Translation, psychometric validation, and baseline results of the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric measures to assess health-related quality of life of patients with pediatric lymphoma in Malawi.

INTRODUCTION: Internationally validated tools to measure patient-reported health-related quality of life (HRQoL) are available, but efforts to translate and culturally validate such tools in sub-Saharan Africa (SSA) are scarce, particularly among children. METHODS: The Patient-Reported Outcomes Measurement Information System 25-item pediatric short form (PROMIS-25) assesses six HRQoL domains-mobility, anxiety, depression, fatigue, peer relationships, and pain interference-by asking four questions per domain. There is a single-item pain intensity item. The PROMIS-25 was translated into Chichewa and validated for use in Malawi using mixed qualitative and quantitative methods. The validity and reliability of the PROMIS-25 was assessed. RESULTS: Fifty-four pediatric patients with lymphoma completed the PROMIS-25. Structural validity was supported by interitem correlations and principal component analysis. Reliability of each scale was satisfactory (range alpha = 0.71-0.93). Known group validity testing showed that anemic children had worse fatigue (P = 0.016) and children with poor performance status had worse mobility (P < 0.001) and pain interference (P = 0.005). Compared to children with cancer in the United States, children from Malawi reported lower levels of mobility, higher anxiety, higher depressive symptoms, higher fatigue, better satisfaction with peer relationships, and higher pain interference. CONCLUSION: Translation and cultural validation of the PROMIS-25 into Chichewa for Malawi was successful. Baseline HRQoL for patients with pediatric lymphoma in Malawi is poor for all domains except peer relationships. This emphasizes an urgent need to address HRQoL among children undergoing cancer treatment in SSA using self-reported instruments validated within the local context.

'Caring around the clock': a new approach to intentional rounding.

Intentional rounding is a widely debated topic and, in this article, Nottingham University Hospitals NHS Trust shares its experience and learning from implementing an innovative approach based on the process across 79 wards. The authors look at the need for education and for cultural shift to achieve the best results. The issue of intentional rounding was raised in 2012 by prime minister David Cameron, who responded to a report of failings published by the Parliamentary and Health Service Ombudsman (2011) by announcing that all nurses would be expected to do hourly rounds to improve care. The need for the process has been demonstrated further in the recommendations from the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013).

Brown and black grease suitability for incorporation into feeds and suitability for biofuels.

Waste grease lipids used in animal feeds have been the cause of food recalls in Europe, where such materials were incorporated into animal feedstuffs. This resulted in unwanted residues in human food. The composition of such lipid sources has been lacking. Seventeen composite trap grease and isolated brown grease samples were analyzed. Analytes included nutrients, metals, and volatile organic compounds. Analytes were selected for relevance to wastewater treatment and resource reuse potential. Moisture averaged 89.4% and the pH was 3.8. The 5-day biological oxygen demand was 32,531 mg/liter, solids were 7.5%, and fats, oil, and grease were 48,970 mg/liter. Non-polychlorinated biphenyl volatile organic compounds were surveyed. In the 17 grease samples, 14 contained an average of 102.5 µg/liter chloroform; 11 samples contained acetone, averaging 369 µg/liter; 9 samples contained 2-butanone, with an average of 484 µg/liter; and 8 contained an average of 710 µg/liter methylene chloride and toluene at 311 µg/liter. The mean concentration of copper in 17 composite samples ranged from 15 to 239 mg/liter, iron averaged 314 mg/liter, lead means ranged from 2.5 to 24 mg/liter, and magnesium averaged 975 mg/liter. It is hypothesized that food preparation facility cleaning and chlorinated cleaning-disinfection agents combined with the organics in the low-pH environment of the traps produce potentially carcinogenic compounds. It is recommended that these waste grease materials be used as a feedstock for biofuel.

Development of in vitro antimicrobial resistance in bacteria exposed to residue level exposures of antimicrobial drugs, pesticides and veterinary drugs.

Ten ppb or less of antibacterial drugs, pesticides and veterinary drugs could increase antibacterial resistance in bacteria. The minimum inhibitory concentration (MIC) was the indicator of resistance and Staphylococcus aureus ATCC 9144 the indicator organism. Seventeen compounds used in human, veterinary medicine, crop production, and found in the environment, were studied singly, and as combinations. Single compounds decreased MIC values in 5.3% of possibilities; showed no changes in 74.4% of values; increased values in 21.8%; 16.5% of MICs increased 4- to 8-fold; 4.7% of changes were >8-fold. For two-compound mixtures 5.1% of MICs showed no changes; 34.3% increased 4-8 times; 60.6% increased >8-fold. For six-compound combinations: 5.9% of MICs showed no changes; 15.6% increased 4- to 8-fold; 78.5% increased >8-fold.

Novel reduction of mercury (II) by mercury-sensitive dissimilatory metal reducing bacteria.

The dissimilatory metal reducing bacterium (DMRB) Shewanella oneidensis MR-1 reduces ionic mercury (Hg[II]) to elemental mercury (Hg[0]) by an activity not related to the MerA mercuric reductase. In S. oneidensis, this activity is constitutive and effective at Hg(II) concentrations too low to induce mer operon functions. Reduction of Hg(II) by MR-1 required the presence of electron donors and electron acceptors. Reduction occurred with oxygen or fumarate, but had the highest rate when ferric oxyhydroxide was used as a terminal electron acceptor. Geobacter sulfurreducens PCA and Geobacter metallireducens GS-15 reduced Hg(II) to Hg(0) with activity comparable to MR-1; however, neither the DMRB Anaeromyxobacter dehalogenans 2CP-C nor the nitrate reducer Pseudomonas stutzeri OX-1 reduced Hg(II) during growth. This discovery of constitutive mercury reduction among anaerobes has implications to the mobilization of mercury and production of methylmercury in anoxic environments.

Multiphase blends from poly(L-lactide) and poly(methyl mathacrylate).

Melt processing of poly(L-lactide) (PLLA) and poly(methyl methacrylate) (PMMA) was conducted over a targeted range of compositions with PLLAs of 118 and 316 kDa in molecular mass to identify morphologies and the phase relationships in these blends. These blends are of interest for use in biomaterials and the morphologies are critical for tissue-engineering studies where biodegradability, pore connectivity and surface texture control tissue viability and adhesion. Simple extrusion of the two polymers produced multiphase blends with an average domain size near 25 microm. Scanning electron microscopy and dynamic mechanical analysis demonstrated that these blends are immiscible, at least in a metastable sense, and regions of co-continuous structures were identified. Such co-continuous, which occurred generally in accordance with rheology prediction models, exhibit a fine interconnected structure that appears effective for fabricating certain biomaterials. A broad and unexpected transition appears in these blends, as measured by modulated differential scanning calorimetry between 70 and 100 degrees C, which may be the glass transition temperature of an alloy phase. The magnitude of this transition is greatest in the fine-structured co-continuous composition region of blends, suggesting the presence of a complex or other derivative of the two primary phases.