Heavy metal contamination (Cu, Pb, and Cd) of washed and unwashed roadside blackberries (Rubus fruticose L.).

Foraging provides a multitude of individual, social, and environmental benefits. With green spaces decreasing in the United Kingdom, there is an opportunity for roadside verges to become valuable foraging resources; however, there is public concern over the safety of roadside forage. Human ingestion of heavy metal contaminants, such as copper (Cu), lead (Pb), and cadmium (Cd), originating from traffic activity, induces toxic effects in the body. Therefore, maximum Cu, Pb, and Cd guideline limits for human consumption in small fruits were established. However, studies of heavy metal concentrations in roadside forage and the effects of surface washing on concentrations are limited. This study examined Cu, Pb, and Cd in washed and unwashed wild blackberries (Rubus fruticose L.) along a main road in Kent, UK, and compares the values with maximum guideline limits. In all 44 samples, Cu, Pb and Cd concentrations were well below the maximum guideline limit or daily reference intake (RI) value. Cu and Pb concentrations were below the maximum daily intake in every sample if foragers eat one portion (80 g) of berries a day, but consuming a larger quantity of berries per day (e.g., 1 kg) could lead to an intake above the guideline limit for Cu (1 mg) and Pb (0.1 mg), but not Cd (0.03 mg). Washing did not significantly reduce the concentrations of Cu (p = 0.174) or Cd (p = 0.752) in blackberries, but did significantly reduce the Pb concentration (p < 0.001). However, Pb concentration was below maximum guideline limits for every sample regardless of washing treatment. Thus, wild blackberries collected from the roadside were suitable for human consumption, although the findings are not representative of all foraged berries or road networks. Integr Environ Assess Manag 2024;00:1-9. © 2024 The Author(s). Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Moyamoya syndrome in a young person with Down syndrome: diagnostic and therapeutic considerations.

An 18-year-old woman with a history of Down syndrome (DS) presented with left upper extremity weakness. Neurological examination revealed moderate hypotonia throughout, with mild spasticity of the left ankle. She had 2/5 left upper and lower extremity strength, mild pronation with drift in the left arm and 3+ deep tendon reflexes in the left biceps, brachioradialis, patellar and Achilles. Strength was 5/5 in the right upper and lower extremities. A CT angiography of the head and neck with contrast demonstrated severe narrowing of the bilateral supraclinoid internal carotid arteries (ICAs), suggestive of moyamoya pattern. A diagnostic angiography confirmed stenosis in the right and left supraclinoid ICAs. The patient was started on aspirin therapy and underwent an indirect bypass procedure via encephaloduroarteriosynangiosis 6 weeks after initial presentation. DS is associated with a high risk of congenital heart disease, which in turn increases risk of stroke, namely cardioembolic events, including moyamoya disease. Intellectual disability is nearly ubiquitous in DS, thus adding to the challenges of making a diagnosis of moyamoya in this population.

Quality improvement initiative to improve infant safe sleep practices in the newborn nursery.

The American Academy of Pediatrics recommends that healthcare professionals model their safe infant sleeping environment recommendations, yet adherence to safe sleep practices within our community hospital mother-baby unit was low. We used quality improvement (QI) methodology to increase adherence to infant safe sleep practices, with a goal to improve the proportion of infants sleeping in an environment that would be considered 'perfect sleep' to 70% within a 1-year period. The project occurred while the hospital was preparing for Baby Friendly certification, with increased emphasis on rooming in and skin to skin at the same time.Multiple Plan-Do-Study-Act cycles were performed. Initial cycles targeted nurse and parental education, while later cycles focused on providing sleep sacks/wearable blankets for the infants.While we did not meet our goal, the percentage of infants with 'perfect sleep' increased from a baseline of 41.9% to 67.3%, and we also saw improvement in each of the individual components that contribute to this composite measure. Improvements were sustained over 12 months later, suggesting that QI interventions targeting infant safe sleep in this inpatient setting can have long-lasting results. This project also suggests that infant safe sleep QI initiatives and preparation towards Baby Friendly Hospital Certification can be complementary.

Long-term outcomes of patients with conserved breast cancer treated with adjuvant hypofractionated prone breast intensity-modulated radiation therapy.

INTRODUCTION: New techniques for adjuvant radiation therapy after breast conservation include prone positioning, hypofractionation and intensity-modulated radiation therapy (IMRT). Long-term evaluations of this combination are lacking, and we report our own experience. METHODS: Patients with invasive breast cancer followed for a minimum 36 months post-IMRT were eligible. Dose used was 40 Gray in 15 fractions over 3 weeks to the whole breast via forward-planned prone, whole breast IMRT. A 10 Gy in 5 fraction supine boost was offered. RESULTS: Between January 2012 and January 2020, 2199 patients had breast conservation and adjuvant radiation: 489 received hypofractionated prone breast IMRT, with 155 eligible for our evaluation. Median follow-up was 52 months. Median age was 62 (range 36-80), 78.7% were T1, 20.6% were T2, and 12.3% were node-positive. Grade was 1 in 26.5%, 2 in 43.9% and 3 in 29.7%; 87.1% were oestrogen receptor positive, 3.2% were HER2 positive, and 11.0% were triple negative. 58.6% received a boost, 74.8% endocrine therapy and 32.3% chemotherapy. No patient developed local recurrence. One regional recurrence was successfully salvaged. Six patients (3.9%) developed metastases, and 1.9% died. Five-year actuarial local recurrence-free, regional recurrence-free and breast cancer-specific survival rates were 100.0%, 98.2% and 94.8%. Late grade 1 and 2 breast pain occurred in 20.0% and 1.3% of patients. Only 11.0% had new pain compared to pre-radiation. No patient developed radiation-induced pneumonitis, pulmonary fibrosis, rib fracture or cardiac toxicity. All patients scored cosmesis as 'good' or better. CONCLUSION: Adjuvant hypofractionated prone breast IMRT has excellent locoregional control and minimal toxicity.