Ocean acidification does not limit squid metabolism via blood oxygen supply.

Ocean acidification is hypothesized to limit the performance of squid owing to their exceptional oxygen demand and pH sensitivity of blood-oxygen binding, which may reduce oxygen supply in acidified waters. The critical oxygen partial pressure (Pcrit), the PO2  below which oxygen supply cannot match basal demand, is a commonly reported index of hypoxia tolerance. Any CO2-induced reduction in oxygen supply should be apparent as an increase in Pcrit In this study, we assessed the effects of CO2 (46-143 Pa; 455-1410 µatm) on the metabolic rate and Pcrit of two squid species - Dosidicus gigas and Doryteuthis pealeii - through manipulative experiments. We also developed a model, with inputs for hemocyanin pH sensitivity, blood PCO2  and buffering capacity, that simulates blood oxygen supply under varying seawater CO2 partial pressures. We compare model outputs with measured Pcrit in squid. Using blood-O2 parameters from the literature for model inputs, we estimated that, in the absence of blood acid-base regulation, an increase in seawater PCO2  to 100 Pa (≈1000 µatm) would result in a maximum drop in arterial hemocyanin-O2 saturation by 1.6% at normoxia and a Pcrit increase of ≈0.5 kPa. Our live-animal experiments support this supposition, as CO2 had no effect on measured metabolic rate or Pcrit in either squid species.

The Evolving Need for Neuropsychology in Neurosurgical Settings: Challenges Facing Transformative Care.

Clinical neuropsychology has been a valuable asset to neurologic surgery, contributing to lateralization and localization of pathologic brain tissue, identification of eloquent cortex, and evaluation of postoperative neuropsychological functioning. Moreover, neuropsychologists provide empirically driven interventions aimed at supporting preparation and/or recovery of neurosurgery patients. Nonetheless, several challenges may limit the reliability, validity, and generalizability of the assessment data obtained and reduce the usefulness of other neuropsychological services provided. Specifically, linguistic, cultural, educational, and other biases associated with demographic characteristics can lead to a narrowed view of an individual's life experiences, which must be confronted to fulfill the mission of ensuring that all patients have access to care that is appropriate to their needs. Instead of perceiving these challenges as insurmountable barriers, such issues can be viewed as opportunities to catalyze change and foster innovation for the future of neuropsychological care in neurosurgical settings. In addition to reviewing the possible mechanisms of these obstacles, the current article offers tangible solutions at both a macro level (e.g., discipline-wide transformations) and micro level (e.g., individualized patient-centric approaches). Outlined are practical techniques to potentially improve consensus and standardization of methods, advance and globalize research, expand representativeness of measures and practices to serve diverse individuals, and increase treatment adherence through engagement of patients and their families.

Foundations of Neuropsychology: Collaborative Care in Neurosurgery.

The disciplines of neuropsychology and neurosurgery have a history of partnership that has improved prognoses for patients with neurologic diagnoses that once had poor outcomes. This article outlines the evolution of this relationship and describes the current role that clinical neuropsychology has within a department of neurological surgery across the preoperative, intraoperative, and postoperative stages of treatment. Understanding the foundations of collaboration between neuropsychology and neurosurgery contextualizes present challenges and future innovations for advancing excellence along the continuum of care for all neurosurgical patients.

Innovations in Neuropsychology: Future Applications in Neurosurgical Patient Care.

Over the last century, collaboration between clinical neuropsychologists and neurosurgeons has advanced the state of the science in both disciplines. These advances have provided the field of neuropsychology with many opportunities for innovation in the care of patients prior to, during, and following neurosurgical intervention. Beyond giving a general overview of how present-day advances in technology are being applied in the practice of neuropsychology within a neurological surgery department, this article outlines new developments that are currently unfolding. Improvements in remote platform, computer interface, "real-time" analytics, mobile devices, and immersive virtual reality have the capacity to increase the customization, precision, and accessibility of neuropsychological services. In doing so, such innovations have the potential to improve outcomes and ameliorate health care disparities.

Refocusing vitamin A supplementation programmes to reach the most vulnerable.

WHO recommends vitamin A supplementation (VAS) programmes for children 6-59 months where vitamin A deficiency is a public health problem. However, resources for VAS are falling short of current needs and programme coverage is suffering. The authors present the case for considering the options for shifting efforts and resources from a generalised approach, to prioritising resources to reach populations with continued high child mortality rates and high vitamin A deficiency prevalence to maximise child survival benefits . This includes evaluating where child mortality and/or vitamin A deficiency has dropped, as well as using under 5 mortality rates as a proxy for vitamin A deficiency, in the absence of recent data. The analysis supports that fewer countries may now need to prioritise VAS than in the year 2000, but that there are still a large number of countries that do. The authors also outline next steps for analysing options for improved targeting and cost-effectiveness of programmes. Focusing VAS resources to reach the most vulnerable is an efficient use of resources and will continue to promote young child survival.

Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries.

Inadequate micronutrient intakes are relatively common in low- and middle-income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost-effectiveness of MMS compared with IFA. Recent meta-analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual-participant data meta-analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost-effective method to reduce the risk of adverse birth outcomes.

Iodine deficiency in 2007: global progress since 2003.

BACKGROUND: Iodine deficiency is a global public health problem, and estimates of the extent of the problem were last produced in 2003. OBJECTIVES: To provide updated global estimates of the magnitude of iodine deficiency in 2007, to assess progress since 2003, and to provide information on gaps in the data available. METHODS: Recently published, nationally representative data on urinary iodine (UI) in school-age children collected between 1997 and 2006 were used to update country estimates of iodine nutrition. These estimates, alongside the 2003 estimates for the remaining countries without new data, were used to generate updated global and regional estimates of iodine nutrition. The median UI was used to classify countries according to the public health significance of their iodine nutrition status. Progress was measured by comparing current prevalence figures with those from 2003. The data available for pregnant women by year of survey were also assessed. RESULTS: New UI data in school-age children were available for 41 countries, representing 45.4% of the world's school-age children. These data, along with previous country estimates for 89 countries, are the basis for the estimates and represent 91.1% of this population group. An estimated 31.5% of school-age children (266 million) have insufficient iodine intake. In the general population, 2 billion people have insufficient iodine intake. The number of countries where iodine deficiency is a public health problem is 47. Progress has been made: 12 countries have progressed to optimal iodine status, and the percentage ofschool-age children at risk of iodine deficiency has decreased by 5%. However, iodine intake is more than adequate, or even excessive, in 34 countries: an increase from 27 in 2003. There are insufficient data to estimate the global prevalence of iodine deficiency in pregnant women. CONCLUSIONS: Global progress in controlling iodine deficiency has been made since 2003, but efforts need to be accelerated in order to eliminate this debilitating health issue that affects almost one in three individuals globally. Surveillance systems need to be strengthened to monitor both low and excessive intakes of iodine.

Review of the magnitude of folate and vitamin B12 deficiencies worldwide.

Human deficiencies of folate and vitamin B12 result in adverse effects which may be of public health significance, but the magnitude of these deficiencies is unknown. Therefore, we examine the prevalence data currently available, assess global coverage of surveys, determine the frequency with which vitamin status assessment methods are used, and identify patterns of status related to geographical distribution and human development. Surveys were identified through PubMed and the Vitamin and Mineral Nutrition Information System at the World Health Organization (WHO). Since different thresholds were frequently used to define deficiency, measures of central tendency were used to compare blood vitamin concentrations among countries. The percentage of countries with at least one survey is highest in the WHO Regions of South-East Asia and Europe. Folate and vitamin B12 status were most frequently assessed in women of reproductive age (34 countries), and in all adults (27 countries), respectively. Folate status assessment surveys assessed plasma or serum concentrations (55%), erythrocyte folate concentrations (21%), or both (23%). Homocysteine was assessed in one-third of the surveys of folate and vitamin B12 status (31% and 34% respectively), while methylmalonic acid was assessed in fewer surveys of vitamin B12 status (13%). No relationship between vitamin concentrations and geographical distribution, level of development, or population groups could be identified, but nationally representative data were few. More representative data and more consistent use of thresholds to define deficiency are needed in order to assess whether folate and vitamin B12 deficiencies are a public health problem.

Vitamin A Supplementation Programs and Country-Level Evidence of Vitamin A Deficiency.

Vitamin A supplementation (VAS) programs targeted at children aged 6-59 months are implemented in many countries. By improving immune function, vitamin A (VA) reduces mortality associated with measles, diarrhea, and other illnesses. There is currently a debate regarding the relevance of VAS, but amidst the debate, researchers acknowledge that the majority of nationally-representative data on VA status is outdated. To address this data gap and contribute to the debate, we examined data from 82 countries implementing VAS programs, identified other VA programs, and assessed the recentness of national VA deficiency (VAD) data. We found that two-thirds of the countries explored either have no VAD data or data that were >10 years old (i.e., measured before 2006), which included twenty countries with VAS coverage ≥70%. Fifty-one VAS programs were implemented in parallel with at least one other VA intervention, and of these, 27 countries either had no VAD data or data collected in 2005 or earlier. To fill these gaps in VAD data, countries implementing VAS and other VA interventions should measure VA status in children at least every 10 years. At the same time, the coverage of VA interventions can also be measured. We identified three countries that have scaled down VAS, but given the lack of VA deficiency data, this would be a premature undertaking in most countries without appropriate status assessment. While the global debate about VAS is important, more attention should be directed towards individual countries where programmatic decisions are made.

Aluminium in coal fly ash (FA), in plants grown on FA, and in the leachates from FA.

Two coal fly ashes (FA), one from Montana semi-bituminous coal and another from North Dakota lignite alone or in combination with bottom ash (BA) from Montana semi-bituminous coal were tested as plant growth media for the following plant species: barley (Hordeum vulgare), oats (Avena sativa), rye (Secale cereale), wheat (Triticum aestivum), regreen; a hybrid between wheatgrass (Agropyron cristatum) and winter wheat (Triticum aestivum), and triticale; a hybrid between wheat (Triticum aestivum) and rye (Secale cereale). The concentration of Al, in coal ashes and in plant seedlings was determined using Inducted Coupled Plasma Spectrophotometry (ICP). All tested plant species germinated and grow in FA and/or FA + BA containing media. These data demonstrate that tested plants can grow on media consisting of coal ash, and therefore these plants can be used to cover FA or BA residue piles. In summary, the presence of sphagnum peat moss and soil in coal ash based plant growth media expressed ameliorative role by reducing the presence of Al in plant growth media and in plant seedlings grown on these media, but it did not translate into the decrease of the presence of Al in the leachate from these media. Elevated concentrations of Al in the leachate may cause some environmental health concerns and require further investigations.

Preliminary study of coal fly ash (FA) phytoremediation by selected cereal crops.

This study focuses on the environmentally friendly utilization of coal combustion residue, fly ash (FA) containing significant amounts of heavy metals. Knowledge about the potential use of FA as a component of growth media for plants is fragmentary. Preliminary experiments tested the possibility to grow cereal crops on media composed exclusively of FA. The analysis of seven different FA from lignite and semi-bituminous coal from North Dakota and Montana sources using inductively coupled plasma emission spectrophotometry showed high concentrations of heavy metals in coal (up to, in mg/kg): As:65, Cd:3.9, Co:38, Cr:77, Li:109, Mn:1547, Pb:106, Ni:41, V:306. Seedlings of rye, wheat, oats, barley, triticale, and regreen (hybrid between wheat and ryegrass) were planted in Petri dishes (10 cm in diameter) in growth media containing FA from lignite coal, FA from semi-bituminous coal, bottom ash, and Fargo clay soil as the control. Each treatment was performed in 3 replications, and each experiment was repeated 3 times. Germination rates, plant growth analysis, and dry matter yield were determined 2-3 weeks after planting. Germination rates and dry matter yield of oats, winterwheat and regreen were greater (10-20% above controls) in media composed of coal ash, but rye, barley, and wheat seedlings were affected by FA in media. These results show the potential for the utilization of FA as a growth media for cereal crops. Therefore, these plants might be used as green cover preventing wind erosion over the coal ash piles. However, this issue requires additional in depth investigation, including a thorough chemical analysis of plant material.

Amelioration of coal fly ash used as cereal crops growth media by sphagnum peat moss and soil.

Coal fly ash (FA) has a potential to be used as a soil amendment for growing plants. Toxicity of heavy metals present in FY, FA high salinity, and high pH of coal FA may potentially restrict or even prevent plant growth on the media with high concentration of FA. Sphagnum peat moss (SPM) shows a potential to ameliorate coal FA based plant media by improving the texture of such media, making media less harder, decreasing high pH of the media, and potentially binding heavy metals present in FA. Therefore, the aim of this study was to determine the effects of growth media containing differing concentration of FA and/or sphagnum peat moss (SPM) on growth of selected plants. The following plant species have been tested: barley (Hordeum vulgare), oats (Avena sativa), rye (Secale cereale), wheat (Triticum aestivum), Regreen; a hybrid between wheatgrass (Agropyron cristatum) and winter wheat (Triticum aestivum), Triticale; a hybrid between wheat (Triticum aestivum) and rye (Secale cereale),, and perennial ryegrass (Lolium multiflorum). The addition of SPM to FA based plant growth media expressed ameliorative role, allowing the growth of seedlings on such media. In addition, our results indicate that the transfer of heavy metals from coal FA to plants and possibly to a food chain either did not exist or was very low.

Agro-toxicological aspects of coal fly ash (FA) phytoremediation by cereal crops: effects on plant germination, growth and trace elements accumulation.

A vegetative cover is a remedial technique utilized on coal fly ash (FA) landfills for soil stabilization and for the physical and chemical immobilization of contaminants. There is a great concern, that plants planted or voluntarily growing on media with high content of FA may absorb toxic amounts of Se and/or heavy metals. If such plants are ingested, it may result in toxicity to animals or humans. Despite these objections, the utilization of FA as a growth medium for plants is an attractive alternative for disposal of FA in landfills. We hypothesized that selected plants will grow in media containing FA and/or bottom ash (BA) from several sources. Two coal FA, one from Montana semi-bituminous coal and another from North Dakota lignite alone or in combination with BA from Montana semi-bituminous coal were tested as plant growth media for the following plant species: barley (Hordeum vulgare), oats (Avena sativa), rye (Secale cereale), wheat (Triticum aestivum), regreen; a hybrid between wheatgrass (Agropyron cristatum) and winter wheat (Triticum aestivum), and triticale; a hybrid between wheat (Triticum aestivum) and rye (Secale cereale). The concentration of Al, As, B, Ba, Be, Co, Cd, Cr, Cu, Mo, Pb, Sr, Ti, Tl, and V in growth media and in young plants was determined using Inducted Coupled Plasma Spectrophotometry (ICP). All tested plant species germinated and grow in FA and/or FA + BA containing media. However, germination and/or growth of the majority of tested plants were decreased by the presence of FA and/or BA in growth media. Concentration of all analyzed elements was greater in growth media containing FA and/or BA than in soil control, and also was greater in plants grown on medium containing FA and/or BA than in soil. These data demonstrate that tested plants can grow on media consisting of coal ash, and therefore these plants can be used to cover FA or BA residue piles.

Environmental health aspects of coal ash phytoremediation by selected crops.

The objective of this research was to determine the effects of growth media containing FA and FA mixed with soil on selected crop plants seedlings growth. We studied the influence of various FA concentrations (e.g., 0, 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100% of FA in growth media by weight basis) in FA/soil composed media on the germination, growth, and heavy metals uptake of the following plants: barley, Sudan grass, ryegrass, rape, alfalfa, and canola. Plants were grown on Petri dishes (10 cm diameter, 3 replications) for 14-21 days, harvested, dried, and weighed. Experiments have been replicated three times. The concentrations of Al, B, Ba, Co, Cr, Cu, Mo, Sr, Ti, Tl, and V in growth media were determined, and the concentrations of the same elements in young plants were analyzed. Addition of 10, 20, and 30% of FA to the soil were acceptable for most plants, as compared to FA alone used as a growth media. Barley was the only plant of plants used in our research, which was able to sustain seedlings growth on media consisting on FA alone. Preliminary results of chemical analysis of FA and harvested young plants implicate that plants do not accumulate toxic amounts of heavy metals even being grown on media containing 100% FA. Our research results indicate that coal FA might be used as a plant growth media additive. However, additional studies should be undertaken to determine the effects of FA on plants grown till maturity.

Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005.

OBJECTIVE: To provide current global and regional estimates of anaemia prevalence and number of persons affected in the total population and by population subgroup. SETTING AND DESIGN: We used anaemia prevalence data from the WHO Vitamin and Mineral Nutrition Information System for 1993-2005 to generate anaemia prevalence estimates for countries with data representative at the national level or at the first administrative level that is below the national level. For countries without eligible data, we employed regression-based estimates, which used the UN Human Development Index (HDI) and other health indicators. We combined country estimates, weighted by their population, to estimate anaemia prevalence at the global level, by UN Regions and by category of human development. RESULTS: Survey data covered 48.8 % of the global population, 76.1 % of preschool-aged children, 69.0 % of pregnant women and 73.5 % of non-pregnant women. The estimated global anaemia prevalence is 24.8 % (95 % CI 22.9, 26.7 %), affecting 1.62 billion people (95 % CI 1.50, 1.74 billion). Estimated anaemia prevalence is 47.4 % (95 % CI 45.7, 49.1 %) in preschool-aged children, 41.8 % (95 % CI 39.9, 43.8 %) in pregnant women and 30.2 % (95 % CI 28.7, 31.6 %) in non-pregnant women. In numbers, 293 million (95 % CI 282, 303 million) preschool-aged children, 56 million (95 % CI 54, 59 million) pregnant women and 468 million (95 % CI 446, 491 million) non-pregnant women are affected. CONCLUSION: Anaemia affects one-quarter of the world's population and is concentrated in preschool-aged children and women, making it a global public health problem. Data on relative contributions of causal factors are lacking, however, which makes it difficult to effectively address the problem.

Comparison of plasma ferritin concentration with the ratio of plasma transferrin receptor to ferritin in estimating body iron stores: results of 4 intervention trials.

BACKGROUND: Efforts to develop global programs for the control of iron deficiency require simple, low-cost, and accurate indicators of iron status. OBJECTIVE: We aimed to compare estimates of body iron (BI) stores, as calculated from either plasma ferritin concentration alone (BI-ferritin) or the ratio of plasma transferrin receptor (TfR) to ferritin (BI-TfR/ferritin). DESIGN: Data were analyzed from 4 previously completed, randomized intervention trials that enrolled infants, schoolchildren, or pregnant women (total n = 1189, after excluding subjects with elevated C-reactive protein). RESULTS: The correlation coefficients between BI-ferritin and BI-TfR/ferritin were >0.95 for all studies. The kappa index ranged from 0.5 to 1.0. All of the sensitivities of BI-ferritin for identifying persons with low iron stores (defined as BI-TfR/ferritin < 0 mg/kg body wt) were >0.90. All of the specificities were >0.90 except the study of pregnant women (specificity = 0.66). The effect sizes of iron intervention trials were significantly greater for change in iron reserves estimated by BI-TfR/ferritin than by BI-ferritin in 2 studies with larger effect sizes (1.11 compared with 1.00 and 1.56 compared with 1.44, respectively; P < 0.05) and 1 study with medium effect size (0.70 compared with 0.57; P < 0.05). However, there were no significant differences between estimates of these effect sizes for 1 study with a medium effect size and 1 study with a smaller effect size (0.78 compared with 0.83 and 0.37 compared with 0.35, respectively; P > 0.2). CONCLUSION: Plasma ferritin concentration alone provides a good approximation of total BI reserves, as estimated by BI-TfR/ferritin, on the basis of high correlation, sensitivity, and specificity among nonpregnant persons with unelevated C-reactive protein.

Low plasma vitamin B-12 in Kenyan school children is highly prevalent and improved by supplemental animal source foods.

The high prevalence of vitamin B-12 deficiency in many regions of the world is becoming recognized as a widespread public health problem, but it is not known to what extent this deficiency results from a low intake of the vitamin or from its malabsorption from food. In rural Kenya, where a previous study identified a high prevalence of inadequate vitamin B-12 intakes, this study examined whether plasma vitamin B-12 concentrations were associated with dietary sources of the vitamin at baseline and could be increased by supplementation with animal source foods (ASF). The 4 experimental groups in 503 school children were: 1) control (no food provided); 2) githeri (a maize and bean staple with added oil); 3) githeri + meat (githeri + minced beef); or 4) githeri + milk (githeri + milk). Feedings were isocaloric. Dietary data were collected at baseline, and biochemical data at baseline and after 1 and 2 y of feeding. Baseline plasma vitamin B-12 concentration was 193.6 +/- 105.3 pmol/L and correlated with % energy from ASF (r = 0.308, P < 0.001). The odds ratio for low plasma vitamin B-12 (<148 pmol/L), which occurred in 40% of children, was 6.28 [95% CI: 3.07-12.82] for the lowest vs. highest ASF intake tertile (P < 0.001). Feeding ASF (meat or milk) greatly reduced the prevalence of low plasma vitamin B-12 (P < 0.001). The high prevalence of low plasma vitamin B-12 concentrations in these children is predicted by a low intake of ASF, and supplemental ASF improves vitamin B-12 status.