Life or limb: an international qualitative study on decision making in sarcoma surgery during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic is unprecedented as a global crisis over the last century. How do specialist surgeons make decisions about patient care in these unprecedent times? DESIGN: Between April and May 2020, we conducted an international qualitative study. Sarcoma surgeons from diverse global settings participated in 60 min interviews exploring surgical decision making during COVID-19. Interview data were analysed using an inductive thematic analysis approach. SETTING: Participants represented public and private hospitals in 14 countries, in different phases of the first wave of the pandemic: Australia, Argentina, Canada, India, Italy, Japan, Nigeria, Singapore, Spain, South Africa, Switzerland, Turkey, UK and USA. PARTICIPANTS: From 22 invited sarcoma surgeons, 18 surgeons participated. Participants had an average of 19 years experience as a sarcoma surgeon. RESULTS: 17/18 participants described a decision they had made about patient care since the start of the pandemic that was unique to them, that is, without precedence. Common to 'unique' decisions about patient care was uncertainty about what was going on and what would happen in the future (theme 1: the context of uncertainty), the impact of the pandemic on resources or threat of the pandemic to overwhelm resources (theme 2: limited resources), perceived increased risk to self (theme 3: duty of care) and least-worst decision making, in which none of the options were perceived as ideal and participants settled on the least-worst option at that point in time (theme 4: least-worst decision making). CONCLUSIONS: In the context of rapidly changing standards of justice and beneficence in patient care, traditional decision-making frameworks may no longer apply. Based on the experiences of surgeons in this study, we describe a framework of least-worst decision making. This framework gives rise to actionable strategies that can support decision making in sarcoma and other specialised fields of surgery, both during the current crisis and beyond.

Nutrient content in wheat grain and straw using sludge and compost from a wastewater treatment plant as a fertiliser.

BACKGROUND: The present study aimed: (i) to evaluate the response of nutrient uptake after applying 15 ha-1 of sewage sludge, compost and a commercial fertiliser to soil in the grain and straw of winter wheat (Triticum turgidum L. cv. Vitron) and (ii) to investigate the composition of the same parameters in the original soil and compare them with soil after applying fertiliser treatments. A field-scale experiment established the agronomic performance of air-dried sewage sludge and composted sludge for winter wheat. RESULTS: Sewage sludge promoted a higher grain Zn content and yield than compost or the commercial fertiliser. N, P and Zn were higher after harvests in soils where sludge or compost was applied, showing significant differences compared to those with a commercial fertiliser. When sludge or compost was used as an organic amendment, no significant differences were observed in pH or electrical conductivity in soils, as well as nutrient absorption for crop. CONCLUSION: Because no nutritional imbalances were observed in either grain or straw of durum wheat (Triticum turgidum L. cv. Vitron), sewage sludge from the Alcázar de San Juan wastewater treatment plant has an aptitude for agricultural use and could be recommended as an alternative to the standard commercial fertilisation used in the study area. © 2018 Society of Chemical Industry.

Effects of wastewater irrigation on soil properties and turfgrass growth.

Reuse of treated wastewater for turf irrigation is often viewed as one way to maximize existing urban water resources. The aim of this study is to evaluate the applicability of treated wastewater for turfgrass and assess the effects of continuous use of treated water on the soil and crop. Two turfgrass plots irrigated with drinking water and treated wastewater were monitored over a two-year period. Physical and chemical parameters in the soil and foliar tissue were analyzed. Plants irrigated with treated wastewater had highest sodium content. There were no negative effects with respect to changes in soil pH but a significant increase in electrical conductivity and sodium content was observed in wastewater-irrigated soil. Treated wastewater could be used as a resource for agricultural irrigation since it contributes phosphorus and organic matter. However, it is necessary to consider that several crops could be negatively affected by wastewater irrigation because of the sodium content and this should be taken into account when water-sprinklers are in use, since this is the case in the present study. The benefits of irrigation with treated urban wastewater include contributing plant nutrients to turfgrass while conserving freshwater.

Irrigation with treated wastewater: effects on soil, lettuce (Lactuca sativa L.) crop and dynamics of microorganisms.

The aim of this study was to evaluate the applicability of treated wastewater for horticultural crops, assess the effects of continuous use of treated water on soil and crops, and analyse the physical, chemical and biological effects of irrigation with recycled water. Two lettuce plots watered with drinking water and treated wastewater were monitored over a three year period. Nutrients, heavy metal and the dynamics of pathogen and indicator microorganism content in soil and foliar tissues were analysed. Wastewater irrigation had a high influence on soil parameters: organic matter, N, P, Ca, Al, Fe, Pb and Zn. Indicator and pathogenic microorganisms were detected in soil and plants grown in the wastewater-irrigated plot, and persisted in the soil for 27 days during the study under humid conditions. N, P, Pb and Al content were significantly higher in plant tissues of wastewater-irrigated plots than in the control after 3 years of irrigation. Harvest was significantly higher in the wastewater-irrigated plot. Wastewater can be a resource for agricultural irrigation. In any case, the possible heavy metal accumulation in soils and presence of pathogenic organisms require careful management of this alternative resource: use of a drip irrigation system, previous wastewater disinfection and a limited irrigation period are recommended.

Long-term results of the Spanish Protocol SO-95 for the treatment of non-metastatic high-grade osteosarcoma of the extremities in children.

INTRODUCTION: The long-term results of the Spanish Study Protocol SEOP-SO-95 for treatment of localised osteosarcoma of the extremities in children were evaluated. PATIENTS AND METHODS: One hundred consecutive patients under 18 years of age from 22 institutions were enrolled from January 1995 to December 2000. Immunohistochemical expression of p53, HER/erbB-2 and P-glycoprotein were retrospectively studied in 27 patients. Treatment consisted of: preoperative chemotherapy with doxorubicin, cisplatin, high-dose methotrexate with leucovorin rescue and ifosfamide for 14 weeks; surgery of primary tumour in week 16; postoperative chemotherapy with the above-mentioned drugs for 25 weeks. RESULTS: With a median follow-up of 124 months (range 84-158 months), 69 patients (69%) were continuously event-free survivors; the 10-year probability of event-free survival (EFS) was 62%. Conservative surgery was performed in 85% of patients. Twenty-six patients had local recurrence or distant relapse. The median time to recurrence/ relapse was 27 months (range 17-93 months). The local recurrence rate was 7% (7 of the 100 patients); 4 had wide surgical margins, 2 marginal and 1 intralesional. Four patients died as a result of chemotherapy-related toxicity and 1 developed a second neoplasia (acute myeloid leukaemia). p53 expression and HER2/erbB-2 expression showed no effect on survival or EFS. CONCLUSIONS: This therapeutic protocol achieved good oncologic and orthopaedic results. We observed a significant treatment-related toxicity.

Supracondylar fractures of the humerus in children.

Supracondylar fractures of the humerus need a precise treatment in order to obtain a satisfactory result because of the low bone remodeling associated with these injuries. It is important to use a systematic procedure for closed reduction and percutaneous fixation. A retrospective review of fractures treated using two K-wires from the lateral side was done in 77 patients with a mean age of 6.7 years (range, 1-13 years). Displacement of the fracture was classified as Gartland Type II in 39 patients (50.6%) and Gartland Type III in 38 patients (49.4%). The results according to Flynn criteria were excellent in 70 patients (90.9%), fair in three patients (3.9%) and poor in four patients (5.2%), with overall satisfactory results in 96.1% of the cases. In four patients there was secondary displacement of the fragments in internal rotation and three of these patients were operated on again, increasing fixation with a third K-wire either from the lateral or medial side. There were two nerve lesions (2.6%), and four patients (5.2%) had a pulseless pink hand that recovered when the fracture was reduced. In three patients (3.9%) infection developed. To obtain satisfactory results using this procedure, enough stability should be achieved, avoiding iatrogenic damage of the ulnar nerve.

Effects of several applications of digested sewage sludge on soil and plants.

Sewage sludge production has significantly increased during the last years in European Union (EU) countries, being primarily used for agricultural purposes. In this study, digested sewage sludge was applied to greenhouse soil over a three-year period (2001--2003), with three sludge treatments in the first two years (2, 4, and 6 kg m(-2)) and three more applications using a greater quantity in the last year (6, 8, and 10 kg m(-2)). The effects of sewage sludge application on soil and on a leafy crop (Lactuca sativa L.) were studied. Mineral elements, organic matter, pH, and heavy metals were measured in soil and plant tissues. Pathogen and indicator microorganism dynamics in soil were also determined after each sludge application. Results showed that sewage sludge applications increased organic matter, P, and N Ca content in soil. Furthermore, Zn, Pb, Ni, and Cu content increased in soils, primarily after high doses of sludge. The highest yield value was obtained in the second-year harvest, since the last sludge application did not increase yield. Fecal coliform numbers decreased significantly one month after sludge application. However, total coliforms, Clostridium sulphite-reducers and Salmonella, were present in soils three months after sludge application.

STR data for nine Y-chromosomal loci in Guinea Equatorial (central Africa).

Allele and haplotype frequencies for nine Y-specific STR loci (DYS19, DYS389-I, DYS389-II, DYS390, DYS391, DYS393, DYS434, DYS437, and DYS439) were obtained from a sample of 57 males from Guinea Equatorial.