Addressing health inequalities in times of austerity: implementation of a place-based approach in multitiered local government.

AIMS: This article focuses on how local authorities in England are tackling wider determinants of health and inequalities in their population's outcomes while budgets for public services are diminishing. METHODS: It reports the experience from one case study engaged in rolling out a devolved, place- and asset-based strategy over multiple tiers of local government. Relating these findings to relevant social theory, we draw out aspects of context and mechanisms of change. We offer plausible hypotheses for the experiences observed, which supports transferability and implementation of place-based strategies in other local authority areas struggling with similar challenges. RESULTS: Findings highlight the importance of high-level and political buy-in, as well as the role of the COVID-19 pandemic as a potential catalyst to rollout. Creating the foundations for a new, place-based working was important for achieving coherence among partners around what local government was trying to achieve. These included investment in infrastructure, both relational and tangible inputs such as organisational and human resources, to establish the conditions for systemic change towards early intervention and prevention. CONCLUSION: This study identified clear foundations for place-based action, plus enablers and barriers to significant transformation of practice towards asset-based approaches between local authorities, partners and the public.

"Notice of major cleaning": A qualitative study of the negative impact of encampment sweeps on the ontological security of unhoused people who use drugs.

BACKGROUND: Unhoused people who use drugs in the United States are at risk for a variety of negative health outcomes. As the crisis of houselessness continues to impact major urban areas, a wave of punitive policies has been enacted to remove visible unhoused people from public spaces. There is reason to believe that harsh policies of encampment displacement will have negative immediate and downstream impacts on this community. METHODS: Participant observation was conducted weekly or bi-weekly at unhoused encampments in Los Angeles County, USA over the course of two years (2021, 2022). Data were generated through the lens of ontological security theory via in-field jottings and comprehensive field notes. Formal, semi-structured qualitative interviews were conducted with 30 unhoused people who use drugs recruited primarily through peer-referral sampling at these same venues. Data were coded and analyzed thematically using the Template Analysis approach. Field notes were used to triangulate and further contextualize thematic analysis of interview data. RESULTS: Encampment sweeps impacted nearly all participants and occurred multiple times at every visited field site. They were observed to occur both with and without the presence of police, but always resulted in the loss of the personal property of encampment residents. Sweeps occurred across seasons, hazardous weather, and without offers of alternative shelter. Participants described sweeps as impacting all aspects of their ontological security, including dismantling material and social constancy, disrupting routines of daily life and resource management, increasing feelings of surveillance, and potentially creating negative identity formation. CONCLUSIONS: In both ethnographic observation and participant interviews, encampment sweeps were noted to be physically, psychologically, and socially destructive. Sweeps left participants feeling anger, loss, and hopelessness while further driving the societal marginalization of unhoused people who use drugs. Sweeps should be discontinued as they harm the capacity of unhoused people to improve their well-being.

Isolation of bacteria with plant growth-promoting properties from microalgae-bacterial flocs produced in high-rate oxidation ponds.

Exploring plant growth-promoting (PGP) bacterial activity of microbial components aggregated by wastewater treatment can reduce dependence on fossil fuel-derived fertilisers. This study describes the isolation and identification of bacteria from microalgae-bacteria flocs (MaB-flocs) generated in high-rate algal oxidation ponds (HRAOP) of an integrated algal pond system (IAPS) remediating municipal wastewater. Amplified 16S rRNA gene sequence analysis determined the molecular identity of the individual strains. Genetic relatedness to known PGP rhizobacteria in the NCBI GenBank database was by metagenomics. Isolated strains were screened for the production of indoles (measured as indole-3-acetic acid; IAA) and an ability to mineralise NH4+, PO43-, and K + . Of the twelve bacterial strains isolated from HRAOP MaB-flocs, four produced indoles, nine mineralised NH4+, seven solubilised P, and one K. Potential of isolated strains for PGP activity according to one-way ANOVA on ranks was: ECCN 7b > ECCN 4b > ECCN 6b > ECCN 3b = ECCN 10b > ECCN 1b = ECCN 5b > ECCN 8b > ECCN 2b > ECCN 12b > ECCN 9b = ECCN 11b. Further study revealed that cell-free filtrate from indole-producing cultures of Aeromonas strain ECCN 4b, Enterobacter strain ECCN 7b, and Arthrobacter strain ECCN 6b promoted mung bean adventitious root formation suggestive of the presence of auxin-like biological activity.

Elaboration of an algae-to-energy system and recovery of water and nutrients from municipal sewage.

Increasing pressure is being exerted on the peri-urban space that has elevated the demand for electricity, affects the global water resource, and impacts the potential to produce food, fiber, and commodity products. Algae-based technologies and in particular algae-based sewage treatment provides an opportunity for recovery of water for recycle and re-use, sequestration of greenhouse gases, and generation of biomass. Successful coupling of municipal sewage treatment to an algae-to-energy facility depends largely on location, solar irradiance, and temperature to achieve meaningful value recovery. In this paper, an algae-to-energy sewage treatment system for implementation in southern Africa is elaborated. Using results from the continued operation of an integrated algal pond system (IAPS), it is shown that this 500-person equivalent system generates 75 kL per day water for recycle and re-use and, ∼9 kg per day biomass that can be converted to methane with a net energy yield of ∼150 MJ per day, and ∼0.5 kL per day of high nitrogen-containing liquid effluent (>1 g/L) with potential for use as organic fertilizer. It is this opportunity that IAPS-based algae-to-energy sewage treatment provides for meaningful energy and co-product recovery within the peri-urban space and, which can alleviate pressure on an already strained water-energy-food nexus.

Evaluation of oats with varying hull inclusion in broiler diets up to 35 days.

Use of local feed ingredients in poultry feed, such as oats, can be limited by their perceived less than ideal nutritional content. Dehulling oats is expensive, and it may be that removing hull is detrimental to the bird in terms of gastrointestinal (GI) development, therefore maintaining some of the high-fiber oat hull (OH) might reduce costs and improve potential for inclusion in poultry diets. Male broilers were fed diets with oats replacing 30% of wheat in diets, either dehulled or with graded inclusions of OH from day of hatch until day 35. Each diet was fed to 8 pens of 8 birds and performance recorded weekly. Samples were collected at day 21 and 35 for analysis of ileal amino acid digestibility, apparent metabolizable energy (AME), and gross gut development measures. No detrimental effect was seen on bird weight with hull inclusion, though higher inclusion levels did deleteriously effect feed intake because of increased gut fill from the fiber. Nitrogen corrected AME was also adversely effected in the highest hull inclusion diets. However, amino acid digestibility was improved with hull addition, which may be because of an increase in GI tract length, improving nutrient absorption. Gizzard development was also significantly improved, and thereby, more efficient grinding of diet may also have improved digestibility. At a lower level of hull inclusion (3% total diet) where digestibility is improved without any detrimental effects on gut fill and intake. Oat hull is well known to improve gut development, especially of the gizzard, with resultant increases in digestibility. This is usually attributed to the mechanical effect of fiber in the gizzard having a grinding effect. However in this study, all fiber was finely ground, so the improvements seen cannot be attributed to a physical cause. Oat including diets with some hull remaining are a cost effective way of using oats as a raw material while maximizing bird performance.

Community exchange and time currencies: a systematic and in-depth thematic review of impact on public health outcomes.

OBJECTIVES: Austerity in government funding, and public service reform, has heightened expectations on UK communities to develop activities and resources supportive of population health and become part of a transformed place-based system of community health and social care. As non-monetary place-based approaches, Community Exchange/Time Currencies could improve social contact and cohesion, and help mobilise families, neighbourhoods, communities and their assets in beneficial ways for health. Despite this interest, the evidence base for health outcomes resulting from such initiatives is underdeveloped. STUDY DESIGN: A systematic review. METHODS: A literature review was conducted to identify evidence gaps and advance understanding of the potential of Community Exchange System. Studies were quality assessed, and evidence was synthesised on 'typology', population targeted and health-related and wider community outcomes. RESULTS: The overall study quality was low, with few using objective measures of impact on health or well-being, and none reporting costs. Many drew on qualitative accounts of impact on health, well-being and broader community outcomes. Although many studies lacked methodological rigour, there was consistent evidence of positive impacts on key indicators of health and social capital, and the data have potential to inform theory. CONCLUSIONS: Methodologies for capturing impacts are often insufficiently robust to inform policy requirements and economic assessment, and there remains a need for objective, systematic evaluation of Community Exchange and Time Currency systems. There is also a strong argument for deeper investigation of 'programme theories' underpinning these activities, to better understand what needs to be in place to trigger their potential for generating positive health and well-being outcomes.

A Randomised Controlled Trial of a Universal Bonding Agent at Three Years: Self Etch vs Total Etch.

General dental practice is increasingly being recognised as the ideal situation for the conduct of clinical trials into the longevity of restorations. The aim of this study was to investigate the survival of 64 nanofilled resin composite (Filtek Supreme XTE) restorations placed principally in loadbearing cavities using a Universal dentine bonding agent (Scotchbond Universal), in five UK dental practices by members of the UK-based practice-based research group, the PREP Panel. A split mouth design was used, comprising patients who required two restorations, with one of the restorations receiving a total etch approach using phosphoric acid and the other being placed using a self-etch approach. The results indicated good performance of the restorations examined, with no difference, in terms of marginal characteristics, between the restorations which received total etching and those which did not.

Extracellular polymeric substance production in high rate algal oxidation ponds.

Integrated algal pond systems (IAPSs) combine anaerobic and aerobic bioprocesses to affect sewage treatment. The present work describes the isolation and partial characterisation of soluble extracellular polymeric substances (EPSs) associated with microalgal bacterial flocs (MaB-flocs) generated in high rate algal oxidation ponds (HRAOPs) of an IAPS treating domestic sewage. Productivity and change in MaB-flocs concentration, measured as mixed liquor suspended solids (MLSS) between morning (MLSSAM) and evening (MLSSPM) were monitored and the substructure of the MaB-flocs matrix examined by biochemical analysis and Fourier transform infrared spectroscopy (FT-IR). Results show that MaB-flocs from HRAOPs are assemblages of microorganisms produced as discrete aggregates as a result of microbial EPS production. Formation and accumulation of the EPS was stimulated by light. Analysis by FT-IR revealed characteristic carbohydrate enrichment of these polymeric substances. In contrast, FT-IR spectra of EPSs from dark-incubated MaB-flocs confirmed that these polymers contained increased aliphatic and aromatic functionalities relative to carbohydrates. These differences, it was concluded, were due to dark-induced transition from phototrophic to heterotrophic metabolism. The results negate microalgal cell death as a contributor to elevated chemical oxygen demand of IAPS treated water.

Characterization of the Microbiome along the Gastrointestinal Tract of Growing Turkeys.

The turkey microbiome is largely understudied, despite its relationship with bird health and growth, and the prevalence of human pathogens such as Campylobacter spp. In this study we investigated the microbiome within the small intestine (SI), caeca (C), large intestine (LI), and cloaca (CL) of turkeys at 6, 10, and 16 weeks of age. Eight turkeys were dissected within each age category and the contents of the SI, C, LI, and CL were harvested. 16S rDNA based QPCR was performed on all samples and samples for the four locations within three birds/age group were sequenced using ion torrent-based sequencing of the 16S rDNA. Sequencing data showed on a genus level, an abundance of Lactobacillus, Streptococcus, and Clostridium XI (38.2, 28.1, and 13.0% respectively) irrespective of location and age. The caeca exhibited the greatest microbiome diversity throughout the development of the turkey. PICRUSt data predicted an array of bacterial function, with most differences being apparent in the caeca of the turkeys as they matured. QPCR revealed that the caeca within 10 week old birds, contained the most Campylobacter spp. Understanding the microbial ecology of the turkey gastrointestinal tract is essential in terms of understanding production efficiency and in order to develop novel strategies for targeting Campylobacter spp.

Design of a highly photocatalytically active ZnO/CuWO4 nanocomposite.

Here we report the synthesis, photocatalytic activity and mechanistic study of a novel charge separation heterostructure (HTS). A ZnO/CuWO4 HTS material is reported for the first time. The nanocomposite (NC) consist of CuWO4 nanoparticles (ca. 200-400nm) decorated with ZnO nanorods (ca. 30nm, 100nm length) and is shown to be a highly active photocatalyst for the decomposition of model contaminants including methyl orange (MO) and terephthalic acid (TPA). The ZnO/CuWO4 interface is shown to be key in controlling the enhanced activity of the composite material. Transient absorption (TA) spectroscopy studies demonstrate that photoinduced charge transfer across the ZnO/CuWO4 interface increases electron-hole lifetimes by 3 orders of magnitude, from <20µs in ZnO to 30ms in the ZnO/CuWO4 NC sample. Our findings show that through interface design efficient HTS materials can be prepared for a wide range of photocatalytic applications.

Phoenixin: A candidate pruritogen in the mouse.

Phoenixin (PNX) is a 14-amino acid amidated peptide (PNX-14) or an N-terminal extended 20-residue amidated peptide (PNX-20) recently identified in neural and non-neural tissue. Mass spectrometry analysis identified a major peak corresponding to PNX-14, with negligible PNX-20, in mouse spinal cord extracts. Using a previously characterized antiserum that recognized both PNX-14 and PNX-20, PNX-immunoreactivity (irPNX) was detected in a population of dorsal root ganglion (DRG) cells and in cell processes densely distributed to the superficial layers of the dorsal horn; irPNX cell processes were also detected in the skin. The retrograde tracer, Fluorogold, injected subcutaneously (s.c.) to the back of the cervical and thoracic spinal cord of mice, labeled a population of DRG, some of which were also irPNX. PNX-14 (2, 4 and 8 mg/kg) injected s.c.to the nape of the neck provoked dose-dependent repetitive scratching bouts directed to the back of the neck with the hindpaws. The number of scratching bouts varied from 16 to 95 in 30 min, commencing within 5 min post-injection and lasted 10-15 min. Pretreatment of mice at -20 min with nalfurafine (20 µg/kg, s.c.), the kappa opioid receptor agonist, significantly reduced the number of bouts induced by PNX-14 (4 mg/kg) compared with that of saline-pretreated mice. Our results suggest that the peptide, PNX-14, serves as one of the endogenous signal molecules transducing itch sensation in the mouse.

Operation of an integrated algae pond system for the treatment of municipal sewage: a South African case study.

Integrated algae pond systems (IAPS) combine the use of anaerobic and aerobic bioprocesses to effect sewage treatment. In the present work, the performance of IAPS was evaluated to determine the efficiency of this technology for treatment of municipal sewage under South African conditions. Composite samples were analysed over an 8 month period before and after tertiary treatment. Spectrophotometric assays indicated that the treated water from this IAPS was compliant with the discharge limits for phosphate-P, ammonium-N and nitrate/nitrite-N, and mean values were: 5.3, 2.9 and 12.4 mg L(-1), respectively. Chemical oxygen demand (COD), however, fluctuated significantly and was dependent on full function of the IAPS. Mean COD of the final treated water was 72.2 mg L(-1). Although these results suggest that the treated water discharged from this IAPS operating under South African conditions meets the standard for discharge, mean total suspended solids (TSS) was routinely above the limit at 34.5 ± 13 mg L(-1) and faecal coliforms were higher than expected. Tertiary treatment using a maturation pond series (MPS), slow sand filtration (SSF), or a controlled rock filter (CRF) ensured that the final treated water from the IAPS was of a quality suitable for discharge to the environment with CRF > SSF > MPS.

Lack of synergistic interaction between the two mechanisms of action of tapentadol in gastrointestinal transit.

BACKGROUND: A multi-mechanistic approach offers potential enhancement of analgesic efficacy, but therapeutic gain could be offset by an increase in adverse events. The centrally acting analgesic tapentadol [(-)-(1R,2R)-3-(3-dimethylamino-1-ethyl-2-methyl-propyl)-phenol hydrochloride] combines µ-opioid receptor (MOR) agonism and neuronal noradrenaline reuptake inhibition (NRI), both of which contribute to its analgesic effects. Previously, isobolographic analysis of occupation-effect data and a theoretically equivalent methodology determining interactions from the effect scale demonstrated pronounced synergistic interaction between the two mechanisms of action of tapentadol in two models of antinociception (low-intensity tail-flick and spinal nerve ligation). The present study investigated the nature of interaction of the two mechanisms on a surrogate measure for gastrointestinal adverse effect (inhibition of gastrointestinal transit). METHODS: Dose-response curves were generated in rats for tapentadol alone or in combination with the opioid receptor antagonist, naloxone, or the α2 -adrenoceptor antagonist, yohimbine, to reveal the effect of tapentadol based upon MOR agonism, NRI, and combined mechanisms. RESULTS: The dose-effect curve of tapentadol was shifted to the right by both antagonists, thereby providing data to distinguish between MOR agonism and NRI. Analysis revealed a simple additive interaction between the two mechanisms on this endpoint, in contrast to the synergistic interaction previously demonstrated for antinociception. CONCLUSIONS: We believe this is the first published evaluation of mechanistic interaction for a surrogate measure of adverse effect of a single compound with two mechanisms of action, and the results suggest that there is a greater separation between the analgesic and gastrointestinal effects of tapentadol than expected based upon its analgesic efficacy.

Zyklophin, a short-acting kappa opioid antagonist, induces scratching in mice.

It has been shown previously that norbinaltorphimine (norBNI) and 5'-guanidinonaltrindole (5'-GNTI), long-acting kappa opioid receptor (KOPR) antagonists, cause frenzied scratching in mice [1,2]. In the current study, we examined if zyklophin, a short-acting cyclic peptide KOPR antagonist, also elicited scratching behavior. When injected s.c. in the nape of the neck of male Swiss-Webster mice, zyklophin at doses of 0.1, 0.3 and 1mg/kg induced dose-related hindleg scratching of the neck between 3 and 15 min after injection. Pretreating mice with norBNI (20mg/kg, i.p.) at 18-20 h before challenge with zyklophin (0.3mg/kg) did not markedly affect scratching. Additionally, KOPR-/- mice given 0.3mg/kg of zyklophin displayed similar levels of scratching as wild-type animals. The absence of KOPR in KOPR-/- mice was confirmed with ex vivo radioligand binding using [(3)H]U69,593. Taken together, our data suggest that the presence of kappa receptors is not required for the excessive scratching caused by zyklophin. Thus, zyklophin, similar to the structurally different KOPR antagonist 5'-GNTI, appears to act at other targets to elicit scratching and potentially the sensation of itch.

Five-year clinical evaluation of zirconia-based bridges in patients in UK general dental practices.

OBJECTIVES: This study reported the results at 5 years of fixed-fixed all-ceramic bridges, constructed in a yttria oxide stabilized tetragonal zirconium oxide polycrystal (Y-TZP) substructure, placed in adult patients in UK general dental practices. MATERIALS AND METHODS: Four UK general dental practitioners recruited patients who required fixed bridgework and, after obtaining informed written consent, appropriate clinical and radiographic assessments were completed. The teeth were prepared and bridges constructed in accordance with the manufacturer's instructions. Each bridge was reviewed annually within 3 months of the anniversary of its placement by a calibrated examiner, together with the clinician who had placed the restoration, using modified USPHS criteria. RESULTS: Of the 41 bridges originally placed, 33 bridges were examined at 5 years. All Y-TZP frameworks were intact and no bridge retainers had debonded. Eight chipping fractures in the veneering ceramic were noted over the 5-year period. In five cases the patients were unaware of these and these cases were polished. Of the remaining three cases, in one a repair was attempted but was unsuccessful, but the bridge remained in satisfactory service. However, in the case involving a chipping fracture of the mesial-incisal angle of a central incisor, it was considered that replacement of the bridge was necessary. CONCLUSION: 97% (n=32) of the 33 Lava Y-TZP fixed-fixed bridges, evaluated in patients attending UK general dental practices, were found to be performing satisfactorily. CLINICAL RELEVANCE: The use of Y-TZP frameworks holds promise.

Biological degradation and solubilisation of coal.

This review focuses on ligninolytic fungi, soil bacteria, plants and root exudates in the degradation and solubilisation of low grade and waste coal and the interaction between these mutualistic biocatalysts. Coal represents a considerable portion of the total global fossil fuel reserve and continued demand for, and supply of this resource generates vast quantities of spoil and low grade waste. Large scale bioremediation technologies for the beneficiation of waste coal have unfortunately not yet been realised despite the many discoveries of microorganisms capable of lignite, lignin, and humic acid breakdown. Even so, solubilisation and depolymerization of low grade coal appears to involve either ligninolytic enzyme action or the production of alkaline substances or both. While the precise mechanism of coal biosolubilisation is unclear, a model for the phyto-biodegradation of low rank coal by mutualistic interaction between ligninolytic microorganisms and higher plants is proposed. Based on accumulated evidence this model suggests that solubilisation and degradation of lignite and waste coals commences upon plant root exudate and ligninolytic microorganism interaction, which is mutualistic, and includes soil bacteria and both mycorrhizal and non-mycorrhizal fungi. It is envisaged that this model and its further elaboration will aid in the development of functional technologies for commercial bioremediation of coal mine spoils, contribute to soil formation, and the overall biogeochemistry of organic carbon in the global ecosystem.

A clinical evaluation of all-ceramic bridges placed in patients attending UK general dental practices: three-year results.

OBJECTIVES: To report the results at year three of an evaluation of fixed-fixed all-ceramic bridges, constructed in a yttria oxide stabilized tetragonal zirconium oxide polycrystal (Y-TZP) substructure, placed in adult patients in UK general dental practices and luted using a self-adhesive resin-based cement. METHODS: Ethical approval was obtained. Four UK general dental practitioners were asked to recruit patients in accordance with the trial protocol. After obtaining informed written consent, appropriate vitality and radiographic assessments were completed and the pre-operative status of the gingival tissues noted. The teeth were prepared and bridges constructed in accordance with the manufacturer's instructions. Each bridge was reviewed annually within 3 months of the anniversary of its placement by a calibrated examiner, together with the clinician who had placed the restoration. The examiners evaluated the integrity of the restoration, its anatomic form, marginal adaptation, surface quality, sensitivity, the condition of the adjacent gingivae, and the presence or absence of secondary caries. RESULTS: A total of 34 bridges were examined at the three-year review. All Y-TZP frameworks were intact and no bridge retainers had debonded. Two veneering ceramic chips, in total, were detected over the three-year period of observation: the patients in whom this had occurred were unconcerned. A further abutment tooth had been successfully endodontically treated, through an occlusal access cavity, in addition to the two already reported at year one. SIGNIFICANCE: At year three, the 34 Lava Y-TZP fixed-fixed bridges, placed in patients attending UK general dental practices, were found to be performing satisfactorily.