TREatment of ATopic eczema (TREAT) Registry Taskforce: consensus on how and when to measure the core dataset for atopic eczema treatment research registries.

BACKGROUND: Comparative, real-life and long-term evidence on the effectiveness and safety of phototherapy and systemic therapy in moderate-to-severe atopic eczema (AE) is limited. Such data must come from well-designed prospective patient registries. Standardization of data collection is needed for direct comparisons and data pooling. OBJECTIVES: To reach a consensus on how and when to measure the previously defined domain items of the TREatment of ATopic eczema (TREAT) Registry Taskforce core dataset for research registries for paediatric and adult patients with AE. METHODS: Proposals for the measurement instruments were based on recommendations of the Harmonising Outcome Measures for Eczema (HOME) initiative, the existing AE database of TREATgermany, systematic reviews of the literature and expert opinions. The proposals were discussed at three face-to-face consensus meetings, one teleconference and via e-mail. The frequency of follow-up visits was determined by an expert survey. RESULTS: A total of 16 experts from seven countries participated in the 'how to measure' consensus process and 12 external experts were consulted. A consensus was reached for all domain items on how they should be measured by assigning measurement instruments. A minimum follow-up frequency of initially 4 weeks after commencing treatment, then every 3 months while on treatment and every 6 months while off treatment was defined. CONCLUSIONS: This core dataset for national AE research registries will aid in the comparability and pooling of data across centres and country borders, and enables international collaboration to assess the long-term effectiveness and safety of phototherapy and systemic therapy used in patients with AE. What's already known about this topic? Comparable, real-life and long-term data on the effectiveness and safety of phototherapy and systemic therapy in patients with atopic eczema (AE) are needed. There is a high diversity of outcomes and instruments used in AE research, which require harmonization to enhance comparability and allow data pooling. What does this study add? Our taskforce has reached international consensus on how and when to measure core domain items for national AE research registries. This core dataset is now available for use by researchers worldwide and will aid in the collection of unified data. What are the clinical implications of this work? The data collected through this core dataset will help to gain better insights into the long-term effectiveness and safety of phototherapy and systemic therapy in AE and will provide important information for clinical practice. Standardization of such data collection at the national level will also allow direct data comparisons and pooling across country borders (e.g. in the analysis of treatment-related adverse events that require large patient numbers).

Linking Inuit Knowledge and Public Health for Improved Child and Youth Oral Health in NunatuKavut.

The oral health of Inuit children in Canada has been identified as a public health crisis. Although efforts are being made to identify and address ways to deal with this crisis, current policy and program approaches are largely entrenched within the prevailing paradigm of dental science to the exclusion of Indigenous people's understandings of health. This article reports qualitative findings of a larger study aimed at identifying, understanding, and addressing rates of oral disease among children living in NunatuKavut, a cluster of small, coastal Inuit communities located in southern Labrador, Canada. Through 18 focus groups with youth (n = 86), caregivers (n = 22), and interviews with key informant (n = 13), this study begins to elucidate southern Inuit understandings of oral health. Theorized using Two-Eyed Seeing, an Indigenous approach to balancing both Indigenous and non-Indigenous understandings of the world, the findings reported here reveal 3 themes, each of which is crosscut by historical and contemporary dimensions: 1) (w)holistic conceptualizations of health are essential to good oral health, 2) achieving optimal oral health is prohibitive for Inuit communities, and 3) community-engaged oral health service delivery is needed. Our recommendations have implications for improved oral public health service delivery for Inuit communities, in that the inclusion of Inuit perspectives on oral health should form an instrumental element of oral public health service delivery. Knowledge Transfer Statement: The results of this study may be used by clinicians and oral health educators to inform approaches to oral health service delivery within the context of Indigenous communities. It may also be used by policymakers to recognize how historical and contemporary issues of colonization relate to the formation of oral health-related policies.

Nutrient, metal and microbial loss in surface runoff following treated sludge and dairy cattle slurry application to an Irish grassland soil.

Treated municipal sewage sludge ("biosolids") and dairy cattle slurry (DCS) may be applied to agricultural land as an organic fertiliser. This study investigates losses of nutrients in runoff water (nitrogen (N) and phosphorus (P)), metals (copper (Cu), nickel (Ni), lead (Pb), zinc (Zn), cadmium (Cd), chromium (Cr)), and microbial indicators of pollution (total and faecal coliforms) arising from the land application of four types of treated biosolids and DCS to field micro-plots at three time intervals (24, 48, 360 h) after application. Losses from biosolids-amended plots or DCS-amended plots followed a general trend of highest losses occurring during the first rainfall event and reduced losses in the subsequent events. However, with the exception of total and faecal coliforms and some metals (Ni, Cu), the greatest losses were from the DCS-amended plots. For example, average losses over the three rainfall events for dissolved reactive phosphorus and ammonium-nitrogen from DCS-amended plots were 5 and 11.2 mg L(-1), respectively, which were in excess of the losses from the biosolids plots. When compared with slurry treatments, for the parameters monitored biosolids generally do not pose a greater risk in terms of losses along the runoff pathway. This finding has important policy implications, as it shows that concern related to the reuse of biosolids as a soil fertiliser, mainly related to contaminant losses upon land application, may be unfounded.

Evaluating the critical source area concept of phosphorus loss from soils to water-bodies in agricultural catchments.

Using data collected from six basins located across two hydrologically contrasting agricultural catchments, this study investigated whether transport metrics alone provide better estimates of storm phosphorus (P) loss from basins than critical source area (CSA) metrics which combine source factors as well. Concentrations and loads of P in quickflow (QF) were measured at basin outlets during four storm events and were compared with dynamic (QF magnitude) and static (extent of highly-connected, poorly-drained soils) transport metrics and a CSA metric (extent of highly-connected, poorly-drained soils with excess plant-available P). Pairwise comparisons between basins with similar CSA risks but contrasting QF magnitudes showed that QF flow-weighted mean TRP (total molybdate-reactive P) concentrations and loads were frequently (at least 11 of 14 comparisons) more than 40% higher in basins with the highest QF magnitudes. Furthermore, static transport metrics reliably discerned relative QF magnitudes between these basins. However, particulate P (PP) concentrations were often (6 of 14 comparisons) higher in basins with the lowest QF magnitudes, most likely due to soil-management activities (e.g. ploughing), in these predominantly arable basins at these times. Pairwise comparisons between basins with contrasting CSA risks and similar QF magnitudes showed that TRP and PP concentrations and loads did not reflect trends in CSA risk or QF magnitude. Static transport metrics did not discern relative QF magnitudes between these basins. In basins with contrasting transport risks, storm TRP concentrations and loads were well differentiated by dynamic or static transport metrics alone, regardless of differences in soil P. In basins with similar transport risks, dynamic transport metrics and P source information additional to soil P may be required to predict relative storm TRP concentrations and loads. Regardless of differences in transport risk, information on land use and management, may be required to predict relative differences in storm PP concentrations between these agricultural basins.

Traumeel S in preventing and treating mucositis in young patients undergoing SCT: a report of the Children's Oncology Group.

Mucositis can be a serious complication of hematopoietic SCT (HSCT). A previous phase II trial in 32 children undergoing HSCT reported a beneficial effect of the homeopathic remedy Traumeel S. The Children's Oncology Group sought to replicate the results in a multi-institutional trial. The study was an international multi-center, double-blind, randomized trial comparing Traumeel with placebo in patients aged 3-25 years undergoing myeloablative HSCT. Traumeel/placebo was started on Day -1 as a five-time daily mouth rinse. Efficacy of the treatment was assessed using the modified Walsh scale for mucositis, scored daily from Day -1 to 20 days after HCST. The main outcome was the sum of Walsh scale scores (area-under-the-curve (AUC)) over this period. Other outcomes included narcotic use, days of total parenteral feeding, days of nasogastric feeding and adverse events. In 181 evaluable patients, there was no statistical difference in mucositis (AUC) in the Traumeel group (76.7) compared with placebo (67.3) (P=0.13). There was a trend towards less narcotic usage in the Traumeel patients. No statistically beneficial effect from Traumeel was demonstrated for mucositis. We could not confirm that Traumeel is an effective treatment for mucositis in children undergoing HSCT.

Comparison of the capabilities of liquid isoelectric focusing-one-dimensional nonporous silica reversed-phase liquid chromatography-electrospray ionization time-of-flight mass spectrometry and liquid isoelectric focusing-one-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis mass mapping for the analysis of intact protein molecular masses.

Nonporous silica reversed-phase HPLC coupled to electrospray ionization with on-line time-of-flight mass spectrometric detection (NPS-RP-HPLC-ESI-TOF-MS) is shown to be an effective liquid phase method for obtaining the molecular masses of proteins from pH fractionated cellular lysates where the method is capable of generating the same banding patterns typically observed using gel phase one-dimensional sodium dodecyl sulfatepolyacrylamide gel electrophoresis. The liquid-phase mass spectrometry-based method provides a mass accuracy of at least 150 ppm, with 4000 mass resolution and provides improved sensitivity as the protein molecular mass (MW) decreases. The liquid and gel phase methods are shown to be complementary in terms of their mass range but the liquid phase method has the advantage over the gel method in that the analysis times are 50 times shorter, the mass accuracy is 70 times better and the resolution is 130 times higher. The liquid phase method is shown to be more effective for detection of proteins below 40 kDa, while the gel phase separation can access many more proteins, including more hydrophobic proteins, at increasing MW.