A prospective cohort study exploring the impact of tonsillectomy on feeding difficulties in children.

OBJECTIVES: Paediatric feeding difficulties are common, affecting up to 25% of otherwise healthy children, symptoms include food refusal, gagging, choking, and excessive mealtime duration. These symptoms are commonly described in pre-operative discussions about tonsillectomy. This prospective study explores the impact of tonsillectomy on paediatric feeding difficulties. DESIGN: This prospective cohort study invited caregivers of children undergoing tonsillectomy to complete a PediEAT questionnaire about their children's feeding behaviours, pre and post-operatively. The study was completed in two phases with 9 questions administered in phase 1 and three additional questions added for phase 2. A free text comments box was also provided. Responses were graded from 0 to 5, where 0 is 'never a problem' and 5 is 'always a problem' with eating behaviours. SETTING: The study was conducted at our institution, a tertiary paediatric ENT unit. PARTICIPANTS: Children aged between 6 months - 7 years undergoing tonsillectomy for any indication were invited to participate. MAIN OUTCOME MEASURES: Changes to the Pedi-EAT scores pre and post operatively were the main outcome measure. RESULTS: 102 participants were recruited between January 2020 and January 2022. The mean age of participants was 4.1 years, 87% had a concurrent adenoidectomy. The mean time to completion of post-operative questionnaire was 23 weeks after surgery. 9 of the 12 questions showed a statistically significant improvement in post-operative scores using a paired student t-test (p < 0.05). The most significant improvements related to 'gets tired from eating and is not able to finish' (1.49 pre-op, 0.91 post op, p < 0.01) and 'eats food that needs to be chewed' (1.4 pre-op, 0.72 post-op, p < 0.01). 13% of participants only underwent tonsillectomy and this group also showed a statistically significant improvement in fatigue during eating (p < 0.05). CONCLUSION: Symptoms of fatigue during eating and avoidance of food requiring mastication are most likely to improve following tonsillectomy in children.

Trends in hip fracture care in the Republic of Ireland from 2013 to 2018: results from the Irish Hip Fracture Database.

Hip fractures continue to be one of the most serious and costly injuries suffered by older people globally. This paper describes the development of a national hip fracture audit and summarises the first 6 years of data from the Republic of Ireland. This can help inform care, standards and outcomes of hip fracture patients. INTRODUCTION: Ireland has one of the highest standardised rates of hip fracture in the world behind northern European countries. The Irish Hip Fracture Database (IHFD) was established in 2012 to drive clinical and organisational improvements in quality and effectiveness of hip fracture care. This paper describes the progression of the IHFD between 2013 and 2018 and identifies trends and areas for improvement. METHODS: The IHFD is a clinically led, web-based audit, with data collected through the national Hospital Inpatient Enquiry (HIPE) electronic system, the principal source of information from publicly funded acute hospitals in Ireland. Eligible cases are aged ≥ 60 years with hip fracture as defined by IHFD or with other specified hip fracture excluding periprosthetic fractures. As of 2015, all 16 trauma-receiving hospitals within Ireland submitted data. Demographics and adherence to six national quality standards are described. RESULTS: A total of 17,983 cases were included in the analysis. National coverage has increased from 63% in 2013 to 99% in 2018. Demographic characteristics are unchanged, but higher levels of comorbidity are seen. Internal fixation and hemiarthroplasty are the most common modes of surgical repair with two-thirds of cases receiving spinal rather than general anaesthesia. Increasingly patients are being assessed by a geriatrician (11% in 2013 to 69% in 2018) and receive a bone health assessment (65% in 2013 to 84% in 2018). CONCLUSION: While some hip fracture standards have improved, further improvements are required to compare favourably internationally. Reduction of surgical delay and ensuring early mobilisation post-operatively are immediate priorities for the IHFD.

Does the shoe really fit? Characterising ill-fitting footwear among community-dwelling older adults attending geriatric services: an observational cross-sectional study.

BACKGROUND: Falls in older people are common and can result in loss of confidence, fear of falling, restriction in activity and loss of independence. Causes of falls are multi-factorial. There is a paucity of research assessing the footwear characteristics among older people who are at high risk of falls, internationally and in the Irish setting. The aim of this study was to examine the proportion of older adults attending a geriatric day hospital in Ireland who were wearing incorrectly sized shoes. METHODS: A consecutive sample of 111 older adults aged 60 years and over attending a geriatric day hospital in a large Irish teaching hospital was recruited. Demographic data including age, mobility, medications, co-habitation status, footwear worn at home and falls history were recorded. Shoe size and foot length were measured in millimetres using an internal shoe gauge and SATRA shoe size stick, respectively. Participants' self-reported shoe size was recorded. Footwear was assessed using the Footwear Assessment Form (FAF). A Timed Up and Go (TUG) score was recorded. Functional independence was assessed using the Nottingham Extended Activities of Daily Living (NEADL) Scale. The primary outcome of interest in this study was selected as having footwear within the suggested range (10 to 15 mm) on at least one foot. Participants who met this definition were compared to those with ill-fitting footwear on both feet using Chi-square tests, T-tests or Mann-Whitney U tests. RESULTS: The mean difference between shoe length and foot length was 18.6 mm (SD: 9.6 mm). Overall, 72% of participants were wearing footwear that did not fit correctly on both feet, 90% had shoes with smooth, partly worn or fully worn sole treading and 67% reported wearing slippers at home. Participant age, TUG score and NEADL score were not associated with ill-fitting footwear. CONCLUSIONS: Wearing incorrectly fitting shoes and shoes with unsafe features was common among older adults attending geriatric day services in this study. A large number of participants reported wearing slippers at home.

Effect of coagulation and flocculation conditions on water quality in an immersed ultrafiltration process.

The removal of natural organic matter under variable coagulation and flocculation pretreatment conditions was evaluated for three surface waters in an immersed ultrafiltration (UF) process. Coagulation with alum, flocculation and UF treatment were conducted in a bench-scale test apparatus designed to simulate pilot- and full-scale water treatment systems. Variable coagulation and flocculation operating conditions were investigated, including coagulant dose, hydraulic retention time (HRT) and mixing intensity (e.g. velocity gradient). Treatment performance was evaluated by measuring specific water quality parameters in the permeate stream, including dissolved organic carbon (DOC), UV254 and true colour. Coagulant dose was found to be the most important variable for treatment performance with regard to permeate water quality, with significantly lower alum dosages required to achieve enhanced coagulation water quality targets than conventional filtration systems. Experiments conducted to evaluate variable flocculation stage HRT and applied velocity gradient demonstrated that traditional set points for these operating variables, applied in conventional filtration systems, may not be required in UF systems. In particular, optimized UF permeate water quality was found with reduced flocculation retention times (e.g. <10 minutes) and mixing intensities (e.g. < 100 s(-1)). The impact of intermittent air scour, or air sparging, operations in the UF process tank during operation was also evaluated. The use of air scour, tested as an intermittent operation at an applied velocity gradient of 50 s(-1) was found to significantly reduce DOC concentrations and UV254 measurements in the UF permeate stream when compared with UF operations without air scour.

Biostability and disinfectant by-product formation in drinking water blended with UF-treated filter backwash water.

The overall objective of this study was to investigate the impact of blending membrane-treated water treatment plant (WTP) residuals with plant-filtered water on finished water quality in terms of biostability and disinfectant by-product (DBP) formation. Filter backwash water (FBWW) was treated with a pilot-scale ultrafiltration (UF) membrane to produce permeate that was blended with plant-finished water. The batch studies involved storing samples for a specified time with a disinfectant residual to simulate residence time in the distribution system. Both chlorinated and non-chlorinated FBWW streams were evaluated, and the experimental design incorporated free chlorine, monochloramine, and chlorine dioxide in parallel to a model system that did not receive a disinfectant dose. The results of the study found that blending 10% UF-treated FBWW with plant-filtered water did not have an impact on water biostability as monitored with heterotrophic plate counts (HPCs) or DBP concentrations as monitored by TTHM and HAA5 concentrations. However, the presence of preformed THM and HAA species found in chlorinated FBWW streams may result in higher levels of initial DBP concentrations in blended water matrices, and could have a significant impact on finished water quality in terms of meeting specific DBP guidelines or regulations.

Impact of recycling filter backwash water on organic removal in coagulation-sedimentation processes.

The overall purpose of this research was to examine the impacts of filter backwash water (FBWW) and membrane backwash water (MBWW) recycles on water quality in coagulation-sedimentation processes. Specifically, the impact of recycling 5 or 10% by volume of FBWW and MBWW with surface water on the removal of natural organic matter (NOM) was evaluated at bench-scale using a standard jar-test apparatus and measurement of specific water quality parameters including total organic carbon (TOC), dissolved organic carbon (DOC), UV254, turbidity, total aluminum and zeta potential. The results of jar test conducted on a source water with a specific UV absorbance (SUVA) value within the range of 2-4 mg/Lm showed a significantly higher removal of DOC from the raw water that was blended with 5 and 10% by volume of FBWW as compared to control trials where backwash water was not added. Increasing rates of MBWW that did not contain destabilized hydroxide precipitates did not significantly change DOC concentrations in the settled water samples as compared to the control trials. For source waters that are characterized as having low turbidity with medium SUVA values, these results could hold particular significance for plants that have reached treatment ceilings in terms of dissolved NOM removal using conventional coagulation designs.

The Toledo Exercise and Diet Study. Results at 26 weeks.

This study was designed to test whether an exercise program is additive to diet counseling in lowering elevated blood cholesterol levels. From a screened population of 1024 subjects, we randomized 66 predominantly female subjects to two intervention groups: diet counseling and diet counseling with exercise. Subjects were selected who had elevated levels of serum low-density lipoprotein cholesterol, an average or low fitness level, and a diet high in saturated fat and cholesterol. After 26 weeks of intervention, 51 subjects exhibited significant decreases in serum levels of cholesterol, high-density lipoprotein cholesterol, triglycerides, and low-density lipoprotein cholesterol. The addition of exercise to diet counseling resulted in improved aerobic capacity, losses of body fat and weight, and further nonsignificant decreases in serum cholesterol and low-density lipoprotein cholesterol levels. Since these results differ from data acquired in individuals with normal to borderline serum cholesterol levels, further studies appear indicated in hypercholesterolemic subjects, especially in women.

Development of children's concepts of illness.

This study examines the development of children's concepts of illness in light of Piaget's and Werner's findings regarding the ontogenesis of causal relations. Six developmentally ordered categories of explanation of illness have been articulated. These categories, which are consistent with Piaget's three major stages of cognitive development, can be useful to pediatricians (1) in explaining illness and providing "reassurance" to children, (2) in developing meaningful health education strategies, and (3) in responding to the degree of control the child feels over the illness.

Exogenous GM1 ganglioside effects on conductive and sensorineural hearing losses.

Both CBA/J mice with neonatal cochlea removals and CBA/J mice with neonatal atresias of the external auditory meatus have significantly smaller ventral cochlear nucleus is greater in the mice with cochlea removals, but the soma area reduction is greater in the mice with external auditory meatus atresias. GM1 gangliosides were subcutaneously injected daily into a group of CBA/J mice with conductive hearing loss caused by neonatal removals of their left external auditory meatus, and into a group of CBA/J mice unilaterally deafened by left cochlea removals. In the mice with conductive hearing loss, the ganglioside treatment significantly ameliorated the atrophy of spiral ganglion neurons, ventral cochlear nucleus neurons, and ventral cochlear nucleus volume. In unilaterally deafened mice, the ganglioside treatment had no measurable effect on the atrophy of ventral cochlear nucleus neurons or of ventral cochlear volume. It is suggested that GM1 ganglioside treatment potentiates growth factors which sustain spiral ganglion integrity and that this sustained activity of the spiral ganglion in turn maintains the integrity of the cochlear nuclei.

Development of field screening methods for TNT, 2,4-DNT and RDX in soil.

Simple field-screening methods are presented for detecting 2,4,6-TNT, 2,4-DNT and RDX in soil. A 20-g portion of soil is extracted by manually shaking with 100 ml of acetone for three minutes. After the soil settles, the supernatant is filtered and divided into three aliquots. Two aliquots are reacted with potassium hydroxide and sodium sulfite to form the red-colored Janowsky complex when 2,4,6-TNT is present or the blue-purple complex when 2,4-DNT is present. The third aliquot of the extract is passed through a strong anion exchange resin to remove nitrate and nitrite. Then the extract is acidified and RDX is reduced with zinc to nitrous acid, which is reacted with a Griess reagent to produce a highly colored azo dye. Concentrations of TNT, 2,4-DNT and RDX are estimated from their absorbances at 540, 570 and 507 nm, respectively. Detection limits are about 1 microg/g for 2,4,6-TNT and RDX and about 2 microg/g for 2,4-DNT. Concentration estimates from field analyses correlate well with laboratory analyses.

Treatment of drinking water residuals: comparing sedimentation and dissolved air flotation performance with optimal cation ratios.

Spent filter backwash water (SFBW) and clarifier sludge generally comprise the majority of the waste residual volume generated and in relative terms, these can be collectively referred to as combined filter backwash water (CFBW). CFBW is essentially a low-solids wastewater with metal hydroxide flocs that are typically light and slow to settle. This study evaluates the impact of adding calcium and magnesium carbonates to CFBW in terms of assessing the impacts on the sedimentation and DAF separation processes. Representative CFBW samples were collected from two surface water treatment plants (WTP): Lake Major WTP (Dartmouth, Nova Scotia, Canada) and Victoria Park WTP (Truro, Nova Scotia, Canada). Bench-scale results indicated that improvements in the CFBW settled water quality could be achieved through the addition of the divalent cations, thereby adjusting the monovalent to divalent (M:D) ratios of the wastewater. In general, the DAF process required slightly higher M:D ratios than the sedimentation process. The optimum M:D ratios for DAF and sedimentation were determined to be 1:1 and 0.33:1, respectively. It was concluded that the optimisation of the cation balance between monovalent cations (e.g., Na(+), K(+)) and added divalent cations (i.e., Ca(2+), Mg(2+)) aided in the settling mechanism through charge neutralisation-precipitation. The increase in divalent cation concentrations within the waste residual stream promoted destabilisation of the negatively charged colour molecules within the CFBW, thereby causing the colloidal content to become more hydrophobic.

RDX loss in a surface soil under saturated and well drained conditions.

On military training ranges, low-order, incomplete detonations deposit RDX (hexahydro-1,3,5-trinitro-1,3,5-triazine) into surface soils. In this study, we evaluated RDX biodegradation in surface soils obtained from a military training range in Alaska. Two factors were compared: (i) soil water potential during the incubations; and (ii) the use of acetonitrile (ACN) as an RDX carrier to spike samples. Organic solvents have been used in laboratory studies to dissolve slightly water-soluble contaminants before addition to soil. We added ACN to obtain final soil ACN concentrations of 0 mg kg(-1) (0%), 1000 mg kg(-1) (0.1%) and 10 000 mg kg(-1) (1%). We then compared RDX attenuation in the soil under saturated and unsaturated conditions. RDX fell below the limit of detection within 3 wk of study initiation under the saturated condition. A maximum degradation rate of 0.15 mg RDX L(-1) d(-1) was measured. Under the unsaturated condition, 42% of the original RDX was still present at study termination (5 wk). The addition of acetonitrile at 0.1 or 1.0% had no affect on RDX loss in the saturated soil. In the unsaturated soil, however, ACN at 1.0% inhibited RDX loss by as much as 25%. These findings indicate that soil water potential and carrier solvent concentrations can impact the rate and extent to which RDX is attenuated in a surface soil.

Solitary fibrous tumour of the forearm. A rare tumour in an atypical site.

Solitary fibrous tumour (SFT) is a rare spindle cell neoplasm that usually arises from serosal surfaces. Although it is now increasingly recognized in extra-serosal locations, only two previous cases of SFT arising in an extremity have been reported. We describe another such case and review the literature regarding extra-serosal SFT.

White phosphorus poisoning of waterfowl in an Alaskan salt marsh.

The cause of the yearly death of an estimated 1,000 to 2,000 migrating dabbling ducks (Anas spp.) and 10 to 50 swans (Cygnus buccinator and C. columbianus) has remained a mystery for the last ten years in Eagle River Flats (ERF), a 1,000 ha estuarine salt marsh near Anchorage, Alaska, used for artillery training by the U.S. Army. We have gathered evidence that the cause of this mortality is the highly toxic, incendiary munition white phosphorus (P4). The symptoms of poisoning we observed in wild ducks included lethargy, repeated drinking, and head shaking and rolling. Death was preceded by convulsions. Farm-reared mallards dosed with white phosphorus showed nearly identical behavioral symptoms to those of wild ducks that became sick in ERF. White phosphorus does not occur in nature but was found in both the sediments where dabbling ducks and swans feed and in the gizzards of all carcasses collected in ERF. We hypothesize that feeding waterfowl are ingesting small particles of the highly toxic, incendiary munition P4 stored in the bottom anoxic sediments of shallow salt marsh ponds.

Developmentally-based AIDS/HIV education.

A growing number of health and education professionals argue that AIDS/HIV education curricula should be developmentally-based. They suggest the principles of developmental psychology be used to design curricula based on the sequentially ordered ways children of different ages understand AIDS. Relying on findings of research on development of children's conceptions of illness, a specific developmentally-based approach to educating school-age children about AIDS/HIV is presented in this paper. For each of three major age groups, the paper describes general characteristics for children's thought processes, ways in which children assimilate information about various aspects of AIDS, and implications for educating children about causes, prevention, and fear of AIDS. The focus of AIDS/HIV education can move from reducing fear in the younger group, to identifying and differentiating causes and noncauses of AIDS in the intermediate groups, to articulating strategies for AIDS prevention in the older group.

PIP: A growing number of health and education professional argue that AIDS/HIV education curricula should be developmentally-based. They suggest the principles of developmental psychology be use to design curricula based on the sequentially ordered ways children of different ages understand AIDS. Relying on findings of research on development of children's conceptions of illness, a specific developmentally-based approach to educating school-age children about AIDS/HIV is presented in this paper. For each of the 3 major age groups (young, intermediate, and older), the paper describes general characteristics for children's though processes, ways in which children assimilate information about various aspects of AIDs, and implications for educating children about causes, prevention, and fear of AIDS. With maturity, though processes change from an egocentric viewpoint of self to an integration of self and others, from focusing only on external events to distinguishing between external and internal domains, from the inability to differentiate between cause and effect to complex causal reasoning, and from absolute thinking to relativistic thinking. These characteristics are evident in their knowledge about AIDS. While younger children define AIDS on terms of an external event and cannot articulate a cause for AIDS, children at the intermediate age level define AIDS by specific symptoms, attribute its cause to an external agent, and perceive AIDS as occurring in more general groups of people. Older children define a specific illness as a syndrome, perceive the causes of AIDS to include sex and drugs, and have a more complex understanding of the consequences of AIDs. The focus of AIDS/HIV education can move from reducing fear in the younger group thought reassurance from authority figures about their nonvulnerability, to identifying and differentiating causes and noncauses of AIDS in the intermediate groups by providing them with a list of noncauses, and to articulate strategies for AIDS prevention in the older group through detailed explanations of modes of transmission and prevention behavior. (author's modified).

Self-reported chemical sensitivity and wartime chemical exposures in Gulf War veterans with and without decreased global health ratings.

This cross-sectional telephone survey study assessed prevalence rates of current chemical sensitivity, frequency of chemical odor intolerance, and self-reported Persian Gulf chemical exposures among 41 randomly sampled Department of Veterans Affairs outpatients who were Persian Gulf War (PGW) and PGW-era veterans. The participants were drawn from an initial random list of 100 veterans, of whom 28 PGW and 20 era veterans had correct telephone data on file. Of those contacted, 86% of PGW veterans (24/28) and 85% of era veterans (17/20) agreed to participate. Significantly more PGW veterans with poorer global health after military service reported considering themselves now "especially sensitive to certain chemicals" (86%, 12/14) than did the PGW veterans or era veterans in stable health (both comparison groups 30%, 3/10). Among PGW veterans, the subset with worse health associated with marked increases in chemical odor intolerance since their military service had a significantly higher odds ratio for exposure to multiple chemicals, notably wartime pesticides and insect repellent, than did comparison groups. The high rate of chemical sensitivity of PGW veterans with deteriorated health is almost three times that in PGW-era veterans and in elderly primary care outpatient veterans at the same Department of Veterans Affairs medical center and in community-based civilian samples (i.e., 30%). These preliminary findings suggest the need for further study of chemical sensitivity, including tests for acquired increases in neural sensitizability to multiple low-level chemicals, in ill PGW veterans.

Increasing autistic children's spontaneous verbalizations of affection: an assessment of time delay and peer modeling procedures.

We assessed the efficacy of time delay and peer modeling procedures in increasing autistic children's spontaneous verbalizations of affection. Four autistic children were taught to spontaneously say "I like (love) you" in response to a hug from a familiar person and their mother. Generalization from a free play training setting to free play outdoors and at home was assessed. Ancillary social and affection behaviors were also observed. Results indicated that the time delay was a quick and effective procedure for all the children. Peer modeling was unsuccessful in teaching the target behavior.

Minimizing venous thromboembolic complications in the orthopaedic patient.

Venous thromboembolic events (VTE), which include deep venous thrombosis (DVT) and pulmonary embolus (PE), are the most common life-threatening complications associated with orthopaedic surgical procedures. DVT is particularly prevalent in patients undergoing total knee and hip arthroplasty, occurring at a rate of 50 to 60%. In addition, up to 2% of orthopaedic patients receiving pharmacologic prophylaxis still develop PE. Because the majority of candidates for these procedures are older adults with a multitude of comorbid conditions, standard prophylactic practices may not always result in optimal clinical outcomes. Thus, it is important for nurses to have a general understanding of appropriate thromboprophylaxis. This article will provide an overview of the current recommended guidelines and explore the risks and benefits of both pharmacologic agents and adjunctive treatment modalities.

A new method for in vitro evaluation of the interproximal penetration of manual toothbrushes.

A new in vitro method for determining interproximal penetration of different toothbrush designs is reported. This method is based on videotape recordings of the brushing patterns of 31 subjects. Circular, up-and-down, and back-and-forth brush strokes were all employed, with the brush being set at both 45 degrees and 90 degrees angles for back-and-forth brushing. Overall results were weighted according to the proportion of brushing time during which participants typically use each stroke. The tooth morphology was closely simulated by the use of typodonts. Interproximal penetration was measured by removal of "artificial plaque" (an ethyl ester of PVM/MA copolymer) shown to have a tenacity on the typodont tooth surface similar to 12-hour plaque as measured on 6 subjects. The brushing force used was based on the measured brushing force of 8 panelists during actual brushing and was consistent with forces reported in the literature. This method was used to test the interproximal penetration of three different toothbrush designs: rippled pattern (Crest Complete), multi-level (Colgate Precision), and flat-tufted (Oral-B P40). The Crest Complete was found to provide superior interproximal penetration to Oral-B P40 and Colgate Precision for all brushing techniques, although its advantage over the Colgate Precision failed to reach statistical significance for back-and-forth brushing with the brush at a 45 degree angle to the tooth. The Colgate Precision was superior to the Oral-B overall, and for three of four brushing techniques tested. There was no difference between the two brushes on back-and-forth brushing at a 90 degree angle.(ABSTRACT TRUNCATED AT 250 WORDS)

Controlled expedient disposal of excess gun propellant.

The expedient field disposal of excess gun propellants on the ground is an integral part of live-fire training in many countries. However, burning excess propellant in the field will leave significant quantities of energetic residues and heavy metals in the environment. Compounds such as dinitrotoluene and nitroglycerin and metals such as lead will leach into the soil column, eventually migrating to groundwater. Contamination of the environment will lead to high remediation costs and the possible loss of the training facility. After investigating the contamination at several propellant disposal sites, a portable propellant burn pan was developed and tested. The pan was transported to training sites where excess propellant was loaded and burned in a controlled manner. Up to 120 kg of excess single-base propellant charges have been burned during two series of tests at a consumption rate of greater than 99.9%. Less than 0.03% of the energetic material was recovered outside the burn pan. Recovered lead is largely contained within the pan. The turnover rate for burns is 15 min. The residues can be collected following cool-down for proper disposal.