Enhancing radiological monitoring of 137Cs in coastal environments using taxonomic signals in brown seaweeds.

With the rapidly expanding global nuclear industry, more efficient and direct radiological monitoring approaches are needed to ensure the associated environmental health impacts and risk remain fully assessed and undertaken as robustly as possible. Conventionally, radiological monitoring in the environment consists of measuring a wide range of anthropogenically enhanced radionuclides present in selected environmental matrices and using generic transfer values for modelling and prediction that are not necessarily suitable in some situations. Previous studies have found links between taxonomy and radionuclide uptake in terrestrial plants and freshwater fish, but the marine context remains relatively unexplored. This preliminary study was aimed at investigating a similar relationship between brown seaweed, an important indicator in radiological monitoring programmes in the marine environment, and Caesium-137, an important radionuclide discharged to the marine environment. A linear mixed model was fitted using REsidual Maximum Likelihood (REML) to activity concentration data collected from literature published worldwide and other databases. The output from REML modelling was adjusted to the International Atomic Energy Agency (IAEA) quoted transfer value for all seaweed taxa in order to produce mean estimate transfer value for each species, which were then analysed by hierarchical ANalysis Of VAriance (ANOVA) based on the taxonomy of brown seaweeds. Transfer value was found to vary between taxa with increasing significance up the taxonomic hierarchy, suggesting a link to evolutionary history. This novel approach enables contextualisation of activity concentration measurements of important marine indicator species in relation to the wider community, allows prediction of unknown transfer values without the need to sample specific species and could, therefore, enhance radiological monitoring by providing accurate, taxon specific transfer values for use in dose assessments and models of radionuclide transfer in the environment.

Anatomical and molecular characterization of some rhigonematid parasites of millipedes in Nigeria, with new insights into their phylogeny.

Parasitic nematodes of millipedes from Nigeria are molecularly characterized for the first time. During nematode surveys on live giant African millipedes from several localities in Nigeria, 4 species of rhigonematids were identified by application of integrative taxonomical approaches (morpho-anatomy and molecular markers), including Brumptaemilius sp., Gilsonema gabonensis, Obainia pachnephorus, and Rhigonema disparovis. The results of morphometric and molecular analyses of D2-D3 28S, ITS, partial 18S rRNA, and cytochrome oxidase c subunit 1 (COI) gene sequences further characterized the rhigonematid species, and clearly separated them from other related species. Phylogenetic relationships based on 28S and 18S rRNA genes suggest that genera within Ransomnematoidea (Ransomnema, Heth, Carnoya, Brumptaemilius, Cattiena, Insulanema, Gilsonema) and Rhigonematoidea (Rhigonema, Obainia, Xystrognathus, Trachyglossoides, Ichthyocephaloides) clustered rather closer than could be expected in view of their morphological differences. Phylogenetic relationships based on ITS and COI are congruent with those of other ribosomal genes; however, they are not conclusive due to the scarcity of available sequences of these genes for these genera in NCBI.

Listeria monocytogenes Illness and Deaths Associated With Ongoing Contamination of a Multiregional Brand of Ice Cream Products, United States, 2010-2015.

BACKGROUND: Frozen foods have rarely been linked to Listeria monocytogenes illness. We describe an outbreak investigation prompted by both hospital clustering of illnesses and product testing. METHODS: We identified outbreak-associated listeriosis cases using whole-genome sequencing (WGS), product testing results, and epidemiologic linkage to cases in the same Kansas hospital. We reviewed hospital medical and dietary records, product invoices, and molecular subtyping results. Federal and state officials tested product and environmental samples for L. monocytogenes. RESULTS: Kansas officials were investigating 5 cases of listeriosis at a single hospital when, simultaneously, unrelated sampling for a study in South Carolina identified L. monocytogenes in Company A ice cream products made in Texas. Isolates from 4 patients and Company A products were closely related by WGS, and the 4 patients with known exposures had consumed milkshakes made with Company A ice cream while hospitalized. Further testing identified L. monocytogenes in ice cream produced in a second Company A production facility in Oklahoma; these isolates were closely related by WGS to those from 5 patients in 3 other states. These 10 illnesses, involving 3 deaths, occurred from 2010 through 2015. Company A ultimately recalled all products. CONCLUSIONS: In this US outbreak of listeriosis linked to a widely distributed brand of ice cream, WGS and product sampling helped link cases spanning 5 years to 2 production facilities, indicating longstanding contamination. Comprehensive sanitation controls and environmental and product testing for L. monocytogenes with regulatory oversight should be implemented for ice cream production.

Reasons for Turnover of Kansas Public Health Officials during the COVID-19 Pandemic.

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

Racial differences in overdose training, naloxone possession, and naloxone administration among clients and nonclients of a syringe services program.

OBJECTIVE: To evaluate racial (Black/White) differences in overdose response training and take-home naloxone (THN) possession and administration among clients and nonclients of the Baltimore syringe service program (SSP). METHODS: The study derived data from a cross-sectional survey of 263 (183 SSP clients, 80 nonclients) people who inject drugs (PWID). The study recruited SSP clients using targeted sampling and recruited nonclients through peer referral from April to November 2016. RESULTS: In our sample, 61% of the participants were Black, 42% were between the ages of 18 and 44, and 70% were males. SSP clients, regardless of race, were more likely to have received overdose response training than Black nonclients (Black clients AOR: 3.85, 95% CI: 1.88, 7.92; White clients AOR: 2.73, 95% CI: 1.29, 5.75). The study found no significant differences in overdose response training between Black and White nonclients. SSP clients and White nonclients were more likely to possess THN than Black nonclients (Black clients: AOR: 4.21, 95% CI: 2.00, 8.87; White clients: AOR: 3.54, 95% CI: 1.56, 8.04; White nonclients AOR: 4.49, 95% CI: 1.50,13.47). CONCLUSION: SSP clients were more likely to receive overdose response training than their nonclient peers who they referred to the study, illustrating the utility of SSPs in reaching PWID at high risk of overdose. We also observed that Black PWID, who did not access services at the SSP, were the least likely to possess THN, suggesting the need to employ outreach targeting Black PWID who do not access this central harm reduction intervention.

Enhancing psychological safety in mental health services.

BACKGROUND: Psychological safety-speaking up about ideas and concerns, free from interpersonal risk-are essential to the high-risk environment, such as healthcare settings. Psychologically safe working is particularly important in mental health where recovery-oriented approaches rely on collaborative efforts of interprofessional teams to make complex decisions. Much research focuses on antecedents and outcomes associated with psychological safety, but little focus on the practical steps for how to increase psychological safety across and at different levels of a healthcare organisation. AIMS: We explore how a mental health organisation creates an organisation-wide plan for building the foundations of mental health and how to enhance psychological safety. METHODS: This review encompasses strategies across psychological safety and organisational culture change to increase psychological safety at an individual, team and organisational level. We set out a comprehensive overview of the types of strategies and interventions for increasing the ethos of psychological safety and setting the foundations for delivering an organisation-wide programme on this topic. We also provide a list of key targeted areas in mental health that would maximally benefit from increasing psychological safety-both in clinical and non-clinical settings. CONCLUSIONS: Psychological safety is a crucial determinant of safe and effective patient care in mental health services. This paper provides the key steps and considerations, creating a large-scale programme in psychological safety with a focus on mental health and drawing from the current literature, providing concrete steps for how our current understanding of psychological safety into practice.

Heritable and non-heritable uncommon causes of stroke.

Despite intensive investigations, about 30% of stroke cases remains of undetermined origin. After exclusion of common causes of stroke, there is a number of rare heritable and non-heritable conditions, which often remain misdiagnosed, that should be additionally considered in the diagnosis of cryptogenic stroke. The identification of these diseases requires a complex work up including detailed clinical evaluation for the detection of systemic symptoms and signs, an adequate neuroimaging assessment and a careful family history collection. The task becomes more complicated by phenotype heterogeneity since stroke could be the primary or unique manifestation of a syndrome or represent just a manifestation (sometimes minor) of a multisystem disorder. The aim of this review paper is to provide clinicians with an update on clinical and neuroradiological features and a set of practical suggestions for the diagnostic work up and management of these uncommon causes of stroke. The identification of these stroke causes is important to avoid inappropriate and expensive diagnostic tests, to establish appropriate management measures, including presymptomatic testing, genetic counseling, and, if available, therapy. Therefore, physicians should become familiar with these diseases to provide future risk assessment and family counseling.

Trends in County-Level COVID-19 Incidence in Counties With and Without a Mask Mandate - Kansas, June 1-August 23, 2020.

Wearing masks is a CDC-recommended* approach to reduce the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), by reducing the spread of respiratory droplets into the air when a person coughs, sneezes, or talks and by reducing the inhalation of these droplets by the wearer. On July 2, 2020, the governor of Kansas issued an executive order† (state mandate), effective July 3, requiring masks or other face coverings in public spaces. CDC and the Kansas Department of Health and Environment analyzed trends in county-level COVID-19 incidence before (June 1-July 2) and after (July 3-August 23) the governor's executive order among counties that ultimately had a mask mandate in place and those that did not. As of August 11, 24 of Kansas's 105 counties did not opt out of the state mandate§ or adopted their own mask mandate shortly before or after the state mandate was issued; 81 counties opted out of the state mandate, as permitted by state law, and did not adopt their own mask mandate. After the governor's executive order, COVID-19 incidence (calculated as the 7-day rolling average number of new daily cases per 100,000 population) decreased (mean decrease of 0.08 cases per 100,000 per day; net decrease of 6%) among counties with a mask mandate (mandated counties) but continued to increase (mean increase of 0.11 cases per 100,000 per day; net increase of 100%) among counties without a mask mandate (nonmandated counties). The decrease in cases among mandated counties and the continued increase in cases in nonmandated counties adds to the evidence supporting the importance of wearing masks and implementing policies requiring their use to mitigate the spread of SARS-CoV-2 (1-6). Community-level mitigation strategies emphasizing wearing masks, maintaining physical distance, staying at home when ill, and enhancing hygiene practices can help reduce transmission of SARS-CoV-2.

Improved tolerability of neratinib in patients with HER2-positive early-stage breast cancer: the CONTROL trial.

BACKGROUND: Neratinib is an irreversible pan-HER tyrosine kinase inhibitor approved for extended adjuvant treatment in early-stage HER2-positive breast cancer based on the phase III ExteNET study. In that trial, in which no antidiarrheal prophylaxis was mandated, grade 3 diarrhea was observed in 40% of patients and 17% discontinued due to diarrhea. The international, open-label, sequential-cohort, phase II CONTROL study is investigating several strategies to improve tolerability. PATIENTS AND METHODS: Patients who completed trastuzumab-based adjuvant therapy received neratinib 240 mg/day for 1 year plus loperamide prophylaxis (days 1-28 or 1-56). Sequential cohorts evaluated additional budesonide or colestipol prophylaxis (days 1-28) and neratinib dose escalation (DE; ongoing). The primary end point was the incidence of grade ≥3 diarrhea. RESULTS: Final data for loperamide (L; n = 137), budesonide + loperamide (BL; n = 64), colestipol + loperamide (CL; n = 136), and colestipol + as-needed loperamide (CL-PRN; n = 104) cohorts, and interim data for DE (n = 60; completed ≥six cycles or discontinued; median duration 11 months) are available. No grade 4 diarrhea was observed. Grade 3 diarrhea rates were lower than ExteNET in all cohorts and lowest in DE (L 31%, BL 28%, CL 21%, CL-PRN 32%, DE 15%). Median number of grade 3 diarrhea episodes was one; median duration per grade 3 episode was 1.0-2.0 days across cohorts. Most grade 3 diarrhea and diarrhea-related discontinuations occurred in month 1. Diarrhea-related discontinuations were lowest in DE (L 20%, BL 8%, CL 4%, CL-PRN 8%, DE 3%). Decreases in health-related quality of life did not cross the clinically important threshold. CONCLUSIONS: Neratinib tolerability was improved with preemptive prophylaxis or DE, which reduced the rate, severity, and duration of neratinib-associated grade ≥3 diarrhea compared with ExteNET. Lower diarrhea-related treatment discontinuations in multiple cohorts indicate that proactive management can allow patients to stay on neratinib for the recommended time period. CLINICALTRIALS.GOV: NCT02400476.

Monogenic cerebral small-vessel diseases: diagnosis and therapy. Consensus recommendations of the European Academy of Neurology.

BACKGROUND AND PURPOSE: Guidelines on monogenic cerebral small-vessel disease (cSVD) diagnosis and management are lacking. Endorsed by the Stroke and Neurogenetics Panels of the European Academy of Neurology, a group of experts has provided recommendations on selected monogenic cSVDs, i.e. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), autosomal dominant High Temperature Requirement A Serine Peptidase 1 (HTRA1), cathepsin-A-related arteriopathy with strokes and leukoencephalopathy (CARASAL), pontine autosomal dominant microangiopathy and leukoencephalopathy (PADMAL), Fabry disease, mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and type IV collagen (COL4)A1/2. METHODS: We followed the Delphi methodology to provide recommendations on several unanswered questions related to monogenic cSVD, including genetic testing, clinical and neuroradiological diagnosis, and management. RESULTS: We have proposed 'red-flag' features suggestive of a monogenic disease. General principles applying to the management of all cSVDs and specific recommendations for the individual forms of monogenic cSVD were agreed by consensus. CONCLUSIONS: The results provide a framework for clinicians involved in the diagnosis and management of monogenic cSVD. Further multicentre observational and treatment studies are still needed to increase the level of evidence supporting our recommendations.

The complementary use of game theory for the circular economy: A review of waste management decision-making methods in civil engineering.

Circular economy principles aim to contribute towards sustainability and resilience through several simultaneous agendas including economic growth, social development and environmental responsibility. Stakeholders from each perspective have their own interests and priorities, which often result in conflict. There are several and varied methodologies which address the decision-making process, however in engineering spheres these techniques are usually limited to optimising resources, time or costs. Decisions that are comprehensive in scope and integrated across all affected systems are required to transition towards a circular economy, effective cross-disciplinary thinking is imperative and cooperation amongst diverse areas is essential. Game theory is a useful technique when analysing the interactions of stakeholders with multiple objectives and perspectives. This paper aims to critically review methodological approaches used in waste management practice and provide a guidance on how game theory differs from, and is complementary to, the primary decision-making tools available where cooperation is a feature too often missing. This review seeks to justify the development of game theory to complement waste management decision-making methods in civil engineering, where resource consumption and waste management is often voluminous. An application of game theory to a waste management example illustrates that this methodological approach is of complementary value. The contribution of this study to circular economy and solid waste agendas is to emphasise the capability of game theory to help facilitate conflict resolution, competition, and stakeholder consensus when capturing multiple (sometimes conflicting) values in line with circular economy principles.

Assessing the effects of manure application rate and timing on nitrous oxide emissions from managed grasslands under contrasting climate in Canada.

It is uncertain whether process-based models are currently capable of simulating the complex soil, plant, climate, manure management interactions that influence soil nitrous oxide (N2O) emissions from perennial cropping systems. The objectives of this study were (1) to calibrate and evaluate the DeNitrification DeComposition (DNDC) model using multi-year datasets of measured nitrous oxide (N2O) fluxes, soil moisture, soil inorganic nitrogen, biomass and soil temperature from managed grasslands applied with manure slurry in contrasting climates of Canada, and (2) to simulate the impact of different manure management practices on N2O emissions including slurry application i) rates (for both single vs. split); and ii) timing (e.g., early vs. late spring). DNDC showed "fair" to "excellent" performance in simulating biomass (4.7% ≤ normalized root mean square error (NRMSE) ≤ 29.8%; -9.5% ≤ normalized average relative error (NARE) ≤ 16.1%) and "good" performance in simulating soil temperature (13.2% ≤ NRMSE ≤ 18.1%; -0.7% ≤ NARE ≤ 10.8%) across all treatments and sites. However, the model only showed "acceptable" performances in estimating soil water and inorganic N contents which was partially attributed to the limitation of a cascade water sub-model and inaccuracies in simulating root development/uptake. Although, the DNDC model only demonstrated "fair" performance in simulating daily N2O fluxes, it generally captured the impact of the timing and rate of slurry application and soil texture (loam vs. sandy loam) on total N2O emissions. The DNDC model simulated N2O emissions from spring better than split manure application (fall and spring) at the Manitoba site partially due to the overestimation of available substrates for microbial denitrification from fall application during the wet spring periods. Although DNDC performed adequately for simulating most of the manure management impacts considered in this study we recommend improvements in the simulation of soil freeze-thaw cycles, manure decomposition dynamics, soil water storage, rainfall canopy interception, and microbial denitrification and nitrification activities in grasslands.

How efficient is modern peri-urban nitrogen cycling: A case study.

Urban centres acquire and accumulate many materials from their hinterland, among these are nutrient elements such as nitrogen (N). The popular North American vision of a peri-urban setting is one where urban food production, composting and re-cycling are assumed to limit urban accumulation of nutrients. This study quantifies this assumption using the Lower Fraser Valley (LFV) of British Columbia as an example, ideal because it is surrounded by mountains, ocean and an international border which collectively delimit the peri-urban boundaries. Nitrogen influxes are dominated by livestock feed imports to support dairy and poultry production (18000 tonnes N), followed by human food imports (9210 tonnes N), as well as 5410 tonnes N as fertilizer and 4690 tonnes N in atmospheric deposition. There is a transfer of 6700 tonnes N from agricultural to urban ecosystems displacing food imports, but food production contributes to the N footprint of the LFV. Nitrogen effluxes are dominated by sewage disposal (10400 tonnes N), solid waste disposal (7020 tonnes N) and atmospheric emissions (9460 tonnes N). The total influx is 15 kg N per person, the net influx is 3.1 kg N per person. Per unit land area, these are a total influx of 24 kg N/ha and a net influx of 4.7 kg N/ha. The atmospheric emissions are 4.7 kg N per person and 7.2 kg/ha. The N in soil is mobile and it is assumed soil N is at a steady state concentration, thus the surplus N is lost from the soil, probably by leaching and runoff. The Fraser River is estimated to acquire and transport 5230 tonnes N from the region into the ocean each year, in addition to 10300 tonnes N from sewage outfall. This is coupled with effluxes of phosphorus (estimated previously), and the result probably has an impact on the coastal waters. There is little reuse of imported N and current waste management practices including composting and combustion do little to improve N efficiency.

A palaeopathological analysis of skeletal remains from Bronze Age Mongolia.

Little is known about the lifeways of the people who inhabited the Mongolian steppe during the Bronze Age (c. 4450-2650 BP). Palaeopathological analysis allows us to draw inferences about the lifeways of past people from the indicators of health and lifestyle recorded in human remains. This paper presents results of analysis of the remains of 25 individuals excavated in northern Mongolia. Overall, the remains demonstrated very little pathology. In particular the lack of evidence for both infectious and non-communicable diseases, along with the patterns of dental pathology indicate a group of people who experienced few health insults and little stress. The types of trauma, Schmorl's nodes and patterns of degenerative joint disease present in the sample are suggestive of interpersonal violence and horse riding. The findings are consistent with a traditional pastoral lifeway where people live in small groups, rely on a protein-rich diet and use animals for transportation.

Availability of Phosphorus after Long-term Whole and Separated Slurry Application to Perennial Grass prior to Corn Silage.

Removing solids from whole dairy slurry (WS) can reduce P loading on fields. This study investigated the effects of 11 yr of applications of WS, separated liquid fraction (LF), commercial fertilizer, WS plus fertilizer, and a control on total and extractable (Kelowna) soil P in perennial grass ( Schreb.) and two subsequent silage corn ( L.) crops. Plots received 200 kg N ha with or without 40 kg P ha. Shoot biomass, P uptake, arbuscular mycorrhizal fungi root colonization, and soil microbial P were determined for corn at six leaves. Whole-crop and grain yield, P uptake, dry matter, and grain content were determined at maturity. The LF treatment received 30% less manure P than WS, had lower extractable soil P at 0 to 15 and 15 to 30 cm, and had lower total P at 0 to 15 cm. Historical treatments had no effect on soil microbial P or arbuscular mycorrhizal fungi colonization. At six leaves, corn shoot biomass, P concentration, and P uptake were related to historical P rates in Year 2, but the relationship was not apparent in Year 1. Starter P fertilizer increased shoot yield and P uptake for all treatments in both years. At maturity, most yield parameters for WS and LF were similar in Year 1, but in Year 2, there was a significant response to starter P fertilizer and a positive relationship between historical P rate and corn performance. This study shows that long-term LF treatments reduced the risk of P pollution with relatively little effect on the P response of subsequent corn crops.

Do you see what I see? Mobile eye-tracker contextual analysis and inter-rater reliability.

Mobile eye-trackers are currently used during real-world tasks (e.g. gait) to monitor visual and cognitive processes, particularly in ageing and Parkinson's disease (PD). However, contextual analysis involving fixation locations during such tasks is rarely performed due to its complexity. This study adapted a validated algorithm and developed a classification method to semi-automate contextual analysis of mobile eye-tracking data. We further assessed inter-rater reliability of the proposed classification method. A mobile eye-tracker recorded eye-movements during walking in five healthy older adult controls (HC) and five people with PD. Fixations were identified using a previously validated algorithm, which was adapted to provide still images of fixation locations (n = 116). The fixation location was manually identified by two raters (DH, JN), who classified the locations. Cohen's kappa correlation coefficients determined the inter-rater reliability. The algorithm successfully provided still images for each fixation, allowing manual contextual analysis to be performed. The inter-rater reliability for classifying the fixation location was high for both PD (kappa = 0.80, 95% agreement) and HC groups (kappa = 0.80, 91% agreement), which indicated a reliable classification method. This study developed a reliable semi-automated contextual analysis method for gait studies in HC and PD. Future studies could adapt this methodology for various gait-related eye-tracking studies.

Clinical efficacy of a next-generation sequencing gene panel for primary immunodeficiency diagnostics.

Primary immunodeficiencies (PIDs) are rare monogenic inborn errors of immunity that result in impairment of functions of the human immune system. PIDs have a broad phenotype with increased morbidity and mortality, and treatment choices are often complex. With increased accessibility of next-generation sequencing (NGS), the rate of discovery of genetic causes for PID has increased exponentially. Identification of an underlying monogenic diagnosis provides important clinical benefits for patients with the potential to alter treatments, facilitate genetic counselling, and pre-implantation diagnostics. We investigated a NGS PID panel of 242 genes within clinical care across a range of PID phenotypes. We also evaluated Phenomizer to predict causal genes from human phenotype ontology (HPO) terms. Twenty-seven participants were recruited, and a total of 15 reportable variants were identified in 48% (13/27) of the participants. The panel results had implications for treatment in 37% (10/27) of participants. Phenomizer identified the genes harbouring variants from HPO terms in 33% (9/27) of participants. This study shows the clinical efficacy that genetic testing has in the care of PID. However, it also highlights some of the disadvantages of gene panels in the rapidly moving field of PID genomics and current challenges in HPO term assignment for PID.