The PEP++ study protocol: a cluster-randomised controlled trial on the effectiveness of an enhanced regimen of post-exposure prophylaxis for close contacts of persons affected by leprosy to prevent disease transmission.

BACKGROUND: Leprosy is an infectious disease with a slow decline in global annual caseload in the past two decades. Active case finding and post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) are recommended by the World Health Organization as measures for leprosy elimination. However, more potent PEP regimens are needed to increase the effect in groups highest at risk (i.e., household members and blood relatives, especially of multibacillary patients). The PEP++ trial will assess the effectiveness of an enhanced preventive regimen against leprosy in high-endemic districts in India, Brazil, Bangladesh, and Nepal compared with SDR-PEP. METHODS: The PEP++ study is a cluster-randomised controlled trial in selected districts of India, Brazil, Bangladesh, and Nepal. Sub-districts will be allocated randomly to the intervention and control arms. Leprosy patients detected from 2015 - 22 living in the districts will be approached to list their close contacts for enrolment in the study. All consenting participants will be screened for signs and symptoms of leprosy and tuberculosis (TB). In the intervention arm, eligible contacts receive the enhanced PEP++ regimen with three doses of rifampicin (150 - 600 mg) and clarithromycin (150 - 500 mg) administered at four-weekly intervals, whereas those in the control arm receive SDR-PEP. Follow-up screening for leprosy will be done for each individual two years after the final dose is administered. Cox' proportion hazards analysis and Poisson regression will be used to compare the incidence rate ratios between the intervention and control areas as the primary study outcome. DISCUSSION: Past studies have shown that the level of SDR-PEP effectiveness is not uniform across contexts or in relation to leprosy patients. To address this, a number of recent trials are seeking to strengthen PEP regimens either through the use of new medications or by increasing the dosage of the existing ones. However, few studies focus on the impact of multiple doses of chemoprophylaxis using a combination of antibiotics. The PEP++ trial will investigate effectiveness of both an enhanced regimen and use geospatial analysis for PEP administration in the study communities. TRIAL REGISTRATION: NL7022 on the Dutch Trial Register on April 12, 2018. Protocol version 9.0 updated on 18 August 2022 https://www.onderzoekmetmensen.nl/en/trial/23060.

Variations in antibiotic resistance genes during long-term operation of an upflow anaerobic sludge blanket reactor.

Antibiotic resistance genes (ARGs) have been widely detected in the environment. Anaerobic digestion (AD) has the potential ability to remove ARGs, and a comprehensive study is needed on the variations in ARGs during AD. In this study, variations in antibiotic resistance genes (ARGs) and microbial communities were investigated during the long-term operation of an upflow anaerobic sludge blanket (UASB) reactor. An antibiotic mixture of erythromycin, sulfamethoxazole and tetracycline was added to the UASB influent and the operation period was 360 days. The abundances of 11 ARGs and class 1 integron-integrase gene were detected in the UASB reactor, and the correlation between the ARGs and the microbial community was analyzed. The composition of ARGs indicated that the main ARGs in the effluent were sul1, sul2, and sul3, whereas the main ARG in the sludge was tetW. Correlation analysis indicated a negative correlation between microorganisms and ARGs in the UASB. In addition, most of ARGs showed a positive correlation with norank_f_Propionibacteriaceae and Clostridum_sensu_stricto_6, which were identified as potential hosts. These findings may help develop a feasible strategy for removing ARGs from aquatic environments during anaerobic digestion.

Effects of different forced-air warming systems on the core temperature of patients: a manikin and multi-center clinical study.

BACKGROUND: The use of forced-air warming (FAW) blankets is widely recognized for preventing shivering and hypothermia in patients under general anesthesia. Various types of products are currently available for hospitals, and we have conducted a preliminary evaluation of insulation equipment based on expert opinions and initial parameters. However, we lack real-world experiments and accurate clinical data to validate these parameters and the accuracy of our decision-making results. This study aims to confirm the effectiveness of different FAW systems by assessing the thermal protection and operational characteristics of the equipment in both experimental and clinical settings, thereby enhancing our evaluation database. METHODS: In the manikin test, we conducted six tests including heat distribution and heating rate, heater outlet temperature stability, etc. In the clinical study, patients were randomly assigned to four groups [Group A (Bair Hugger Therapy, 3 M, St. Paul, MN, USA; 63500); Group B (EQUATOR® level I, Smith Medical ASD, MN, USA; Snuggle Warm, SW-2013); Group C (Jiang Men Da Cheng Medical Devices Co., Ltd, China; IOB-006); and Group D (Shang Hai Nest Tech Medical Materials Co., Ltd, China; BH-017)], with each group comprising 30 individuals. At the start of anesthesia induction, the FAW blanket was activated and set to 43 °C until the completion of surgery. The primary endpoint was the average core body temperature during surgery. Secondary endpoints included hemodynamic and surgical variables, adverse events, and recovery metrics. RESULTS: In the manikin test, the observed results of the experimental parameters (heat distribution, air pressure difference, and hole observation test) for Group A are superior to those of the other groups. In the clinical study, although the mean perioperative core body temperature remained above 36 °C across all groups [Group A: 36.31 ± 0.04; Group B: 36.26 ± 0.06; Group C: 36.17 ± 0.03; Group D: 36.25 ± 0.05], patients in Group A maintained higher temperatures compared to the other groups (p < 0.001). CONCLUSIONS: Among patients undergoing laparoscopic radical resection of colorectal cancer with general anesthesia, all four FAW systems effectively prevented perioperative hypothermia. However, the system in Group A minimized heat loss more effectively than the others, providing superior thermal protection. TRIAL REGISTRATION: ChiCTR2200065394, 03/11/2022.

Rumen-protected methionine supplementation during the transition period under artificially induced heat stress: Effects on cow-calf performance.

Dairy cows experiencing heat stress (HS) during the precalving portion of the transition period give birth to smaller calves and produce less milk and milk protein. Supplementation of rumen-protected methionine (RPM) has been shown to modulate protein, energy, and placenta metabolism, making it a potential candidate to ameliorate HS effects. We investigated the effects of supplementing RPM to transition cows under HS induced by electric heat blanket (EHB) on cow-calf performance. Six weeks before expected calving, 53 Holstein cows were housed in a tiestall barn and fed a control diet (CON, 2.2% Met of MP) or a CON diet supplemented with SmartamineM (MET, 2.6% Met of MP, Adisseo Inc., France). Four weeks precalving, all MET and half CON cows were fitted with an EHB. The other half of the CON cows were considered thermoneutral (TN), resulting in 3 treatments: CONTN (n = 19), CONHS (n = 17), and METHS (n = 17). Respiratory rate (RR), skin temperature (ST), and rectal temperature (RT) were measured thrice weekly and core body temperatures recorded biweekly. Postcalving BW and BCS were recorded weekly, and DMI was calculated and averaged weekly. Milk yield was recorded daily and milk components were analyzed every third DIM. Biweekly AA and weekly nonesterified fatty acids (NEFA), BHB, insulin, and glucose were measured from plasma. Calf birth weight and 24 h growth, thermoregulation, and hematology profile were measured and apparent efficiency of absorption (AEA) of immunoglobulins was calculated. Data were analyzed using the MIXED procedure of SAS with 2 preplanned orthogonal contrasts: CONTN versus the average of CONHS and METHS (C1) and CONHS versus METHS (C2). Relative to TN, EHB cows had increased RT during the postcalving weeks and increased RR and ST during the entire transition period. Body weight, BCS, DMI, and milk yield were not affected by the EHB or RPM. However, protein percentage and SNF were lower in CONHS, relative to METHS cows. At calving, METHS dams had higher glucose concentrations, relative to CONHS, and during the postcalving weeks, the EHB cows had lower NEFA concentrations than TN cows. Calf birthweight and AEA were reduced by HS, whereas RR was increased by HS. Calf withers height tended to be shorter and RT were lower in CONHS, compared with METHS heifers. Overall, RPM supplementation to transition cows reverts the negative effect of HS on blood glucose concentration at calving and milk protein percentage in the dams and increases wither height while decreasing RT in the calf.

Rumen-protected methionine supplementation during the transition period under artificially induced heat stress: impacts on cow-calf performance.

Dairy cows experiencing heat stress (HS) during the pre-calving portion of the transition period give birth to smaller calves and produce less milk and milk protein. Supplementation of rumen-protected methionine (RPM) has been shown to modulate protein, energy, and placenta metabolism, making it a potential candidate to ameliorate HS effects. We investigated the effects of supplementing RPM to transition cows under HS induced by electric heat blanket (EHB) on cow-calf performance. Six weeks before expected calving, 53 Holstein cows were housed in a tie-stall barn and fed a control diet (CON, 2.2% Met of MP) or a CON diet supplemented with Smartamine®M (MET, 2.6% Met of MP, Adisseo Inc., France). Four weeks pre-calving, all MET and half CON cows were fitted with an EHB. The other half of the CON cows were considered thermoneutral (TN), resulting in 3 treatments: CONTN (n = 19), CONHS (n = 17), and METHS (n = 17). Respiratory rate (RR), skin temperature (ST), and rectal temperature (RT) were measured thrice weekly and core body temperatures recorded bi-weekly. Post-calving body weights (BW) and BCS were recorded weekly, and DMI was calculated and averaged weekly. Milk yield was recorded daily and milk components were analyzed every third DIM. Biweekly AA and weekly nonesterified fatty acids (NEFA), ß-hydroxybutyrate (BHB), insulin, and glucose were measured from plasma. Calf birth weight and 24 h growth, thermoregulation, and hematology profile were measured and apparent efficiency of absorption (AEA) of immunoglobulins was calculated. Data were analyzed using the MIXED procedure of SAS with 2 preplanned orthogonal contrasts: CONTN vs. the average of CONHS and METHS (C1) and CONHS vs. METHS (C2). Relative to TN, EHB cows had increased RT during the post-calving weeks and increased RR and ST during the entire transition period. Body weight, BCS, DMI, and milk yield were not impacted by the EHB or RPM. However, protein % and SNF were lower in CONHS, relative to METHS cows. At calving, METHS dams had higher glucose concentrations, relative to CONHS, and during the post-calving weeks, the EHB cows had lower NEFA concentrations than TN cows. Calf birthweight and AEA were reduced by HS, while RR was increased by HS. Calf withers height tended to be shorter and RT were lower in CONHS, compared with MTHS heifers. Overall, RPM supplementation to transition cows reverts the negative impact of HS on blood glucose concentration at calving and milk protein % in the dams and increases wither height while decreasing RT in the calf.

The effect of forced-air warming blanket position during spinal surgery on patients' intra-operative body temperature.

BACKGROUND: The use of body-warming systems is recommended by international anaesthesia societies for patients undergoing surgery. Limited research is however available on the influence of positioning of forced-air warming blankets for patients undergoing spinal surgery. This study aimed to investigate how patients' intra-operative body temperature was affected by the position of forced-air warming blankets while undergoing spinal surgery on a spinal table. DESIGN: A randomized comparative experimental study was conducted with 60 adult patients undergoing posterior spinal surgery. METHODS: Patients were randomized into full underbody (n = 30) or surgical access (n = 30) forced-air warming blanket groups. Intra-operative body temperature was recorded at regular time intervals. The student's T-test, Chi-square, and MANOVA tests were performed to determine the differences between the two groups. RESULTS: Intraoperative hypothermia was significantly lower in the full underbody group than in the surgical access group (p = 0.020). The change in body temperature differed significantly between the two groups from 15 min until 240 min, with a mean difference of 0.5 °C. CONCLUSION: The full underbody position of the forced-air warming blanket was effective for maintaining normal range core body temperature. The use of full underbody forced-air warming blanket for spinal surgery when patients are positioned on a spinal table in a prone position is recommended.

Comparative study of the removal of sulfate by UASB in light and dark environment.

At present, the application of sewage treatment technologies is restricted by high sulfate concentrations. In the present work, the sulfate removal was biologically treated using an upflow anaerobic sludge blanket (UASB) in the absence/presence of light. First, the start-up of UASB for the sulfate removal was studied in terms of COD degradation, sulfate removal, and effluent pH. Second, the impacts of different operation parameters (i.e., COD/SO42- ratio, temperature and illumination time) on the UASB performance were explored. Third, the properties of sludge derived from the UASB at different time were analyzed. Results show that after 28 days of start-up, the COD removal efficiencies in both the photoreactor and non-photoreactor could reach a range of 85-90% while such reactors could achieve > 90% of sulfate being removed. Besides, higher illumination time could facilitate the removal of pollutants in the photoreactor. To sum up, the present study can provide technical support for the clean removal of sulfate from wastewater using photoreactors.

A Warm Air Blanket is Superior to a Heated Mattress in Preventing Perioperative Hypothermia in Orthopedic Arthroplasties, a Time-Series Analyses.

BACKGROUND: Hypothermia is a common perioperative problem that can lead to severe complications. We evaluated whether a heated mattress (HM) is superior to a warm air blanket (WA) in preventing perioperative hypothermia in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS: A retrospective cohort study was performed in a teaching hospital and data were collected for all patients undergoing THA or TKA between January 1, 2015 and May 1, 2022. We used logistic and linear regressions to analyze hypothermia occurrence and important complications. Results were adjusted for confounders and time, and was present in all subgroups and after imputation of missing data. RESULTS: In total, 4,683 of 5,497 patients had information on type of heating. We found more perioperative hypothermia in patients treated with an HM compared to a WA for both THA (odds ratio-adjusted 1.42 [1.0 to 1.6] P = .06) and TKA (odds ratio-adjusted 2.10 [1.5 to 3.0] P < .01). There was no difference in postoperative infections between groups (all between 0.5% and 1.3%). Patients who had an HM significantly stayed longer in the postoperative ward (a mean difference of 4 [TKA] to 6 [THA] minutes, P < .01), but there was no difference in hospital stay. CONCLUSION: A WA is superior compared to an HM in preventing perioperative hypothermia, with no increased risk of complications. Patients who have an HM stayed longer at the postoperative ward, potentially because of higher hypothermia rates. Therefore, it is suggested to use a WA instead of an HM.

Enhancing physiological recovery and subsequent exercise performance in the heat using a phase-change material cooling blanket.

This study aimed to assess the effect of a phase-change material (PCM) cooling blanket for cooling between exercise bouts on recovery of physiological parameters and subsequent exercise performance in the heat. Eighteen male volunteers were recruited to participate in human trials involving two exhaustive treadmill running bouts (Bout1 for 3 km and Bout2 for 1.5 km) in a climate chamber (temperature = 33 °C; relative humidity = 40%). Participants were randomly subjected to one of two cooling conditions for a 10-min period between exercise bouts: CON: natural cooling; 10-min PCM: with a PCM cooling blanket for 10 min. Several physiological parameters including mean skin temperature (Tskin), oral temperature (Toral), core temperature (Tcore), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peripheral capillary oxygen saturation (SpO2), average running speed and rating of perceived exertion (RPE) scale score were analyzed. The results showed that compared to the CON group, participants in the 10-min PCM group had a significant lower Tskin, Tcore, HR and RR at post-cooling, as well as greater reductions in mean skin temperature (ΔTskin) and core temperature (ΔTcore) from post-Bout1 to post-cooling. Additionally, the 10-min PCM group exhibited significantly lower peak Tcore, peak HR and RPE scale score during Bout2, while the average running speed during Bout2 was significantly higher. The present study suggests that cooling with a PCM cooling blanket can enhance physiological recovery and subsequent exercise performance in the heat.

Treatment of azo dye-containing wastewater in a combined UASB-EMBR system: Performance evaluation and membrane fouling study.

This work investigated the treatment of azo dye-containing wastewater in an upflow anaerobic sludge blanket (UASB) reactor combined with an electro-membrane bioreactor (EMBR). Current densities of 20 A m-2 and electric current exposure mode of 6'ON/30'OFF were applied to compare the performance of the EMBR to a conventional membrane bioreactor (MBR). The results showed that dye (Drimaren Red CL-7B) removal occurred predominantly in the UASB reactor, which accounted for 57% of the total dye removal achieved by the combined system. When the MBR was assisted by electrocoagulation, the overall azo dye removal efficiency increased from 60.5 to 67.1%. Electrocoagulation batch tests revealed that higher decolorization rates could be obtained with a current density of 50 A m-2. Over the entire experimental period, the combined UASB-EMBR system exhibited excellent performance in terms of chemical oxygen demand (COD) and NH4+-N removal, with average efficiencies above 97%, while PO43--P was only consistently removed when the electrocoagulation was used. Likewise, a consistent reduction in the absorption spectrum of aromatic amines was observed when the MBR was electrochemically assisted. In addition to improving the pollutants removal, the use of electrocoagulation reduced the membrane fouling rate by 68% (0.25-0.08 kPa d-1), while requiring additional energy consumption and operational costs of 1.12 kWh m-3 and 0.32 USD m-3, respectively. Based on the results, it can be concluded that the combined UASB-EMBR system emerges as a promising technological approach for textile wastewater treatment.

Water quality effects of peat rewetting and leftover conifer brash, following peatland restoration and tree harvesting.

Harvesting of plantation conifers on peatlands is carried out as part of restoration and forestry operations. In particular, in the UK and Ireland, conifer plantations on drained ombrotrophic blanket and raised bogs are increasingly being removed (by harvesting), along with blocking of drainage ditches to help raise water tables to reinitiate and restore bog vegetation and function. However, both tree harvesting and peatland restoration operations can have significant impacts on water quality at local and catchment scales. Previous research has suggested that leaching from leftover decomposing brash (tree tops and branches, including wood and needles) is the primary cause, while other work has suggested that release from rewetted peat also contributes to water quality changes. This research investigates the relative importance of peat rewetting, needles and branches on water quality using mesocosm experiments, to help elucidate the mechanisms behind water quality changes following restoration and harvesting operations. Peat and brash were collected from a drained afforested blanket bog in the Flow Country, Scotland. Short-term mesocosm experiments were conducted by incubating peat, peat + needles and peat + needles + branches with rainwater in quadruplicate. Brash from Sitka spruce (Picea sitchensis) and lodgepole pine (Pinus contorta) was investigated separately, while we also conducted experiments with fresh and aged (∼18 months) brash. Peat, needles and branches all significantly impacted water quality in the order of branches > needles > peat, while concentrations of DOC, PO43-, NH4+, K and Mn were most impacted. Water quality impacts of spruce brash appeared generally greater than pine, while fresh brash had larger effects than aged brash. In our mesocosms, relative contributions to water quality changes were estimated by elemental yields. On average, peat contributed 25.4% (range 0.6-72.3%), while needles and brash contributed 19.7% (range 3.0-37.0%) and 54.9% (range 22.1-70.2%) to yields, respectively. We further estimate that 267 kg C ha-1 (255.8 kg as DOC, 10.7 kg as DIC), 27.4 kg K ha-1, 5.8 kg P ha-1 (as PO43-) and 0.5 kg N ha-1 (as NH4+) could be released from brash, over nine days.

Feasibility, acceptability, and perceived effectiveness of weighted blankets during paediatric dental care.

BACKGROUND: Weighted blankets are one method to provide deep pressure touch sensations, which are associated with a calming effect on the nervous system. Weighted blankets have been reported to elicit a calming effect during stressful dental encounters and routine prophylactic visits in older adolescents and adults. Preliminary research suggests that weighted blankets are safe and feasible for children in both hospital and home settings; this, however, has not yet been examined in a paediatric dental environment. AIM: To examine the feasibility, acceptability, and perceived effectiveness of a weighted blanket during paediatric dental care. DESIGN: This cross-sectional study examined child, caregiver, and dentist-reported responses to survey questions asking about their experience with the weighted blanket during care (n = 20 each per child and caregiver group, n = 9 dentists). RESULTS: The use of a weighted blanket is feasible, acceptable, and appropriate as reported by caregivers and dentists (means ≥ 4.70 on the Feasibility of Intervention, Acceptability of Intervention, and Intervention Appropriateness Measures). Few problems were described, and all groups overwhelmingly responded with enthusiasm, noted the blanket's potential for future use, and perceived that a weighted blanket improved care (means ≥ 4.10). CONCLUSIONS: Study findings support the feasibility and acceptability of using a weighted blanket during a routine, noninvasive paediatric dental care.

Application of a GIS-Based Hydrological Model to Predict Surface Wetness of Blanket Bogs.

Understanding hydrological processes operating on relatively intact blanket bogs provides a scientific basis for establishing achievable restoration targets for damaged sites. A GIS-based hydrological model, developed to assess restoration potential of Irish raised bogs, was adapted and applied to four relatively intact blanket bogs in Ireland. The Modified Flow Accumulation Capacity (MFAC) model utilised high-resolution topographic data to predict surface wetness, based on climatic conditions, contributing catchment and local surface slope. Modifications to MFAC parameters aimed to account for differences in hydrological processes between raised bogs and blanket bogs. Application of a climatic correction factor accounted for variations in effective rainfall between the four study sites, while monitoring of water table levels indicated a log-linear relationship between MFAC values and summer water table levels and range of water table fluctuations. Deviations from the observed relationship between MFAC and water table levels were associated with hydrological pressures, such as artificial drainage or the occurrence of subsurface macropores (peat pipes), which further lowered summer water tables. Despite being effective as a predictor of relative surface wetness, the relationship between MFAC and ecological variables such as Sphagnum spp. cover proved poor, pointing to the impact of past activities and damage caused by anthropogenic pressures. Findings demonstrated MFAC as an effective tool in predicting surface wetness within blanket bog-covered landscapes, thus proving useful to peatland practitioners in planning and prioritising areas for restoration. Supplementary Information: The online version contains supplementary material available at 10.1007/s13157-023-01765-5.

Performance and health status in preweaning semi-indoor holstein calves wearing calf jackets during winter months.

The purpose of this study was to investigate whether jacket wearing by semi-indoor Holstein calves affected performance, body measurements and health status in the preweaning period throughout the winter months. A total of one hundred calves were allocated into two treatment groups (control and jacket) in terms of their weights and sex. The calves throughout the study period were raised at individual calf hutches in a semi-open barn. All calves and the consumed concentrate intakes were weighed every 28 days to determine body weight (BW), average daily gain (ADG), total and daily feed consumption (TFC, DFC). Incidence rate (IR) ratios were calculated from the records of daily health assessments. Calves in treatment group were jacketed from first to 45 days of age. The weaning process started gradually at 56 days of age and the calves were weaned on day 63. No significant effects of wearing jackets in terms of body measurements and performance. The respiratory diseases IR was 1.15 times higher in calves without jackets, which means that calf health was positively affected by wearing jackets. The improved health status of the treatment group showed that wearing jackets may protect calves from adverse effects of cold stress. There is a need for more comprehensive studies about the effect of calf jackets in early periods of preweaning, especially in calves in outdoor hutches.

Effect of a Forced-Air Warming Blanket on Different Parts of the Body on Core Temperature of Patients Undergoing Elective Open Abdominal Surgery: A Randomized Controlled Single-Blind Trial.

PURPOSE: This study aimed to determine the effect of a forced-air warming blanket placed on different body parts on the core temperature of patients undergoing elective open abdominal surgery. DESIGN: Prospective, single-center, randomized, controlled, single-blind trial. METHODS: A total of 537 patients who underwent open abdominal surgery were randomized into groups A, B, and C and provided with different forced-air warming blankets. Group A was given an upper body blanket, group B a lower body blanket, and group C an underbody blanket. The incidence of intraoperative hypothermia, the time maintaining the core temperature over 36 â„ƒ before hypothermia, the duration of hypothermia, the rewarming rate, and relevant complications were compared among three groups. FINDINGS: Intraoperative hypothermia occurred in 51.4% of patients in group B, 37.6% of patients in group A, and 34.1% of patients in group C (P = .002). Maintaining the core temperature above 36 â„ƒ was longer before hypothermia in groups A and C (log-rank P = .006). In groups A and C, the duration of hypothermia was shorter, the rewarming rate was higher, and the incidence of shivering and postoperative nausea and vomiting were lower, compared to group B. CONCLUSIONS: In patients undergoing elective open abdominal surgery, a forced-air warming blanket on the upper body part or underbody area decreased intraoperative hypothermia, prolonged the time to maintain the core temperature above 36 â„ƒ before hypothermia, and could better prevent further hypothermia when the core temperature had decreased below 36 â„ƒ. In addition, it was significantly superior in reducing shivering and postoperative nausea and vomiting in the postanesthesia care unit.

Microbial granules on reactors performance during organic butyrate digestion: clean production.

This critical review for anaerobic degradation of complex organic compounds like butyrate using reactors has been enormously applied for biogas production. Biogas production rate has a great impact on: reactor granulation methanogenesis, nutrient content, shear velocity, organic loading and loss of nutrients taking place in the reactor continuously. Various technologies have been applied to closed anaerobic reactors to improve biogas production and treatment efficiency. Recent reviews showed that the application of closed anaerobic reactors can accelerate the degradation of organics like volatile fatty acid-butyrate and affect microbial biofilm formation by increasing the number of methanogens and increase methane production 16.5 L-1 CH4 L-1 POME-1. The closed anaerobic reactors with stable microbial biofilm and established organic load were responsible for the improvement of the reactor and methane production. The technology mentioned in this review can be used to monitor biogas concentration, which directly correlates to organic concentrations. This review attempts to evaluate interactions among the: degradation of organics, closed anaerobic reactors system, and microbial granules. This article provides a useful picture for the improvement of the degradation of organic butyrate for COD removal, biogas and methane production in an anaerobic closed reactor.

Recent reviews showed that the application of closed anaerobic reactors can accelerate the degradation of organic compounds, such as volatile fatty acid-butyrate, and affect microbial biofilm formation by increasing the number of methanogens, thus enhancing biogas production. The closed anaerobic reactors with stable microbial biofilm established the organic load and improved the performance of the reactor for methane production. The technology used involves monitoring biogas concentrations which correlates with organic concentrations. This review attempts to evaluate interactions among: the degradation of organics, closed anaerobic reactors system, and microbial granules. This review, therefore, provides a useful picture for the improvement of butyrate degradation for COD removal and methane production with the help of various anaerobic closed reactors. The performance of UASBR depends on granulation. The granulation process in UASB reactors can be divided into four steps: (1) Transport of cells to the surface of other cells; (2) Initial reversible adsorption by physicochemical forces; (3) Irreversible adhesion of the cells by microbial appendages and/or polymers; and (4) Multiplication of the cells and development of the granules. Any factor which can complement any one of the four steps will be able to accelerate the granulation process and shorten the startup time of UASB reactors.

A weighted blanket increases pre-sleep salivary concentrations of melatonin in young, healthy adults.

Weighted blankets have emerged as a potential non-pharmacological intervention to ease conditions such as insomnia and anxiety. Despite a lack of experimental evidence, these alleged effects are frequently attributed to a reduced activity of the endogenous stress systems and an increased release of hormones such as oxytocin and melatonin. Thus, the aim of the present in-laboratory crossover study (26 young and healthy participants, including 15 men and 11 women) was to investigate if using a weighted blanket (~12% of body weight) at bedtime resulted in higher salivary concentrations of melatonin and oxytocin compared with a light blanket (~2.4% of body weight). We also examined possible differences in salivary concentrations of the stress hormone cortisol, salivary alpha-amylase activity (as an indicative metric of sympathetic nervous system activity), subjective sleepiness, and sleep duration. When using a weighted blanket, the 1 hour increase of salivary melatonin from baseline (i.e., 22:00) to lights off (i.e., 23:00) was about 32% higher (p = 0.011). No other significant differences were found between the blanket conditions, including subjective sleepiness and total sleep duration. Our study is the first to suggest that using a weighted blanket may result in a more significant release of melatonin at bedtime. Future studies should investigate whether the stimulatory effect on melatonin secretion is observed on a nightly basis when frequently using a weighted blanket over weeks to months. It remains to be determined whether the observed increase in melatonin may be therapeutically relevant for the previously described effects of the weighted blanket on insomnia and anxiety.

Correlation between Bacterial Cell Density and Abundance of Antibiotic Resistance on Milking Machine Surfaces Assessed by Cultivation and Direct qPCR Methods.

The relative abundance of antibiotic-resistant bacteria and antibiotic-resistance genes was surveyed for different parts of a milking machine. A cultivation approach based on swab samples showed a highly diverse microbiota, harboring resistances against cloxacillin, ampicillin, penicillin, and tetracycline. This approach demonstrated a substantial cloxacillin resistance of numerous taxa within milking machine microbiota coming along with regular use of cloxacillin for dry-off therapy of dairy cows. For the less abundant tetracycline-resistant bacteria we found a positive correlation between microbial cell density and relative abundance of tetracycline-resistant microorganisms (R2 = 0.73). This indicated an accelerated dispersion of resistant cells for sampling locations with high cell density. However, the direct quantification of the tetM gene from the swap samples by qPCR showed the reverse relation to bacterial density if normalized against the abundance of 16S rRNA genes (R2 = 0.88). The abundance of 16S rRNA genes was analyzed by qPCR combined with a propidium monoazide treatment, which eliminates 16S rRNA gene signals in negative controls.

Analgesia for the Bayesian Brain: How Predictive Coding Offers Insights Into the Subjectivity of Pain.

PURPOSE OF REVIEW: In order to better treat pain, we must understand its architecture and pathways. Many modulatory approaches of pain management strategies are only poorly understood. This review aims to provide a theoretical framework of pain perception and modulation in order to assist in clinical understanding and research of analgesia and anesthesia. RECENT FINDINGS: Limitations of traditional models for pain have driven the application of new data analysis models. The Bayesian principle of predictive coding has found increasing application in neuroscientific research, providing a promising theoretical background for the principles of consciousness and perception. It can be applied to the subjective perception of pain. Pain perception can be viewed as a continuous hierarchical process of bottom-up sensory inputs colliding with top-down modulations and prior experiences, involving multiple cortical and subcortical hubs of the pain matrix. Predictive coding provides a mathematical model for this interplay.

What is the best way to keep the patient warm during technical rescue? Results from two prospective randomised controlled studies with healthy volunteers.

BACKGROUND: Accidental hypothermia is a manifest problem during the rescue of entrapped victims and results in different subsequent problems as coagulopathy and wound infection. Different warming methods are available for the preclinicial use. However, their effectiveness has hardly been evaluated. METHODS: In a first step a survey among German fire brigades was performed with questions about the most used warming methods. In a second step two crossover studies were conducted. In each study two different warming method were compared with forced air warming - which is the most frequently used and highly effective warming method in operation rooms (Study A: halogen floodlight vs. forced air warming; Study B: forced air warming vs. fleece blanket). In both studies healthy volunteers (Study A: 30 volunteers, Study B: 32 volunteers) were sitting 60 min in a cold store. In the first 21 min there was no subject warming. Afterwards the different warming methods were initiated. Every 3 min parameters like skin temperature, core body temperature and cold perception on a 10-point numeric rating scale were recorded. Linear mixed models were fitted for each parameter to check for differences in temperature trajectories and cold perception with regard to the different warming methods. RESULTS: One hundred fifty-one German fire brigades responded to the survey. The most frequently used warming methods were different rescue blankets (gold/silver, wool) and work light (halogen floodlights). Both studies (A and B) showed significantly (p < 0.05) higher values in mean skin temperature, mean body temperature and total body heat for the forced air warming methods compared to halogen floodlight respectively fleece blanket shortly after warming initiation. In contrast, values for the cold perception were significantly lower (less unpleasant cold perception) during the phase the forced air warming methods were used, compared to the fleece blanket or the halogen floodlight was used. CONCLUSION: Forced air warming methods used under the standardised experimental setting are an effective method to keep patients warm during technical rescue. Halogen floodlight has an insufficient effect on the patient's heat preservation. In healthy subjects, fleece blankets will stop heat loss but will not correct heat that has already been lost. TRIAL REGISTRATION: The studies were registered retrospectively on 14/02/2022 on the German Clinical Trials registry (DRKS) with the number DRKS00028079.