Urban green waste bulking agent is the major source of antimicrobial resistance genes persisted in home compost, not animal manure.

Urban green waste and food waste are often used as bulking agents to prepare home compost in combination with animal manure in urban horticulture and community gardening. Although it is known that antimicrobial resistance genes (ARGs) persist in home compost, their origins have not been determined. In addition, the factors contributing to ARGs persistence remain unclear. In this study, we aim to (i) characterize the changes in the microbiome and antimicrobial resistome during the composting process of home compost using metagenomics shotgun sequencing, (ii) identify the source of the ARGs persisted in home compost using SourceTracker, and (iii) elucidate the collective effect of compost microbiome and environmental factors, including the physicochemical properties and antibiotics concentration of home compost, in contributing to ARG persistence using Procrustes analysis, co-occurrence network analysis, variation partitioning analysis, and structural equation modeling. SourceTracker analysis indicated that urban green waste bulking agent was the major source of the persisting ARGs in home compost instead of animal manure. Procrustes analysis and co-occurrence network analysis revealed a strong association between microbiome and antimicrobial resistome. Variation partitioning analysis and structural equation modeling suggested that physicochemical properties shaped the antimicrobial resistome directly and indirectly by influencing the microbiome. Our results indicated that the persistence of ARGs in home compost might be due to the succession of microbial species from the urban green waste bulking agent, and the physicochemical properties might have defined the compost environment to shape the microbiome in the compost, thus, in turn, the persisting antimicrobial resistome.

Faecal microbiota transplantation for treatment of recurrent or refractory Clostridioides difficile infection in Hong Kong.

INTRODUCTION: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infection globally, causing significant morbidity and mortality. Faecal microbiota transplantation (FMT) has emerged as a promising option for recurrent and refractory CDI. This study aimed to assess the safety, efficacy, and feasibility of FMT for CDI in Hong Kong. METHODS: We conducted a single-centre, retrospective study for all consecutive cases of recurrent or refractory CDI who underwent FMT from 2013 to 2018. Clinical demographics, outcome, and safety parameters were collected. RESULTS: A total of 24 patients with recurrent or refractory CDI (median age 70 years, interquartile range=45.0-78.3 years; 67% male) were included. Over 80% had been recently hospitalised or were long-term care facility residents. Faecal microbiota transplantation was delivered by feeding tube in 11 (45.8%), oesophagogastroduodenoscopy in eight (33.3%), and colonoscopy in six (25%) of the patients. Resolution of diarrhoea without relapse within 8 weeks was achieved in 21 out of 24 patients (87.5%) after FMT. No deaths occurred within 30 days. The FMT was well tolerated and no serious adverse events attributable to FMT were reported. CONCLUSION: Our results confirm that FMT is a safe, efficacious, and feasible intervention for patients with refractory or recurrent CDI in Hong Kong. Given the increasing disease burden and the lack of effective alternatives in Hong Kong for difficult-to-treat cases of CDI, we recommend that a territory-wide FMT service be established to address increasing demand for this treatment.

Dynamic cyclic compression modulates the chondrogenic phenotype in human chondrocytes from late stage osteoarthritis.

Human osteoarthritic chondrocytes (hOACs) are characterized by their "dedifferentiated" and catabolic phenotype and lack the ability for restoring their inherent functions by themselves. Here we investigated whether extrinsically supplemented mechanical signal via compression loading would affect the phenotype of hOACs. Specifically, we applied cyclic compression loading on cultured hOACs-collagen constructs and measured the expression of the major chondrogenic factors, cell-matrix interaction molecules and matrix degradation enzymes. Dynamic compression loading stimulates the expression and nuclear localization of sox9 in hOACs and reduces the catabolic events via downregulated expression of collagenases. These results contribute to better understanding towards mechanoregulation of hOACs.

Opportunities and challenges of tackling Scope 3 "Indirect" emissions from residential hot water.

The water sector could play a major role towards a Net Zero greenhouse gas (GHG) future if Scope 3 emissions were embraced and operationalised. Significant opportunities and challenges exist in tackling Scope 3 emissions including those associated with customer hot water use. Present GHG emission reduction practices predominantly focus on Scope 1 "within utility" and Scope 2 "purchased energy" emissions. In the urban water cycle, Scope 3 "indirect" emissions dominate, and water use is only one example of Scope 3 emissions. Over 90% of all water cycle GHG emissions can be attributed to water use in residential, industrial and commercial premises, collectively some 7% of global GHG emissions. One possibility is for water utilities to actively support efficient hot water use such as new ultra-low flow shower heads. Scope 3 opportunities also offer a range of cost-effective emissions-reduction opportunities, particularly when the wider perspective of "community value" is considered and not just a "business financial perspective". Hot water efficiency is additionally essential to Net Zero carbon futures, even with decarbonised grids, because most major Net Zero roadmaps require energy efficiency gains. Scientific and management advance needed includes: accounting methodologies, clear roles, collaboration, new business models, and clear definitions. The water sector has the opportunity to play a significant role in achieving Net Zero cities. The decision how much is yet to be made.

Anti-fungal effect of Hevea brasiliensis latex C-serum on Aspergillus niger.

OBJECTIVES: Hevea brasiliensis extract could potentially be employed as a relatively low cost resource for various anti-fungal activities due to the simplicity of latex preparation and the abundance of latex that can be obtained in rubber producing regions. The present study was aimed at examining the species specific anti-fungal property of H. brasilensis latex C-serum against Aspergillus niger. RESULTS: The results showed that the latex C-serum exerted a specific antifungal activity against Aspergillus niger, but not Candida albicans. Low toxicity of the C-serum was demonstrated in Brine Shrimp Lethality Test (BSLT) with an LC50 value of 98.4 mg/ml. CONCLUSIONS: Pending further more elaborated investigations, H. brasiliensis latex C-serum, with its species specific anti-fungal and cancer-origin cell line specific anti-proliferation properties, would probably contribute in healthcare in addition to its traditional role in polymer industry.

Anti-Candida albicans activity and brine shrimp lethality test of Hevea brasiliensis latex B-serum.

BACKGROUND AND OBJECTIVES: Hevea brasiliensis extracts could potentially be employed as a relatively low cost resource for various anti-fungal activities due to the simplicity of the extract preparation and its abundance especially in the tropical region. Latex B-serum was reported to have anti-cancer property and its specificity in anti-fungal property has not been elucidated. The present study was conducted to determine the anti-fungal activity of Hevea latex B-serum against Candida (C.) albicans (a rounded cell fungus) and Aspergillus (A.) niger (a filamentous fungus). METHODS AND RESULTS: The results showed that the anti-fungal activity of latex B-serum was specific to C. albicans but not to A. niger. The MIC value of latex B-serum for C. albicans was found to be 2.5 mg/ml. The time-killing profile showed that the growth of C. albicans was inhibited and the inhibition was prolonged throughout the tested time period. Brine shrimp toxicity test showed an LC50 of 461.0 mg/ml with latex B-serum, indicating the non-toxicity of the serum. CONCLUSION: Further purification and identification of the crude extract should point the way to bioactive compound(s) responsible for anti-Candida activity.

Uncertainties in CT-based radiation therapy treatment planning associated with patient breathing.

PURPOSE: To evaluate uncertainties associated with treatment-planning computed tomography (CT) data obtained with the patient breathing freely. METHODS AND MATERIALS: Patients with thoracic or abdominal tumors underwent a standard treatment-planning CT study while breathing quietly and freely, followed by CT scans while holding their breath at normal inhalation and normal exhalation. Identical treatment plans on all three CT data sets for each patient pointed out differences in: (a) radiation path lengths; (b) positions of the organs; (c) physical volumes of the lung, liver, and kidneys; (d) the interpretation of plan evaluation tools such as dose-volume histograms and normal tissue complication probability (NTCP) models; and (e) how well the planning CT data set represented the average of the inhalation and exhalation studies. RESULTS: Inhalation and exhalation data differ in terms of radiation path length (nearly one quarter of the cases had path-length differences > 1 cm), although the free breathing and average path lengths do not exhibit large differences (0-9 mm). Liver and kidney movements averaged 2 cm, whereas differences between the free breathing and average positions averaged 0.6 cm. The physical volume of the liver between the free breathing and static studies varied by as much as 12%. The NTCP calculations on exhale and inhale studies varied from 3 to 43% for doses that resulted in a 15% NTCP on the free-breathing studies. CONCLUSION: Free-breathing CT studies may improperly estimate the position and volume of critical structures, and thus may mislead evaluation of plans based on such volume dependent criteria such as dose-volume histograms and NTCP calculations.

Improvement of CT-based treatment-planning models of abdominal targets using static exhale imaging.

PURPOSE: CT-based models of the patient that do not account for the motion of ventilation may not accurately predict the shape and position of critical abdominal structures. Respiratory gating technology for imaging and treatment is not yet widely available. The purpose of the current study is to explore an intermediate step to improve the veracity of the patient model and reduce the treated volume by acquiring the CT data with the patients holding their breath at normal exhale. METHODS AND MATERIALS: The ventilatory time courses of diaphragm movement for 15 patients (with no special breathing instructions) were measured using digitized movies from the fluoroscope during simulation. A subsequent clinical protocol was developed for treatment based on exhale CT models. CT scans (typically 3.5-mm slice thickness) were acquired at normal exhale using a spiral scanner. The scan volume was divided into two to three segments, to allow the patient to breathe in between. Margins were placed about intrahepatic target volumes based on the ventilatory excursion inferior to the target, and on only the reproducibility of exhale position superior to the target. RESULTS: The average patient's diaphragm remained within 25% of the range of ventilatory excursion from the average exhale position for 42% of the typical breathing cycle, and within 25% of the range from the average inhale position for 15% of the cycle. The reproducibility of exhale position over multiple breathing cycles was 0.9 mm (2sigma), as opposed to 2.6 mm for inhale. Combining the variation of exhale position and the uncertainty in diaphragm position from CT slices led to typical margins of 10 mm superior to the target, and 19 mm inferior to the target, compared to margins of 19 mm in both directions under our prior protocol of margins based on free-breathing CT studies. For a typical intrahepatic target, these smaller volumes resulted in a 3.6% reduction in Veff for the liver. Analysis of portal films shows proper target coverage for patients treated based on exhale modeled plans. CONCLUSIONS: Modeling abdominal treatments at exhale, while not realizing all the gains of gated treatments, provides an immediate reduction in the volume of normal tissue treated, and improved reliability of patient data for NTCP modeling, when compared to current "free breathing" CT models of patients.

Automated localization of the prostate at the time of treatment using implanted radiopaque markers: technical feasibility.

PURPOSE: Prostate movement is a major consideration in the formation of target volumes for conformal radiation therapy of prostate cancer. The goal of this study was to determine the technical feasibility of using implanted radiopaque markers and digital imaging to localize the prostate at the time of treatment, thus allowing for reduction of the margin required for uncertainty in target position. METHODS AND MATERIALS: Radiopaque markers implanted around the prostate prior to treatment are visible on electronic radiographs generated with a portal imager or diagnostic imaging device. The locations of the images of these markers on the digital radiographs were automatically determined by a template-matching algorithm. The coordinates of the markers were found by projecting rays through the marker locations on orthogonal radiographs using a three-dimensional (3D) point-matching algorithm. Prostate and/or patient movement was inferred from the marker displacements. Images generated from known movements of a phantom with implanted markers were tested with this algorithm. Locations of markers from daily images of patients with implanted markers were determined by both manual and automatic techniques to determine the efficacy of automated localization on typical clinical images. RESULTS: Prostate movements can be automatically detected in a phantom using low-energy photons within 30 s after image acquisition and with a precision of better than 1 mm in translation and 1 degree in rotation (indistinguishable from the uncertainty in measuring precision). CONCLUSION: The studies show that on-line repositioning of the patient based on localization of the markers at the time of treatment is feasible, and may reduce the uncertainty in prostate location when combined with practical on-line repositioning techniques.

Computer-aided detection of microcalcifications in mammograms. Methodology and preliminary clinical study.

The authors investigated the feasibility of using computer methods for automated detection of clustered microcalcifications on clinical mammograms. A new difference-image approach using a matched filter/box-rim filter combination effectively removed the structured background from the image. A locally adaptive gray-level thresholding technique was then used for extraction of the signals from the resulting difference image. Signal-extraction criteria based on the size, contrast, number, and clustering properties of microcalcifications were next imposed on the detected signals to distinguish true signals from noise or artifacts. The detection accuracy of the computer scheme was evaluated by means of a free response receiver operating characteristic (FROC) analysis. It was found that, for simulated subtle microcalcifications superimposed on normal mammograms, the difference-image approach with a matched filter/box-rim filter combination could yield a true-positive cluster detection rate of 80% at a false-positive detection rate of one cluster per image. In a study of 20 clinical images containing moderately subtle microcalcifications, the automated computer scheme obtained an 82% true-positive cluster detection rate at a false-positive detection rate of one cluster per image. These results indicate that the automated method has the potential to aid radiologists in screening mammograms for clustered microcalcifications.

Dynamic digital subtraction evaluation of regional pulmonary ventilation with nonradioactive xenon.

A method of evaluating pulmonary ventilation with a 57-cm image intensifier/television (II/TV) digital chest system is reported. With this method, the patient inhales a mixture of xenon and oxygen gases while dynamic imaging of the chest is done. Images of the airways and ventilated portions of the lungs are obtained by subtraction of images acquired before and after the xenon-oxygen mixture is administered. The feasibility of the method was evaluated by studies with xenon-filled tubes, an airway phantom, and a ventilation phantom. The results indicate that tubes larger than 3.2 mm in diameter are detectable at a xenon concentration of 41%, and that gas flow and flow distribution can be examined after image subtraction. If background subtraction is incomplete because of motion, the visibility of small airways is reduced greatly, although unventilated regions can still be delineated. The initial evaluation of this technique included imaging a healthy volunteer during xenon inhalation.

Improvement in radiologists' detection of clustered microcalcifications on mammograms. The potential of computer-aided diagnosis.

Relatively simple, but important, detection tasks in radiology are nearing accessibility to computer-aided diagnostic (CAD) methods. The authors have studied one such task, the detection of clustered microcalcifications on mammograms, to determine whether CAD can improve radiologists' performance under controlled but generally realistic circumstances. The results of their receiver operating characteristic (ROC) study show that CAD, as implemented by their computer code in its present state of development, does significantly improve radiologists' accuracy in detecting clustered microcalcifications under conditions that simulate the rapid interpretation of screening mammograms. The results suggest also that a reduction in the computer's false-positive rate will further improve radiologists' diagnostic accuracy, although the improvement falls short of statistical significance in this study.

Effects of x-ray beam equalization on mammographic imaging.

We employed an elastic reservoir filled with tissue-equivalent fluid as an x-ray beam filter for exposure equalization. The filter is designed to be placed between the upper compression plate and the breast. During compression, it will conform to the shape of the peripheral region of the breast and fill the space between the upper and lower compression plates, thereby reducing the variation in x-ray penetration between the thick and thin regions of the breast and compressing the dynamic range of the breast image. Results of a phantom study showed that the visibility of low-contrast features was improved in the peripheral region of the equalized breast phantom image. Experimental measurements indicated that the filter reduced scattered radiation in the peripheral region. This result was confirmed by a Monte Carlo simulation study. The radiation contrast, with the effect of beam hardening included, was also improved when equalization was employed.

Technical note: acquisition of CT models for radiotherapy applications with reduced tube heating.

The potential or changing computed tomography (CT) protocols to provide data sets that generate high quality digitally reconstructed radiographs (DRRs) from scans with very low tube currents is demonstrated. DRRs were generated from CT data acquired with slice thickness of 1, 3, and 5 mm, using high current to reduce noise in axial images. These DRRs were compared to one generated from a CT scan acquired using 1 mm aperture and very low (10 mA) current. The DRR generated via this technique is comparable to that generated with high current and 1 mm aperture, and higher resolution than from the 3 and 5 mm CT scans.

Optical image processing with liquid-crystal display for image intensifier/television systems.

We have studied the effect of real-time optical image processing (OIP) in an image intensifier/television (II-TV) radiographic imaging system by using a liquid-crystal display (LCD) placed between the II and the TV camera. The LCD compresses the dynamic range of the transmitted image by modulating the spatial distribution of the light intensity of the image from the output phosphor of the II. The degree of dynamic-range compression can be designed so that the dependence of the signal-to-noise ratio (SNR) of the LCD-TV system on x-ray intensity matches that of the quantum noise. We measured the physical properties of an LCD and evaluated its capability for OIP. Our experimental results demonstrate that it is feasible to use an LCD to compress the dynamic range and to improve the SNR of the image. The advantages of implementing OIP with an LCD in image acquisition systems in which a TV camera is used are discussed.

In phantom determination of collimator scatter factor.

The collimator scatter factor Sc has generally been measured in air using an ionization chamber inside a buildup cap or mini-phantom. Here, Sc was measured in phantom at 10 cm depth for 6 and 15 MV photons with square collimator settings of 2.5-40.0 cm. The results were consistent with in air measurements with a mini-phantom to within 0.4%. In the measurements, a series of Cerrobend field shaping blocks were used to define the field size in the phantom while the collimator settings were varied from the field size in the phantom to twice that value. Corrections of up to 2% for scattered radiation from the added Cerrobend field shaping blocks were necessary. Since a buildup cap or mini-phantom is not used, the smallest field size that can be measured is limited only by the size of the detector and the measurement is performed with full scatter resembling the treatment condition of a patient.

Improvement of precision in spatial localization of radio-opaque markers using the two-film technique.

Radio-opaque markers implanted inside or placed on the skin of patients can be used to detect set-up errors and patient motion. The effects of imaging geometry accuracy for standard radiotherapy equipment on the precision of calculating the positions of radio-opaque spherical markers using two orthogonal radiographic film projections is investigated. Inaccuracies in the imaging geometry are computed from the manually digitized positions of the marker images on each film pair. Actual marker locations are calculated with a precision limited only by the variance in manual digitization by incorporating those imaging geometry inaccuracies into their computation. Results of a phantom study using a grid of markers in a plastic block indicate that submillimeter precision can be obtained for the spatial coordinates of individual markers, and that the precision is not sensitive to the small inaccuracies in imaging geometry present within the mechanical tolerances of modern radiotherapy treatment machines and simulators.

Flattening-filter-based empirical methods to parametrize the head scatter factor.

Parametrizing the collimator scatter factor, Sc (or head scatter factor), of a linear accelerator by the side of the equivalent square of the collimator setting at the isocenter does not accurately predict the change in Sc when the width and length of a rectangular field are exchanged. We have studied two methods based on measurements of square fields to predict Sc's of rectangular fields more accurately. The first method parametrizes Sc by the side of the equivalent square of the flattening filter region visible from the point of calculation. The Sc's of rectangular fields were predicted to an accuracy of 1% from measurements with square fields. The second method computes Sc of rectangular configurations by integrating radiation that can reach the point of calculation from a point source at the target and a second extended source at the flattering filter. The radial distribution of the extended source at the level of the flattering filter is computed from Sc of square fields measured at the isocenter. Effects of extended distance are modeled by separately performing inverse square law corrections for the two sources. This method also predicted the measured values to within 1% accuracy.

Measurement of backscatter to the monitor chamber of medical accelerators using target charge.

A simple noninvasive method is described for determining the backscatter to a monitor chamber of a medical accelerator based on the measurement of charge deposited in the target. This method is compared quantitatively to the more elaborate telescopic method for photon beams of 6 MV and 15 MV on linear accelerators having mica and Kapton monitor chambers. The new target charge method gives results consistent with the telescopic method to within 0.3%.

Studies of performance of antiscatter grids in digital radiography: effect on signal-to-noise ratio.

We developed a theoretical model which describes the improvement of signal-to-noise ratio (SNR) by a grid in digital radiography. The model takes into account the effects of spatial variations in the scatter-to-primary ratio and in the large-area contrast over an image with structured background on quantum noise, and the effects of noise in the imaging system such as electronic noise and digitization noise. Based on the theoretical model, we analyzed the effects of these factors on the SNR when a grid is employed. We performed experimental measurements to evaluate the improvement in the SNR by a grid when quantum noise is the dominant noise source. It was found that the measured SNR improvement factor due to quantum noise agreed closely with that determined from the measured transmission values of a grid, as predicted from our theoretical model. In order to evaluate the relative performance of grids with various geometric design parameters for digital radiographic systems, we employed Monte Carlo calculations and determined the transmission values of a number of grids under various scatter conditions. The calculated SNR improvement factor, due to quantum noise, correlated well with the measured improvement of the SNR by the grids. Our model predicts that the SNR improvement factor depends strongly on the local contrast ratio and also on the scatter-to-primary ratio. The SNR improvement factor is higher in the underpenetrated regions than in the well-penetrated regions of an image.