Global view of vasomotor symptoms and sleep disturbance in menopause: a systematic review.

Studies have shown racial/ethnic differences in the prevalence of vasomotor symptoms (VMS), sleep disturbance and VMS treatment in menopause. To assess the reproducibility of these differences, we systematically reviewed observational studies, published in 2000-2021, reporting the prevalence/incidence of VMS, sleep disturbance or treatment use in menopausal women stratified by race/ethnicity. We screened 3799 records from PubMed and Embase and included 27 papers (19 studies). No incidence data were found. Prevalence data varied widely, but some common patterns emerged. In all five studies comparing VMS between Black women and White, Hispanic and/or East Asian women, the prevalence was highest in Black women and lowest in East Asian women. The prevalence of sleep disturbance overall was compared among Black, White and East Asian women in two study populations, and was highest in White women in both papers. Sleep disturbance was more common than VMS in East Asian women. In all four studies comparing hormone therapy use between White women and Black and/or East Asian women, treatment use was more common in White women. These results highlight the need for individualized counseling and treatment, outreach to under-served minorities, and standardized definitions and outcome measures for VMS and sleep disturbance for future studies.

Towards globally relevant, small-footprint dewatering solutions: Optimal conditioner dose for highly variable blackwater from non-sewered sanitation.

Globally, the sanitation needs of three billion people are met by non-sewered sanitation. Small-footprint treatment technologies are needed that are appropriate for dense urban areas. Blackwater (BW) (or fecal sludge), contains more than 95% liquid, and dewatering it without conditioning requires large footprints. Chemically-enhanced dewatering with conditioners is a promising option to increase dewatering performance and reduce required footprints. However, before implementation of this solution there is a need for increased knowledge on selection and dosing of conditioners. This study evaluated bio-based and synthetic conditioners (chitosan, tannin-, and starch-based, synthetic with and without poly-acrylamide) with 14 types of BW from five countries. The supernatant after settling with jar-tests was analyzed to quantify optimal dose and dewatering performance. The reduction of total chemical oxygen demand (COD) was >55%, achieved by removal of particulate constituents with mainly soluble COD remaining in the supernatant. A reduction in particulate COD could lead to increased efficiency of soluble COD in supernatant treatment. Bio-based conditioners are as effective as synthetic conditioners, and when performance was variable, it was due to differing properties of TSS, TS, EC and pH. Optimal conditioner dose for synthetic conditioners and chitosan could be predicted using concentrations of total solids (TS) (R2 > 0.7), whereas optimal dose for starch- and tannin-based conditioners could be predicted with electrical conductivity (EC) (R2 > 0.8), and colloid titration (R2 > 0.8). In addition, real-time optical TSS and EC sensors could accurately predict chitosan dose for fresh BW treated at source (R2 = 0.97, R2 = 0.95). This study validates that use of conditioners for dewatering with highly variable BW can be implemented with real-time measurements for optimal dose, in globally relevant implementations.

Evaluation and application of chlorine decay models for humanitarian emergency water supply contexts.

Chlorine is a widely used water disinfectant in humanitarian emergency water supply. However, its effective application can be limited by the uncertainty in initial dose determination. The target free chlorine residual in water should achieve both health objectives and aesthetic considerations, but the varying field conditions and changing source water quality may affect the performance of chlorination strategies. A chlorine dose predictive tool could assist in initial dose determination. To this end, an accurate chlorine decay kinetic model can serve as a strong foundation for developing such a tool. In this study, a literature search identified 7 basic chlorine decay kinetic models that were subsequently tested with 610 different chlorine decay test data (from a semi-systematic literature search and laboratory-generated results). The models were then ranked based on their goodness of fit (R2) and root mean square error. An empirical model, power models and parallel models were found able to fit most decay data with more than half of the regressions resulting in R2 value over 0.97. First order models can achieve R2 value above 0.95 when the data points in the rapid phase are excluded from the model fitting. The power models and parallel models can form a strong basis for developing a chlorine dose predictive tool if the power term and the ratio term (model parameters) can be controlled. An essential next step is to evaluate the relationships between easily obtainable water parameters in the field and the decay term in the models to allow rapid model calibration.

Assessment of Decontamination and Reuse of Disposable Filter Funnels Used in Microbiological Water Quality Tests.

To monitor safely managed drinking water services, an increasing number of countries have integrated water quality testing for Escherichia coli into nationally-representative household surveys such as the Multiple Indicator Cluster Surveys (MICS). However, plastic waste generated during such water quality testing programs, mostly through the use of pre-sterilized disposable materials, is non-negligible. The objective of this study was to evaluate several re-use protocols for disposable filter funnels used by the MICS water quality test kits. Decontamination and re-use protocols were assessed in centralized laboratory and decentralized field settings and neither yielded positive results. Re-use of 100 mL sterile funnels decontaminated with an alcohol wipe resulted in a higher incidence of false positive results (i.e., positive contamination when processing sterile water), both in the laboratory and field; therefore, a higher proportion of positives tests can be expected if these components are re-used. Further improvements to the decontamination technique and training are needed before material re-use can be reliably adopted. Autoclaving the funnels for re-use is feasible, provided that there is capacity to re-package and distribute funnels in a sterile manner.

The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey.

PURPOSE: Up to 30% of women of reproductive age experience HMB, which has a substantial impact on their quality of life. A clinical care pathway for women with HMB is an unmet need, but its development requires better understanding of the factors that characterise current diagnosis and management of the condition. MATERIALS AND METHODS: This observational, survey-based study assessed the burden, personal experiences, and path through clinical management of women with HMB in Canada, the USA, Brazil, France and Russia using a detailed, semi-structured online questionnaire. After excluding those reporting relevant organic pathology, responses to the questionnaire from 200 women per country were analysed. RESULTS: Around 75% of women with HMB had actively sought information about heavy periods, mostly through internet research. The mean time from first symptoms until seeking help was 2.9 (Standard deviation, 3.1) years. However, 40% of women had not seen a health care professional about the condition. Furthermore, 54% had never been diagnosed or treated. Only 20% had been diagnosed and received appropriate treatment. Treatment was successful in 69% of those patients currently receiving treatment. Oral contraceptives were the treatment most commonly prescribed for HMB, although the highly effective levonorgestrel-intrauterine system was used by only a small proportion of women. CONCLUSIONS: This study provides insight into the typical journey of a woman with HMB which may help patients and health care professionals improve the path to diagnosis and treatment, although further research with long-term outcomes is needed.

Rapid Changes in Microbial Community Structures along a Meandering River.

Streams and rivers convey freshwater from lands to the oceans, transporting various organic particles, minerals, and living organisms. Microbial communities are key components of freshwater food webs and take up, utilize, and transform this material. However, there are still important gaps in our understanding of the dynamic of these organisms along the river channels. Using high-throughput 16S and 18S rRNA gene sequencing and quantitative PCR on a 11-km long transect of the Saint-Charles River (Quebec, CA), starting from its main source, the Saint-Charles Lake, we show that bacterial and protist community structures in the river drifted quickly but progressively downstream of its source. The dominant Operational Taxonomic Units (OTUs) of the lake, notably related to Cyanobacteria, decreased in proportions, whereas relative proportions of other OTUs, such as a Pseudarcicella OTU, increased along the river course, becoming quickly predominant in the river system. Both prokaryotic and protist communities changed along the river transect, suggesting a strong impact of the shift from a stratified lake ecosystem to a continuously mixed river environment. This might reflect the cumulative effects of the increasing water turbulence, fluctuations of physicochemical conditions, differential predation pressure in the river, especially in the lake outlet by benthic filter feeders, or the relocation of microorganisms, through flocculation, sedimentation, resuspension, or inoculation from the watershed. Our study reveals that the transit of water in a river system can greatly impact both bacterial and micro-eukaryotic community composition, even over a short distance, and, potentially, the transformation of materials in the water column.

Risk and limits in dental practice: a Portuguese approach to medical-legal evaluation and professional liability.

Patient safety and quality of healthcare delivery systems are an objective of WHO. This study aims to present and analyse Portuguese clinical data on risk and malpractice in dental practice. Data from the Forensic Dentistry Laboratory (Faculty of Medicine, University of Coimbra) was analysed, between the years of 2013 to 2018. One hundred and seven technical reports were selected, and seventy nine files were included in the iatrogenic sequelae group. Data included the analysis of the performance of dental professionals. Sequelae were divided in descending order of occurrence:1) mandibular dysfunction (53,2%)[(42)79]; 2) neurological deficit (39,2%)[(31)79]; 3) tooth loss (6,3%)[(5)79]; and 4) opening deficit (1,3%)[(1)79].Three major areas with significant expression in the field of expert evaluations were analysed: 1) orthodontic treatment (51,9%), implant rehabilitation (29,1%), and oral surgery. Given the prevalence of malpractice, the need to assess its causes and recognise standards for its prevention is necessary.

Reply to Comment on "Enumeration of Escherichia coli in Probiotic Products. Microorganisms 2019, 7. 437".

We thank Wassenaar and colleagues for their Comment on our recent paper [1] and appreciate the opportunity to address it [...].

Intestinal Parasites, Anemia and Nutritional Status in Young Children from Transitioning Western Amazon.

Young children are particularly vulnerable to the chronic sequelae of anemia, including poor nutritional status. The aim of this study was to assess intestinal parasitic-infections and nutritional status (anemia and linear growth) in preschool children living in contemporary Amazonian communities. A cross-sectional study measured children's intestinal parasites and hair-Hg (HHg)-biomarkers of fish consumption, hemoglobin levels, and growth (anthropometric Z-scores). Children came from traditional-living families (Itapuã), and tin-mining settlements (Bom Futuro) representing current transitioning populations. It covered 937 pre-school children (from 1 to 59 months of age) from traditional (247) and immigrant tin-mining families (688). There was a high prevalence of intestinal polyparasitic-infection in children from both communities, but mild anemia (hemoglobin concentrations) and moderate (chronic) malnutrition were more frequent in children from traditional families than in children from tin-mining settlers. Children from traditional families ate significantly more fish (HHg mean of 4.3 µg/g) than children from tin-mining families (HHg mean of 2.3 µg/g). Among traditional villagers, children showed a significant correlation (r = 0.2318; p = 0.0005) between hemoglobin concentrations and HHg concentrations. High rates of parasitic infection underlie the poverty and attendant health issues of young children in the Brazilian Amazon. The intestinal parasite burden affecting poor Amazonian children resulting from unsafe water, lack of sanitation and poor hygiene is the most urgent environmental health issue.

Passive phosphorus capture in biofiltration context: nitrate impact on the performance.

Research on the development of a passive phosphorus entrapment process characterized by biofilters with active wood-based media impregnated with iron hydroxide has been conducted. Phosphorus removal was done by sorption which includes adsorption, exchange of ions and precipitation. Experiments were performed in order to investigate the effect of nitrate, generally present at the end of secondary treatment, on the phosphorus removal performance. Columns tests were performed with anaerobic activated wood-based media and immersion over a period of 150 days. Columns were fed for 32 days with a synthetic solution of 5 mg P L-1. Different concentrations of nitrate (5, 10 and 25 mg N-NO3 L-1) were then applied on three columns (C2, C3 and C4), column C1 serving as a control. Results showed total phosphorus (TP) removal efficiencies of 96.9%, 81.7%, 70.6% and 75.7%, respectively, for C1, C2, C3 and C4. Addition of nitrate increases the oxidoreduction potential (ORP). This results in an inhibition of the reductive dissolution, characterized by a decrease in the release of ferrous ions. Simultaneous denitrification occurs within the columns. It is both biological and chemical through the oxidation of ferrous ions by NO2, produced during biological denitrification. Furthermore, bacterial identification tests have highlighted the presence of iron-related bacteria (Pseudomonas, Thiobacillus, Enteric bacteria, e.g. E. coli), slym forming bacteria, sulphate reducing bacteria and denitrifying microorganisms such as Pseudomonas and E. bacteria in biofilters.

Dominant decomposition pathways in pit latrines: a commentary.

In a recent article an assessment of decomposition within pit latrines measured with regard to chemical oxygen demand (COD) reductions was reported on. Some fundamental concerns were raised with regard to a key assumption of the study. The alternative perspective that is presented here does not support the study's conclusion that anaerobic processes are the dominant decomposition pathway in pit latrines. Furthermore, it is argued that their analysis and some implications of their data interpretation can be viewed in a different manner.

Annual Protist Community Dynamics in a Freshwater Ecosystem Undergoing Contrasted Climatic Conditions: The Saint-Charles River (Canada).

Protists are key stone components of aquatic ecosystems, sustaining primary productivity and aquatic food webs. However, their diversity, ecology and structuring factors shaping their temporal distribution remain strongly misunderstood in freshwaters. Using high-throughput sequencing on water samples collected over 16 different months (including two summer and two winter periods), combined with geochemical measurements and climate monitoring, we comprehensively determined the pico- and nanoeukaryotic community composition and dynamics in a Canadian river undergoing prolonged ice-cover winters. Our analysis revealed a large protist diversity in this fluctuating ecosystem and clear seasonal patterns demonstrating a direct and/or indirect selective role of abiotic factors, such as water temperature or nitrogen concentrations, in structuring the eukaryotic microbial community. Nonetheless, our results also revealed that primary productivity, predatory as well as parasitism lifestyles, inferred from fine phylogenetic placements, remained potentially present over the annual cycle, despite the large seasonal fluctuations and the remodeling of the community composition under ice. In addition, potential interplays with the bacterial community composition were identified supporting a possible contribution of the bacterial community to the temporal dynamics of the protist community structure. Our results illustrate the complexity of the eukaryotic microbial community and provide a substantive and useful dataset to better understand the global freshwater ecosystem functioning.

Are there unmet needs in contraceptive counselling and choice? Findings of the European TANCO Study.

INTRODUCTION: Effective use of contraception requires women to make an informed choice about methods that match their individual needs and expectations. The European Thinking About Needs in Contraception (TANCO) study is a quantitative, online survey of healthcare provider and women's views on aspects of counselling around contraception and contraceptive use. METHODS: Healthcare providers and women attending their practices for contraceptive counselling were invited to complete online questionnaires. The women's survey explored knowledge and use of contraceptive methods, satisfaction with current method, and interest in receiving more information about all methods. Healthcare provider views were gathered in parallel. RESULTS: A total of 676 healthcare providers and 6027 women completed the online surveys in 11 countries. There was a high prevalence of contraceptive use and general satisfaction with current method across the countries. Fifty-five percent of women were using short-acting contraception (SAC) methods; 19% were using a long-acting reversible contraception (LARC) method. Sixty percent of women were interested in receiving more information about all methods; 73% of women said they would consider LARC if they received more comprehensive information. Healthcare providers tend to underestimate women's interest in receiving information on contraception in general and, more specifically, LARC methods. CONCLUSIONS: Despite high levels of use and satisfaction with current methods, women were interested in receiving more information about all contraceptive methods. Greater exploration of women's views on their needs and expectations of contraception could lead to increased knowledge, more effective discussions with healthcare providers and the greater likelihood of informed contraceptive choice.

The origin of grain boundary capacitance in highly doped ceria.

The origin of a grain-boundary capacitance in mixed oxide-ion/electronic conductors has been investigated for the case of Ce0.8Sm0.2O1.9-δ using a.c. impedance spectroscopy under low pO2 from 250 to 400 °C. The observed capacitance is interpreted in terms of Ce(III):4f(1) electrons first introduced into the grains and not into the grain boundaries.

The relationship between microbial community evenness and function in slow sand filters.

UNLABELLED: Two full-scale slow sand filters (SSFs) were sampled periodically from April until November 2011 to study the spatial and temporal structures of the bacterial communities found in the filters. To monitor global changes in the microbial communities, DNA from sand samples taken at different depths and locations within the SSFs and at different filters ages was used for Illumina 16S rRNA gene sequencing. Additionally, 15 water quality parameters were monitored to assess filter performance, with functionally relevant microbial members being identified by using multivariate statistics. The bacterial diversity in the SSFs was found to be much larger than previously documented, with community composition being shaped by the characteristics of the SSFs (filter age and depth) and sampling characteristics (month, side, and distance from the influent and effluent pipes). We found that several key genera (Acidovorax, Halomonas, Sphingobium, and Sphingomonas) were associated with filter performance. In addition, at the whole-community level, a strong positive correlation was found between species evenness and filter performance. This study is the first to comprehensively characterize the microbial community of SSFs and link specific microbes to water quality parameters. In doing so, we reveal key patterns in microbial community structure that relate to overall community function. IMPORTANCE: The supply of sustainable, energy-efficient, and safe drinking water to an increasing world population is a huge challenge faced by the water industry. SSFs have been used for hundreds of years to provide a safe and reliable source of potable drinking water, with minimal energy requirements. However, a lack of knowledge pertaining to the treatment mechanisms, particularly the biological processes, underpinning SSF operation has meant that SSFs are still operated as "black boxes." Understanding these dynamics alongside performance-induced effects associated with operational differences will promote optimized SSF design, maintenance, and operation, creating more efficient and environmentally sustainable filters. Through a spatial-temporal survey of full-scale SSFs at various points of operation, we present the most detailed characterization to date of the functional microbial communities found in SSFs, linking various taxa and community metrics to optimal water quality production.

Evaluation of semidecentralized emergency drinking water treatment.

This study evaluates the potential for a novel semidecentralized approach that uses coagulant disinfectant products (CDPs) for humanitarian water treatment, by testing two commercially available products (CDP-W and CDP-T). Their performances were evaluated against the relevant water quality treatment objectives (The Sphere Project) under laboratory conditions, using a standardized testing protocol with both synthetic and natural surface test waters. Tests indicated a satisfactory performance by one of the products (CDP-W) with respect to humanitarian water quality objectives, (i.e., free chlorine residual, pH, and turbidity) that was dependent on initial water quality characteristics. Adequate bacterial inactivation (final thermotolerant coliform concentration of < 1 cfu/100 mL) was always attained and log reductions of up to 5 were achieved. The other product (CDP-T) did not exhibit any measurable coagulation and disinfection properties, indicating the variability of product quality and the need to conduct evaluations such as the ones presented in this study. Such results are of relevance to relief agencies delivering water supply interventions.

Replicating the microbial community and water quality performance of full-scale slow sand filters in laboratory-scale filters.

Previous laboratory-scale studies to characterise the functional microbial ecology of slow sand filters have suffered from methodological limitations that could compromise their relevance to full-scale systems. Therefore, to ascertain if laboratory-scale slow sand filters (L-SSFs) can replicate the microbial community and water quality production of industrially operated full-scale slow sand filters (I-SSFs), eight cylindrical L-SSFs were constructed and were used to treat water from the same source as the I-SSFs. Half of the L-SSFs sand beds were composed of sterilized sand (sterile) from the industrial filters and the other half with sand taken directly from the same industrial filter (non-sterile). All filters were operated for 10 weeks, with the microbial community and water quality parameters sampled and analysed weekly. To characterize the microbial community phyla-specific qPCR assays and 454 pyrosequencing of the 16S rRNA gene were used in conjunction with an array of statistical techniques. The results demonstrate that it is possible to mimic both the water quality production and the structure of the microbial community of full-scale filters in the laboratory - at all levels of taxonomic classification except OTU - thus allowing comparison of LSSF experiments with full-scale units. Further, it was found that the sand type composing the filter bed (non-sterile or sterile), the water quality produced, the age of the filters and the depth of sand samples were all significant factors in explaining observed differences in the structure of the microbial consortia. This study is the first to the authors' knowledge that demonstrates that scaled-down slow sand filters can accurately reproduce the water quality and microbial consortia of full-scale slow sand filters.

Blood clearance of Howell-Jolly bodies in an experimental autogenic splenic implant model.

BACKGROUND: Autogenic splenic implant (ASI) is one of the few alternatives for preservation of splenic tissue when total splenectomy is inevitable. The aim of this study was to determine the morphological and functional regeneration of ASIs, as indicated by the clearance of Howell-Jolly (HJ) bodies, in an experimental model. METHODS: Ninety-nine male Wistar rats were divided into three groups: sham-operated (group 1), total splenectomy alone (group 2), and total splenectomy combined with ASI (group 3). Animals in group 3 were further allocated to nine subgroups of nine rats each, and analysed at different time points (1, 4, 8, 12, 16, 20, 24, 28 and 32 weeks after surgery). Blood smears were prepared at predetermined times for detection of HJ bodies. Morphological regeneration of tissue in the ASI was analysed by histology. RESULTS: At 1 week, the regenerated mass corresponded to about 7 per cent of the tissue implanted, reaching approximately 54 per cent at 24 weeks. The HJ body levels were increased in groups 2 and 3 until 8 weeks after surgery, following which levels in the ASI group became similar to those in the sham-operated group. HJ bodies were difficult to detect when a level of 22.5 per cent of regenerated ASI mass was reached. CONCLUSION: Functional regeneration of ASIs occurred from 8 weeks after surgery. When 22.5 per cent of regenerated ASI mass was reached almost no HJ bodies could be observed in the bloodstream, resembling a spleen in situ. SURGICAL RELEVANCE: Splenectomy has been practised routinely, both in the emergency setting and as a therapeutic elective procedure. There is a correlation between asplenia/hyposplenia and the occurrence of fulminant sepsis, underlining the importance of developing surgical methods for preserving splenic function. Both clinical and experimental studies have shown at least partial morphological and functional regeneration of autogenic splenic implants (ASIs). Experimental studies investigating the immunoprotective effect of ASIs, based mostly on exposure of animals to various bacteria, have demonstrated that ASIs can increase the rate of bacterial clearance and decrease mortality from sepsis. Clinical studies have shown their ability to remove colloidal substances and altered erythrocyte corpuscular inclusions, such as Howell-Jolly, Heinz and Pappenheimer bodies, from the bloodstream. In this experimental study the functional and morphological regeneration of ASIs was studied over time in rats.

Effects of temperature and pH on reduction of bacteria in a point-of-use drinking water treatment product for emergency relief.

The effects of temperature and pH on the water treatment performance of a point-of-use (POU) coagulant/disinfectant product were evaluated. Cold temperatures (∼5°C) reduced the bactericidal efficiency of the product with regard to Escherichia coli and total coliform log(10) reductions.