Evaluation of effects-based methods as monitoring tools for assessing ecological impacts of metals in aquatic ecosystems.

Effects-based methods (EBMs) are considered part of a more integrative strategy for regulating substances of concern under the European Union Water Framework Directive. In general, EBMs have been demonstrated as useful indicators of effects on biota, although links to population and community-level effects are sometimes uncertain. When EBMs are sufficiently specific and sensitive, and links between measured endpoints and apical or higher level effects are established, they can be a useful tool in assessing effects from a specific toxicant or class of toxicants. This is particularly valuable for toxicants that are difficult to measure and for assessing the effects of toxicant mixtures. This paper evaluates 12 EBMs that have been proposed for potential use in the assessment of metals. Each EBM was evaluated with respect to metal specificity and sensitivity, sensitivity to other classes of toxicants, and the strength of the relationship between EBM endpoints and effects observed at the whole organism or population levels of biological organization. The evaluation concluded that none of the EBMs evaluated meet all three criteria of being sensitive to metals, insensitive to other classes of toxicants, and a strong indicator of effects at the whole organism or population level. Given the lack of suitable EBMs for metals, we recommended that the continued development of mixture biotic ligand models (mBLMs) may be the most effective way to achieve the goal of a more holistic approach to regulating metals in aquatic ecosystems. Given the need to further develop and validate mBLMs, we suggest an interim weight-of-evidence approach that includes mBLMs, macroinvertebrate community bioassessment, and measurement of metals in key macroinvertebrate species. This approach provides a near-term solution and simultaneously generates data needed for the refinement and validation of mBLMs. Once validated, it should be possible to rely primarily on mBLMs as an alternative to EBMs for metals. Integr Environ Assess Manag 2023;19:24-31.  © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Service user experiences of community services for complex emotional needs: A qualitative thematic synthesis.

BACKGROUND: There is a recognised need to develop clear service models and pathways to provide high quality care in the community for people with complex emotional needs, who may have been given a "personality disorder" diagnosis. Services should be informed by the views of people with these experiences. AIMS: To identify and synthesise qualitative studies on service user experiences of community mental health care for Complex Emotional Needs. METHODS: We searched six bibliographic databases for papers published since 2003. We included peer reviewed studies reporting data on service user experiences and views about good care from community-based mental health services for adults with CEN, including generic mental health services and specialist "personality disorder" services. Studies using any qualitative method were included and thematic synthesis used to identify over-arching themes. RESULTS: Forty-seven papers were included. Main themes were: 1) The need for a long-term perspective on treatment journeys; 2) The need for individualised and holistic care; 3) Large variations in accessibility and quality of mental health services; 4) The centrality of therapeutic relationships; 5) Impacts of 'personality disorder' diagnosis. Themes tended to recur across studies from different countries and years. DISCUSSION: Recurrent major themes included wanting support that is individualised and holistic, provides continuity over long journeys towards recovery, and that is delivered by empathetic and well-informed clinicians who are hopeful but realistic about the prospects of treatment. Care that met these simple and clearly stated priorities tended to be restricted to often limited periods of treatment by specialist "personality disorder" services: generic and primary care services were often reported as far from adequate. There is an urgent need to co-design and test strategies for improving long-term support and treatment care for people with "personality disorders" throughout the mental health care system.

Immunosuppressive agents in adult kidney transplantation in the National Health Service: a model-based economic evaluation.

BACKGROUND: Immunosuppression is required in kidney transplantation to prevent rejection and prolong graft survival. We conducted an economic evaluation to support England's National Institute for Health and Care Excellence in developing updated guidance on the use of immunosuppression, incorporating new immunosuppressive agents, and addressing changes in pricing and the evidence base. METHODS: A discrete-time state transition model was developed to simulate adult kidney transplant patients over their lifetime. A total of 16 different regimens were modelled to assess the cost-effectiveness of basiliximab and rabbit anti-thymocyte globulin (rabbit ATG) as induction agents (with no antibody induction as a comparator) and immediate-release tacrolimus, prolonged-release tacrolimus, mycophenolate mofetil, mycophenolate sodium, sirolimus, everolimus and belatacept as maintenance agents (with ciclosporin and azathioprine as comparators). Graft survival was extrapolated from acute rejection rates, graft function and post-transplant diabetes rates, all estimated at 12 months post-transplantation. National Health Service (NHS) and personal social services costs were included. Cost-effectiveness thresholds of £20 000 and £30 000 per quality-adjusted life year were used. RESULTS: Basiliximab was predicted to be more effective and less costly than rabbit ATG and induction without antibodies. Immediate-release tacrolimus and mycophenolate mofetil were cost-effective as maintenance therapies. Other therapies were either more expensive and less effective or would only be cost-effective if a threshold in excess of £100 000 per quality-adjusted life year were used. CONCLUSIONS: A regimen comprising induction with basiliximab, followed by maintenance therapy with immediate-release tacrolimus and mycophenolate mofetil, is likely to be effective for uncomplicated adult kidney transplant patients and a cost-effective use of NHS resources.

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations.

BACKGROUND: Lateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient's social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year. OBJECTIVES: This systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET. DATA SOURCES: A comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases. METHODS AND OUTCOMES: We conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013. RESULTS: A total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified. LIMITATIONS: The summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect. CONCLUSIONS: Clinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003593. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Glycosidic conjugates of C13 norisoprenoids, monoterpenoids, and cucurbates in Boronia megastigma (Nees).

Analysis of a methanolic extract of marc from Boronia megastigma (Nees) using LC-MS (APCI, nominal mass) provided strong evidence for the presence of both glycosides and malonyl glycosides of methyl cucurbates, C13 norisoprenoids including megastigmanes, and monoterpene alcohols. Subsequent fractionation of an extract from the marc using XAD-2 and LH 20 chromatography followed by LC-UV/MS-SPE-NMR and accurate mass LC-MS resulted in the isolation and identification of (1R,4R,5R)-3,3,5-trimethyl-4-[(1E)-3-oxobut-1-en-1-yl]cyclohexyl ß-D-glucopyranoside (3-hydroxy-5,6-dihydro-ß-ionone-ß-D-glucopyranoside); 3,7-dimethylocta-1,5-diene-3,7-diol-3-O-ß-D-glucopyranoside; and a methyl {(1R)-3-(ß-D-glucopyranosyloxy)-2-[(2Z)-pent-2-en-1-yl]cyclopentyl}acetate stereoisomer (a methyl cucurbate-ß-D-glucopyranoside); and provided evidence for 3,7-dimethylocta-1,5-diene-3,7-diol-3-O-(6'-O-malonyl)-ß-D-glucopyranoside in boronia flowers.

Changes in some carotenoids and apocarotenoids during flower development in Boronia megastigma (Nees).

The carotenoid profile of an acetone extract from the flowers and leaves of Boronia megastigma (Nees) was examined. A comparison was made of the major carotenoids found in boronia flowers and leaves. The C-40 carotenoids beta-carotene, zeaxanthin, lutein, and neoxanthin were positively identified in boronia flowers using known standards, UV-vis spectra, and mass spectrometry. Two other carotenoids were tentatively assigned as the palmitic acid ester of 3-hydroxy-10'-apocaroten-10'-oic acid and 9,15,9'-tri-cis-zeta-carotene. Additionally, changes in the levels of C-40 carotenoids, C-27 apocarotenoids, and beta-ionone during flower development were measured. Significant increases in beta-carotene and apocarotenoids that could be derived from cleavage in the 9,10-position, including beta-ionone and various C-27 apocarotenoids, were observed at the time of flower opening. An increase in lutein, which is derived through an alternative biosynthetic pathway, was not observed during flower opening, thus indicating the possibility that the beta-carotene pathway was activated during flower opening in boronia. The understanding of these processes may assist in optimizing harvest and postharvest processes useful to the boronia extraction industry.

Global iron-dependent gene regulation in Escherichia coli. A new mechanism for iron homeostasis.

Organisms generally respond to iron deficiency by increasing their capacity to take up iron and by consuming intracellular iron stores. Escherichia coli, in which iron metabolism is particularly well understood, contains at least 7 iron-acquisition systems encoded by 35 iron-repressed genes. This Fe-dependent repression is mediated by a transcriptional repressor, Fur (ferric uptake regulation), which also controls genes involved in other processes such as iron storage, the Tricarboxylic Acid Cycle, pathogenicity, and redox-stress resistance. Our macroarray-based global analysis of iron- and Fur-dependent gene expression in E. coli has revealed several novel Fur-repressed genes likely to specify at least three additional iron-transport pathways. Interestingly, a large group of energy metabolism genes was found to be iron and Fur induced. Many of these genes encode iron-rich respiratory complexes. This iron- and Fur-dependent regulation appears to represent a novel iron-homeostatic mechanism whereby the synthesis of many iron-containing proteins is repressed under iron-restricted conditions. This mechanism thus accounts for the low iron contents of fur mutants and explains how E. coli can modulate its iron requirements. Analysis of 55Fe-labeled E. coli proteins revealed a marked decrease in iron-protein composition for the fur mutant, and visible and EPR spectroscopy showed major reductions in cytochrome b and d levels, and in iron-sulfur cluster contents for the chelator-treated wild-type and/or fur mutant, correlating well with the array and quantitative RT-PCR data. In combination, the results provide compelling evidence for the regulation of intracellular iron consumption by the Fe2+-Fur complex.

C-27 apocarotenoids in the flowers of Boronia megastigma (Nees).

Five C-27 apocarotenoids were detected in acetone extracts of the flowers of Boronia megastigma (Nees) using HPLC with UV-vis photodiode array and MS detection. Comparison of methylated and unmethylated extracts aided identification when considered with the UV-vis and MS data. The five apocarotenoids identified here were hydroxy-apo-10'-carotenoic acid (1), methyl hydroxy-apo-10'-carotenoate (2), apo-10'-carotenoic acid (3), apo-10'-carotenal (4), and methyl apo-10'-carotenoate (5). The data obtained was not sufficient to allow the specific isomeric forms to be unequivocally identified. The results further support speculation that the C-13 norisoprenoids found in boronia are derived from C-40 carotenoids. Possible parent molecules of beta-ionone, an important component of boronia extract, were identified. An understanding of C-13 norisoprenoid biosynthesis may assist in the selection and postharvest processing of boronia flowers for flavor and fragrance applications.

Zanamivir prophylaxis: an effective strategy for the prevention of influenza types A and B within households.

A double-blind, randomized study of inhaled zanamivir for the prevention of influenza in families was conducted. Once a person with a suspected case of influenza was identified (index patient), treatment of all other household members (contacts) > or =5 years old was initiated. Contacts received either 10 mg zanamivir or placebo inhaled once daily for 10 days. Index patients received relief medication only. In total, 487 households (242 placebo and 245 zanamivir) were enrolled, with 1291 contacts randomly assigned to receive prophylaxis. Four percent of zanamivir versus 19% of placebo households (P<.001) had at least 1 contact who developed symptomatic, laboratory-confirmed influenza, representing 81% protective efficacy (95% confidence interval, 64%-90%). Protective efficacy was similarly high for individuals (82%) and against both influenza types A and B (78% and 85%, respectively, for households). Zanamivir was well tolerated and was effective in preventing influenza types A and B within households where the index patient was not treated.