Environmental scan of anal cancer screening practices: worldwide survey results.

Anal squamous cell carcinoma is rare in the general population but certain populations, such as persons with HIV, are at increased risk. High-risk populations can be screened for anal cancer using strategies similar to those used for cervical cancer. However, little is known about the use of such screening practices across jurisdictions. Data were collected using an online survey. Health care professionals currently providing anal cancer screening services were invited to complete the survey via email and/or fax. Information was collected on populations screened, services and treatments offered, and personnel. Over 300 invitations were sent; 82 providers from 80 clinics around the world completed the survey. Fourteen clinics have each examined more than 1000 patients. Over a third of clinics do not restrict access to screening; in the rest, eligibility is most commonly based on HIV status and abnormal anal cytology results. Fifty-three percent of clinics require abnormal anal cytology prior to performing high-resolution anoscopy (HRA) in asymptomatic patients. Almost all clinics offer both anal cytology and HRA. Internal high-grade anal intraepithelial neoplasia (AIN) is most often treated with infrared coagulation (61%), whereas external high-grade AIN is most commonly treated with imiquimod (49%). Most procedures are performed by physicians, followed by nurse practitioners. Our study is the first description of global anal cancer screening practices. Our findings may be used to inform practice and health policy in jurisdictions considering anal cancer screening.

Emission of methane and carbon dioxide and earthworm survival during composting of pharmaceutical sludge and spent mycelia.

Emissions of methane (CH4) and carbon dioxide (CO2) from spent mycelia of the mold Penicilium notatum and sludge from the effluent treatment facility (ETPS) of a pharmaceutical industry were estimated twice during a two-week composting before vermicomposting. These wastes are dumped in landfills or sometimes used in agricultural fields and no reports are available on their greenhouse gas producing potentials. The solid wastes contained appreciable organic carbon and nitrogen while very high Fe, Mn and Zn were found in ETPS only. Pure wastes did not support germination of Vigna radiata L. while mixing soil with ETPS and spent mycelia at the ratios of 12:1 and 14:1 led to 80% and 50% germination, respectively. The wastes were mixed with cowdung at the ratios of 1:1, 1:3 and 3:1 for composting. Carbon dioxide emissions were always significantly higher than CH4 emissions from all the treatments due to prevalence of aerobic condition during composting. From some treatments, CH4 emissions increased with time, indicating increasing activity of anaerobic bacteria in the waste mixtures. Methane emissions ranged from 21.6 to 231.7 microg m(-2) day(-1) while CO2 emissions were greater than thousand times at 39.8-894.8 mg m(-2) day(-1). The amount of C emitted as CH4-C and CO2-C from ranged from 0.007% to 0.081% of total C composted. Cowdung emitted highest CH4 followed by spent mycelia and ETPS while ETPS emitted more CO2 than spent mycelia but lesser than cowdung. Global warming potential of emitted CH4 was found to be in the range of 10.6-27.7 mg-CO2-equivalent on a 20-year time horizon. The results suggest that pharmaceutical wastes can be an important source of CH4 and CO2 during composting or any other stockpiling under suitable moisture conditions. The waste mixtures were found not suitable for vermicomposting after two weeks composting and earthworms did not survive long in the mixtures.