Impacts of Fulvic Acid on the Toxicity of the Herbicide Atrazine to Lemna minor.

Fulvic acids (FA) are environmentally prevalent components of dissolved organic carbon. Little research has evaluated their potential influence on the bioavailability of herbicides to non-target aquatic plants. This study evaluated the potential impacts of FA on the bioavailability of atrazine (ATZ) to the aquatic plant Lemna minor. Plants were exposed to 0, 15, 30, 60, 125, and 750 µg/L ATZ in media containing three FA concentrations (0, 5, and 15 mg/L) in a factorial study under static conditions. Fronds were counted after 7- and 14-days exposure and intrinsic growth rates (IGR) and total frond yields were calculated for analysis. Atrazine NOAECs and LOAECs within each FA treatment series (0, 5, or 15 mg/L) were identified and EC50s were estimated. NOAEC/LOAECs for yield and IGR were 60/125 µg/L except for yield in the 0 mg/L-FA series (30/60) and IGR in the 5 mg/L-FA series (30/60). NOAEC/LOAECs were 30/60 µg/L for all treatments and both endpoints after 14 days exposure. EC50s ranged from 88.2 to 106.1 µg/L (frond production 7 DAT), 158.0-186.0 µg/L (IGR, 7 DAT), 74.7-86.3 µg/L (frond production, 14 DAT), and 144.1-151.3 µg/L (IGR, 14 DAT). FA concentrations did not influence the toxicity of ATZ.

Hepatobiliary circulation and dominant urinary excretion of homogentisic acid in a mouse model of alkaptonuria.

Altered activity of specific enzymes in phenylalanine-tyrosine (phe-tyr) metabolism results in incomplete breakdown of various metabolite substrates in this pathway. Increased biofluid concentration and tissue accumulation of the phe-tyr pathway metabolite homogentisic acid (HGA) is central to pathophysiology in the inherited disorder alkaptonuria (AKU). Accumulation of metabolites upstream of HGA, including tyrosine, occurs in patients on nitisinone, a licenced drug for AKU and hereditary tyrosinaemia type 1, which inhibits the enzyme responsible for HGA production. The aim of this study was to investigate the phe-tyr metabolite content of key biofluids and tissues in AKU mice on and off nitisinone to gain new insights into the biodistribution of metabolites in these altered metabolic states. The data show for the first time that HGA is present in bile in AKU (mean [±SD] = 1003[±410] µmol/L; nitisinone-treated AKU mean [±SD] = 45[±23] µmol/L). Biliary tyrosine, 3(4-hydroxyphenyl)pyruvic acid (HPPA) and 3(4-hydroxyphenyl)lactic acid (HPLA) are also increased on nitisinone. Urine was confirmed as the dominant elimination route of HGA in untreated AKU, but with indication of biliary excretion. These data provide new insights into pathways of phe-tyr metabolite biodistribution and metabolism, showing for the first time that hepatobiliary excretion contributes to the total pool of metabolites in this pathway. Our data suggest that biliary elimination of organic acids and other metabolites may play an underappreciated role in disorders of metabolism. We propose that our finding of approximately 3.8 times greater urinary HGA excretion in AKU mice compared with patients is one reason for the lack of extensive tissue ochronosis in the AKU mouse model.

Assessment of mould remediation in a healthcare setting following extensive flooding.

BACKGROUND: A new hospital building was close to completion when a large pipe carrying clean water broke, causing extensive flooding. AIM: To determine the flood-associated fungal risk to susceptible patients who would use that building. METHODS: Though standard flood remediation by the builders was relatively straightforward, there was no model for specialist assessment of patient risk due to the flood-associated mould growth. As levels of background airborne fungal spores can be expected to vary significantly over time, we could not use absolute levels to indicate either an excess of airborne fungal spores or successful remediation. Therefore it was decided to use weekly settle plates, exposed at the same time in flooded (test) and equivalent non-flooded (control) areas to compensate for variations in background levels. Flood-related risk was estimated by the ratio between fungal colonies on the test and control sets of settle plates, rather than absolute number. FINDINGS: Whereas the physical flood remediation, including the use of 'anti-fungal' treatments, was completed in three weeks post flooding, fungal contamination in flooded areas took 38 weeks to return to control levels and remained so for a further six weeks of observation. CONCLUSION: By the use of this method, we were able to assure the absence of flood-associated fungal risk to susceptible patients who would use that building. We recommend that infection prevention and control teams consider using this approach should they be faced with similar situations.

Associations between patient factors and successful colon capsule endoscopy - A prospective cohort study.

AIM: To establish patient factors associated with a successful colon capsule endoscopy (CCE) test. METHOD: This prospective cohort study used data collected from patients who underwent CCE as part of the ScotCap evaluation prior to April 2020. A CCE was defined as successful if the capsule visualized the whole colon and rectum (complete test) with sufficient bowel cleansing to permit assessment of the colonic mucosa (adequate bowel preparation). Factors from patients in symptomatic and surveillance groups were analysed for associations with a successful test, complete test, adequate bowel preparation and requirement for further procedure using univariate, multivariate logistic, least absolute shrinkage and selection operator regression. RESULTS: Data from 263 symptomatic and 137 surveillance patients were analysed. There was an association between a symptomatic patient's age and a successful test (OR = 0.97, 95% CI: 0.95-0.99), adequate bowel preparation (OR = 0.97, 95% CI: 0.94-1.00) and further procedure requirement (OR = 1.04, 95% CI: 1.02-1.06). An association was found, for symptomatic patients, between a faecal immunochemical test result in the range 10-399 µg/g and a further procedure (OR = 2.32, 95% CI: 1.23-4.48). In patients undergoing surveillance for previous colorectal cancer (OR = 0.42, 95% CI: 0.18-0.97), had previous bowel resection surgery (OR = 0.43, 95% CI: 0.19-0.98) or took a beta blocker medication (OR = 0.32, 95% CI: 0.11-0.88), an association was found with further procedure requirement. CONCLUSIONS: Among symptomatic patients, younger age was associated with obtaining a successful CCE test. Clinicians could consider patient selection based on these results to improve the rate of successful testing in clinical practice.

Developing Decision-Making Expertise in Professional Sports Staff: What We Can Learn from the Good Judgement Project.

Success within performance sports is heavily dependent upon the quality of the decisions taken by educated and experienced staff. Multi-disciplinary teams (MDTs) typically collate voluminous data, and staff typically undergo extensive and rigorous technical and domain-specific training. Although sports professionals operate in sometimes volatile, uncertain, complex and ambiguous decision-making environments, a common assumption seems to be that education and experience will automatically lead to enhanced and effective decision-making capabilities. Accordingly, there are few formal curriculums, in coaching or sports science contexts, focussed on translating the extensive research on judgement and decision-making expertise to professional sports staff. This article aims to draw on key research findings to offer insights and practical recommendations to support staff working within professional performance contexts. Through this distillation, we hope to enhance understanding of the factors underpinning effective decision-making in dynamic, high-stakes professional sporting environments. Broadly, the conclusions of this research demonstrate that decision-making efficacy is enhanced through application of three specific strategies: (i) Design of more engaging professional cultures harnessing the power of collectives encouraging diverse opinions and perspectives, and fostering and promoting collaborative teamwork, (ii) education specifically targeting debiasing training, designed to counter the most common cognitive pitfalls and biases and, (iii) the implementation of evaluation strategies integrating rigorous testing and real-time feedback.

Factors Associated With Otolaryngologists Performing Tracheotomy.

Importance: Tracheotomies are frequently performed by nonotolaryngology services. The factors that determine which specialty performs the procedure are not defined in the literature but may be influenced by tracheotomy approach (open vs percutaneous) and other clinicodemographic factors. Objective: To evaluate demographic and clinical characteristics associated with tracheotomies performed by otolaryngologists compared with other specialists and to differentiate those factors from factors associated with use of open vs percutaneous tracheotomy. Design, Setting, and Participants: This multicenter, retrospective cohort study included patients aged 18 years or older who underwent a tracheotomy for cardiopulmonary failure at 1 of 8 US academic institutions between January 1, 2013, and December 31, 2016. Data were analyzed from September 2022 to July 2023. Exposure: Tracheotomy. Main Outcomes and Measures: The primary outcome was factors associated with an otolaryngologist performing tracheotomy. The secondary outcome was factors associated with use of the open tracheotomy technique. Results: A total of 2929 patients (mean [SD] age, 57.2 [17.2] years; 1751 [59.8%] male) who received a tracheotomy for cardiopulmonary failure (652 [22.3%] performed by otolaryngologists and 2277 [77.7%] by another service) were analyzed. Although 1664 of all tracheotomies (56.8%) were performed by an open approach, only 602 open tracheotomies (36.2%) were performed by otolaryngologists. Most tracheotomies performed by otolaryngologists (602 of 652 [92.3%]) used the open technique. Multivariable regression analysis revealed that self-reported Black race (odds ratio [OR], 1.89; 95% CI, 1.52-2.35), history of neck surgery (OR, 2.71; 95% CI, 2.06-3.57), antiplatelet and/or anticoagulation therapy (OR, 1.74; 95% CI, 1.29-2.36), and morbid obesity (OR, 1.54; 95% CI, 1.24-1.92) were associated with greater odds of an otolaryngologist performing tracheotomy. In contrast, history of neck surgery (OR, 1.36; 95% CI, 0.96-1.92), antiplatelet and/or anticoagulation therapy (OR, 0.80; 95% CI, 0.56-1.14), and morbid obesity (OR, 0.94; 95% CI, 0.74-1.19) were not associated with undergoing open tracheotomy when performed by any service, and Black race (OR, 0.56; 95% CI, 0.44-0.71) was associated with lesser odds of an open approach being used. Age-adjusted Charlson Comorbidity Index score greater than 4 was associated with greater odds of both an otolaryngologist performing tracheotomy (OR, 1.26; 95% CI, 1.03-1.53) and use of the open tracheotomy technique (OR, 1.48, 95% CI, 1.21-1.82). Conclusions and Relevance: In this study, otolaryngologists were significantly more likely than other specialists to perform a tracheotomy for patients with history of neck surgery, morbid obesity, and ongoing anticoagulation therapy. These findings suggest that patients undergoing tracheotomy performed by an otolaryngologist are more likely to present with complex and challenging clinical characteristics.

Immersion of debrided diabetic foot ulcer tissue in electrochemically generated pH neutral hypochlorous acid significantly reduces the microbial bioburden: whole-genome sequencing of Staphylococcus aureus, the most prevalent species recovered.

BACKGROUND: Diabetic foot ulcer infections (DFUIs) are the leading cause of lower-limb amputations, mediated predominantly by Staphylococcus aureus. pH-neutral electrochemically generated hypochlorous acid (anolyte) is a non-toxic, microbiocidal agent with significant potential for wound disinfection. AIMS: To investigate both the effectiveness of anolyte for microbial bioburden reduction in debrided ulcer tissues and the population of resident S. aureus. METHODS: Fifty-one debrided tissues from 30 people with type II diabetes were aliquoted by wet weight and immersed in 1- or 10-mL volumes of anolyte (200 parts per million) or saline for 3 min. Microbial loads recovered were determined in colony forming units/g (cfu/g) of tissue following aerobic, anaerobic and staphylococcal-selective culture. Bacterial species were identified and 50 S. aureus isolates from 30 tissues underwent whole-genome sequencing (WGS). FINDINGS: The ulcers were predominantly superficial, lacking signs of infection (39/51, 76.5%). Of the 42/51 saline-treated tissues yielding ≥105 cfu/g, a microbial threshold reported to impede wound-healing, only 4/42 (9.5%) were clinically diagnosed DFUIs. Microbial loads from anolyte-treated tissues were significantly lower than saline-treated tissues using 1 mL (1065-fold, 2.0 log) and 10 mL (8216-fold, 2.1 log) immersion volumes (P<0.0005). S. aureus was the predominant species recovered (44/51, 86.3%) and 50 isolates underwent WGS. All were meticillin susceptible and comprised 12 sequence types (STs), predominantly ST1, ST5 and ST15. Whole-genome multi-locus sequence typing identified three clusters of closely related isolates from 10 patients indicating inter-patient transmission. CONCLUSIONS: Short immersions of debrided ulcer tissue in anolyte significantly reduced microbial bioburden: a potential novel DFUI treatment.

Environmental risk assessment for fecal contamination sources in urban and peri-urban estuaries, in Escambia and Santa Rosa counties, FL, USA.

Fecal pollution of estuaries and adjacent creeks and streams is of significant concern along the Gulf of Mexico. The prospective threat to human life and water quality impairment via fecal pollution is a substantial danger to the strength and resistance of coastline areas. Pensacola, FL, has a prosperous coastal tourism industry that is utilized for numerous other uses, such as recreational watersports and boating, seafood, and shellfish harvesting. However, the frequency and severity of fecal contamination present possible socio-economic issues, specifically financial hardships. Therefore, understanding the source, abundance, and fate of fecal microbial pollutants in aquatic systems signifies an imperative initial stage for detecting the host sources and techniques to lessen their transport from the landscape. This research aimed to quantify the fecal indicator bacteria (FIB), Escherichia coli, and perform microbiological fecal source tracking to verify if the fecal inputs are of either animal or human host origin. Surface water samples were taken from urban and peri-urban creeks for two sampling periods (February 2021 and January 2022), and IDEXX Colilert-18 (USEPA Standard Method 9223) was used for E. coli enumeration. DNA extractions were obtained from each sample, and quantitative PCR was utilized for fecal microbial source tracking (MST) to detect human, dog, ruminant, and bird host-specific Bacteroides DNA. The result indicates elevated quantities of FIB, E. coli, that surpass the threshold considered safe regarding human health. E. coli at six sites over the two sampling periods exceeded the impairment threshold, reaching as high as 866.4 MPN/100 ml. Fecal source tracking identified human host fecal contamination at four of nine sites, dogs at three of nine, and birds at one site. However, those sites with sources identified via MST all had E. coli levels below impairment thresholds. No sites were determined to be positive for ruminant as a source or for the pathogen Helicobacter pylori. No canine host fecal inputs were found in January 2022, and only one site with human sewage. Our results highlight the utility of MST in assessing bacterial inputs to water bodies and the challenges.

An analysis of the maxillary beak shape variation between 2 pure layer lines and its relationship to the underlying premaxillary bone, feather cover, and mortality.

Beak shape varies considerably within and between intact-beak laying hens, and aspects of beak shape appear to be heritable. As an alternative to beak treatment (an effective method of reducing damage from severe feather pecking (SFP)), this variation could be used to genetically select hens whose beak shapes are less apt to cause damage. To be able to select certain phenotypes, the beak shape variation that exists within laying hen flocks must first be characterized. The objectives of this study were to 1) describe the maxillary beak shape variation in 2 pure White Leghorn layer lines with intact beaks using geometric morphometrics to analyze images, and 2) examine the beak shape's relationship to the premaxillary bone, feather cover, and mortality. A lateral head image was taken of each hen (n = 710), and 20 landmarks were placed along each image's dorsal and ventral margins of the maxillary beak. Landmark coordinates were standardized by Procrustes superimposition, and the covariation was analyzed by principal components analysis and multivariate regression. Feather cover was scored at 3 ages and mortality was monitored throughout the production cycle. Three principal components (PCs) explained 83% of the maxillary beak shape variation and the first PC partially separated the 2 lines. Maxillary beak shapes ranged from long and narrow with pointed tips to short and wide with more curved tips. Moderate correlations were found between the maxillary beak and premaxillary bone shape (rs = 0.44) and size (rs = 0.52). Line A hens had better feather cover than Line B at all ages. Line A hens also had less total and cannibalism-related mortality than Line B (10.7 and 0.4% vs. 16.7 and 2.4%, respectively). Beak shape may be one factor contributing to the observed differences in feather cover and mortality. The results suggest that distinct maxillary beak phenotypes within each line could be selected to help reduce SFP damage and improve bird welfare.

Leaching of select per-/poly-fluoroalkyl substances, pharmaceuticals, and hormones through soils amended with composted biosolids.

The use of organic amendments to enhance soil health is increasingly being identified as a strategy to improve residential landscapes while also reducing the need for external inputs (e.g., fertilizers, irrigation). Composted biosolids are a re-purposed waste product that can be used in organic amendments to improve the overall sustainability of a municipality by enhancing residential soil carbon content while simultaneously reducing waste materials. However, the biosolids-based feedstock of these compost products has the potential to be a source of organic contaminants. We conducted a laboratory-based soil column experiment to evaluate the potential for different commercially available compost products to act as a source of emerging organic contaminants in residential landscapes. We compared two biosolids-based compost products, a manure-based compost product, and a control (no compost) treatment by irrigating soil columns for 30 days and collecting daily leachate samples to quantify leaching rates of six hormones, eight pharmaceuticals, and seven per- and polyfluoroalkyl substances (PFAS). Detection of hormones and pharmaceuticals was rare, suggesting that compost amendments are likely not a major source of these contaminants to groundwater resources. In contrast, we detected three of the seven PFAS compounds in leachate samples throughout the study. Perfluorohexanoic acid (PFHxA) was more likely to leach from biosolids-based compost treatments than other treatments (p < 0.05) and perfluorobutane sulfonate (PFBS) was only detected in biosolids-based treatments (although PFBS concentrations did not significantly differ among treatments). In contrast, perfluorooctanoic acid (PFOA) was commonly detected across all treatments (including controls), suggesting potential PFOA experimental contamination. Overall, these results demonstrate that commercially available composted biosolids amendments are likely not a major source of hormone and pharmaceutical contamination. The detection of PFHxA at significantly higher concentrations in biosolids treatments suggests that biosolids-based composts may act as sources of PFHxA to the environment. However, concentrations of multiple PFAS compounds found in leachate in this study were lower than concentrations found in known PFAS hotspots. Therefore, there is potential for environmental contamination from PFAS leaching from composted biosolids, but leachate concentrations are low which should be considered in risk-benefit analyses when considering whether or not to use composted biosolids as an organic amendment to enhance residential soil health.

Absorption, translocation, and metabolism of atrazine, carbamazepine, and sulfamethoxazole by the macrophyte Orange King Humbert canna lily (Canna × generalis L.H. Bailey (pro sp.) [glauca × indica]).

Canna × generalis L.H. Bailey (pro sp.) [glauca × indica] (common name: Orange King Humbert canna lily) has been reported as a promising plant species that can effectively remove contaminants of emerging concern (CECs), such as atrazine (ATZ), carbamazepine (CBZ), and sulfamethoxazole (SMX), from contaminated surface water. In the present study, absorption, translocation, and metabolism of such CECs in canna were examined using carbon-14-labeled ([14C]) analogues of each contaminant to understand the removal of each. Uptake/adsorption of the [14C]-CECs increased over time and was > 47.5% at the end of the 14-day study. The root-shoot translocation of [14C]-ATZ in canna was the greatest at 49.9-78.8%, followed by [14C]-CBZ (1.9-44.7%) and [14C]-SMX (3.3-6.0%). The cumulative transpiration of canna was correlated with absorption (R2 > 0.95) and root-shoot translocation (R2 > 0.97) magnitudes of [14C]-CECs in canna. Radiographic results revealed significant conversion of parent [14C]-CECs into other metabolites during the 14-day study. Metabolism of [14C]-ATZ and [14C]-CBZ occurred mainly in the shoots, whereas metabolism of [14C]-SMX occurred in the roots. Taken together, root-shoot redistribution and metabolism of CECs absorbed into canna can vary by transpiration volume as well as chemical properties.

Clinicodemographic Predictors of Tracheotomy Tube Size and Decannulation: A Multiinstitutional Retrospective Cohort Study on Tracheotomy.

OBJECTIVE: We aimed to discern clinico-demographic predictors of large (≥8) tracheostomy tube size placement, and, secondarily, to assess the effect of large tracheostomy tube size and other parameters on odds of decannulation before hospital discharge. SUMMARY OF BACKGROUND DATA: Factors determining choice of tracheostomy tube size are not well-characterized in the current literature, despite evidence linking large tracheostomy tube size with posttracheotomy tracheal stenosis. The effect of tracheostomy tube size on timing of decannulation is also unknown, an important consideration given reported associations between endotracheal tube size and probability of failed extubation. METHODS: We collected information pertaining to patients who underwent tracheotomy at 1 of 10 U.S. health care institutions between 2010 and 2019. Tracheostomy tube size was dichotomized (≥8 and <8). Multivariable logistic regression models were fit to identify predictors of (1) large tracheostomy tube size, and (2) decannulation before hospital discharge. RESULTS: The study included 5307 patients, including 2797 (52.7%) in the large tracheostomy cohort. Patient height (odds ratio [OR] = 1.060 per inch; 95% confidence interval [CI] 1.041-1.070) and obesity (1.37; 95% CI 1.1891.579) were associated with greater odds of large tracheostomy tube; otolaryngology performing the tracheotomy was associated with significantly lower odds of large tracheostomy tube (OR = 0.155; 95% CI 0.131-0.184). Large tracheostomy tube size (OR = 1.036; 95% CI 0.885-1.213) did not affect odds of decannulation. CONCLUSIONS: Obesity was linked with increased likelihood of large tracheostomy tube size, independent of patient height. Probability of decannulation before hospital discharge is influenced by multiple patient-centric factors, but not by size of tracheostomy tube.

Development of an in vivo radiographic method with potential for use in improving bone quality and the welfare of laying hens through genetic selection.

1. Genetic selection for bone quality can improve this, as it is heritable. A method was established using digital X-ray which took around 40 s in total and gave an image that allowed quantification of bone density from many appendicular bones.2. The tibiotarsus measurement of bone density on the live hen across the different experiments had correlations with post-mortem whole bone radiographic density from 0.62 to 0.7, similar to that between density and material properties for example. Differences between groups of hens, where calcium and phosphorus in the diet were manipulated, were detected within 3 weeks of treatment using live hen measurement (P < 0.001, n = 24).3. In a gage analysis, 'hen' explained more than 86% of the variance, demonstrating the ability to observe clear differences between hens. The effect of different operators' analysis on the contribution to variance was very low as was the repeated measurement of the same hen.4. The measurement of bone density on the live hen described in this paper represented major progress to a usable method for genetic selection to improve bone strength in laying hens. The method has the potential to reduce the number of animals needed to test nutritional and management interventions to improve bone health.

Failure of a hollow-fibre shower filter device to prevent exposure of patients to Pseudomonas aeruginosa.

BACKGROUND: Pseudomonas aeruginosa in hospital water is a risk for invasive infection. Point-of-use (POU) filters are used to reduce patient exposure to the organism, and hollow-fibre filters are becoming more popular. However, retrograde colonization of the filter mechanism may contaminate the effluent. AIMS: To assess the efficacy of POU filter head (polysulfone; hollow-fibre matrix) shower filters in preventing the exposure of high-risk patient groups to P. aeruginosa. METHODS: Pre-flush (opening the outlet and collecting the first 100 mL of water) samples were analysed to measure P. aeruginosa contamination from 25 shower outlets (∼21% of all showers on the six wards), with and without a hollow-fibre filter. P. aeruginosa was measured in a subset of outlets harbouring P. aeruginosa (sampling period 19th August 2019 to 10th January 2020). FINDINGS: Water from all 25 showers was heavily colonized [>300 colony-forming units (cfu)/mL] with P. aeruginosa at the showerhead. P. aeruginosa was found in 32% (8/25) of post-filter shower water effluent samples with a geometric mean of 4x106 cfu/mL (N=4) (6.8x104-2x108). Filters were sampled at 15-150 days of use (median 15 days), with 26% (6/23) of filter units becoming colonized before the expiry date. CONCLUSION: POU filter showerhead units may not be effective in preventing exposure of vulnerable patients to P. aeruginosa in hospital water due to retrograde contamination (external contamination of the showerhead passed back to the filter cartridge itself) or failure of the hollow-fibre filter matrix. Reliance should not be placed on the use of hollow-fibre filters to protect patients from exposure to P. aeruginosa without repeated microbiological monitoring.

Trophic transfer of PFAS from tomato (Solanum lycopersicum) to tobacco hornworm (Manduca sexta) caterpillars.

PFASs are highly persistent in the environment and the potential exists for terrestrial biota to accumulate PFAS, which may result in exposure of higher trophic level organisms to these compounds through consumption. However, trophic transfer of proteinophilic compounds such as PFAS has not been extensively studied and the degree to which plant-accumulated PFAS will be transferred to herbivorous consumers is unclear. Here, we exposed Solanum lycopersicum (tomato) plants to a suite of 7 different PFAS, including 4 carboxylic acids (PFOA, PFHxA, PFHpA and PFDA) and 3 sulfonates (PFBS, PFHxS and PFOS). Exposed leaf tissues were subsequently fed to Manduca sexta (tobacco hornworm) caterpillars. Biomagnification factors (BMFs) were all below 1 and patterns of uptake and elimination were similar between the different PFAS. However, PFOS bioaccumulated in the hornworms to a much higher concentration, with approximately 5-fold higher BMFs and assimilation efficiencies (AEs) than other PFAS tested. AE and BMF, as well as PFAS uptake by the plants, were positively correlated with PFAS carbon chain length for both sulfonates and carboxylic acids, providing evidence that longer chain PFAS may be more efficiently accumulated (or less efficiently eliminated) than shorter-chain PFAS in some contexts.

ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial.

BACKGROUND: Addressing sexual trauma in the context of HIV care is essential to improve clinical outcomes and mental health among women in South Africa. Women living with HIV (WLH) report disproportionately high levels of sexual trauma and have higher rates of posttraumatic stress disorder. Adherence to antiretroviral therapy (ART) may be difficult for traumatized women, as sexual trauma compounds the stress associated with managing HIV and is often comorbid with other mental health disorders, further compromising care engagement and adherence. ART initiation represents a unique window of opportunity for intervention to enhance motivation, increase care engagement, and address the negative effects of trauma on avoidant coping behaviors. Mental health interventions delivered by non-specialists in low- and middle-income countries have potential to treat depression, trauma, and effects of intimate partner violence among WLH. This study will examine the effectiveness of Improving AIDS Care after Trauma (ImpACT +), a task-shared, trauma-focused coping intervention, to promote viral suppression among WLH initiating ART in a South African clinic setting. METHODS: This study will be conducted in Khayelitsha, a peri-urban settlement situated near Cape Town, South Africa. Using a hybrid type 1 effectiveness-implementation design, we will randomize 350 WLH initiating ART to the ImpACT + experimental condition or the control condition (three weekly sessions of adapted problem-solving therapy) to examine the effectiveness of ImpACT + on viral suppression, ART adherence, and the degree to which mental health outcomes mediate intervention effects. ImpACT + participants will receive six once-a-week coping intervention sessions and six monthly maintenance sessions over the follow-up period. We will conduct mental health and bio-behavioral assessments at baseline, 4, 8, and 12 months, with care engagement data extracted from medical records. We will explore scalability using the Consolidated Framework for Implementation Research (CFIR). DISCUSSION: This trial is expected to yield important new information on psychologically informed intervention models that benefit the mental health and clinical outcomes of WLH with histories of sexual trauma. The proposed ImpACT + intervention, with its focus on building coping skills to address traumatic stress and engagement in HIV care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa. TRIAL REGISTRATION: Clinicaltrials.gov NCT04793217 . Retrospectively registered on 11 March 2021.

Influence of Sediments on Concentrations of Fluridone and Penoxsulam in the Water Column and Sediment Pore Water.

Control of invasive aquatic plants is crucial for the maintenance of chemical, biological and ecological balances in many fresh water systems. Exposure of invasive plants to herbicides used for their control may be reduced by sorption to organic matter in sediments. Since granular herbicide formulations have closer contact with sediments (compared to liquid formulations), concentrations in the water column may be much lower. To test this hypothesis, microcosms containing sediments with < 1%, 6.4%, 19.7%, and 44% organic matter were treated with liquid and granular formulations of fluridone and penoxsulam. Herbicide concentrations in the water column and sediment pore water were monitored over 40 days. The presence of sediments (regardless of organic carbon content) significantly reduced concentrations of fluridone in the water column from the granular formulations relative to the liquid formulation. A similar, though less extreme, pattern was observed for penoxsulam in most of the organic carbon treatments.

The Health Economic Impact of Nephrotic Syndrome in the United States.

Background: Nephrotic syndrome (NS) is a rare kidney syndrome with high morbidity. Although a common contributor to the burden of chronic kidney disease, the direct and indirect costs of NS to patients and family caregivers are unrecognized. The objective was to characterize the direct and indirect costs of NS to patients. Methods: Adults with NS and family caregivers of children with NS were eligible to participate if they had a diagnosis of primary NS, had disease for at least 1 year, and had no other severe health conditions. Data-collection surveys were generated with input from the Kidney Research Network Patient Advisory Board, and surveys were mailed to the eligible participants. Participants were provided $50 for the return of completed surveys. Costs were defined as either direct out-of-pocket costs or indirect costs (e.g., time). Descriptive statistics, including percentage and median (interquartile range [IQR]) are reported. Results: Respondents included 28 adult patients and 17 caregivers of patients who were minors. Reported health insurance coverage included 35 (78%) with private insurance, 12 (27%) with public insurance, six (13%) with Children's Special Health Care Services, and one (2%) uninsured. Median annual direct costs were $3464 ($844-$5865) for adult patients and $1687 (IQR $1035-$4763) for caregivers. Of these costs, diet-associated costs contributed $1140 (IQR $600-$2400). The most substantial indirect cost was from the time spent planning/prepping meals (adults: 183 h/yr [IQR 114-331]; caregivers: 173 h/yr [IQR 84-205]). Conclusions: Adults and caregivers of children with NS face substantial disease-related direct and indirect costs beyond those covered by insurance. Following replication, the study will help health care providers, systems, and payers gain a better understanding of the financial and time burden incurred by those living with NS, consider barriers when treating patients, and develop supportive strategies.

Maximum entropy inference of seabed properties using waveguide invariant features from surface ships.

Acoustic data were recorded on two vertical line arrays (VLAs) deployed in the New England Mud Patch during the Seabed Characterization Experiment 2017 in about 75 m of water. The sound recorded during the passage of merchant ships permits identification of singular points for the waveguide invariant ß for mode pairs (1,n):ß1,n,for n=2,3,4,5, in the 15-80 Hz band. Using prior geophysical information and an acoustic data sample from the merchant ship KALAMATA, a geoacoustic model M of the seabed was developed. Then, using data samples from other merchant ships, a feature-ensemble maximum entropy method is employed to infer the statistical properties of geoacoustic parameter values for the sound speeds in a surface mud layer and a deep sand layer. Technical challenges include a sparsity of observed singular points, the unique identification of mode pairs for an observed singular point, and the deviation of the waveguide from horizontal stratification. A geoacoustic model M is developed that reproduced the observed ß≈-1 for f < 20 Hz and mode cutoff features at about 15 Hz. The statistical low-frequency inference of the singular point structure from multiple ships provides evidence of an angle of intromission at the water sediment interface with an average sound speed ratio of about 0.986 and an average sound speed for the deeper sand layer of about 1775 m/s.