Facilitating effects of the synergy with zero-valent iron and peroxysulfate on the sludge anaerobic fermentation system: Combined biological enzyme, microbial community and fermentation mechanism assessment.

This study evaluated a synergetic waste activated sludge treatment strategy with environmentally friendly zero-valent iron nanoparticles (Fe0) and peroxysulfate. To verify the feasibility of the synergistic treatment, Fe0, peroxysulfate, and the mixture of peroxysulfate and Fe0 (synergy treatment) were added to different sludge fermentation systems. The study demonstrated that the synergy treatment fermentation system displayed remarkable hydrolysis performance with 435.50 mg COD/L of protein and 197.67 mg COD/L of polysaccharide, which increased 1.13-2.85 times (protein) and 1.12-1.49 times (polysaccharide) for other three fermentation system. Additionally, the synergy treatment fermentation system (754.52 mg COD/L) exhibited a well acidification performance which was 1.35-41.73 times for other systems (18.08-557.27 mg COD/L). The synergy treatment fermentation system had a facilitating effect on the activity of protease, dehydrogenase, and alkaline phosphatase, which guaranteed the transformation of organic matter. Results also indicated that Comamonas, Soehngenia, Pseudomonas, and Fusibacter were enriched in synergy treatment, which was beneficial to produce SCFAs. The activation of Fe0 on peroxysulfate promoting electron transfer, improving the active groups, and increasing the enrichment of functional microorganisms showed the advanced nature of synergy treatment. These results proved the feasibility of synergy treatment with Fe0 and peroxysulfate to enhance waste activated sludge anaerobic fermentation.

Iron Deficiency in Chronic Pediatric Heart Failure: Overall Assessment and Outcomes in Dilated Cardiomyopathy.

OBJECTIVE: To evaluate the frequency of iron status assessment in pediatric heart failure and the prevalence and adverse effects of absolute iron deficiency in dilated cardiomyopathy-induced heart failure. STUDY DESIGN: We retrospectively reviewed records of children with chronic heart failure at our center between 2010 and 2020. In children with dilated cardiomyopathy, we analyzed baseline cardiac function, hemoglobin level, and subsequent risk of composite adverse events (CAE), including death, heart transplant, ventricular assist device (VAD) placement, and transplant registry listing. Absolute iron deficiency and iron sufficiency were defined as transferrin saturations <20% and ≥30%, respectively; and indeterminant iron status as 20%-29%. RESULTS: Of 799 patients with chronic heart failure, 471 (59%) had no iron-related laboratory measurements. Of 68 children with dilated cardiomyopathy, baseline transferrin saturation, and quantitative left ventricular ejection fraction (LVEF), 33 (49%) and 14 (21%) were iron deficient and sufficient, respectively, and 21 (31%) indeterminant. LVEF was reduced to 23.6 ± 12.1% from 32.9 ± 16.8% in iron deficiency and sufficiency, respectively (P = .04), without a significant difference in hemoglobin. After stratification by New York Heart Association classification, in advanced class IV, hemoglobin was reduced to 10.9 ± 1.3 g/dL vs 12.7 ± 2.0 g/dL in iron deficiency and sufficiency, respectively (P = .01), without a significant difference in LVEF. CONCLUSIONS: In this single-center study, iron deficiency was not monitored in most children with chronic heart failure. In pediatric dilated cardiomyopathy-induced heart failure, absolute iron deficiency was prevalent and associated with clinically consequential and possibly correctable decreases in cardiac function and hemoglobin concentration.

Iron application improves yield, economic returns and grain-Fe concentration of mungbean.

Malnutrition is among the biggest threats being faced globally, and Pakistan is among the countries having high malnutrition rate. Pulses grown in Pakistan have lower amounts of micronutrients, especially iron (Fe) in grains compared to developed world. Biofortification, -a process of integrating nutrients into food crops-, provides a sustainable and economic way of increasing minerals/micronutrients' concentration in staple crops. Mungbean fulfills protein needs of large portion of Pakistani population; however, low Fe concentration in grains do not provide sufficient Fe. Therefore, current study was conducted to infer the impact of different Fe levels and application methods on yield, economic returns and grain-Fe concentration of mungbean. Mungbean was sown under four levels of Fe, i.e., 0, 5, 10 and 15 kg Fe ha-1 applied by three methods, i) as basal application (whole at sowing), ii) side dressing (whole at 1st irrigation) and iii) 50% as basal application + 50% side dressing (regarded as split application). Iron levels and application methods significantly influenced the allometry, yield, economic returns and grain-Fe concentration of mungbean. Split application of 15 kg Fe ha-1 had the highest yield, economic returns and grain-Fe concentration compared to the rest of Fe levels and application methods. Moreover, split application of 15 kg Fe ha-1 proved a quick method to improve the grain-Fe concentration and bioavailability, which will ultimately solve the Fe malnutrition problem of mungbean-consuming population in Pakistan. In conclusion, split application of Fe at 15 kg ha-1 seemed a viable technique to enhance yield, economic returns, grain-Fe concentration and bioavailability of mungbean.

Iron Deficiency and Neuroendocrine Regulators of Basal Metabolism, Body Composition and Energy Expenditure in Rats.

Although dietary iron is a determinant of iron status in animals, body fat mass has been reported to have an inverse association with iron status in human studies. The goal of this study was to determine the relationship between Fe homeostasis, body composition, energy expenditure and neuroendocrine regulators for severe Fe-deficiency anaemia. Forty male Wistar albino rats recently weaned were divided at random into two groups: the control group was fed the basal diet, AIN-93G diet (normal-Fe) and the anaemic group received a low-Fe diet for 40 days. Neuroendocrine parameters that regulate basal metabolism and appetite (thyroid hormones, ghrelin, glucose-dependent insulinotropic polypeptide (GIP), glucagon, insulin, adrenocorticotropic hormone and corticosterone), body composition, respiratory volumes, energy expenditure, haematological and biochemical were assessed. Total body fat was lower, whereas lean mass, free and total water were higher in the anemic group. O2 consumption, CO2 production, energy expenditure (EE) and respiratory quotient (RQ) were lower in the Fe-deficient animals. Triiodothyronine and thyroxine hormones decreased, while thyroid-stimulating hormone increased in the anemic group. Circulating levels of ghrelin were lower in the anemic group, while GIP, glucagon, insulin, corticosterone and adrenocorticotropic hormone levels were higher. Fe-deficiency impairs weight gain in the rats, with marked reductions in lean mass and body fat, indicating lower energy stores.

Biocompatibility of new low-cost (α + ß)-type Ti-Mo-Fe alloys for long-term implantation.

In this work, two new α +â€¯ß titanium alloys with low contents of ubiquitous and low-cost alloying elements (i.e., Mo and Fe) were designed on the basis of the electronic parameters and molybdenum equivalent approaches. The designed Ti - 2Mo - 0.5Fe at. % (TMF6) and Ti - 3Mo - 0.5Fe at. % (TMF8) alloys were produced using arc melting process for studying their mechanical, electrochemical and cytotoxicity compatibilities and comparing these compatibilities to those of Ti-6Al-4V ELI alloy. The cost of the used raw materials for producing the TMF6 and TMF8 alloys are almost 1/6 of those for producing the Ti-6Al-4V ELI alloy. The hardness of the two alloys are higher than that of the Ti-6Al-4V ELI alloy, while their Young's moduli (in the range of 85-82 GPa) are lower than that of the Ti-6Al-4V ELI alloy (110 GPa). Increasing the Mo equivalent from 6 (in TMF6 alloy) to 8 (in TMF8 alloy) led to an increase in the plastic strain percent from 4% to 17%, respectively, and a decrease in the ultimate tensile strength from 949 MPa to 800 MPa, respectively. The microstructure of TMF6 alloy consists of α'/α″ phases, while TMF8 alloy substantially consists of α″ phase. The corrosion current densities and the film resistances of the new alloys are in the range of 0.70-1.07 nA/cm2 and on the order of 105â€¯Ω·cm2, respectively. These values are more compatible with biomedical applications than those measured for the Ti-6Al-4V ELI alloy. Furthermore, the cell viabilities of the TMF6 and TMF8 alloys indicate their improved compatibility compared to that of the Ti-6Al-4V ELI alloy. The CCK-8 (Cell Counting Kit-8) assay was conducted to investigate the cytotoxicity, proliferation, and shape index of the cells of the candidate alloys. Overall, the measured compatibility of the new V-free low-cost alloys, particularly TMF8, makes them promising candidates for replacing the Ti-6Al-4V ELI alloy in biomedical applications.

Assessment of zero-valent iron-based nanotherapeutics for ferroptosis induction and resensitization strategy in cancer cells.

Addressing nanomedicine resistance is critical for its ultimate clinical success; despite this, advancing the therapeutic designs for cancer therapy are rarely discussed in the literature. In this study, we discovered that ferroptosis is the central mechanism governing the therapeutic efficacy and resistance of treatment with zero-valent iron nanoparticles (ZVI NPs). In ZVI-sensitive oral cancer cells, ZVI NPs-induced ferroptosis was characterized by mitochondrial lipid peroxidation and reduced levels of glutathione peroxidases (GPx) in subcellular organelles. However, resistant cells could attenuate ZVI-induced oxidative stress and GPx reduction. They also showed stronger mitochondrial respiration ability, thus resisting ZVI NPs-induced mitochondrial membrane potential loss. Transcriptome comparison and quantitative polymerase chain reaction (qPCR) analysis revealed that ZVI-resistant cancer cells expressed a gene set related to enhanced NADPH supply, higher detoxification capacity of reactive oxygen species, and decreased sensitivity to ferroptosis inducers (FINs). Finally, we discovered that certain FINs were able to sensitize ZVI-resistant cancer cells to become treatable without compromising healthy non-malignant cells. These findings suggest that ferroptosis can serve as a druggable target for anti-cancer nanomedicine and therapeutic resistance modulation using ZVI NPs.

A novel iron supplements preparation from Grifola frondosa polysaccharide and assessment of antioxidant, lymphocyte proliferation and complement fixing activities.

Grifola frondosa polysaccharide-iron (III) complex (GFP-iron) was synthesized and characterized. Based on single factor and orthogonal optimization experiments of GFP-iron (III) complex synthesis, the optimum conditions were the reaction temperature 80°C, pH 8, reaction time 90min and ratio of catalyst to GFP 1:1.0gg-1. The iron content of GFP-iron (III) complex reached 24.15% under the optimums and characterized by fourier transform infrared (FTIR), scanning electron microscopy (SEM), X-Ray Diffraction (XRD), thermogravimetry (TG) and iron release in vitro assay. By 5-axe cobweb charts, the antioxidant activity of GFP-iron (III) complex was comprehensively evaluated. The results showed GFP-iron (III) complex retained a certain antioxidant activity. The lymphocytes proliferation of GFP-iron (III) complex was increased by 61.68% comparing with that of GFP at the sample concentration of 62.5µg/mL. At giving 50% haemolysis, the concentration of GFP-iron (III) complex was 0.261mg/mL. Therefore, GFP-iron (III) complex would be expected to exploit into a new-type comprehensive iron supplements.

Characterization and cellular studies of molecular nanoparticle of iron (III)-tannic complexes; toward a low cost magnetic resonance imaging agent.

Herein, a new magnetic resonance imaging (MRI) agent based on molecular nanoparticles of iron(III)-tannic complexes (Fe-TA NPs) is reported. The paramagnetic and molecularlike Fe-TA NPs were successfully synthesized at room temperature within a few minutes without the use of any toxic agents or expensive equipment. The coordination states of the Fe-TA NPs were pH-dependent. The r1 relaxivity values of the bis-dominated and tris-dominated structures of the Fe-TA NPs were determined to be 6.31 and 5.24 mM-1 s-1, respectively, by using a Philips Achieva 1.5T MRI scanner. The Fe-TA NPs were 177 ± 12 nm in diameter (hydrodynamic size) with a zeta potential value of -28 ± 0.9 mV, dispersing very well in aqueous solution and were highly stable in phosphate buffered saline buffer (pH 7.4) containing competitive ligands and metals. From in vitro studies, it was evident that the Fe-TA NPs exhibited good biocompatibility, with high cellular uptake in HepG2 cells. Clearly, the Fe-TA NPs were found to induce signal enhancement in the T1-weighted image of the HepG2 cells. As a result, it can be stated that the Fe-TA NPs may have the potential for being developed as low-cost and clinically translatable magnetic resonance imaging agents in the near future.

Electromagnetic induction of foam-based nanoscale zerovalent iron (NZVI) particles to thermally enhance non-aqueous phase liquid (NAPL) volatilization in unsaturated porous media: Proof of concept.

Nanoscale zerovalent iron (NZVI) is a promising remediation agent for volatile organic compound (VOC) contamination in saturated sub-surfaces, but is rarely applied to the vadose zone as there are not enough water molecules in the unsaturated zone to participate in reductive dechlorination. In this study, we evaluated the possibility of using foam as a carrying vehicle to emplace NZVI in unsaturated porous media followed by the application of low frequency-electromagnetic field (LF-EMF) to enhance VOC volatilization in laboratory batch reactors. We found that the optimal condition for generating foam-based NZVI (F-NZVI) was using sodium lauryl ether sulfate (SLES) at a concentration of 3% (w/w) and a N2 flow rate of 500 mL/min. Also, F-NZVI could carry as much as 41.31 g/L of NZVI in the liquid phase of the foam and generate heat to raise ΔT to 77 °C in 15 min under an applied LF-EMF (150 kHz and 13 A). Under these conditions, F-NZVI together with LF-EMF enhanced trichloroethylene (TCE) volatilization from TCE-dense non-aqueous phase liquid (DNAPL) in unsaturated sand by 39.51 ± 6.59-fold compared to reactors without LF-EMF application. This suggested that using F-NZVI together with LF-EMF could theoretically be an alternative to radio frequency heating (RFH) as it requires a much lower irradiation frequency (336-fold lower), which should result in significantly lower capital and operational costs compared to RFH.

Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children's cognition at age 9-12 years in Indonesia: follow-up of the SUMMIT randomised trial.

BACKGROUND: Brain and cognitive development during the first 1000 days from conception are affected by multiple biomedical and socioenvironmental determinants including nutrition, health, nurturing, and stimulation. An improved understanding of the long-term influence of these factors is needed to prioritise public health investments to optimise human development. METHODS: We did a follow-up study of the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), a double-blind, cluster-randomised trial of maternal supplementation with multiple micronutrients (MMN) or iron and folic acid (IFA) in Indonesia. Of 27 356 live infants from birth to 3 months of age in 2001-04, we re-enrolled 19 274 (70%) children at age 9-12 years, and randomly selected 2879 from the 18 230 who were attending school at a known location. Of these, 574 children were oversampled from mothers who were anaemic or malnourished at SUMMIT enrolment. We assessed the effects of MMN and associations of biomedical (ie, maternal and child anthropometry and haemoglobin and preterm birth) and socioenvironmental determinants (ie, parental education, socioeconomic status, home environment, and maternal depression) on general intellectual ability, declarative memory, procedural memory, executive function, academic achievement, fine motor dexterity, and socioemotional health. The SUMMIT trial was registered, number ISRCTN34151616. FINDINGS: Children of mothers given MMN had a mean score of 0·11 SD (95% CI 0·01-0·20, p=0·0319) higher in procedural memory than those given IFA, equivalent to the increase in scores with half a year of schooling. Children of anaemic mothers in the MMN group scored 0·18 SD (0·06-0·31, p=0·0047) higher in general intellectual ability, similar to the increase with 1 year of schooling. Overall, 18 of 21 tests showed a positive coefficient of MMN versus IFA (p=0·0431) with effect sizes from 0·00-0·18 SD. In multiple regression models, socioenvironmental determinants had coefficients of 0·00-0·43 SD and 22 of 35 tests were significant at the 95% CI level, whereas biomedical coefficients were 0·00-0·10 SD and eight of 56 tests were significant, indicating larger and more consistent impact of socioenvironmental factors (p<0·0001). INTERPRETATION: Maternal MMN had long-term benefits for child cognitive development at 9-12 years of age, thereby supporting its role in early childhood development, and policy change toward MMN. The stronger association of socioenvironmental determinants with improved cognition suggests present reproductive, maternal, neonatal, and child health programmes focused on biomedical determinants might not sufficiently enhance child cognition, and that programmes addressing socioenvironmental determinants are essential to achieve thriving populations. FUNDING: Grand Challenges Canada Saving Brains Program.

Safe-by-Design CuO Nanoparticles via Fe-Doping, Cu-O Bond Length Variation, and Biological Assessment in Cells and Zebrafish Embryos.

The safe implementation of nanotechnology requires nanomaterial hazard assessment in accordance with the material physicochemical properties that trigger the injury response at the nano/bio interface. Since CuO nanoparticles (NPs) are widely used industrially and their dissolution properties play a major role in hazard potential, we hypothesized that tighter bonding of Cu to Fe by particle doping could constitute a safer-by-design approach through decreased dissolution. Accordingly, we designed a combinatorial library in which CuO was doped with 1-10% Fe in a flame spray pyrolysis reactor. The morphology and structural properties were determined by XRD, BET, Raman spectroscopy, HRTEM, EFTEM, and EELS, which demonstrated a significant reduction in the apical Cu-O bond length while simultaneously increasing the planar bond length (Jahn-Teller distortion). Hazard screening was performed in tissue culture cell lines and zebrafish embryos to discern the change in the hazardous effects of doped vs nondoped particles. This demonstrated that with increased levels of doping there was a progressive decrease in cytotoxicity in BEAS-2B and THP-1 cells, as well as an incremental decrease in the rate of hatching interference in zebrafish embryos. The dissolution profiles were determined and the surface reactions taking place in Holtfreter's solution were validated using cyclic voltammetry measurements to demonstrate that the Cu+/Cu2+ and Fe2+/Fe3+ redox species play a major role in the dissolution process of pure and Fe-doped CuO. Altogether, a safe-by-design strategy was implemented for the toxic CuO particles via Fe doping and has been demonstrated for their safe use in the environment.

Uranium in well drinking water of Kabul, Afghanistan and its effective, low-cost depuration using Mg-Fe based hydrotalcite-like compounds.

Toxic elements in drinking water have great effects on human health. However, there is very limited information about toxic elements in drinking water in Afghanistan. In this study, levels of 10 elements (chromium, nickel, copper, arsenic, cadmium, antimony, barium, mercury, lead and uranium) in 227 well drinking water samples in Kabul, Afghanistan were examined for the first time. Chromium (in 0.9% of the 227 samples), arsenic (7.0%) and uranium (19.4%) exceeded the values in WHO health-based guidelines for drinking-water quality. Maximum chromium, arsenic and uranium levels in the water samples were 1.3-, 10.4- and 17.2-fold higher than the values in the guidelines, respectively. We next focused on uranium, which is the most seriously polluted element among the 10 elements. Mean ± SD (138.0 ± 1.4) of the 238U/235U isotopic ratio in the water samples was in the range of previously reported ratios for natural source uranium. We then examined the effect of our originally developed magnesium (Mg)-iron (Fe)-based hydrotalcite-like compounds (MF-HT) on adsorption for uranium. All of the uranium-polluted well water samples from Kabul (mean ± SD = 190.4 ± 113.9 µg/L; n = 11) could be remediated up to 1.2 ± 1.7 µg/L by 1% weight of our MF-HT within 60 s at very low cost (<0.001 cents/day/family) in theory. Thus, we demonstrated not only elevated levels of some toxic elements including natural source uranium but also an effective depurative for uranium in well drinking water from Kabul. Since our depurative is effective for remediation of arsenic as shown in our previous studies, its practical use in Kabul may be encouraged.

Scalable and Cost-Effective Synthesis of Highly Efficient Fe2N-Based Oxygen Reduction Catalyst Derived from Seaweed Biomass.

A simple and scalable synthesis of a 3D Fe2N-based nanoaerogel is reported with superior oxygen reduction reaction activity from waste seaweed biomass, addressed the growing energy scarcity. The merits are due to the synergistic effect of the 3D porous hybrid aerogel support with excellent electrical conductivity, convenient mass transport and O2 adsorption, and core/shell structured Fe2N/N-doped amorphous carbon nanoparticles.

Urban net-zero water treatment and mineralization: experiments, modeling and design.

Water and wastewater treatment and conveyance account for approximately 4% of US electric consumption, with 80% used for conveyance. Net zero water (NZW) buildings would alleviate demands for a portion of this energy, for water, and for the treatment of drinking water for pesticides and toxic chemical releases in source water. However, domestic wastewater contains nitrogen loads much greater than urban/suburban ecosystems can typically absorb. The purpose of this work was to identify a first design of a denitrifying urban NZW treatment process, operating at ambient temperature and pressure and circum-neutral pH, and providing mineralization of pharmaceuticals (not easily regulated in terms of environmental half-life), based on laboratory tests and mass balance and kinetic modeling. The proposed treatment process is comprised of membrane bioreactor, iron-mediated aeration (IMA, reported previously), vacuum ultrafiltration, and peroxone advanced oxidation, with minor rainwater make-up and H2O2 disinfection residual. Similar to biological systems, minerals accumulate subject to precipitative removal by IMA, salt-free treatment, and minor dilution. Based on laboratory and modeling results, the system can produce potable water with moderate mineral content from commingled domestic wastewater and 10-20% rainwater make-up, under ambient conditions at individual buildings, while denitrifying and reducing chemical oxygen demand to below detection (<3 mg/L). While economics appear competitive, further development and study of steady-state concentrations and sludge management options are needed.

Consideraciones para la transformación del sistema de salud del Ecuador desde una perspectiva de equidad / Equity-based considerations for transforming the Ecuadorian health system

Objectivo El propósito del presente estudio es analizar las inequidades socioeconómicas en la utilización de servicios de salud en el Ecuador, las inequidades en la distribución geográfica de recursos humanos en salud, y reflexionar sobre los retos de equidad que el sistema de salud ecuatoriano enfrenta en la actualidad. Métodos Se utilizó la Encuesta Demográfica y de Salud Materno-Infantil (ENDEMAIN 2004) como la principal fuente de datos, cuya muestra es representativa de la población ecuatoriana. Para estimar los efectos en utilización de servicios de salud utilizamos análisis multivariado multinivel (usando el paquete estadístico MLWiN 2.02) y análisis espacial de recursos en salud (usando GeoDa 1.0.1 ). Resultados Nuestro análisis encontró que inequidades sociales, económicas y geográficas limitan el acceso a servicios de salud en el Ecuador. Hogares de bajos recursos, indígenas y aquellos que viven enáreas rurales (muchos con las tres características a la vez) tienen menos posibilidades de utilizar servicios de salud. A pesar de la marcada concentración de proveedores de salud en zonas urbanas, encontramos que la presencia de personal de salud (excluyendo a médicos) en entidades públicas rurales incrementa la posibilidad de utilización de servicios preventivos y curativos. Conclusiones Los esfuerzos para transformar el sistema de salud deben reducir barreras sociales, culturales, financieras; y las desigualdades en la distribución de recursos humanos en salud, particularmente en elárea rural. Consideramos que la orientación comunitaria y familiar de los servicios, y el incremento de espacios de participación ciudadana son necesarios para reducir dichas inequidades.

Objective The present study was aimed at analysing socioeconomic inequity regarding the use of health services in Ecuador, inequity regarding the geographic distribution of healthcare-related human resources and reflecting on the challenges concerning equity which the Ecuadorian health system is currently facing. Methods The Ecuadorian Demographic, Maternal and Infant Health Survey (2004) was used as the main data source, as its sample was representative of the Ecuadorian population. Multilevel multivariate analysis (MLWiN 2.02 statistical software) and spatial data analysis regarding health resources (GeoDa 1.0.1) were used for estimating the effects of using health services. Results It was found that social, economic and geographic inequity limited access to health services in Ecuador. People living in low economic resource households or indigenous housing and people living in rural areas (many of them having all three characteristics at the same time) had less possibility of using health services. In spite of a marked concentration of health-service providers in urban areas, it was found that the presence of healthcare personnel (excluding doctors) in rural public entities increased the possibility of using preventative and curative services. Conclusions Efforts at transforming the Ecuadorian health system must be aimed at reducing social, cultural and financial barriers and inequality regarding the distribution de healthcare-related human resources, particularly in rural areas. Community and family orientation of the services and increasing spaces for citizen participation are necessary for reducing such inequity.

Weekly iron-folic acid supplementation with regular deworming is cost-effective in preventing anaemia in women of reproductive age in Vietnam.

BACKGROUND: To estimate the cost and cost-effectiveness of a project administering de-worming and weekly iron-folic acid supplementation to control anaemia in women of reproductive age in Yen Bai province, Vietnam. METHODS AND FINDINGS: Cost effectiveness was evaluated using data on programmatic costs based on two surveys in 2006 and 2009 and impact on anaemia and iron status collected in 2006, 2007, and 2008. Data on initial costs for training and educational materials were obtained from the records of the National Institute of Malariology, Parasitology and Entomology and the Yen Bai Malaria Control Program. Structured questionnaires for health workers at district, commune and village level were used to collect ongoing distribution and monitoring costs, and for participants to collect transport and loss of earnings costs. The cost per woman treated (defined as consuming at least 75% of the recommended intake) was USD0.76 per annum. This estimate includes financial costs (for supplies, training), and costs of health care workers' time. Prevalence of anaemia fell from 38% at baseline, to 20% after 12 months. Thus, the cost-effectiveness of the project is assessed at USD 4.24 per anaemia case prevented per year. Based on estimated productivity gains for adult women, the benefit:cost ratio is 6.7∶1. Cost of the supplements and anthelminthics was 47% of the total, while costs of training, monitoring, and health workers' time accounted for 53%. CONCLUSION: The study shows that weekly iron-folic acid supplementation and regular de-worming is a low-cost and cost-effective intervention and would be appropriate for population-based introduction in settings with a high prevalence of anaemia and iron deficiency and low malaria infection rates.

Sustainable disposal of municipal solid waste: post bioreactor landfill polishing.

Sustainable disposal of municipal solid waste (MSW) requires assurance that contaminant release will be minimized or prevented within a reasonable time frame before the landfill is abandoned so that the risk of contamination release is not passed to future generations. This could be accomplished through waste acceptance criteria such as those established by the European Union (EU) that prohibit land disposal of untreated organic matter. In the EU, mechanical, biological and/or thermal pretreatment of MSW is therefore necessary prior to landfilling which is complicated and costly. In other parts of the world, treatment within highly engineered landfills is under development, known as bioreactor landfills. However, the completed bioreactor landfill still contains material, largely nonbiodegradable carbon and ammonia that may be released to the environment over the long-term. This paper provides a conceptual analysis of an approach to ensure landfill sustainability by the rapid removal of these remaining materials, leachate treatment and recirculation combined with aeration. The analysis in this paper includes a preliminary experimental evaluation using real mature leachate and waste samples, a modeling effort using a simplified mass balance approach and input parameters from real typical bioreactor cases, and a cost estimate for the suggested treatment method.

Effects of micronutrients on growth of children under 5 y of age: meta-analyses of single and multiple nutrient interventions.

BACKGROUND: Micronutrient interventions have received much attention as a cost-effective and promising strategy to improve child health, but their roles in improving child growth remain unclear. OBJECTIVE: Meta-analyses of randomized controlled trials were conducted to evaluate the effect of micronutrient interventions on the growth of children aged <5 y old. DESIGN: Eligible studies were identified by PubMed database searches and other methods. Weighted mean effect sizes and 95% CIs were calculated for changes in height, weight, and weight-for-height z scores (WHZ) by using random-effect models. Tests for publication bias were done by using funnel plots, heterogeneity, and stratified analyses by predefined characteristics. RESULTS: Interventions including iron (n = 27) or vitamin A (n = 17) only had no significant effects on growth. Interventions including zinc only (n = 43) had a small positive effect (effect size = 0.06; 95% CI: 0.006, 0.11) on change in WHZ but no significant effect on height or weight gain. Multiple micronutrient interventions (n = 20) improved linear growth (0.09; 95% CI: 0.008, 0.17). CONCLUSIONS: Our findings confirm earlier results of no benefits for interventions including iron and vitamin A only but differ from the earlier meta-analysis that found improvements in linear growth for zinc only interventions. This may be due to the improved nutritional status of children in the more recent studies. Multiple micronutrient interventions improve linear growth, but the benefits are small. Other strategies are needed to prevent stunting.

Haemophilic arthropathy: the importance of the earliest haemarthroses and consequences for treatment.

In a case of massive bleeding, the possibility of puncturing the joint can be considered to reduce the total load of intra-articular blood, and thus the total load of iron which, in time, can be found in the synovium with devastating long-term effects. Subsequent initiation of prophylaxis, still very early in life, might be more beneficial for the preservation of joints. Thus, it might be argued that the initiation of primary prophylaxis should be based on joint haemorrhage history rather than age and, according to some authors, preferably after the bleed in a single joint. The high cost of recombinant factor VIII may make widespread acceptance of prophylaxis impractical. Thus, beneficial results should be balanced with cost considerations. In this balance of treatment cost and efficacy, it must be taken into account that improperly treated haemophilia patients make great demands on healthcare systems (in terms of costs) because of their need for additional treatments such as expensive joint replacement surgery. However, where resources are limited, it can be argued that prophylaxis may be stopped in adulthood, in a certain proportion of all adult patients, with acceptable consequences for orthopaedic outcome in the long term. By doing so, limited amounts of clotting factor can be used for young patients with optimal cost effectiveness.

Adding zinc to supplemental iron and folic acid does not affect mortality and severe morbidity in young children.

Studies have found a substantial reduction in diarrhea and respiratory morbidity in young children receiving zinc supplementation. The impact of daily zinc supplementation administered with iron plus folic acid (IFA) in young children on all-cause hospitalizations and mortality in comparison with IFA alone was evaluated. In a double blind cluster-randomized controlled trial, 94,359 subjects aged 1-23 mo were administered a daily dose of zinc plus IFA or IFA alone for a duration of 12 mo after enrollment. The intervention group tablet contained 10 mg of elemental zinc, 12.5 mg of iron, and 50 microg of folic acid. The control group tablets were similar except that they contained a placebo for zinc. Infants aged <6 mo were administered half a tablet, and those older received 1 tablet dissolved in breast milk or water. Hospitalizations were captured by trained study physicians through the surveillance of 8 hospitals. Deaths and hospitalizations were ascertained through visits to households by study supervisors once every 2 mo. The overall death rates did not differ significantly between the 2 groups when adjusted for cluster randomization (hazard ratio = 1.02, 95% CI 0.87, 1.19). Zinc and IFA supplementation compared with IFA alone did not affect adjusted hospitalization rates (overall rate ratio = 1.08, 95% CI 0.98, 1.19; diarrhea-specific rate ratio = 1.15, 95% CI 0.99, 1.34; or pneumonia-specific rate ratio = 1.09, 95% CI 0.94, 1.25). The lack of impact of zinc on mortality and hospitalization rates in this study may have been due to the use of lower daily zinc dosing than used in some of the morbidity prevention trials or from an interaction between zinc and iron, where the addition of iron may have adversely affected potential effects of zinc on immune function and morbidity. Future research should address iron and zinc interaction effects on important functional outcomes.