Assessing the genotoxic potential of wastewater effluents from three wastewater treatment plants in South Africa.

Wastewater treatment plants are mainly monitored for quality in terms of their biological oxygen demand and microbiological constituents as stipulated in the specific discharge permit. Wastewater influents and effluents were taken from three WWTPs in South Africa over the summer and winter seasons. Previous toxicity tests such as the Vibrio fischeri bioluminescence assay and the Selenastrum capricornutum algal growth inhibition test have shown that the effluents displayed acute toxicity. To further investigate the quality of the effluent, the genotoxic potential was determined using the SOS Chromosome and UMU Chromosome test. The SOS Chromotest demonstrated induction factor values of above 1.5 for influents during both seasons indicating that the influents were genotoxic (p < 0.05). Effluents discharged during winter and summer also had induction factors greater than 1.5 (p < 0.05). A range of induction factors was detected with the UMU-Chromotest for influents and effluents (1.98 ± 0.38 and 2.40 ± 0.51, respectively). Findings show point sources in the area can lead to influents and effluents that are potentially genotoxic. Designing a monitoring programme that encompasses testing of both the regulatory determinants with additional specialized tests can provide a more holistic view of wastewater quality and the efficiency of WWTP to reduce the discharge of hazards.

The association of fear of falling and physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons; a cross-sectional study of Urban Health Centres Europe (UHCE).

BACKGROUND: The share of people over 80 years in the European Union is estimated to increase two-and-a-half-fold from 2000 to 2100. A substantial share of older persons experiences fear of falling. This fear is partly associated with a fall in the recent past. Because of the associations between fear of falling, avoiding physical activity, and the potential impact of those on health, an association between fear of falling and low health-related quality of life, is suggested. This study examined the association of fear of falling with physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons in five European countries. METHODS: A cross-sectional study was conducted using baseline data of community-dwelling persons of 70 years and older participating in the Urban Health Centers Europe project in five European countries: United Kingdom, Greece, Croatia, the Netherlands and Spain. This study assessed fear of falling with the Short Falls Efficacy Scale-International and HRQoL with the 12-Item Short-Form Health Survey. The association between low, moderate or high fear of falling and HRQoL was examined using adjusted multivariable linear regression models. RESULTS: Data of 2189 persons were analyzed (mean age 79.6 years; 60.6% females). Among the participants, 1096 (50.1%) experienced low fear of falling; 648 (29.6%) moderate fear of falling and 445 (20.3%) high fear of falling. Compared to those who reported low fear of falling in multivariate analysis, participants who reported moderate or high fear of falling experienced lower physical HRQoL (ß = -6.10, P < 0.001 and ß = -13.15, P < 0.001, respectively). In addition, participants who reported moderate or high fear of falling also experienced lower mental HRQoL than those who reported low fear of falling (ß = -2.31, P < 0.001 and ß = -8.80, P < 0.001, respectively). CONCLUSIONS: This study observed a negative association between fear of falling and physical and mental HRQoL in a population of older European persons. These findings emphasize the relevance for health professionals to assess and address fear of falling. In addition, attention should be given to programs that promote physical activity, reduce fear of falling, and maintain or increase physical strength among older adults; this may contribute to physical and mental HRQoL.

Hyperlipidaemia prevalence and cholesterol control in obstructive sleep apnoea: Data from the European sleep apnea database (ESADA).

BACKGROUND AND OBJECTIVE: Obstructive sleep apnoea (OSA) and hyperlipidaemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidaemia in patients of the European Sleep Apnea Database (ESADA) cohort. METHODS: The cross-sectional analysis included 11 892 patients (age 51.9 ± 12.5 years, 70% male, body mass index (BMI) 31.3 ± 6.6 kg/m2 , mean oxygen desaturation index (ODI) 23.7 ± 25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidaemia in relation to measures of OSA (ODI, apnoea-hypopnoea index, mean and lowest oxygen saturation) was determined by means of general linear model analysis with adjustment for important confounders such as age, BMI, comorbidities and study site. RESULTS: Hyperlipidaemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, P < 0.001. Corresponding numbers in patients with diabetes were 8.5% and 41.5%, P < 0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an adjusted OR (95% CI) of 1.33 (1.15-1.55), 1.37 (1.17-1.61) and 1.33 (1.12-1.58) (P < 0.001), respectively, for hyperlipidaemia. Obesity was defined as a significant risk factor for hyperlipidaemia. Subgroups of OSA patients with cardio-metabolic comorbidities demonstrated higher prevalence of HL. In addition, differences in hyperlipidaemia prevalence were reported in European geographical regions with the highest prevalence in Central Europe. CONCLUSION: Obstructive sleep apnoea, in particular intermittent hypoxia, was independently associated with the prevalence of hyperlipidaemia diagnosis.

A risk stratification algorithm using non-invasive respiratory volume monitoring to improve safety when using post-operative opioids in the PACU.

Late detection of respiratory depression in non-intubated patients compromises patient safety. SpO2 is a lagging indicator of respiratory depression and EtCO2 has proven to be unreliable in non-intubated patients. A decline in minute ventilation (MV) is the earliest sign of respiratory depression. A non-invasive respiratory volume monitor (RVM) that provides accurate, continuous MV measurements enables clinicians to predict and quantify respiratory compromise. For this observational study, practitioners were blinded to the RVM measurements and pain management followed the usual routine. Patients were stratified by their MV on PACU admission and classified as "At-Risk" or "Not-At-Risk," with progression to "Low MV" status following opioids assessed for each category. The purpose was to determine if stratifying based on MV on PACU arrival could identify patients at higher risk for respiratory depression. Ability to identify in advance patients at higher risk for respiratory depression following standard opioid dosing would drive changes in pain management and improve patient care. RVM and opioid administration data from 150 PACU patients following elective joint-replacement surgery were collected in an observational study. "Predicted" MV (MVPRED) and "Percent Predicted" (MVMEASURED/MVPRED × 100 %) were calculated for each patient using standard formulas. Prior to opioid administration, patients were classified as either "Not-At-Risk" (MV ≥ 80 % MVPRED) or "At-Risk" (MV < 80 % MVPRED). "Low MV" was defined as MV < 40 % MVPRED. Post-operative apnea (POA) was defined as ≥5 ten-second apneas per hour of PACU stay. We compared the incidences of Low MV following a single opioid dose, POA, and Low MV at discharge for both groups. In the PACU, 74/150 patients received opioids. Within 15 min of opioid administration, 32 % (24/74) developed Low MV. The risk-stratification algorithm identified 22/24 patients (92 % sensitivity). Only 46 % of them had POA, and the majority had Low MV without POA. At discharge, 29/150 patients had Low MV and those receiving opioids were 50 % more likely to display Low MV (23 vs. 16 %). The RVM can identify patients at-risk for opioid-induced respiratory depression and/or experiencing POA. Monitoring of MV can guide opioid-dosing regimens and may increase patient safety across the continuum of care.

[CPAP as a predictor of the efficacy of mandibular advancement devices]. / Der therapeutisch notwendige CPAP-Wert als Prädiktor der Wirksamkeit von Unterkieferprotrusionsschienen in der Therapie schlafbezogener obstruktiver Atmungsstörungen.

BACKGROUND: Mandibular advancement devices are used for the therapy of obstructive sleep apnea. We investigated whether the therapeutically necessary CPAP value is a useful predictor of the efficacy of oral devices. METHODS AND PATIENTS: We retrospectively compared polysomnography data from 67 patients, 8 women and 59 men, (age mean/standard deviation: 54.2 ±â€Š12.3 years; BMI: 28.6 ±â€Š4.3 kg/m²; apnea-hypopnea index: 21.9 ±â€Š12.3/h). All patients were initially treated with CPAP. Due to problems with the CPAP mask, they switched to a mandibular advancement device. RESULTS: Under the use of CPAP, the apnea-hypopnea index decreased from 21.9 ±â€Š12.3 to 3.4 ±â€Š4.6/h, with the mandibular advancement device to 9.7 ±â€Š11.6/h. The apnea-hypopnea index while using an oral device was remarkably different when the therapeutically necessary CPAP value was taken into consideration: in the patient group with a pressure of 4 mbar, it was 6.1 ±â€Š8.7 and in the group with values > 8 mbar, it was 23 ±â€Š9.6/h. Thus, the efficacy was signficantly different for CPAP values above 8 mbar. CONCLUSIONS: The therapeutically necessary CPAP value is a valuable predictor for the efficacy of mandibular advancement devices.

[Consensus paper on the diagnosis and treatment of sleep disordered breathing]. / Konsensuspapier zur Diagnostik und Therapie schlafbezogener Atmungsstörungen bei Erwachsenen.

Diagnosis and treatment of sleep disordered breathing (SDB) undergo substantial changes, both in terms of increasing scientific knowledge and also in terms of patient provision and socio-economic aspects. Increasing evidence shows the relevance of SDB on morbidity and mortality of affected patients. The precise differentiation of different phenotypes of SDBs has improved substantially in recent years. These proceedings influence the approach to the patients suspected of suffering from SDB. The scientific advances on the one hand are facing intentions to simplify diagnostical processes and treatment initiation and intentions to translate duties of physicians to non-medical personnel on the other hand. This consensus paper presents the principals of diagnosis, treatment initiation and provision, including the role of different participants of the healthcare system, and compares different treatment options. Major aspects include the differentiation of the diagnostical process in screening, affirmation of diagnosis and differential diagnosis. In addition, it focusses on the relevance of the pretest probability and describes a therapeutical algorithm.

A Rare Case of Remittent Male Invasive Ductal Carcinoma With New Metastasis After Incomplete Adjuvant Therapy.

Breast cancer is a rare disease in men with many barriers to effective management such as limited research and treatment modalities. While the current standard of care utilizes mastectomy and axillary dissection with chemotherapy, clinicians must follow the female-staged breast cancer protocol, as there is no established regimen for men. In this case presentation, we report a 43-year-old male with a prior history of ER-positive invasive ductal carcinoma (IDC) who presented with a recurrent breast lesion. The patient had previously undergone left breast mastectomy with sentinel node biopsy with negative margins. The patient declined adjuvant chemotherapy and tamoxifen therapy after the initial dissection. Three years after the primary dissection, the patient presents with a breast lesion and metastasis to bilateral axillary lymph nodes, lungs, and spine. The diagnosis was supported by a right axillary biopsy which revealed an ER-positive and PR-positive lesion. We want to shed light on the importance of complete and thorough treatment of primary IDC in men while highlighting the implications of incomplete treatment. We hope that this clinical case will serve as a guide for physicians in promoting adjuvant treatments after primary tumor removal in male IDC.

Short- and long-term follow-up after fecal microbiota transplantation as treatment for recurrent Clostridioides difficile infection in patients with inflammatory bowel disease.

Background: Patients with inflammatory bowel disease (IBD) are at an increased risk of developing Clostridioides difficile infection (CDI). Treatment of CDI in patients with IBD is challenging due to higher failure rates and concomitant IBD activity. Objectives: We performed a multicentre cohort study in patients with IBD who received fecal microbiota transplantation (FMT) for recurrent CDI (rCDI), to further investigate factors that influence the clinical outcome and course of both rCDI and IBD. Design: This is a multicentre cohort study conducted in five European FMT centres. Methods: Adult IBD patients treated with FMT for rCDI were studied. Cure was defined as clinical resolution of diarrhoea or diarrhoea with a negative C. difficile test. The definition of an IBD flare was record based. Long-term follow-up data were collected including new episodes of CDI, IBD flares, infections, hospital admissions, and death. Results: In total, 113 IBD patients underwent FMT because of rCDI. Mean age of the patients was 48 years; 64% had ulcerative colitis. Concomitant rCDI was associated with an IBD flare in 54%, of whom 63% had received IBD remission-induction therapy prior to FMT. All FMT procedures were preceded by vancomycin treatment, 40% of patients received FMT via colonoscopy. CDI cure rate was 71%. Long-term follow-up data were available in 90 patients with a median follow-up of 784 days (402-1251). IBD activity decreased in 39% of patients who had active IBD at baseline, whereas an IBD flare occurred in only 5%. During follow-up of up to 2 years, 27% of the patients had infections, 39% were hospitalized, 5% underwent colectomy, and 10% died (median age of these latter patients: 72 years). Conclusion: FMT for rCDI in IBD patients is safe and effective, and IBD exacerbation after FMT is infrequent. Further studies should investigate the effects on IBD course following FMT.

Nanoscale patterning of organosilane molecular thin films from the gas phase and its applications: fabrication of multifunctional surfaces and large area molecular templates for site-selective material deposition.

A simple methodology to fabricate micrometer- and nanometer-scale patterned surfaces with multiple chemical functionalities is presented. Patterns with lateral dimensions down to 110 nm were made. The fabrication process involves multistep gas-phase patterning of amine, thiol, alkyl, and fluorinated alkyl-functional organosilane molecules using PDMS molds as shadow masks. Also, a combination process of channel diffused plasma etching of organosilane molecular thin films in combination with masked gas-phase deposition to fabricate multilength scale, multifunctional surfaces is demonstrated.

Consensus document regarding cardiovascular safety at sports arenas: position stand from the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), section of Sports Cardiology.

Mass gathering events in sports arenas create challenges regarding the cardiovascular safety of both athletes and spectators. A comprehensive medical action plan, to ensure properly applied cardiopulmonary resuscitation, and wide availability and use of automated external defibrillators (AEDs), is essential to improving survival from sudden cardiac arrest at sporting events. This paper outlines minimum standards for cardiovascular care to assist in the planning of mass gathering sports events across Europe with the intention of local adaptation at individual sports arenas, to ensure the full implementation of the chain of survival.

Psychosocial stress among Danish vicars.

BACKGROUND: Burnout and depression are common among clergy members of several religions and denominations. Despite this, no studies have analysed whether differences in psychosocial workloads between vicars and others explain their higher prevalence of stress-related symptoms. AIMS: To test the hypothesis that elements of the job strain model (high work demands, low decision latitude and/or low job support) are mediators of the excess prevalence of stress-related health complaints among vicars compared with other employees in the Church of Denmark. METHODS: Data for this cross-sectional study were collected by means of a self-administered questionnaire sent to all employees in 500 Danish parishes (n = 2254). RESULTS: The study response rate was 73%, 35% of respondents were vicars and 43% were female. Compared with other employees, vicars felt quiet and relaxed less often (53 versus 67%), had less time for pleasure and relaxation (28 versus 11%) and felt happy and satisfied (53 versus 67%) less often. Vicars had significantly higher quantitative, cognitive and emotional work demands, lower work support, less influence on whom to collaborate with and less influence on their workload. Psychosocial workloads were more favourable for the vicars who had greater influence on job decisions and on job organization. The higher prevalence of stress-related symptoms among vicars was strongly modified by high work demands, in particular high quantitative demands. CONCLUSIONS: The higher prevalence of stress-related symptoms among vicars could largely be attributed to high-quantitative work demands.

Standards of liver cirrhosis care in Central Australia.

BACKGROUND: Liver cirrhosis and hepatocellular carcinoma (HCC) are highly prevalent in Australia's Northern Territory. Contributing factors include high levels of alcohol consumption, viral hepatitis and metabolic syndrome. Rural Aboriginal residents form a significant proportion of the Central Australian population and present a challenge to traditional models of liver care. HCC surveillance and variceal screening are core components of liver cirrhosis management. AIM: To assess participation in HCC and variceal surveillance programmes in a Central Australian liver cirrhosis patient cohort. METHODS: Retrospective cohort study of patients with liver cirrhosis presenting to Alice Springs Hospital, Australia between January 1, 2012 and December 31, 2017. Demographic data, disease severity, attendance at hepatology clinics, participation in variceal and/or HCC surveillance programmes was recorded. Regression analyses were conducted to assess factors associated with two independent outcomes: Participation in HCC and variceal surveillance. RESULTS: Of 193 patients were identified. 82 patients (42.4%) were female. 154 patients (80%) identified as Aboriginal. Median Model for End-stage Liver Disease Score at diagnosis was 11. Alcohol was the most common cause of cirrhosis. Aboriginal patients were younger than non-Aboriginal patients (48.4 years vs 59.9 years, P < 0.001). There were similar rates of excess alcohol intake (72.6% vs 66.7%, P = 0.468) and obesity (34.5% vs 38.4%, P = 0.573 across non-Aboriginal and Aboriginal cohorts. 20.1% of patients took part in HCC surveillance and 42.1% of patients completed variceal screening. Aboriginal patients were less likely to engage with either HCC surveillance (OR: 0.38, 95%CI: 0.16-0.9, P = 0.025) or undergo variceal screening (OR: 0.31, 95%CI: 0.14-0.65, P = 0.002). CONCLUSION: HCC or variceal surveillance programmes had less uptake amongst Aboriginal patients. Greater emphasis needs to be placed on eliminating cultural obstacles to accessing hepatology services.

[Management of diagnostic procedures and treatment of sleep related breathing disorders in the context of the coronavirus pandemic]. / Diagnostik und Therapie schlafbezogener Atmungsstörungen im Zusammenhang mit der Corona­Pandemie: Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP), Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM).

When providing sleep medical services special aspects must be taken into account in the context of the coronavirus pandemic. Despite all prevention, due to the high number of unrecognized cases, SARS-CoV2 contacts in the sleep laboratory must be expected and appropriate precautions are necessary. Nevertheless, the continuation or resumption of sleep medical services under the appropriate hygiene measures is strongly recommended to avoid medical and psychosocial complications. There is no evidence for a deterioration of COVID-19 through CPAP therapy. In principle, the application of positive pressure therapy via various mask systems can be accompanied by the formation of infectious aerosols. In the case of confirmed infection with SARS-CoV2, a pre-existing PAP therapy should be continued in an outpatient setting in accordance with the local guidelines for home isolation, since discontinuation of PAP therapy is associated with additional cardiopulmonary complications due to the untreated sleep-related breathing disorder. According to the current state of knowledge inhalation therapy, nasal high-flow (NHF), and PAP therapy can be carried out without increased risk of infection for health care workers (HCW) as long as appropriate personal protective equipment (eye protection, FFP2 or FFP-3 mask, gown) is being used.This position paper of the German Society for Pneumology and Respiratory Medicine (DGP) and the German Society for Sleep Medicine (DGSM) offers detailed recommendations for the implementation of sleep medicine diagnostics and therapy in the context of the coronavirus pandemic.

Reduction of time-varying nanotesla magnetic fields from electric power lines by twisting.

Time-varying magnetic fields generated by electrical power lines in the laboratory can disturb electron microscope imaging. Modern microscopes require these fields to be below 10 nT [2]. We calculated and measured magnetic fields from straight and twisted current-carrying wires, and show that without twisting, this value cannot be reached.

[Are there alternative therapeutical options other than CPAP in the treatment of the obstructive sleep apnea syndrome]. / Gibt es Alternativen zum nCPAP-Verfahren in der Behandlung des obstruktiven Schlafapnoesyndroms?

Many patients with the obstructive sleep apnea syndrome (OSAS) look for alternative conservative or surgical therapies to avoid to be treated with continuous positive airway pressure. In view of the high prevalence and the relevant impairment of the patients lots of methods are offered which promise definitive cure or relevant improvement of OSAS. The working group "Apnea" in the German Society of Sleep Medicine and Research established a task force to evaluate the scientific literature on non-CPAP therapies in the treatment of OSAS according to the standards of evidence-based medicine. This paper summarizes the results of the task force. The data were unsatisfactorily for most of the methods. Sufficient data were available for intraoral appliances (IOA) and the maxillomandibular osteotomy (MMO). IOA's can reduce mild to moderate respiratory disturbances, MMO are efficient in the short and long term but are performed only in special situations such as craniofacial dysmorphias. Weight reduction and body positioning cannot be recommended as a single treatment of OSAS. Most surgical procedures still lack sufficient data according to the criteria of evidence based medicine. Resections of muscular tissue within the soft palate have to be strictly avoided. But even success following gentle soft palate procedures is difficult to predict and often decreases after years. Results in other anatomical regions seem to be more stable over time. Today combined surgeries in the sense of multi-level surgery concepts are of increasing interest in the secondary treatment after failure of nasal ventilation therapy although more data from prospective controlled studies are needed. There is no evidence for any other treatment options.

Acute mesenteric ischemia following cardiovascular surgery--A nested case-control study.

INTRODUCTION: Acute mesenteric ischemia is a rare but often fatal complication following cardiovascular surgery. Early suspicion may reduce overall mortality. This retrospective study aims to identify predictors and risk factors that may determine the onset and evolution of acute mesenteric ischemia. METHODS: In a retrospective case-control study, we compared co-morbidities and peri-operative risk factors of patients with or without mesenteric ischemia following cardiac surgery using univariate and logistic regression analyses. RESULTS: Of 9385 patients, 108 (1.15%) were diagnosed with acute mesenteric ischemia within two weeks after cardiac surgery. In-hospital mortality was 68% for this group. Patients with ischemia and controls were matched in regard to patient's age and type of surgical intervention and showed similar pre-operative parameters. Only liver cirrhosis (OR 13.3, CI95% 3.6-49.3), and emergency operation (OR 2.6, CI95% 1.3-5.2) remained independent pre-operative predictors for acute mesenteric ischemia in multivariate analysis. In contrast, early postoperative parameters revealed a higher correlation with the occurrence of mesenteric ischemia including the use of norepinephrine (OR 3.5 CI95% 1.6-7.8), epinephrine (OR 2.0, CI95% 1.1-3.7), and serum lactate levels >3 mmol/L (OR 2.9, CI95% 1.5-5.6). A set of key markers of regression analysis was evaluated in a ROC curve analysis. The area under curve was 0.835, which indicates moderate to good prognostic accuracy. CONCLUSION: Early identification of pre- and post-operative predictors including liver cirrhosis, emergency operation, serum lactate >3 mmol/L, and the use of norepinephrine and epinephrine may help facilitate early diagnosis of acute mesenteric ischemia following cardiac surgery, and thus may allow immediate adequate treatment, leading to a reduction in mortality rates.