Understandings and practices: Towards socially responsive curricula for the health professions.

Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.

Saturated buffer design flow and performance in Illinois.

There are few peer-reviewed studies documenting saturated buffer annual nitrate (NO3 ) removal or that have assessed the federal practice standard design criteria. Drainage flow, NO3 , and dissolved reactive phosphorus (DRP) were monitored at three saturated buffers in Illinois, USA, for a combined 10 site-years. Nitrate loss reduction averaged 48 ± 19% with removals of 3.5-25.2 kg NO3 -N ha-1 annually. Median DRP concentrations at all sampling locations were at the analytical detection limit of 0.01 mg L-1 . The current design paradigm (i.e., USDA practice standard) prescribes there should be no flow bypassing the saturated buffer at flow rates that are ≤5% of the peak drainage system flow rate. The drainage coefficient-based and Manning's equation-based peak flow estimates were higher and lower, respectively, than the observed annual peaks in all years. This illustrated inherent uncertainty introduced early in the design process, which can be further compounded by dynamic in-buffer hydrology. The percentage of the observed peak flow rate at which bypass initiated ranged across an order of magnitude between sites (4.4-8.1% of peak flow rate at one site and 42-49% of peak at another) despite the buffers providing relatively similar NO3 removal. Bypass at one site (SB2) was related to the concept of "antecedent buffer capacity filled," which was defined as the 5-d average water depth in the middle control structure chamber expressed as a relative percentage of the bypass stop log height. This design flow analysis serves as a call to further evaluate predictive relationships and design models for edge-of-field practices.

Core Ideas Three saturated buffers in Illinois provided an ≈50% annual reduction in NO3 load. Observed peak flow rates differed from estimation methods used for design purposes. Two sites had relatively similar nitrate removals but different bypass trends. "Antecedent buffer capacity filled" was the water depth in the middle chamber as a percent of stop log height.

Phosphorus removal in denitrifying woodchip bioreactors varies by wood type and water chemistry.

Denitrifying woodchip bioreactors are a practical nitrogen (N) mitigation technology but evaluating the potential for bioreactor phosphorus (P) removal is highly relevant given that (1) agricultural runoff often contains N and P, (2) very low P concentrations cause eutrophication, and (3) there are few options for removing dissolved P once it is in runoff. A series of batch tests evaluated P removal by woodchips that naturally contained a range of metals known to sorb P and then three design and environmental factors (water matrix, particle size, initial dissolved reactive phosphorus (DRP) concentration). Woodchips with the highest aluminum and iron content provided the most dissolved P removal (13±2.5 mg DRP removed/kg woodchip). However, poplar woodchips, which had low metals content, provided the second highest removal (12±0.4 mg/kg) when they were tested with P-dosed river water which had a relatively complex water matrix. Chemical P sorption due to woodchip elements may be possible, but it is likely one of a variety of P removal mechanisms in real-world bioreactor settings. Scaling the results indicated bioreactors could remove 0.40 to 13 g DRP/ha. Woodchip bioreactor dissolved P removal will likely be small in magnitude, but any such contribution is an added-value benefit of this denitrifying technology.

Capture and recover dissolved phosphorous from aqueous solutions by a designer biochar: Mechanism and performance insights.

Excessive phosphorus (P) in marine and freshwater systems has been identified as a primary perpetrator for the harmful and nuisance algal blooms. In this study, a novel designer biochar was produced from sawdust biomass treated with lime sludge prior to pyrolysis. The adsorption of dissolved P on the designer biochar was comprehensively evaluated under different experimental conditions. It revealed that the removal of dissolved P by the designer biochar was more efficient than unmodified biochar, lime sludge, and their post-combination, suggesting that the pretreatment of biomass with lime sludge for the designer biochar production has a significantly synergic effect on enhancing P removal. Post-adsorption characterization and mathematical modeling analyses indicated that the adsorption of dissolved P on the designer biochar could be controlled by multiple mechanisms including physical and chemical adsorption. The precipitation reaction between P anions and metal ions on the surface of the designer biochar was identified as a predominant mechanism. The X-ray diffraction showed that the precipitation reaction generated a series of P fertilizer forms depositing onto the designer biochar. In addition, batch adsorption experiments showed that both initial solution pH and coexisting anions had a lesser effect on the P removal by the designer biochar. This study proposed that the designer biochar could be a promising sorbent to remove dissolved P, and the nutrient-captured biochar could be used as a fertilizer to recover nutrients.

Evaluation of fly ash pellets for phosphorus removal in a laboratory scale denitrifying bioreactor.

Nitrate and orthophosphate from agricultural activities contribute significantly to nutrient loading in surface water bodies around the world. This study evaluated the efficacy of woodchips and fly ash pellets in tandem to remove nitrate and orthophosphate from simulated agricultural runoff in flow-through tests. The fly ash pellets had previously been developed specifically for orthophosphate removal for this type of application, and the sorption bench testing showed a good promise for flow-through testing. The lab-scale horizontal-flow bioreactor used in this study consisted of an upstream column filled with woodchips followed by a downstream column filled with fly ash pellets (3 and 1 m lengths, respectively; both 0.15 m diameter). Using influent concentrations of 12 mg/L nitrate and 5 mg/L orthophosphate, the woodchip bioreactor section was able to remove 49-85% of the nitrate concentration at three hydraulic retention times ranging from 0.67 to 4.0 h. The nitrate removal rate for woodchips ranged from 40 to 49 g N/m3/d. Higher hydraulic retention times (i.e., smaller flow rates) corresponded with greater nitrate load reduction. The fly ash pellets showed relatively stable removal efficiency of 68-75% across all retention times. Total orthophosphate adsorption by the pellets was 0.059-0.114 mg P/g which was far less than the saturated capacity (1.69 mg/g; based on previous work). The fly ash pellets also removed some nitrate and the woodchips also removed some orthophosphate, but these reductions were not significant. Overall, woodchip denitrification followed by fly ash pellet P-sorption can be an effective treatment technology for nitrate and phosphate removal in subsurface drainage.

Characterization of fly ash ceramic pellet for phosphorus removal.

Phosphorus has been recognized as a leading pollutant for surface water quality deterioration. In the Midwestern USA, subsurface drainage not only provides a pathway for excess water to leave the field but it also drains out nutrients like nitrogen (N) and phosphorus (P). Fly ash has been identified as one of the viable materials for phosphorus removal from contaminated waters. In this study, a ceramic pellet was manufactured using fly ash for P absorption. Three types of pellet with varying lime and clay proportions by weight (type 1: 10% lime + 30% clay, type 2: 20% lime + 20% clay, and type 3: 30% lime + 10% clay) were characterized and evaluated for absorption efficiency. The result showed that type 3 pellet (60% fly ash with 30% lime and 10% clay) had the highest porosity (14%) and absorption efficiency and saturated absorption capacity (1.98 mg P/g pellet) compared to type 1 and 2 pellets. The heavy metal leaching was the least (30 µg/L of chromium after 5 h) for type 3 pellet compared to other two. The microcosmic structure of pellet from scanning electron microscope showed the type 3 pellet had the better distribution of aluminum and iron oxide on the surface compared other two pellets. This result indicates that addition of lime and clay can improve P absorption capacity of fly ash while reducing the potential to reduce chromium leaching.

Viridans Group Streptococcal Infections in Children After Chemotherapy or Stem Cell Transplantation: A 10-year Review From a Tertiary Pediatric Hospital.

Viridans Group Streptococci (VGS) are associated with high mortality rates in febrile neutropenia; yet there are no recent European pediatric studies to inform antimicrobial therapy. The aim of this study was to describe the characteristics, outcome, and resistance patterns of children with VGS bacteremia (VGSB) undergoing treatment of malignancy or hematopoietic stem cell transplant. Patients aged 0 to 18 years, admitted to a tertiary pediatric hemato-oncology center with VGSB, from 2003 to 2013, were included in the study. All data were collected retrospectively from medical records. A total of 54 bacteremic episodes occurred in 46 patients. The most common underlying diagnosis was relapsed acute lymphoblastic leukemia. Streptococcus mitis was the most frequent organism. A total of 30% of isolates were resistant to penicillin and 100% sensitive to vancomycin. There were 8 episodes (14.8%) of Viridans Group Streptococcal Shock Syndrome; 6 resulted in admission to intensive care and 3 of these patients died of multiorgan failure. The potentially fatal nature of VGSB is confirmed. The high risk in relapsed acute lymphoblastic leukemia is of note. Research is needed to develop risk-stratification scores that identify children at risk of Viridans Group Streptococcal Shock Syndrome to guide empirical antimicrobial therapy in febrile neutropenia.

Runoff losses of suspended sediment, nitrogen, and phosphorus from a small watershed in Korea.

Nutrients and sediments in runoff lead to the degradation of water quality of lakes and streams. The development of schemes to mitigate such degradation requires a characterization of the underlying transport processes. The objectives of this study were to develop annual and seasonal load-discharge relationships for suspended sediment (SS), total nitrogen (TN), and total phosphorus (TP) losses from a small mixed land use watershed and to use these relationships to explicate the annual and monthly patterns of losses of these species. Data from 1996 to 2004 were used to develop load-discharge relationships for SS, TN, and TP at the HP#6 watershed, a subwatershed of the Balhan reservoir watershed located in Bongdam-myun and Paltan-myun, Gyeonggi-do, Korea. Standard least squares curve fitting and S-estimation procedures were used to fit power functions to the data collected over this time period. The fitted load-discharge relationships are indicative of seasonal variations in SS and TN and of TP losses from HP#6. The exponents of the fitted power functions for TN and TP in the fall, for TP in summer season, and for SS in all seasons are >1, indicating that the concentrations of these species increase as flow rate increases. Most of the SS, TN, and TP transported in runoff left the watershed between April and September; thus, cost-efficient strategies can be established by focusing on this period. Further study of the seasonal variations is required for a better characterization of seasonal losses of SS, TN, and TP in runoff from the HP#6 watershed.

Iron retention in preterm infants fed low iron intakes: a metabolic balance study.

There is little data on iron retention in healthy preterm infants. Twenty-four metabolic balance studies were carried out in 13 preterm infants between 17 and 63 days of age, in 11 cases 2 balance were carried out 7d apart. Iron intake was 1.11 mg/kg/day (SD 0.06), less than the 2 mg/kg/d typically recommended for preterm infants. Iron retention was positive in the majority (3/13) of the first balances, and in all 11 of the second balances. Iron retention increased significantly between the two balances (from 0.095 mg/kg/d (SD 0.178) to 0.270 (SD 0.209)). Iron retention was significantly related to the time that the infant had been on enteral feeds at the time the balance was carried out. Iron retention was significantly greater than the requirement estimated to be needed to meet the needs for growth and expansion of the circulating red cell mass. Iron intakes of about 1mg/kg/d seem to be adequate to support the requirements for growth in preterm infants during this time period, but are significantly less than the estimated in utero accretion rate of the fetus.