PBT assessment of chemicals detected in effluent of wastewater treatment plants by suspected screening analysis.

Wastewater treatment plants (WWTPs) are the major sources of contaminants discharged into downstream water bodies. Profiling the contaminants in effluent of WWTPs is crucial to assess the potential eco-risks toward downstream organisms. To this end, this study investigated the contaminants in effluent of 10 WWTPs locating in 10 cities of Yangtze River delta region of China by suspected screening analysis. Further, the persistence, bioaccumulation, toxicity (PBT) and the characteristics sub-structures of PBT-like chemicals were analyzed. Totally, 704 chemicals including 155 chemical products, 31 food additives, 52 natural substances, 112 personal care products, 123 pesticides, 192 pharmaceuticals, 17 hormones and 22 others were found. The results of PBT analysis suggested that 42 chemicals (5.97% among the detected chemicals in WWTPs) were with PBT property. Among them, 31 contaminants were not reported previously. 9 characteristics sub-structures (N-methyleneisobutylamine, 1-naphthaldehyde, 2,3,3-trimethylcyclohexene, cyclohexanol, N-sec-butyl-n-propylamine, (5E)-2,6-dimethylocta-1,5-diene, 2-ethylphenol, pentadecane and 6-methoxyhexane) were found for PBT-like chemicals. The sub-structures of highly linear alkyl partially explained the significantly higher PBT score for personal care products. Present study provides fundamental information on PBT properties of contaminants in effluent of WWTPs, which will benefit to prioritize contaminants with high concerns in effluent of WWTPs.

Three-year hospital-wide pain management system implementation at a tertiary medical center: Pain prevalence analysis.

We developed a pain management system over a 3-year period. In this project, "Towards a pain-free hospital", we combined evidence-based medicine and medical expertise to develop a series of policies. The intervention mainly included the development of standard procedures for inpatient pain management, the implementation of hospital-wide pain medicine education and training, the establishment of a dashboard system to track pain status, and regular audits and feedback. This study aimed to gain an understanding of the changes in the prevalence of pain in inpatients under the care of the pain management system. The subjects of the survey are inpatients over 20 years old, and who had been hospitalized in the general ward for at least 3 days. The patients would be excluded if they were unable to respond to the questions. We randomly selected eligible patients in the general ward. Our trained interviewers visited inpatients to complete the questionnaires designed by our pain care specialists. A total of 3,094 inpatients completed the survey from 2018 to 2020. During the three-year period, the prevalence of pain was 69.5% (2018) (reference), 63.3% (2019) (OR:0.768, p<0.01), and 60.1% (2020) (OR:0.662, p <0.001). The prevalence rates of pain in patients undergoing surgery during the 3-year period were 81.4% (2018), 74.3% (2019), and 68.8% (2020), respectively. As for care-related causes of pain, injection, change in position/chest percussion, and rehabilitation showed a decreasing trend over the 3-year period of study. Our pain management system provided immediate professional pain management, and achieved a good result in the management of acute moderate to severe pain, especially perioperative pain. Studies on pain prevalence and Pain-Free Hospitals are scarce in Asia. With the aid of the policies based on evidence-based medicine and the dashboard information system, from 2018 to 2020, the prevalence of pain has decreased year by year.

Nursing students' cultural competence in caring for older people in a multicultural and developing region.

BACKGROUND: Health disparities exist among different cultural groups in a multicultural society. Older people from minority groups usually face greater challenges in accessing and utilizing healthcare services due to language barriers, low levels of health literacy and cognitive impairment. OBJECTIVES: The aims of this study were to measure nursing students' cultural competence in the context of caring for older people from diverse cultural backgrounds and explore associated factors affecting their cultural competence in order to inform curriculum design in Xinjiang, China. DESIGN: A cross-sectional study design. SETTINGS: The study was undertaken in the School of Nursing, Xinjiang Medical University, Xinjiang Uygur Autonomous Region, China. PARTICIPANTS: Students enrolled in a 4-year Bachelor of Nursing Program. METHODS: Students' cultural competence was measured using a validated Chinese version of Cross-cultural Care Questionnaire. Data were collected using a self-administered survey. RESULTS: The number of students in the survey was 677. Of those students, 59.5% of them were from an ethnic group other than Han Chinese. A higher proportion of students from ethnic groups, other than Han Chinese, were able to fluently speak a language other than Chinese and used this language in their study and daily lives. Nursing students demonstrated low scores in knowledge, skills and encounters subscales for cultural competence, but had a relatively high score in awareness across all academic years. Findings from students' responses to open-ended questions reveal the need to integrate cross-cultural care and gerontological care into the nursing curricula and support students to apply gerontological knowledge to practice in clinical placements. CONCLUSIONS: Nursing students enrolled in a 4-year Bachelor degree program in a multicultural and less developed region demonstrated lower scores on cultural competence and recognized the need to develop crosscultural and gerontological competencies.

Distribution of endotoxins in full scale pharmaceutical wastewater treatment plants and its relationship with microbial community structure.

Endotoxins are potential toxics impacting human health through respiration derived in wastewater treatment plants (WWTPs), yet the formation of endotoxins during wastewater treatment processes is still lacking research. In our study, the distribution of endotoxins and bacterial community structure in the wastewater of three full scale pharmaceutical WWTPs were explored using the limulus amebocyte lysate (LAL) test and MiSeq technique. Results showed that higher endotoxin activities in the influent of Plant A and Plant C (560 and 1140 EU/mL), stemming from the fermentation process, were found compared to that of Plant B (135 EU/mL), coming from the process of chemical synthesis. During the anaerobic treatment and the cyclic activated sludge system (CASS) in the three WWTPs, the endotoxin activity increased, while it declined in the aerobic treatment system. In all bioreactors, the relative abundance of Gram-negative bacteria accounted for 50.0-94.6%. Bacteria with high lipopolysaccharide (LPS) in LAL assay were found at the genus level of Bacteroides, Enterococcus, Desulfovibrio, and Megasphaera.

Development of phage immuno-loop-mediated isothermal amplification assays for organophosphorus pesticides in agro-products.

Two immuno-loop-mediated isothermal amplification assays (iLAMP) were developed by using a phage-borne peptide that was isolated from a cyclic eight-peptide phage library. One assay was used to screen eight organophosphorus (OP) pesticides with limits of detection (LOD) between 2 and 128 ng mL(-1). The iLAMP consisted of the competitive immuno-reaction coupled to the LAMP reaction for detection. This method provides positive results in the visual color of violet, while a negative response results in a sky blue color; therefore, the iLAMP allows one to rapidly detect analytes in yes or no fashion. We validated the iLAMP by detecting parathion-methyl, parathion, and fenitrothion in Chinese cabbage, apple, and greengrocery, and the detection results were consistent with the enzyme-linked immunosorbent assay (ELISA). In conclusion, the iLAMP is a simple, rapid, sensitive, and economical method for detecting OP pesticide residues in agro-products with no instrumental requirement.