Single-use synthetic plastic and natural fibre anaesthetic drug trays: a comparative life cycle assessment of environmental impacts.

BACKGROUND: Single-use anaesthetic drug trays are used widely in Australia, but their environmental impact is unclear. METHODS: A life cycle assessment was completed for 10 different types of single-use anaesthetic drug trays made of four materials: the synthetic plastics polypropylene and polystyrene, and the natural fibres bagasse (sugarcane pulp) and cellulose pulp. RESULTS: Carbon emissions per tray from total life cycle with landfill disposal were 33-454 g CO2-eq, which equates to 152-2066 tonnes CO2-eq annually. Recycling mitigates this impact, reducing emissions per tray to 16-294 g CO2-eq. The tray with the least emissions for landfill and recycling was the small polystyrene injection tray. There was a significant linear relationship between the mass of a tray and its carbon emissions. For landfill, recycling, and incineration disposal, Pearson's r value was 0.98, 0.99, and 0.95, respectively. Composting natural fibres can give a carbon benefit over some synthetic plastics under specific disposal scenarios, but this benefit was not seen under all circumstances. There was a strong positive correlation between the increasing mass of a tray and its increasing environmental impacts for water consumption, particulate matter formation, and mineral depletion. CONCLUSIONS: Single-use trays with the lowest mass should be preferentially chosen. Recycling and composting will reduce environmental impacts. Natural fibre does not automatically confer any environmental benefit over plastic and sustainability claims should be carefully examined for accuracy. The practice of using a single-use drug tray for every procedure should be reconsidered.

Emissions Reduction Strategies for the Orange and Cherry Industries in New South Wales.

The orange and cherry industries in New South Wales, Australia, are major horticulture industries with a high export value. Climate change has resulted in the carbon footprint of products being used by consumers to guide purchases meaning that products with a relatively high carbon footprint risk losing market access. The carbon footprint of cherry and orange production is unknown and there is no assessment of the success of climate change mitigation strategies to reduce the carbon footprint of their production and move production towards being carbon neutral. This study assesses the climate change mitigation potential of five management changes to on-farm cherry and orange production (revegetation, the use of nitrification inhibitors, renewable energy, green N fertilisers, and pyrolysis of orchard residues) over a 25-year period. for example, orchards in relevant growing regions. The results show that the carbon footprint of production can be reduced by 73 and 83% for cherries and oranges, respectively, when strategies that avoid emissions are included in their production. When strategies that sequester C from the atmosphere are also included, cherry and orange production becomes C negative in the first few years of the scenario. The economics of implementing these strategies are unfavourable, at present; however, our results indicate that the NSW cherry and orange industries can be confident in achieving emissions reductions in on-farm production to assure market access for their products.

Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in neonatal sepsis.

BACKGROUND: Efficient and accurate diagnosis of neonatal sepsis is challenging. The potential impact for a reduction in morbidity and mortality as well as antibiotic usage has stimulated the ongoing search for biomarkers of early sepsis. The objective of this pilot study was to quantify the levels of sTREM-1 and correlate with blood cultures and inflammatory markers in neonates evaluated for sepsis. METHODS: Neonates with suspected sepsis were enrolled (n = 83; Preterm n = 35; Term n = 48). Routine bloods for sepsis evaluation were included and plasma sTREM-1 levels were quantified by ELISA. RESULTS: Term and preterm neonates (n = 83; Preterm n = 35; Term n = 48) were enrolled and 16 neonates had positive blood cultures (preterm n = 15; term n = 1). sTREM-1 levels were not significantly different in infants with culture-positive or culture-negative sepsis (356 ± 218 pg/mL and 385 ± 254 pg/mL respectively). The immature-to-total granulocyte (I/T) ratio showed a significant positive correlation with sTREM-1 in the preterm group with positive blood cultures. Additionally, sTREM-1 showed a positive correlation with CRP in the preterm group with negative blood cultures. CONCLUSIONS: sTREM-1 was associated with traditional markers of inflammation (I/T ratio and CRP). However, in this cohort sTREM-1 did not improve the early detection of neonatal culture-positive sepsis.

Reply to Response to Vacuous standards - Subversion of the OSAC standards-development process.

This Letter to the Editor is a reply to Mohammed et al. (2021) https://doi.org/10.1016/j.fsisyn.2021.100145, which in turn is a response to Morrison et al. (2020) "Vacuous standards - subversion of the OSAC standards-development process" https://doi.org/10.1016/j.fsisyn.2020.06.005.

Updating and Road-testing Life Cycle Inventory Data Review Criteria: Toward Global Consensus and Guidance On Data Quality Assessment.

Data quality of life cycle inventory background databases should be ensured in order to be useful for life cycle assessment (LCA) studies. However, databases do not always have procedures to evaluate the quality of the data sets in place. The Global Guidance Principles for LCA Databases of the United Nations Environment Programme (UNEP) in collaboration with the Society of Environmental Toxicology and Chemistry (SETAC) provide, among others, recommendations to enhance data quality through improved documentation and review. Flagship 2a in Phase 3 of the UNEP/SETAC Life Cycle Initiative aimed to enable the practical implementation of these recommendations with the development of review criteria and the testing of these criteria on 3 national databases. After a pilot-testing phase, this project entered a more mature road-testing exercise, of which the results are presented in this paper. The review criteria have been updated and provide more emphasis on goal and scope documentation completeness and include a new cluster of criteria that evaluate the materiality of the data set. The updated criteria have been applied to national databases of Thailand, Australia, and Chile. All databases would benefit from additional documentation, for example, on system boundaries, the reference model, sampling procedures, and cut-off criteria. Furthermore, conducting the review was enabled by extensive documentation and data accessibility in LCA software. Communication of the criteria to the database managers enabled them to anticipate data quality requirements of the global LCA community and improve the data sets in advance. Reviewers sometimes had a different interpretation of the criteria, which suggests that there is room for additional fine-tuning of the process guidance and exemplification of review criteria. This project has demonstrated that the criteria are applicable to and provide useful feedback for databases with different levels of maturity and contribute to improving quality of life cycle inventory (LCI) data. Integr Environ Assess Manag 2020;16:517-524. © 2020 SETAC.

A Case Study Examining the Usefulness of Cure Modelling for the Prediction of Survival Based on Data Maturity.

INTRODUCTION: Mixture modelling is increasingly being considered where a potential cure leads to a long life. Traditional methods use relative survival models for frail populations or cure models that have improper survival functions with theoretical infinite lifespans. Additionally, much of the work uses population data with long follow-up or theoretical data for method development. OBJECTIVE: This case study uses life table data to create a proper survival function in a real-world clinical trial context. In particular, we discuss the impact of the length of trial follow-up on the accuracy of model estimation and the impact of extrapolation to capture long-term survival. METHODS: A review of recent National Institute for Health and Clinical Excellence (NICE) immuno-oncological and chimeric antigen receptor (CAR) T-cell therapy submissions was performed to assess industry uptake and NICE acceptance of survival analysis methods incorporating the potential for long-term survivorship. The case study analysed a simulated trial-based dataset investigating a curative treatment with long-term mortality based on population life tables. The analysis examined three timepoints corresponding to early trial, end-of-trial follow-up and complete follow-up. Mixture modelling approaches were considered, including both cure modelling and relative survival approaches. The curves were evaluated based on the ability to estimate cure fractions and mean life in years within the time span the models are based on and when extrapolating to capture long-term behaviour. The survival curves were fitted with Weibull distributions using non-mixture and mixture cure models. RESULTS: The performance of the cure modelling methods depended on the relative maturity of the data, indicating that care is needed when deciding when the methods should be applied. For progression-free survival, the cure fraction simulated was 15%. The cure fractions estimated using the traditional mixture cure model were 43% (95% confidence interval [CI] 30-57) at the first analysis time point (40 months), 15% (95% CI 12-20) at the end-of-study follow-up (153 months) and 0% (95% CI 0-100) at the end of follow-up. Other standard cure modelling methods produced similar results. For overall survival, we observed a similar pattern of goodness of fit, with a good fit for the end-of-study follow-up and poor fit for the other two data cuts. However, in this case, the estimate of the cure fraction was below the true value in the first analysis data. CONCLUSIONS: This case study suggests cure modelling works well with data in which the disease-specific events have had time to occur. Care is needed when extrapolating from immature data, and further information should support the estimation rather than relying on statistical estimates based on the trial alone.

Structural basis for Fullerene geometry in a human endogenous retrovirus capsid.

The HML2 (HERV-K) group constitutes the most recently acquired family of human endogenous retroviruses, with many proviruses less than one million years old. Many maintain intact open reading frames and provirus expression together with HML2 particle formation are observed in early stage human embryo development and are associated with pluripotency as well as inflammatory disease, cancers and HIV-1 infection. Here, we reconstruct the core structural protein (CA) of an HML2 retrovirus, assemble particles in vitro and employ single particle cryogenic electron microscopy (cryo-EM) to determine structures of four classes of CA Fullerene shell assemblies. These icosahedral and capsular assemblies reveal at high-resolution the molecular interactions that allow CA to form both pentamers and hexamers and show how invariant pentamers and structurally plastic hexamers associate to form the unique polyhedral structures found in retroviral cores.

Zinc and vitamin A deficiency in a cohort of children with autism spectrum disorder.

BACKGROUND AND OBJECTIVES: Studies suggest that trace element and vitamin deficiencies are common in children with autism spectrum disorder (ASD). Data describing the rates of vitamin and trace element deficiencies in the ASD population of the northwest of Ireland is lacking. We wished to determine the prevalence of zinc and vitamin A deficiency in the ASD population compared with controls within this geographical area. METHODS: Parents of children aged 2-18 years with ASD were invited to participate in the study. The control group consisted of well children attending the paediatric department for routine blood sampling. Children on vitamin supplements were excluded from both ASD and control groups. Informed written consent was obtained prior to recruitment. Samples were analysed for zinc and vitamin A levels according to standardized laboratory procedures. RESULTS: Seventy-four of the 150 children with ASD who were invited and 72 controls underwent blood sampling. Mean zinc and vitamin A levels were normal in both groups. There were significantly more males in the ASD group (88% versus 56%, p value < 0.001). The mean (SD) zinc level was not different between the groups (ASD 11.7 [1.7] versus control 11.6 [2.1] µmol/L, p value = 0.86). The mean (standard deviation) vitamin A level was higher in the ASD group (ASD 350.6 [82.6] versus 319.2 [82.8] µg/L, p value = 0.03), but this was likely confounded by age. CONCLUSION: Children with ASD in the northwest of Ireland have mean zinc and vitamin A levels within the normal range. It is important that these findings are relayed to health professionals and to parents of children with ASD so that informed decisions on vitamin supplementation can be made.

The Challenges of Identifying and Classifying Child Sexual Abuse Material.

The aim of the present study was to (a) assess the reliability with which indecent images of children (IIOC) are classified as being of an indecent versus nonindecent nature, and (b) examine in detail the decision-making process engaged in by law enforcement personnel who undertake the difficult task of identifying and classifying IIOC as per the current legislative offense categories. One experienced researcher and four employees from a police force in the United Kingdom coded an extensive amount of IIOC (n = 1,212-2,233) to determine if they (a) were deemed to be of an indecent nature, and (b) depicted a child. Interrater reliability analyses revealed both considerable agreement and disagreement across coders, which were followed up with two focus groups involving the four employees. The first entailed a general discussion of the aspects that made such material more or less difficult to identify; the second focused around images where there had been either agreement (n = 20) or disagreement (n = 36) across coders that the images were of an indecent nature. Using thematic analysis, a number of factors apparent within IIOC were revealed to make the determination of youthfulness and indecency significantly more challenging for coders, with most relating to the developmental stage of the victim and the ambiguity of the context of an image. Findings are discussed in light of their implications for the identification of victims of ongoing sexual exploitation/abuse, the assessment and treatment of individuals in possession of IIOC, as well as the practice of policing and sentencing this type of offending behavior.

CryoEM structures of open dimers of gyrase A in complex with DNA illuminate mechanism of strand passage.

Gyrase is a unique type IIA topoisomerase that uses ATP hydrolysis to maintain the negatively supercoiled state of bacterial DNA. In order to perform its function, gyrase undergoes a sequence of conformational changes that consist of concerted gate openings, DNA cleavage, and DNA strand passage events. Structures where the transported DNA molecule (T-segment) is trapped by the A subunit have not been observed. Here we present the cryoEM structures of two oligomeric complexes of open gyrase A dimers and DNA. The protein subunits in these complexes were solved to 4 Å and 5.2 Å resolution. One of the complexes traps a linear DNA molecule, a putative T-segment, which interacts with the open gyrase A dimers in two states, representing steps either prior to or after passage through the DNA-gate. The structures locate the T-segment in important intermediate conformations of the catalytic cycle and provide insights into gyrase-DNA interactions and mechanism.

Pooling of bronchoalveolar lavage in children with cystic fibrosis does not adversely affect the microbiological yield or sensitivity in detecting pulmonary inflammation.

BACKGROUND: Bronchoalveolar lavage (BAL) is a potentially useful outcome measure for clinical trials in children with CF but its use is limited by variations in approach internationally. We sought to determine if pooling adversely affected the diagnostic properties of BAL. METHODS: Children undergoing bronchoscopy for clinical reasons were included. A multi-step study protocol ensured BAL was collected and analysed both separately and as a pooled fluid. RESULTS: Eighty-five children (53 CF, 32 control) were recruited. There was a high level of concordance between pooled and non-pooled samples in terms of organism identification (76%). There was good agreement (Bland Altman) between the two methods in terms of detection of inflammation independent of centre, microbiological concordance or disease status. Bi-directional variability in IL-8 levels between pooled and non-pooled samples was seen. Free neutrophil elastase (NE) was detected in 4 cases in pooled lavage when absent in non-pooled lavage. Levels of interleukin-8 (IL-8) were similar between the two groups with pooled samples showing a greater spread of values. CONCLUSIONS: Pooling of BAL in children does not negatively impact on either the detection of pulmonary infection or inflammation or the observed relationship between infection and inflammation. Intra-patient variability in BAL IL-8 levels suggests regional differences in inflammation.

Growth Patterns in the Irish Pyridoxine Nonresponsive Homocystinuria Population and the Influence of Metabolic Control and Protein Intake.

A low methionine diet is the mainstay of treatment for pyridoxine nonresponsive homocystinuria (HCU). There are various guidelines for recommended protein intakes for HCU and clinical practice varies. Poor growth has been associated with low cystine levels. This retrospective review of 48 Irish pyridoxine nonresponsive HCU patients assessed weight, height, body mass index (BMI), protein intake, and metabolic control up to 18 years at nine set time points. Patients diagnosed through newborn screening (NBS) were compared to late diagnosed (LD) patients. At 18 years the LD group (n = 12, mean age at diagnosis 5.09 years) were heavier (estimated effect +4.97 Kg, P = 0.0058) and taller (estimated effect +7.97 cm P = 0.0204) than the NBS group (n = 36). There was no difference in growth rate between the groups after 10 years of age. The HCU population were heavier and taller than the general population by one standard deviation with no difference in BMI. There was no association between intermittently low cystine levels and height. Three protein intake guidelines were compared; there was no difference in adult height between those who met the lowest of the guidelines (Genetic Metabolic Dietitians International) and those with a higher protein intake.

Molecular epidemiology of Cryptosporidium species in livestock in Ireland.

Cryptosporidium is a protozoan that can cause gastro-intestinal illness with diarrhoea in a wide range of hosts. In fact some species of Cryptosporidium can infect the broad range of hosts. The current paper is focused to investigate monthly prevalence and diversity of Cryptosporidium spp. during the spring and early summer (March-June) in 2009 and 2010 in farms with no history of cryptosporidiosis. Animal samples were analyzed to elucidate the prevalence of Cryptosporidium in two regions, West and the East catchments in Ireland. Our investigation demonstrates the prevalence ranges from 14% to 26% an early summer peak (June) was observed. Based on the findings of this study Cryptosporidium ryanae (in cattle, horses), and Cryptosporidium bovis/xiaoi followed by Cryptosporidium parvum (in sheep) were found to be the predominant species in asymptomatic cases. The circulation of other Cryptosporidium species such as C. parvum, C. bovis, C. ubiquitum, C. andersoni and Cryptosporidium horse and pig genotypes in livestock was investigated.

Neutrophil and monocyte toll-like receptor 4, CD11b and reactive oxygen intermediates, and neuroimaging outcomes in preterm infants.

BACKGROUND: Activated leukocytes and infection are implicated in neonatal brain injury. Leukocyte surface receptors are increased in stroke models and may be targets for future adjunctive therapies. METHODS: Serial blood samples were analyzed from preterm infants (n = 51; <32 wk gestation) on days 0, 1, 2, and 7 of life. Monocyte and neutrophil activation were evaluated via flow cytometry at baseline and following endotoxin stimulation ex vivo by measuring CD11b (activation), toll-like receptor 4 (TLR-4; endotoxin recognition) expression, and intracellular reactive oxygen intermediate (ROI) production (function). RESULTS: Control preterm infants with normal neuroimaging had elevated baseline CD11b and TLR-4 expression and ROI production compared with adults as well as a robust immune response following endotoxin stimulation. Preterm infants with abnormal neuroimaging had increased neutrophil TLR-4 and ROI compared with all controls. CONCLUSION: Preterm infants have a robust immune response compared with adults. Increased TLR-4 expression in preterm infants with abnormal neuroimaging is similar to findings in adult stroke. In addition, ROI production may cause tissue injury. The modulation of these responses may be beneficial in preterm inflammatory disorders.

Comparison of diagnostic techniques for the detection of Cryptosporidium oocysts in animal samples.

While a large number of laboratory methods for the detection of Cryptosporidium oocysts in faecal samples are now available, their efficacy for identifying asymptomatic cases of cryptosporidiosis is poorly understood. This study was carried out to determine a reliable screening test for epidemiological studies in livestock. In addition, three molecular tests were compared to identify Cryptosporidium species responsible for the infection in cattle, sheep and horses. A variety of diagnostic tests including microscopic (Kinyoun's staining), immunological (Direct Fluorescence Antibody tests or DFAT), enzyme-linked immunosorbent assay (ELISA), and molecular methods (nested PCR) were compared to assess their ability to detect Cryptosporidium in cattle, horse and sheep faecal samples. The results indicate that the sensitivity and specificity of each test is highly dependent on the input samples; while Kinyoun's and DFAT proved to be reliable screening tools for cattle samples, DFAT and PCR analysis (targeted at the 18S rRNA gene fragment) were more sensitive for screening sheep and horse samples. Finally different PCR primer sets targetedat the same region resulted in the preferential amplification of certain Cryptosporidium species when multiple species were present in the sample. Therefore, for identification of Cryptosporidium spp. in the event of asymptomatic cryptosporidiosis, the combination of different 18S rRNA nested PCR primer sets is recommended for further epidemiological applications and also tracking the sources of infection.

Scale for the Assessment of Negative Symptoms structure in first episode psychosis.

Previous studies in schizophrenia samples suggest negative symptoms can be categorized as expressivity or experiential. This study examines the structure of the Scale for the Assessment of Negative Symptoms (SANS) at two separate interviews in a first episode psychosis (FEP) sample. SANS structure was determined with principal components analysis in a schizophrenia spectrum (SSD, N=191) and non-schizophrenia spectrum (NSSD, N=246) sample at first presentation. Confirmatory factor analysis (CFA) was conducted in the entire FEP sample (N=197) at a follow-up assessment. A three factor model solution was extracted in both SSD and NSSD at first presentation. The three components, consisting of expressivity, experiential and alogia/inattention components, explained 26.1%, 16.6% and 13.6% of the variance respectively in SSD. In NSSD the same three components explained 24.2%, 17.9% and 13.1% of the variance respectively. CFA at follow-up showed similar model fit for both the original SANS five factor and for a three factor model solution. The results indicate that either a three or five factor SANS model solution may be appropriate in a psychosis sample inclusive of both SSD and NSSD. The findings also provide initial support for expressivity and experiential domain research in NSSD.

Classification of pathologic response to neoadjuvant therapy in esophageal and junctional cancer: assessment of existing measures and proposal of a novel 3-point standard.

OBJECTIVE: To assess existing measures of pathologic response to neoadjuvant therapy in esophageal and junctional cancer, and to recommend an optimum classification. BACKGROUND: Multimodal therapy is increasingly the standard of care for locally advanced esophageal cancer. Numerous measures of pathologic response have been studied; however, no international standardization exists and no measure is incorporated into the current American Joint Committee on Cancer staging system. METHODS: A total of 393 consecutive patients completing multimodal therapy were studied, all with prospectively recorded Mandard tumor regression grades (TRG). Seven other published methods of response were compared, and a novel 3-point TRG [TRG 1 (complete); TRG 2/3 (partial); TRG 4/5 (none/minimal)] was tested. Clinical and pathologic evidence of nodal regression was assessed in a consecutive subset of 200 comprehensively staged patients. RESULTS: All models had similar discriminatory and stratification power, and they predicted survival (P < 0.0001) on univariate analysis. Conversely, only the 3-point TRG (P = 0.042) along with ypN (P < 0.001) and ypT stage (P < 0.001) independently predicted survival. The median survival for TRG 1 was 71 months compared with 30 and 17 months for TRG 2/3 and TRG 4/5, respectively (P < 0.0001). Apparent complete nodal response (cN1 to ypN0) was seen in 64% of the TRG 1 group, 30% of the TRG 2/3 group, and 5% of the TRG 4/5 group (P < 0.0001). CONCLUSIONS: No existing response measure independently predicts outcome. A complete response (TRG 1) defines a unique cohort after neoadjuvant therapy, associated closely with nodal response, and overall survival. This classification merits consideration for standardization of treatment response, and for inclusion in staging nomenclature.

Using wastewater and high-rate algal ponds for nutrient removal and the production of bioenergy and biofuels.

This paper projects a positive outcome for large-scale algal biofuel and energy production when wastewater treatment is the primary goal. Such a view arises partly from a recent change in emphasis in wastewater treatment technology, from simply oxidising the organic matter in the waste (i.e. removing the biological oxygen demand) to removing the nutrients - specifically nitrogen and phosphorus - which are the root cause of eutrophication of inland waterways and coastal zones. A growing need for nutrient removal greatly improves the prospects for using new algal ponds in wastewater treatment, since microalgae are particularly efficient in capturing and removing such nutrients. Using a spreadsheet model, four scenarios combining algae biomass production with the making of biodiesel, biogas and other products were assessed for two of Australia's largest wastewater treatment plants. The results showed that super critical water reactors and anaerobic digesters could be attractive pathway options, the latter providing significant savings in greenhouse gas emissions. Combining anaerobic digestion with oil extraction and the internal economies derived from cheap land and recycling of water and nutrients on-site could allow algal oil to be produced for less than US$1 per litre.

Implementation of an evidence based guideline reduces blood tests and length of stay for the limping child in a paediatric emergency department.

INTRODUCTION: Acute non-traumatic limp is a common reason for children to present to the emergency department (ED). There is a wide differential diagnosis for these patients, and there are certain serious conditions which cannot be missed. An evidence based guideline for the 'limping child' was designed and the impact of guideline implementation on a number of specific, predefined quantitative outcomes was assessed. METHODS: An initial retrospective chart review over 3 months was carried out for all patients presenting with acute non-traumatic limp. Following guideline introduction and implementation, information was gathered prospectively for a further 3 month period. Data outcomes between the two patient groups were then compared. RESULTS: 110 patients met the criteria for inclusion: 56 pre-guideline and 54 post-guideline implementation. Baseline characteristics and diagnosis breakdown were similar in both groups. The rate of laboratory investigations was significantly reduced following guideline implementation (68% of patients pre-guideline, vs 48% post-guideline; (χ(2)), p=0.03). The number of x-rays carried out was similar in each group (74 pre- vs 67 post-guideline, mean 1.32 vs 1.28; (χ(2)), p=0.53). Length of time spent in the ED was significantly reduced following guideline implementation (median time 150 min pre- vs 82.5 min post-guideline; (χ(2)), p=0.04). No cases of serious pathology were missed using the guideline. CONCLUSION: Implementation of an evidence based clinical practice guideline for the limping child in a paediatric ED reduced the overall time patients spent in the ED, reduced the need for unnecessary laboratory investigations and ensured that appropriate investigations were carried out on an individual patient basis.