The experiences of new mothers accessing feeding support for infants with down syndrome during the COVID-19 pandemic.

Infants with Down syndrome are more likely to experience feeding problems and mothers are likely to require more feeding support than mothers of typically developing infants. During the COVID-19 pandemic, many feeding support services changed from face-to-face to online, which impacted some maternal feeding experiences negatively, but no studies to date have explored the impact for mothers of infants with Down syndrome. Thematic analysis was conducted on semi-structured interviews from thirteen new mothers of infants (aged 8-17 months) with Down syndrome in the UK. Three superordinate themes were generated: (1) Every baby with Down syndrome has a unique journey, (2) There's no point asking, they won't know, (3) Lack of in-person support. Many mothers expressed frustrations over health professionals' lack of Down syndrome specific knowledge resulting in unmet needs, further magnified due to the nature of the virtual support being offered. Moreover, mothers struggled with reduced social support from other mothers when encountering feeding problems. These results hold real-world implications for health professionals who could provide more specialised face-to-face feeding support to mothers of infants with Down syndrome. This should be prioritised for children's overall development and mothers' wellbeing.

Monitoring biodiversity loss in rapidly changing Afrotropical ecosystems: an emerging imperative for governance and research.

Africa is experiencing extensive biodiversity loss due to rapid changes in the environment, where natural resources constitute the main instrument for socioeconomic development and a mainstay source of livelihoods for an increasing population. Lack of data and information deficiency on biodiversity, but also budget constraints and insufficient financial and technical capacity, impede sound policy design and effective implementation of conservation and management measures. The problem is further exacerbated by the lack of harmonized indicators and databases to assess conservation needs and monitor biodiversity losses. We review challenges with biodiversity data (availability, quality, usability and database access) as a key limiting factor that impacts funding and governance. We also evaluate the drivers of both ecosystems change and biodiversity loss as a central piece of knowledge to develop and implement effective policies. While the continent focuses more on the latter, we argue that the two are complementary in shaping restoration and management solutions. We thus underscore the importance of establishing monitoring programmes focusing on biodiversity-ecosystem linkages in order to inform evidence-based decisions in ecosystem conservation and restoration in Africa. This article is part of the theme issue 'Detecting and attributing the causes of biodiversity change: needs, gaps and solutions'.

Dynamics of runoff quality associated with an urban park and WSUD treatment train in a tropical climate.

A combination of discrete sampling using autosamplers triggered by area-velocity metres and continuous water quality monitoring using YSI datasondes enabled us to evaluate the dynamics of both stormwater runoff and dry weather water quality associated with an urban park and WSUD treatment train in Singapore. The WSUD treatment train consisted of a raingarden and sedimentation ponds. A first flush phenomenon was observed for total suspended solids (TSS) in three of four discrete-sampled events, but there was a less pronounced first flush characteristic for nutrients. Mean TN concentrations associated with runoff from the park (upstream of the WSUD treatment train) were in the range that would be associated with eutrophic conditions, while mean TP levels were in the mesotrophic/eutrophic boundary range. The raingarden reduced nutrient and TSS levels by 7-62% and loads by 65-93%, although nitrate levels were higher in the effluent compared to the influent. The sedimentation ponds successfully reduced sediment levels by 56%, based on continuous turbidity measurements. The dissolved oxygen levels in the sedimentation ponds were lower during drought periods, which has implications for aquatic organisms. The WSUD treatment train generally improved runoff quality from the park and such features can be easily integrated into the park design.

A profile of the Centre for Health Record Linkage.

Context: The Centre for Health Record Linkage (CHeReL) was established in 2006 as a dedicated health and human services data linkage facility for two Australian jurisdictions, New South Wales and the geographically-nested Australian Capital Territory. The two jurisdictions have their own Governments and separate Health and Human Service systems. Purpose and Operations: The primary purpose of the CHeReL is to make linked administrative and routinely collected health data available to researchers and government within relevant regulatory and governance frameworks. The CHeReL's data governance and technical operations draw on international best practice and have been refined by learnings from other data linkage centres. Outcomes: Over twelve years of operation, more than 2,320 unique investigators from 140 institutions have used the CHeReL, producing 615 publications in peer-reviewed literature. A robust pipeline of new development is expected to further amplify the use of linked data for cutting edge medical research and support a vision of data-informed policy and data-driven government services.

Radiation and energy budget dynamics associated with a floating photovoltaic system.

Shortwave radiation, longwave radiation, photovoltaic (PV) panel, air and near-surface water temperature data were measured for a floating PV system installed in a shallow tropical reservoir. Similar air and water temperature measurements were conducted in open water (ambient condition) for comparison. The data indicate that shortwave radiation is reduced significantly under the PV panels while the longwave radiation increased, and in fact became higher than the shortwave radiation as compared to open water conditions. The air temperature and the water temperature under the PV panels are higher than in open water. A numerical model was developed to predict the PV panel temperature, air and water temperatures beneath the panels and to investigate the heat balance at the reservoir surface, beneath the panels. The modelled air and PV panel temperatures were in good agreement with the field data. The modelled surface water temperature also replicated field measurements showing an increase of about 0.5 °C as compared to the open water temperature. Heat budget analysis showed that the thermal dynamics under the PV panels is mainly controlled by the longwave radiation from the PV panels and reduction in latent heat flux. The altered flux conditions beneath the panels result in a higher equilibrium temperature near the water surface, compared to open water conditions.

Machine intelligence identifies soluble TNFa as a therapeutic target for spinal cord injury.

Traumatic spinal cord injury (SCI) produces a complex syndrome that is expressed across multiple endpoints ranging from molecular and cellular changes to functional behavioral deficits. Effective therapeutic strategies for CNS injury are therefore likely to manifest multi-factorial effects across a broad range of biological and functional outcome measures. Thus, multivariate analytic approaches are needed to capture the linkage between biological and neurobehavioral outcomes. Injury-induced neuroinflammation (NI) presents a particularly challenging therapeutic target, since NI is involved in both degeneration and repair. Here, we used big-data integration and large-scale analytics to examine a large dataset of preclinical efficacy tests combining five different blinded, fully counter-balanced treatment trials for different acute anti-inflammatory treatments for cervical spinal cord injury in rats. Multi-dimensional discovery, using topological data analysis (TDA) and principal components analysis (PCA) revealed that only one showed consistent multidimensional syndromic benefit: intrathecal application of recombinant soluble TNFα receptor 1 (sTNFR1), which showed an inverse-U dose response efficacy. Using the optimal acute dose, we showed that clinically-relevant 90 min delayed treatment profoundly affected multiple biological indices of NI in the first 48 h after injury, including reduction in pro-inflammatory cytokines and gene expression of a coherent complex of acute inflammatory mediators and receptors. Further, a 90 min delayed bolus dose of sTNFR1 reduced the expression of NI markers in the chronic perilesional spinal cord, and consistently improved neurological function over 6 weeks post SCI. These results provide validation of a novel strategy for precision preclinical drug discovery that is likely to improve translation in the difficult landscape of CNS trauma, and confirm the importance of TNFα signaling as a therapeutic target.

A randomised controlled trial of energetic activity for depression in young people (READY): a multi-site feasibility trial protocol.

BACKGROUND: Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery. METHODS: The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13-17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a 'healthy living' behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness. DISCUSSION: UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression. TRIAL REGISTRATION: ISRCTN, ISRCTN66452702 . Registered 9 April 2020.

Monitoring river water and sediments within a changing Ethiopian catchment to support sustainable development.

In many sub-Saharan states, despite governments' awareness campaigns highlighting potential impacts of aquatic pollution, there is a very limited action to protect the riverine systems. Managing the quality of water and sediments needs knowledge of pollutants, agreed standards, and relevant policy framework supporting monitoring and regulation. This study reports metal concentrations in rivers in industrializing Ethiopia. The study also highlights policy and capacity gaps in monitoring of river and sediments. For two sampling periods in 2013 and 2014, chromium (Cr), copper (Cu), zinc (Zn), and lead (Pb) were monitored in water and sediments of the Leyole and Worka rivers in the Kombolcha city, Ethiopia. The sampling results were compared with international guidelines and evaluated against the Ethiopian water protection policies. Chromium was high in the Leyole river water (median 2660 µg/L) and sediments (maximum 740 mg/kg), Cu concentrations in the river water was highest at the midstream part of the Leyole river (median 63 µg/L), but maximum sediment content of 417 mg/kg was found further upstream. Zinc was the highest in the upstream part of the Leyole river water (median 521 µg/L) and sediments (maximum 36,600 mg/kg). Pb concentrations were low in both rivers. For the sediments, relatively higher Pb concentrations (maximum 3640 mg/kg) were found in the upstream of the Leyole river. Except for Pb, the concentrations of all metals surpassed the guidelines for aquatic life, human, livestock, and irrigation water supplies. The median concentrations of all metals exceeded guidelines for sediment quality for aquatic organisms. In Ethiopia, poor technical and financial capabilities restrict monitoring of rivers and sediments and understanding on the effects of pollutants. The guidelines used to protect water quality is based on the World Health Organization standards for drinking water quality, but this is not designed for monitoring ecological health. Further development of water quality standards and locally relevant monitoring framework are needed. Development of monitoring protocols and institutional capacities are important to overcome the policy gaps and support the government's ambition in increasing industrialization and agricultural intensification. Failure to do so presents high risks for the public and the river ecosystem.

A profile of the Centre for Health Record Linkage.

CONTEXT: The Centre for Health Record Linkage (CHeReL) was established in 2006 as a dedicated health and human services data linkage facility for two Australian jurisdictions, New South Wales and the geographically-nested Australian Capital Territory. The two jurisdictions have their own Governments and separate Health and Human Service systems. PURPOSE AND OPERATIONS: The primary purpose of the CHeReL is to make linked administrative and routinely collected health data available to researchers and government within relevant regulatory and governance frameworks. The CHeReL's data governance and technical operations draw on international best practice and have been refined by learnings from other data linkage centres. OUTCOMES: Over twelve years of operation, more than 2,320 unique investigators from 140 institutions have used the CHeReL, producing 615 publications in peer-reviewed literature. A robust pipeline of new development is expected to further amplify the use of linked data for cutting edge medical research and support a vision of data-informed policy and data-driven government services.

Correction to: Impacts and Policy Implications of Metals Effluent Discharge into Rivers within Industrial Zones: A Sub-Saharan Perspective from Ethiopia.

The original version of this article unfortunately contained mistakes in the Tables (1 and 2) caption and article title is updated.

Impacts and Policy Implications of Metals Effluent Discharge into Rivers within Industrial Zones: A Sub-Saharan Perspective from Ethiopia.

Kombolcha, a city in Ethiopia, exemplifies the challenges and problems of the sub-Saharan countries where industrialization is growing fast but monitoring resources are poor and information on pollution unknown. This study monitored metals Cr, Cu, Zn, and Pb concentrations in five factories' effluents, and in the effluent mixing zones of two rivers receiving discharges during the rainy seasons of 2013 and 2014. The results indicate that median concentrations of Cr in the tannery effluents and Zn in the steel processing effluents were as high as 26,600 and 155,750 µg/L, respectively, much exceeding both the USEPA and Ethiopian emission guidelines. Cu concentrations were low in all effluents. Pb concentrations were high in the tannery effluent, but did not exceed emission guidelines. As expected, no metal emission guidelines were exceeded for the brewery, textile and meat processing effluents. Median Cr and Zn concentrations in the Leyole river in the effluent mixing zones downstream of the tannery and steel processing plant increased by factors of 52 (2660 compared with 51 µg Cr/L) and 5 (520 compared with 110 µg Zn/L), respectively, compared with stations further upstream. This poses substantial ecological risks downstream. Comparison with emission guidelines indicates poor environmental management by industries and regulating institutions. Despite appropriate legislation, no clear measures have yet been taken to control industrial discharges, with apparent mismatch between environmental enforcement and investment policies. Effluent management, treatment technologies and operational capacity of environmental institutions were identified as key improvement areas to adopt progressive sustainable development.

Odonata larvae as a bioindicator of metal contamination in aquatic environments: application to ecologically important wetlands in Iran.

The objectives of this study were twofold: (i) assess the bioaccumulation characteristics of a suite of metals associated with several different species of Odonata and (ii) examine Odonata species richness as a reflection of ecosystem health in two ecologically important wetlands of southwestern Iran, the Shadegan and Hawr Al Azim wetlands. Levels of arsenic (As), cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), mercury (Hg), manganese (Mn), lead (Pb), and zinc (Zn) were determined using inductively coupled plasma optical emission spectrometry (ICP-OES) in nine different Odonata larva species. Based on these data, biota-sediment accumulation factors (BSAFs) were calculated and generally, it was found that Cr, Cu, Mn, and Zn were being taken up by the Odonata (BSAFs >1). Because of its prevalence in the wetland and its observed ability to take up metals, it is suggested that Ischnura ramburii is an appropriate indicator of ecosystem health for these wetlands with respect to metal contamination. Odonata species richness across all sites was 49, while for the individual sites, the greatest species richness was 26 and the lowest species richness was 13. The species richness value across all sites is quite healthy, given the arid climate of the region.

Modeling washoff of total suspended solids in the tropics.

Washoff behavior in the tropics is expected to behave differently from temperate areas due to differences in rainfall characteristics. In this study, rainfall, runoff and total suspended solids (TSS) were monitored from 9 catchments distinguished by different types of land use, in Singapore. The catchments ranged in size from 5.7ha to 85.2ha. Over 120 rain events were studied and more than 1000 storm samples were collected and analyzed. Monte Carlo analysis was applied to obtain the best fit values of the washoff model parameters consisting the washoff coefficient c3, washoff exponent c4 and initial mass on surface Bini. The exponent c4 was found to be approximately unity for all the events monitored, in agreement with other studies. The values of c3 and Bini were found to vary between events. Among all the rainfall and runoff characteristics studied, rainfall depth of the current event (d) was found to be the single parameter that significantly influenced the values of c3 and Bini. Contrary to expectations, Bini did not correlate well with antecedent dry period or with rainfall depth of the prior storm event. The results show that the common modeling practice where Bini is assumed to vary with antecedent dry period and previous rainfall depth should be reassessed when applied to catchments in the tropics. ANCOVA analysis showed that land use was not significant, but rather the variation of c3 and Bini with d was found to correlate well with the catchment area.

Trace metal distributions in the sediments of the Little Akaki River, Addis Ababa, Ethiopia.

The levels and distribution of trace metals (Cr, Mn, Co, Ni, Cu, Zn, Cd and Pb) at eleven water and sediment stations on the Little Akaki River (LAR) in Addis Ababa, Ethiopia, were determined. The binding forms of the metals in various geochemical fractions of the sediments were also quantified. The molar ratio of the sum of the simultaneously extractable metals (∑SEM) and acid-volatile sulphide (AVS)-as a measure for predicting metal-induced toxicity-was estimated. LAR trace levels in water for Cu, Zn, and, particularly Mn were, in most instances, higher than the recommended guidelines for healthy aquatic ecosystems. Total trace metal (TTM) contents in the LAR sediments at certain stations exceeded "threshold effect concentrations" and even "probable effect concentrations", especially in the cases of Zn, Cu, Ni, Pb, and at all stations for Mn. This became more apparent after applying "normalizations" to the relatively lower TTM adsorption capacities of coarse-grained, organic-poor sediments. Sequential extraction of the sediments showed that trace metals generally have a higher affinity for Fe-Mn oxide and organic matter/sulphidic fractions, followed by the residual fraction. Mn was relatively strongly bound to the exchangeable, carbonate bound fractions, whereas a large proportion of Cr was found in the residual fraction. The Σ[SEM]/[AVS] ratio pointed to potential metal-induced toxicity of sediments collected from seven out of the eleven stations. The results indicate that trace metal pollution pose risks to the health of ecosystems, and to human communities that use the river for a range of different purposes.

Assessment of bed sediment metal contamination in the Shadegan and Hawr Al Azim wetlands, Iran.

The Shadegan and Hawr Al Azim wetlands are important natural resources in southwestern Iran, yet relatively little work has been done to assess ecosystem health of the wetlands. Bed sediment from both wetlands was sampled in individual months between October, 2011 and December, 2012 and analyzed for As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Pb, and Zn using inductively coupled plasma optical emission spectrometry (ICP-OES). The metals data were evaluated using a combination of sediment quality guidelines from the Ontario Ministry of Energy and Environment (MOEE, Canada), enrichment factors (EFs), and a geo-accumulation index (Igeo) approach. The sediments exceeded MOEE Lowest Effect Levels (LELs) consistently for Cr and Cu and a small proportion of samples (5%) for Hg. Levels of As, Cd, Fe, Pb, and Zn did not exceed LELs and none of the samples exceeded the Severe Effect Levels (SELs). In addition to the sediment guidelines, both the EF and Igeo calculations suggested levels of Mn and Fe were severely enriched, while the EF indicated Cd was slightly enriched. Metal levels in the Shadegan wetland exhibited both spatial and seasonal trends. Metal levels were greater near input areas from agricultural, urban, and industrial discharges and runoff as compared to the more remote and quiescent central part of the wetland. Except for Fe, the metal levels were greater in the wet season as compared to the dry season, perhaps due to greater stormwater runoff and sediment loads. This study provides baseline data which can be used to support development of appropriate contaminant source management strategies to help ensure conservation of these valuable wetland resources.

Patterns of service utilisation within Australian hepatology clinics: high prevalence of advanced liver disease.

BACKGROUND: Liver diseases in Australia are estimated to affect 6 million people with a societal cost of $51 billion annually. Information about utilisation of specialist hepatology care is critical in informing policy makers about the requirements for delivery of hepatology-related healthcare. AIMS: This study examined the aetiology and severity of liver disease seen in a tertiary hospital hepatology clinic, as well as the resource utilisation patterns. METHODS: A longitudinal cohort study included consecutive patients booked in hepatology outpatient clinics during a 3-month period. Subsequent outpatient appointments for these patients over the following 12 months were then recorded. RESULTS: During the initial 3-month period, 1471 appointments were scheduled with a hepatologist, 1136 of which were attended. Twenty-one per cent of patients were 'new cases'. Hepatitis B virus (HBV) was the most common disease aetiology for new cases (37%). Advanced disease at presentation varied between aetiology; only 5% of HBV cases had advanced liver disease at presentation, in contrast with HCV, NAFLD and ALD, in which advanced disease was identified at presentation in 31%, 46% and 72% of cases, respectively. Most patients (83%) attended multiple hepatology appointments, and a range of referral patterns for procedures, investigations and other specialty assessments were observed. CONCLUSIONS: There is a high prevalence of HBV in new case referrals. Patients with HCV infection, NAFLD and ALD have a high prevalence of advanced liver disease at referral, requiring ongoing surveillance for development of decompensated liver disease and liver cancer. These findings that describe the patterns of health service utilisation among patients with liver disease provide useful information for planning sustainable health service provision for this clinical population.

Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?

BACKGROUND: Ascites, the most frequent complication of cirrhosis, is associated with poor prognosis and reduced quality of life. Recurrent hospital admissions are common and often unplanned, resulting in increased use of hospital services. AIMS: To examine use of hospital services by patients with cirrhosis and ascites requiring paracentesis, and to investigate factors associated with early unplanned readmission. METHODS: A retrospective review of the medical chart and clinical databases was performed for patients who underwent paracentesis between October 2011 and October 2012. Clinical parameters at index admission were compared between patients with and without early unplanned hospital readmissions. RESULTS: The 41 patients requiring paracentesis had 127 hospital admissions, 1164 occupied bed days and 733 medical imaging services. Most admissions (80.3%) were for management of ascites, of which 41.2% were unplanned. Of those eligible, 69.7% were readmitted and 42.4% had an early unplanned readmission. Twelve patients died and nine developed spontaneous bacterial peritonitis. Of those eligible for readmission, more patients died (P = 0.008) and/or developed spontaneous bacterial peritonitis (P = 0.027) if they had an early unplanned readmission during the study period. Markers of liver disease, as well as haemoglobin (P = 0.029), haematocrit (P = 0.024) and previous heavy alcohol use (P = 0.021) at index admission, were associated with early unplanned readmission. CONCLUSION: Patients with cirrhosis and ascites comprise a small population who account for substantial use of hospital services. Markers of disease severity may identify patients at increased risk of early readmission. Alternative models of care should be considered to reduce unplanned hospital admissions, healthcare costs and pressure on emergency services.

A disintegrin and metalloproteinase 12 (ADAM12) localizes to invasive trophoblast, promotes cell invasion and directs column outgrowth in early placental development.

During pregnancy, stromal- and vascular-remodeling trophoblasts serve critical roles in directing placental development acquiring pro-invasive characteristics. The A Disintegrin and Metalloproteinase (ADAM) family of multifunctional proteins direct cellular processes across multiple organ systems via their intrinsic catalytic, cell adhesive and intracellular signaling properties. ADAM12, existing as two distinct splice variants (ADAM12L and ADAM12S), is highly expressed in the human placenta and promotes cell migration and invasion in several tumor cell lines; however, its role in trophoblast biology is unknown. In this study, ADAM12 was localized to anchoring trophoblast columns in first trimester placentas and to highly invasive extracellular matrix-degrading trophoblasts in placental villous explants. The importance of ADAM12 in directing trophoblast invasion was tested using loss-of and gain-of-function strategies, where siRNA-directed knockdown of ADAM12 inhibited trophoblast cell invasion while over-expression promoted migration and invasion in two trophoblastic cell models. In placental villous explant cultures, siRNA-directed loss of ADAM12 significantly dampened trophoblast column outgrowth. Additionally, we provide functional evidence for the ADAM12S variant in promoting trophoblast invasion and column outgrowth through a mechanism requiring its catalytic activity. This is the first study to assign a function for ADAM12 in trophoblast biology, where ADAM12 may play a central role regulating the behavior of invasive trophoblast subsets in early pregnancy. This study also underlines the importance of ADAM12L and ADAM12S in directing cell motility in normal developmental processes outside of cancer, specifically highlighting a potentially important function of ADAM12S in directing early placental development.

Female elk contacts are neither frequency nor density dependent.

Identifying drivers of contact rates among individuals is critical to understanding disease dynamics and implementing targeted control measures. We studied the interaction patterns of 149 female elk (Cervus canadensis) distributed across five different regions of western Wyoming over three years, defining a contact as an approach within one body length (-2 min). Using hierarchical models that account for correlations within individuals, pairs, and groups, we found that pairwise contact rates within a group declined by a factor of three as group sizes increased 33-fold. Per capita contact rates, however, increased with group size according to a power function, such that female elk contact rates fell in between the predictions of density- or frequency-dependent disease models. We found similar patterns for the duration of contacts. Our results suggest that larger elk groups are likely to play a disproportionate role in the disease dynamics of directly transmitted infections in elk. Supplemental feeding of elk had a limited impact on pairwise interaction rates and durations, but per capita rates were more than two times higher on feeding grounds. Our statistical approach decomposes the variation in contact rate into individual, dyadic, and environmental effects, and provides insight into factors that may be targeted by disease control programs. In particular, female elk contact patterns were driven more by environmental factors such as group size than by either individual or dyad effects.