit of the tertiary care center. They were enrolled through total enumerative sampling. Sociodemographic profile and clinical profile were collected. The observation checklist was formed based on standard nursing practices, which included three dimensions for the procedure of assisting renal biopsy. Based on the gaps identified, a standard protocol was developed. Nurses were observed during two shifts and each nurse was observed once. Scoring of items was done in each dimension and for acceptable practices, nurses have to score ≥80% in each dimension. Data were analyzed using descriptive statistics. Results: The majority of nurses (73.7%) have not undergone any special training in nephrology. None (100%) showed an acceptable level of nursing practices for all the dimensions of assisting renal biopsy procedure. Standard protocol was developed by the researcher following a rigorous process. Conclusion: The clinical audit found that there were gaps in the existing nursing practices for the procedure of assisting renal biopsy and these gaps have been addressed by the development of a standard protocol.

Guidelines for Manufacturing and Application of Organoids: Heart.

Cardiac organoids have emerged as invaluable tools for assessing the impact of diverse substances on heart function. This report introduces guidelines for general requirements for manufacturing cardiac organoids and conducting cardiac organoid-based assays, encompassing protocols, analytical methodologies, and ethical considerations. In the quest to employ recently developed three-dimensional cardiac organoid models as substitutes for animal testing, it becomes imperative to establish robust criteria for evaluating organoid quality and conducting toxicity assessments. This guideline addresses this need, catering to regulatory requirements, and describes common standards for organoid quality and toxicity assessment methodologies, commensurate with current technological capabilities. While acknowledging the dynamic nature of technological progress and the potential for future comparative studies, this guideline serves as a foundational framework. It offers a comprehensive approach to standardized cardiac organoid testing, ensuring scientific rigor, reproducibility, and ethical integrity in investigations of cardiotoxicity, particularly through the utilization of human pluripotent stem cell-derived cardiac organoids.

Methods used to develop the SPIRIT 2024 and CONSORT 2024 Statements.

OBJECTIVES: To describe, and explain the rationale for, the methods used and decisions made during development of the updated SPIRIT 2024 and CONSORT 2024 reporting guidelines. METHODS: We developed SPIRIT 2024 and CONSORT 2024 together to facilitate harmonization of the two guidelines, and incorporated content from key extensions. We conducted a scoping review of comments suggesting changes to SPIRIT 2013 and CONSORT 2010, and compiled a list of other possible revisions based on existing SPIRIT and CONSORT extensions, other reporting guidelines, and personal communications. From this, we generated a list of potential modifications or additions to SPIRIT and CONSORT, which we presented to stakeholders for feedback in an international online Delphi survey. The Delphi survey results were discussed at an online expert consensus meeting attended by 30 invited international participants. We then drafted the updated SPIRIT and CONSORT checklists and revised them based on further feedback from meeting attendees. RESULTS: We compiled 83 suggestions for revisions or additions to SPIRIT and/or CONSORT from the scoping review and 85 from other sources, from which we generated 33 potential changes to SPIRIT (n = 5) or CONSORT (n = 28). Of 463 participants invited to take part in the Delphi survey, 317 (68%) responded to Round 1, 303 (65%) to Round 2 and 290 (63%) to Round 3. Two additional potential checklist changes were added to the Delphi survey based on Round 1 comments. Overall, 14/35 (SPIRIT n = 0; CONSORT n = 14) proposed changes reached the predefined consensus threshold (≥80% agreement), and participants provided 3580 free-text comments. The consensus meeting participants agreed with implementing 11/14 of the proposed changes that reached consensus in the Delphi and supported implementing a further 4/21 changes (SPIRIT n = 2; CONSORT n = 2) that had not reached the Delphi threshold. They also recommended further changes to refine key concepts and for clarity. CONCLUSION: The forthcoming SPIRIT 2024 and CONSORT 2024 Statements will provide updated, harmonized guidance for reporting randomized controlled trial protocols and results, respectively. The simultaneous development of the SPIRIT and CONSORT checklists has been informed by current empirical evidence and extensive input from stakeholders. We hope that this report of the methods used will be helpful for developers of future reporting guidelines.

Impact of a standardized protocol for chest tube management after VATS pulmonary resections on post-operative outcomes and complications.

Chest tube management represents a major issue after lung surgery as no protocol is widely accepted and tube management is generally based on local or personal habits. Aim of this study is to evaluate the impact of a standardized protocol for chest tube management after pulmonary resections on the post-operative outcomes. We performed a single center retrospective analysis of all adult patients undergoing thoracoscopic pulmonary resection from January 2020 to December 2021. Starting from January 2021 a standardized protocol of chest tube management was applied after all procedures. Patients were divided into two groups according to the chest tube management strategy. he two groups had similar pre-operative characteristics and the extent of lung resection was comparable. Intervention group had significantly shorter time to chest tube removal (median 1 vs 3 days, p < 0.001) and post-operative length of stay (median 3 vs 4 days, p < 0.001). Despite earlier chest tube removal, there was not an increased incidence of post-removal complications. On multivariable analysis, the new chest drain management strategy was an independent predictor of earlier chest tube removal. A standardized protocol of chest tube management allows for an earlier chest tube removal and a shorter hospital stay, without an increase in post-operative complications.

To analyze or to throw away? On the stability of excitation-emission matrices for different water systems.

Fluorescence spectroscopy has numerous applications to characterize natural and human-influenced water bodies regarding dissolved organic matter (DOM) and contamination. Analyzing samples in a timely manner is crucial to gaining valid and reproducible excitation-emission matrices (EEM) but often difficult, specifically in transnational projects with long transport distances. In this study, eight samples of different water sources (tap water, differently polluted rivers, and wastewater treatment plant (WWTP) effluents) were stored under standardized conditions for 59 days and analyzed regularly. With this data set, the sample and fluorescence spectra stability was evaluated. Established analysis methods such as peak picking and fluorescence metrics were compared over time and benchmarked against dissolved organic carbon (DOC) and a maximal change of 10% in terms of their variability. Additional high-performance liquid chromatography (HPLC) data to identify single organic compounds provides insights into these DOM alterations and allows for conclusions about the underlying biological processes. Our results corroborate in a systematic way that the higher the organic or microbial load, the faster the sample must be processed. For all water sources, considerable changes were found between days zero and one, indicating a potential systematic bias between in-situ and laboratory measurements. The absolute signals of individual peaks vary substantially after only a few days. In contrast, relative metrics are robust for a much longer time. For specific metrics, when filtered and stored under cool and dark conditions, tap water may be stored for up to 59 days, non-polluted river water for up to 31-59 days, and WWTP effluents for up to 14-59 days. The storability thus depends both on the specific water source and the analytical plan. By systematizing our understanding of how the specific water source and DOM concentration determine the stability of samples during storage, these conclusions facilitate efforts to establish a standardized protocol.

Protocol for Brain Magnetic Resonance Imaging and Extraction of Imaging-Derived Phenotypes from the China Phenobank Project.

Imaging-derived phenotypes (IDPs) have been increasingly used in population-based cohort studies in recent years. As widely reported, magnetic resonance imaging (MRI) is an important imaging modality for assessing the anatomical structure and function of the brain with high resolution and excellent soft-tissue contrast. The purpose of this article was to describe the imaging protocol of the brain MRI in the China Phenobank Project (CHPP). Each participant underwent a 30-min brain MRI scan as part of a 2-h whole-body imaging protocol in CHPP. The brain imaging sequences included T1-magnetization that prepared rapid gradient echo, T2 fluid-attenuated inversion-recovery, magnetic resonance angiography, diffusion MRI, and resting-state functional MRI. The detailed descriptions of image acquisition, interpretation, and post-processing were provided in this article. The measured IDPs included volumes of brain subregions, cerebral vessel geometrical parameters, microstructural tracts, and function connectivity metrics.

Investigating the effects of variability of operational parameters on MATH test for bacterial hydrophobicity measurement.

Microbial adhesion and transport are significantly influenced by their hydrophobicity. Various domains, such as biofouling, bioremediation, wastewater treatment, oil recovery, pathogenesis, implant infections, and several other microbial disciplines, make use of hydrophobicity assessment. One easy assay for assessing the microbial surface hydrophobicity is the microbial adhesion to hydrocarbons (MATH) test which works on the differential partitioning of microbes at a hydrocarbon-aqueous interface. Unfortunately, a standard protocol for this test is still unavailable, even though it has been widely studied and it is known that the results are sensitive to the operating parameters used. This study has been envisaged to investigate the effects of variations in the MATH test parameters on the hydrophobicity results. For this purpose, six different test parameters (vortex duration, phase separation period, hydrocarbon-aqueous phase volume ratio, hydrocarbon selection, absorbance wavelength, and suspension medium) were varied. Four different Gram-negative bacteria were used for experimentation. It was observed that except for phase separation period, all other test parameters significantly influenced the hydrophobicity results. Furthermore, the hydrocarbon saturation of the suspension medium was a critical factor for growth medium suspensions. This study is expected to guide researchers in selecting the appropriate values of test parameters for MATH tests and enhance our understanding of this technique and pave the way for developing a standardized protocol.

Protocol for a cluster randomised controlled feasibility study of Prehospital Optimal Shock Energy for Defibrillation (POSED).

Aims: The Prehospital Optimal Shock Energy for Defibrillation (POSED) study will assess the feasibility of conducting a cluster randomised controlled study of clinical effectiveness in UK ambulance services to identify the optimal shock energy for defibrillation. Methods: POSED is a pragmatic, allocation concealed, open label, cluster randomised, controlled feasibility study. Defibrillators within a single UK ambulance service will be randomised in an equal ratio to deliver one of three shock strategies 120-150-200 J, 150-200-200 J, 200-200-200 J. Consecutive adults (≥18 years) presenting with out of hospital cardiac arrest requiring defibrillation will be eligible. The study plans to enrol 90 patients (30 in each group). Patients (or their relatives for non-survivors) will be informed about trial participation after the initial emergency has resolved. Survivors will be invited to consent to participate in follow-up (i.e., at 30 days or discharge).The primary feasibility outcome is the proportion of eligible patients who receive the randomised study intervention. Secondary feasibility outcomes will include recruitment rate, adherence to allocated treatment and data completeness. Clinical outcomes will include Return of an Organised Rhythm (ROOR) at 2 minutes post-shock, refibrillation rate, Return of Spontaneous Circulation (ROSC) at hospital handover, survival and neurological outcome at 30 days. Conclusion: The POSED study will assess the feasibility of a large-scale trial and explore opportunities to optimise the trial protocol.Trial registration: ISRCTN16327029.

A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China.

Background: Among Chinese college students, the burden of depression is considerably high, affecting up to 30 % of the population. Despite this burden, few Chinese students seek mental health treatment. In addition, depression is highly comorbid with other mental health disorders, such as anxiety. Scalable, transdiagnostic, evidence-based interventions are needed for this population. Objective: The study will evaluate the effectiveness of a World Health Organization transdiagnostic digital mental health intervention, Step-by-Step, to reduce depressive and anxiety symptoms and improve well-being compared with enhanced care as usual and its implementation in a Chinese university community. Methods: A type 1 effectiveness-implementation two-arm, parallel, randomized controlled trial will be conducted. The two conditions are 1) the 5-session Step-by-Step program with minimal guidance by trained peer-helpers and 2) psychoeducational information on depression and anxiety and referrals to local community services. A total of 334 Chinese university students will be randomized with a 1:1 ratio to either of the two groups. Depression, anxiety, wellbeing, and client defined problems will be assessed at pre-intervention, post-intervention, and 3-month follow-up. Endline qualitative interviews and focus group discussions will be conducted to explore SbS implementation among service users, university staff, and stakeholders. Data will be analysed based on the intent-to-treat principle. Discussion: Step-by-Step is an innovative approach to address common mental health problems in populations with sufficient digital literacy. It is a promising intervention that can be embedded to scale mental health services within a university setting. It is anticipated that after successful evaluation of the program and its implementation in the type 1 hybrid design RCT study, Step-by-Step can be scaled and maintained as a low-intensity treatment in universities, and potentially extended to other populations within the Chinese community. Trial registration: ChiCTR2100050214.

A Standard Protocol for the Clinical Management of Suicidal Thoughts and Behavior: Implications for the Suicide Prevention Narrative.

The last several decades have witnessed growing and converging evidence from randomized controlled trials (RCT's) that an identifiable set of simple clinical management strategies are effective for those at risk for suicidal thinking and/or suicide attempts. The current article offers a brief review of clinical strategies supported by RCT's targeting suicidality as "commonalities of treatments that work" and related recommendations for use in the delivery of care for suicidal individuals in generic fashion, regardless of any particular treatment, theoretical orientation, or intervention perspective. The article includes eight recommendations that can be easily adapted across the full range of clinical contexts, institutional settings, and delivery systems, recommendations that help frame a broader clinical narrative for suicide prevention. Recommendations cut across five identifiable domains or clinical strategies for the delivery of care: (1) informed consent discussion that identifies risks of opting out of care and emphasizes the importance of shared responsibility and a collaborative process, (2) an explanatory model that emphasizes the importance of individual self-management skills and targeting the causes of suicide rather than describing suicidality as a function of mental illness, (3) the importance of proactively identifying barriers to care and engaging in targeted problem-solving to facilitate treatment adherence, (4) a proactive and specific plan for management of future suicidal episodes, and (5) reinforcing the importance of taking steps to safeguard lethal means and facilitate safe storage of firearms.

Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial.

Gambling Disorder is a prevalent non-substance use disorder, which contrasts with the low number of people requesting treatment. Information and Communication Technologies (ICT) could help to enhance the dissemination of evidence-based treatments and considerably reduce the costs. The current study seeks to assess the efficacy of an online psychological intervention for people suffering from gambling problems in Spain. The proposed study will be a two-arm, parallel-group, randomized controlled trial. A total of 134 participants (problem and pathological gamblers) will be randomly allocated to a waiting list control group (N = 67) or an intervention group (N = 67). The intervention program includes 8 modules, and it is based on motivational interviewing, cognitive-behavioral therapy (CBT), and extensions and innovations of CBT. It includes several complementary tools that are present throughout the entire intervention. Therapeutic support will be provided once a week through a phone call with a maximum length of 10 min. The primary outcome measure will be gambling severity and gambling-related cognitions, and secondary outcome measures will be readiness to change, and gambling self-efficacy. Other variables that will be considered are depression and anxiety symptoms, positive and negative affect, difficulties in emotion regulation strategies, impulsivity, and quality of life. Individuals will be assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-ups. During the treatment, participants will also respond to a daily Ecological Momentary Intervention (EMI) in order to evaluate urges to gamble, self-efficacy to cope with gambling urges, gambling urge frequency, and whether gambling behaviour occurs. The EMI includes immediate automatic feedback depending on the participant's responses. Treatment acceptance and satisfaction will also be assessed. The data will be analysed both per protocol and by Intention-to-treat. As far as we know, this is the first randomized controlled trial of an online psychological intervention for gambling disorder in Spain. It will expand our knowledge about treatments delivered via the Internet and contribute to improving treatment dissemination, reaching people suffering from this problem who otherwise would not receive help. TRIAL REGISTRATION: Clinicaltrials.gov as NCT04074681. Registered 22 July 2019.

COVID-19 Vaccine and Death: Causality Algorithm According to the WHO Eligibility Diagnosis.

The current challenge worldwide is the administration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. Even if rarely, severe vascular adverse reactions temporally related to vaccine administration have induced diffidence in the population at large. In particular, researchers worldwide are focusing on the so-called "thrombosis and thrombocytopenia after COVID-19 vaccination". This study aims to establish a practical workflow to define the relationship between adverse events following immunization (AEFI) and COVID-19 vaccination, following the basic framework of the World Health Organization (WHO). Post-mortem investigation plays a pivotal role to support this causality relationship when death occurs. To demonstrate the usefulness and feasibility of the proposed workflow, we applied it to two exemplificative cases of suspected AEFI following COVID-19 vaccination. Based on the proposed model, we took into consideration any possible causality relationship between COVID-19 vaccine administration and AEFI. This led us to conclude that vaccination with ChAdOx1 nCov-19 may cause the rare development of immune thrombocytopenia mediated by platelet-activating antibodies against platelet factor 4 (PF4), which clinically mimics heparin-induced autoimmune thrombocytopenia. We suggest the adoption of the proposed methodology in order to confirm or rule out a causal relationship between vaccination and the occurrence of AEFI.

From Tube to Structure: SPA Cryo-EM Workflow Using Apoferritin as an Example.

In this chapter, we present an overview of a standard protocol to achieve structure determination at high resolution by Single Particle Analysis cryogenic Electron Microscopy using apoferritin as a standard sample. The purified apoferritin is applied to a glow-discharged support and then flash frozen in liquid ethane. The prepared grids are loaded into the electron microscope and checked for particle spreading and ice thickness. The microscope alignments are performed and the data collection session is setup for an overnight data collection. The collected movies containing two-dimensional images of the apoferritin sample are then processed to obtain a high-resolution three-dimensional reconstruction.

The extraction of microplastics from sediments: An overview of existing methods and the proposal of a new and green alternative.

Microplastics (MPs) contamination is an existing and concerning environmental issue. Plastic particles have been observed worldwide in every natural matrix, with water environments being the final sink of dispersed MPs. Microplastic distribution in water ecosystems varies as a function of multiple factors, including polymer properties (e.g., density and wettability) and environmental conditions (e.g., water currents and temperature). Because of the tendency of MPs to settle, sediment is known to be one of the most impacted environmental matrices. Despite the increasing awareness of their diffusion in sediments, a proper quantification of dispersed particles is still difficult, due to the lack of standard protocols, which avoid a proper comparison of different sites. This hampers the current knowledge on environmental implications and toxicological effects of MPs in sediments. In this work, we examined 49 studies carried out from 2004 to 2020 to describe the different extraction methods applied, and to highlight pros and cons, with the aim of evaluating the more promising protocols. Therefore, we evaluated each proposed method by considering precision, reproducibility, economic viability and greenness (in term of used reagents). Finally, we proposed a valid alternative procedure in term of reliability and costs, which can attract increasing interest for future studies.

Stress and circulating cell-free mitochondrial DNA: A systematic review of human studies, physiological considerations, and technical recommendations.

Cell-free mitochondrial DNA (cf-mtDNA) is a marker of inflammatory disease and a predictor of mortality, but little is known about cf-mtDNA in relation to psychobiology. A systematic review of the literature reveals that blood cf-mtDNA varies in response to common real-world stressors including psychopathology, acute psychological stress, and exercise. Moreover, cf-mtDNA is inducible within minutes and exhibits high intra-individual day-to-day variation, highlighting the dynamic regulation of cf-mtDNA levels. We discuss current knowledge on the mechanisms of cf-mtDNA release, its forms of transport ("cell-free" does not mean "membrane-free"), potential physiological functions, putative cellular and neuroendocrine triggers, and factors that may contribute to cf-mtDNA removal from the circulation. A review of in vitro, pre-clinical, and clinical studies shows conflicting results around the dogma that physiological forms of cf-mtDNA are pro-inflammatory, opening the possibility of other physiological functions, including the cell-to-cell transfer of whole mitochondria. Finally, to enhance the reproducibility and biological interpretation of human cf-mtDNA research, we propose guidelines for blood collection, cf-mtDNA isolation, quantification, and reporting standards, which can promote concerted advances by the community. Defining the mechanistic basis for cf-mtDNA signaling is an opportunity to elucidate the role of mitochondria in brain-body interactions and psychopathology.

Effect of tofogliflozin and pioglitazone on hepatic steatosis in non-alcoholic fatty liver disease patients with type 2 diabetes mellitus: A randomized, open-label pilot study (ToPiND study).

BACKGROUND: The incidence of nonalcoholic fatty liver disease (NAFLD) has increased recently and is related to obesity and the associated surge in type 2 diabetes mellitus (DM) and metabolic syndrome diagnoses. We aim to compare the effectiveness of tofogliflozin and pioglitazone treatment on hepatic steatosis in patients with NAFLD with type 2 DM. METHODS: This is an open label, prospective, randomized exploratory study. Patients who meet the inclusion criteria and do not meet any exclusion criteria will undergo magnetic resonance imaging (MRI)-based proton density fat fraction (MRI-PDFF). Patients with ≥10% liver fat content on MRI-PDFF will be randomly assigned to receive tofogliflozin 20 mg per day (n = 20) or pioglitazone 15-30 mg per day (n = 20). MRI will be performed after 24 weeks following initiation of medication therapy. Then, patients will take tofogliflozin and pioglitazone in combination in both groups for 24 weeks. MRI will be performed again at 48 weeks (24 weeks after initiation medication in combination). RESULTS: Our study's primary endpoint will be change in hepatic steatosis measured by MRI-PDFF at 24 weeks after medication therapy. The secondary endpoint will be change in alanine aminotransferase at 24 weeks of medication therapy and the main exploratory endpoint will be changes in liver fat content and liver sclerosis at 48 weeks of medication. CONCLUSIONS: We will compare the effectiveness of tofogliflozin and pioglitazone treatment using MRI for improving hepatic steatosis in patients with NAFLD complicated by DM and investigate if the combination of these two medications is effective for treating NAFLD. TRIAL REGISTRATION: This trial is registered in the Japan Registry of Clinical Trials (jRCTs031180159). PROTOCOL VERSION: 1.2, 14 December 2018.

Data on the effects of filters, storage conditions, and chlorination in fluorescence and absorbance wastewater measurements.

Data presented in this data article show artifacts (bias and error) that influence fluorescence measurement of dissolved organic matter (DOM) due to samples handling and storage. Data show interferences in fluorescence measurements related to filtration of water by different filter materials, including 0.7 µm glass microfiber filter, 0.45 µm polyvinylidene fluoride (PVDF) membrane, 0.45 µm cellulose nitrate membrane, and 0.45 µm polyethersulfone (PES) syringe filter. Data show also changes of several fluorescence indexes and UV absorbance measurements of wastewater organic matter respect to time under different storage conditions. Particularly, spectroscopic data were acquired using 0.7 µm filtered and unfiltered wastewater samples stored at different temperatures (i.e, room temperature, 4 °C, -20 °C) over a testing period of 21 days. Finally, data show the effect of chlorine disinfection (doses of 0.5-8 mg/L) in fluorescence measurements accomplished in samples from two secondary wastewater effluents. Data of this article are related to the publication "M. Sgroi, E. Gagliano, F.G.A. Vagliasindi, P. Roccaro, Absorbance and EEM fluorescence of wastewater: effects of filters, storage conditions, and chlorination, Chemosphere, 243, 2020, 125292 [1]". Raw data are available in a public repository (https://doi.org/10.17632/pf86xs7ybk.1).

Safety and Feasibility of Various Functional Electrical Stimulation Cycling Protocols in Individuals With Multiple Sclerosis Who Are Nonambulatory.

OBJECTIVE: To examine the safety, feasibility, and response to functional electrical stimulation (FES) cycling protocols requiring differing levels of effort in people with multiple sclerosis (MS) who are nonambulatory. DESIGN: Pilot study with pre-post intervention testing. SETTING: Outpatient clinic setting of a long-term acute care hospital. PARTICIPANTS: Individuals (N=10) with MS (6 men; mean age 58.6±9.86y) who use a wheelchair for community mobility. Participants' Expanded Disability Status Scale score ranged from 6.5 to 8.5 (median 7.5). INTERVENTION: Participants performed 3 or 4 FES cycling protocols requiring different levels of volitional effort during 6-8 testing sessions. MAIN OUTCOME MEASURES: The primary outcome was safety, measured by adverse events and increase in MS symptoms, all assessed throughout, immediately post- and 1 day postsession. FES cycling performance for each protocol was also recorded. Exploratory outcome measures collected before and after all testing sessions included functional assessment of MS, MS Impact Scale, Exercise Self Efficacy Scale, Patient Health Questionnaire-9 item, and the Zarit Caregiver Burden Scale. RESULTS: All participants (4 women, 6 men) completed all testing sessions. There were no serious adverse events or differences in vitals or symptoms between protocols. Two participants had an isolated episode of mild hypotension. Changes in pain, spasticity, and fatigue were minimal. Five participants were able to cycle for 30 minutes and completed interval training protocols requiring increasing difficulty. The remainder cycled for <3 minutes and completed a rest interval protocol. There was modest improvement on the exploratory outcome measures. CONCLUSIONS: People with MS who use a wheelchair for community mobility can safely perform FES cycling requiring more effort than previously reported research. Therefore, the individuals may experience greater benefits than previously reported. Further study is required to better understand the potential benefits for optimizing function and improving health in people with MS.

Absorbance and EEM fluorescence of wastewater: Effects of filters, storage conditions, and chlorination.

Aim of this study was to delineate sample handling procedures for accurate fluorescence and UV absorbance measurements of wastewater organic matter. Investigations were performed using different wastewater qualities, including primary, secondary and tertiary wastewater effluents, and a wastewater-impacted surface water. Filtration by 0.7 µm glass microfiber filter, 0.45 µm polyvinylidene fluoride (PVDF) membrane, 0.45 µm cellulose nitrate membrane, and 0.45 µm polyethersulfone (PES) syringe filter released manufacture impurities in water that affected fluorescence measurements. However, pre-washing of filter by Milli-Q water was able to eliminate these interferences. Different storage conditions were tested, including storage of filtered and unfiltered samples under different temperatures (25 °C, 4 °C, -20 °C). According to the obtained results, the best practice of wastewater samples preservation was sample filtration at 0.7/0.45 µm immediately after collection followed by storage at 4 °C. However, the time of storage that assured changes of these spectroscopic measurements that do not exceed the 10% of the original value was dependent on water quality and selected wavelengths (i.e., selected fluorescing organic matter component). As a general rule, it is advisable to perform fluorescence and UV absorbance measurements as soon as possible after collection avoiding storage times of filtered water longer than 2 days. Finally, addition of chlorine doses typical for wastewater disinfection mainly affected tryptophan-like components, where changes that exceed the 10% of the fluorescence intensity measured in the unchlorinated sample were observed even at very low doses (≥1 mg/L). On the contrary, tyrosine-like and humic-like components showed changes <10% at chlorine doses of 0.5-5 mg/L.

Standard protocol devised by the Japanese Pediatric Impedance Working Group for combined multichannel intraluminal impedance-pH measurements in children.

Multichannel intraluminal impedance-pH measurements (MII-pH) are useful for evaluating acid and non-acid gastroesophageal reflux (GER). However, the use of MIH-pH is not yet established in Japan. The Japanese Pediatric Impedance Working Group (Japanese-PIG) convened to devise a standard protocol for MII-pH in Japanese children. The expert members of the Japanese-PIG collected data on pediatric MII-pH from the relevant literature in English, including the standard protocol of MII-pH presented by the European PIG, and the insights of international experts. The resultant consensus was included in the contents of the standard protocol of MII-pH. The standard protocol included standardization of the indication, methodology, and interpretation of MII-pH in Japanese children. The criteria for abnormal GER by MII-pH were defined using the Reflux Index and number of total reflux episodes independently in children aged < 1 year and those aged ≥ 1 year. Moreover, a significant relationship between GER and symptoms was identified using the symptom index and symptom association probability approach. We conclude that the current version of the protocol for MII-pH is tentative because it is not based on data from Japanese children. Further studies are needed to render this protocol clinically beneficial and expand its use in Japan.