Effect of algal contact time and horizontal water velocity on the performance of Filamentous Algal Nutrient Scrubbers (FANS).

We investigated the effect of algal contact time (ACT) and horizontal water velocity (HWV) on the performance of pilot-scale Filamentous Algae Nutrient Scrubbers (FANS) treating river water during the NZ summer. The FANS floways were seeded with a mixture of four New Zealand native filamentous algal species (Oedogonium sp., Cladophora sp., Rhizoclonium sp., and Spirogyra sp.) and allowed to establish over one month. River water was pumped onto the top of each FANS at different flow rates (2, 4 or 8 L min-1) to give ACTs from 0.6 to 10.1 min depending on FANS length (6-24 m) and HWV from 0.04 to 0.16 m s-1. FANS inflow and final outflows were monitored three times a week for nitrate and DRP concentrations and FANS algal biomass was harvested weekly. Average biomass productivity was significantly higher on the FANS with shorter ACT. For example, biomass productivity of the 24 m length FANS with 2.5 min ACT were 67% higher (11.2 g DW m-2 d-1) than that with four times the ACT (10.1 min). Irrespective of the HWV the biomass productivity declined down the length of the floways (with longer ACT) and the decline was greater at lower HWV. The decreased biomass productivity at lower HWV (and/or higher ACT) was likely attributable to the daytime carbon limitation of photosynthesis (at pH > 9.5) and heat stress with elevated daytime water temperature (at >30 °C). Despite the short ACT (<10.1 min) the single pass pilot-scale FANS effectively removed both nitrate-N and DRP from the river water, with >35% removal of both NO3-N (from 0.49 to <0.32 mg N L-1) and DRP (from 0.14 to <0.09 mg P L-1). Both the nitrogen and phosphorus content of the harvested algal biomass were unaffected by both HWV and ACT and typical (N: ∼2.0%; P: 0.2-0.3%) of the literature values (N: 1.5-3.0%; P: 0.15-0.32%). Compared with constructed wetland nutrient removal (0.1 g N m-2 d-1; 0.08 g P m-2 d-1), the FANS achieved up to 2.5-fold higher nitrogen removal (0.24 N m-2 d-1) through algal nitrogen assimilation followed by subsequent algal harvest and up to 4-fold higher phosphorus removal (0.34 g P m-2 d-1) through a combination of algal phosphorus assimilation and some P-precipitation under photosynthesis-mediated elevated daytime pH levels (pH > 9.0). This research indicates that FANS have the potential to require less than half the land area of constructed wetlands for the same level of nitrogen removal and that they require only a few weeks to establish to achieve full performance. Moreover, FANS have the further benefit of resource recovery for beneficial re-use of harvested algal biomass for animal feed, fertiliser, or biofuel.

Aquatic Antagonists: Jellyfish Stings.

Jellies, more commonly known as jellyfish, are a common cause of stings in oceans throughout the world. Most stings result in immediate painful skin reactions that can be treated with hot water immersion and careful removal of adherent tentacles. Rarely, certain jellyfish species can cause life-threatening systemic reactions that must be treated promptly and monitored in the acute care setting. Wearing a full-body stinger suit or applying a sting-inhibiting lotion are common strategies that may reduce the risk for jellyfish injuries. Avoidance of waters during jellyfish season is prudent in regions that harbor more dangerous species of jellyfish, particularly along the Australian and Indo-Pacific coastlines.

Development and evaluation of a patient-centred program for low anterior resection syndrome: protocol for a randomized controlled trial.

INTRODUCTION: Low anterior resection syndrome (LARS) is described as disordered bowel function after rectal resection that leads to a detriment in quality of life, and affects the majority of individuals following restorative proctectomy for rectal cancer. The management of LARS includes personalised troubleshooting and effective self-management behaviours. Thus, affected individuals need to be well informed and appropriately engaged in their own LARS management. This manuscript describes the development of a LARS patient-centred programme (LPCP) and the study protocol for its evaluation in a randomised controlled trial. METHODS AND ANALYSIS: This will be a multicentre, randomised, assessor-blind, parallel-groups, pragmatic trial evaluating the impact of an LPCP, consisting of an informational booklet, patient diaries and nurse support, on patient-reported outcomes after restorative proctectomy for rectal cancer. The informational booklet was developed by a multidisciplinary LARS team, and was vetted in a focus group and semistructured interviews involving patients, caregivers, and healthcare professionals. The primary outcome will be global quality of life (QoL), as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30), at 6 months after surgery. The treatment effect on global QoL will be modelled using generalised estimating equations. Secondary outcomes include symptom change, patient activation, bowel function measures, emotional distress, knowledge about LARS and satisfaction with the LPCP. ETHICS AND DISSEMINATION: The Research Ethics Committee (REC) at the Integrated Health and Social Services Network for West-Central Montreal (health network responsible for the Jewish General Hospital) is the overseeing REC for all Quebec sites. They have granted ethical approval (MP-05-2019-1628) for all Quebec hospitals (Jewish General Hospital, McGill University Health Center, CHU de Quebec) and have granted full authorisation to begin research at the Jewish General Hospital. Patient recruitment will not begin at the other Quebec sites until inter-institutional contracts are finalised and feasibility/authorisation for research is granted by their respective REC. The results of this study will be presented at national and international conferences, and a manuscript with results will be submitted for publication in a high-impact peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT03828318; Pre-results.

Timing of Palliative Care in Colorectal Cancer Patients: Does It Matter?

BACKGROUND: Palliative care can improve end-of-life care and reduce health care expenditures, but the optimal timing for initiation remains unclear. We sought to characterize the association between timing of palliative care, in-hospital deaths, and health care costs. METHODS: This is a retrospective cohort study including all patients who were diagnosed and died of colorectal cancer between 2004 and 2012 in Manitoba, Canada. The primary exposure was timing of palliative care, defined as no involvement, late involvement (less than 14 d before death), early involvement (14 to 60 d before death), and very early involvement (>60 d before death). The primary outcome was in-hospital deaths and end-of-life health care costs. RESULTS: A total of 1607 patients were included; 315 (20%) received palliative care and 162 (10%) died in hospital. Compared to those who did not receive palliative care, patients with early and very early involvement experienced significantly decreased odds of dying in hospital (OR 0.21 95% CI 0.06-0.69 P = 0.01 and OR 0.11 95% CI 0.01-0.78 P = 0.03, respectively) and significantly lower health care costs. There were no significant differences in in-hospital deaths and health care costs between patients without palliative care and those who received late palliative care. CONCLUSIONS: Early palliative care involvement is associated with decreased odds of dying in hospital and lower health care utilization and costs in patients with colorectal cancer. These findings provide real-world evidence supporting early integration of palliative care, although the optimal timing (early versus very early) remains a matter of debate.

Triheptanoin for glucose transporter type I deficiency (G1D): modulation of human ictogenesis, cerebral metabolic rate, and cognitive indices by a food supplement.

IMPORTANCE: Disorders of brain metabolism are multiform in their mechanisms and manifestations, many of which remain insufficiently understood and are thus similarly treated. Glucose transporter type I deficiency (G1D) is commonly associated with seizures and with electrographic spike-waves. The G1D syndrome has long been attributed to energy (ie, adenosine triphosphate synthetic) failure such as that consequent to tricarboxylic acid (TCA) cycle intermediate depletion. Indeed, glucose and other substrates generate TCAs via anaplerosis. However, TCAs are preserved in murine G1D, rendering energy-failure inferences premature and suggesting a different hypothesis, also grounded on our work, that consumption of alternate TCA precursors is stimulated and may be detrimental. Second, common ketogenic diets lead to a therapeutically counterintuitive reduction in blood glucose available to the G1D brain and prove ineffective in one-third of patients. OBJECTIVE: To identify the most helpful outcomes for treatment evaluation and to uphold (rather than diminish) blood glucose concentration and stimulate the TCA cycle, including anaplerosis, in G1D using the medium-chain, food-grade triglyceride triheptanoin. DESIGN, SETTING, AND PARTICIPANTS: Unsponsored, open-label cases series conducted in an academic setting. Fourteen children and adults with G1D who were not receiving a ketogenic diet were selected on a first-come, first-enrolled basis. INTERVENTION: Supplementation of the regular diet with food-grade triheptanoin. MAIN OUTCOMES AND MEASURES: First, we show that, regardless of electroencephalographic spike-waves, most seizures are rarely visible, such that perceptions by patients or others are inadequate for treatment evaluation. Thus, we used quantitative electroencephalographic, neuropsychological, blood analytical, and magnetic resonance imaging cerebral metabolic rate measurements. RESULTS: One participant (7%) did not manifest spike-waves; however, spike-waves promptly decreased by 70% (P = .001) in the other participants after consumption of triheptanoin. In addition, the neuropsychological performance and cerebral metabolic rate increased in most patients. Eleven patients (78%) had no adverse effects after prolonged use of triheptanoin. Three patients (21%) experienced gastrointestinal symptoms, and 1 (7%) discontinued the use of triheptanoin. CONCLUSIONS AND RELEVANCE: Triheptanoin can favorably influence cardinal aspects of neural function in G1D. In addition, our outcome measures constitute an important framework for the evaluation of therapies for encephalopathies associated with impaired intermediary metabolism.

Development of PTH eluting microspheres for the treatment of hypoparathyroidism.

BACKGROUND: Parathyroid hormone (PTH) replacement has been demonstrated to be superior to conventional treatment with calcium supplementation and vitamin D analogs for the treatment of hypoparathyroidism. In this investigation we evaluated the feasibility of using PTH microsphere encapsulation as a potential delivery system for PTH. MATERIALS AND METHODS: Using the spontaneous emulsion technique, PTH microspheres were created by encapsulating PTH (1-34) in a copolymer of polyglycolic and polylactic acid (PLGA). Additional microspheres were constructed by coencapsulating calmodulin with PTH (1-34) in the PLGA microspheres. Microsphere production was confirmed using electron microscopy. PTH release was measured in vitro using an enzyme-linked immunosorbent assay. The bioactivity of PTH released from the microspheres was confirmed in vivo using a hypoparathyroid rat model by measuring serum calcium concentrations before and 3 h after subcutaneous injection of PTH microspheres. RESULTS: PTH microsphere and PTH/calmodulin microspheres could be created using the spontaneous emulsion technique. Physiologically significant PTH release was measured in vitro for 20 days. PTH release was calcium sensitive and exhibited negative feedback. This effect was augmented by coencapsulation with calmodulin. PTH released from the microspheres caused a significant rise in serum calcium levels from an average of 6.35 (6.19-6.48 mg/dL) to 8.55 mg/dL (8.22-8.73). PTH released from the PTH/calmodulin microspheres resulted in an increase in serum calcium from a mean of 6.8 (6.7-6.9 mg/dL) to 8.1 mg/dL (7.8-8.2). CONCLUSIONS: The PLGA microspheres can be used to provide calcium sensitive controlled release of biologically active PTH and offer a potential mean of providing biomimetic hormone replacement therapy.