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An examination of shallow GAC filter caps to promote biological filtration without requiring costly full filter bed media replacements.

AimsIn many low-income countries, fasting glucose is the primary measure of glycaemic control used for treatment titration, as HbA1c is often unavailable or unaffordable. Many patients in these countries walk long distances to the clinic, but the impact of walking on fasting glucose in type 2 diabetes is unknown. We aimed to determine whether this prolonged walking affects the reliability of fasting plasma glucose as a measure of glycaemic control.MethodsIn a randomised crossover trial, the change in glucose from baseline in the fasting state was compared between walking on a treadmill at a predetermined speed of 4.5 km/hour for 1 hour and not walking (resting) in people with type 2 diabetes. The pre-specified primary outcome was glucose at 1 and 2 hours.Results45 participants were enrolled and all completed both visits. 21/45 (46.7%) were female, and the median age was 51. Glucose during and after walking was similar to glucose while at rest; glucose difference (walking minus rest) was -0.15 (95% CI: -0.55, 0.26) and -0.10 (95% CI: - 0.50, 0.31) mmol/L at 1 and 2 hours respectively, p>0.4 for both).ConclusionsFasting plasma glucose is not meaningfully affected by prolonged walking in participants with type 2 diabetes; therefore, the reliability of fasting glucose for monitoring glycaemic burden is unlikely to be altered in patients who walk to the clinic.Research in contextWhat is already known about this subject?Fasting glucose is widely used to assess glycaemic control in people living with diabetes in low income countries, as HbA1c and home glucose monitoring are unaffordable. In these settings people living with diabetes will often walk long distances to receive healthcare.Little is known on the impact of walking on fasting glucose in people living with diabetes.What is the key question?Is fasting plasma glucose measure affected by a single bout of exercise such as walking in individuals with type 2 diabetes (T2D)?What are the new findings?There was no significant change in fasting glucose at the end of the walking exercise.There was no meaningful change in fasting glucose observed at any point up to 3 hours after commencing exercise.How might this impact on clinical practice in the foreseeable future?Fasting plasma glucose is not meaningfully affected by prolonged walking in participants with type 2 diabetes; therefore, the reliability of fasting glucose for monitoring glycaemic burden is unlikely to be altered in patients who walk to the clinic.

Background: The role of nutrient timing in energy intake amongst people with dysglycaemia is understudied but could be a simple method to help regulate appetite. This study analysed within-person associations of sugar intake at breakfast and subsequent energy intake. Methods: We used 4-day diet diary data from 147 participants (47 % men) encompassing 547 days of diet recording in the Sedentary Time and Metabolic Health in People with Type 2 diabetes project (STAMP-2). Linear two-level models were used to investigate within- (day-level) and between-person (participant-level) variation in total and post-breakfast energy intake according to skipping breakfast, low- (> 0-14.2 g) or high- (> 14.2 g) sugar intake at breakfast, adjusting for potential confounding or mediation. Results: Post-breakfast energy intakes were observed to be lower after eating low- and high-sugar breakfasts (compared to skipping), but higher total energy intake was associated with eating a high-sugar breakfast. Compared to breakfast skipping, both low- and high-sugar breakfasts were strongly associated with lower post-breakfast energy intake (-178, 95 % confidence interval [CI] -261, -94 kcal/d; ‑151, 95 % CI -235, -67 kcal/d, respectively). However, compared to skipping breakfast, low-sugar breakfasts were weakly associated with higher total daily energy intake (64, 95 % CI -18, 146 kcal/d), whereas high-sugar breakfasts had a strong association (135, 95 % CI 52, 217 kcal/d). Post-breakfast energy intakes were similar between low- and high-sugar breakfast days (27, 95 % CI -53, 106 kcal/d), whilst total daily energy intake tended to be higher with high- (compared to low-) sugar breakfasts (70, -8, 149 kcal/d). We also observed evidence of energy compensation whereby 86 % of the extra energy consumed in a low-sugar breakfast was compensated for by reductions in post-breakfast energy intakes, compared to only 53 % after a high-sugar breakfast. Conclusion: Overall, high-, but not low-, sugar breakfasts were associated with higher total daily energy intake when compared to breakfast skipping, despite a similar reduction in post-breakfast energy intake. We found evidence of poorer post-breakfast energy intake compensation with high-sugar breakfasts than low-sugar breakfasts. These findings suggest portion size may be important to consider in future breakfast research, with sugar being a proxy of portion size.

Concern exists regarding potential health impacts associated with contaminants of emerging concern (CECs) that adsorb to microplastics (MPs). Previous studies have examined MPs as potential contaminant vectors in marine environments as opposed to freshwaters that represent drinking water sources. This study examined adsorption of two polycyclic aromatic hydrocarbons (PAHs), phenanthrene and fluoranthene, by virgin and weathered polyethylene (PE) in both artificial and natural freshwater matrices. Adsorption kinetics and isotherms conducted in artificial freshwater (AFW) consistently showed higher adsorption onto smaller (200 μm) PE when compared to 1090 μm PE. Adsorption mechanisms were primarily associated with hydrophobic interactions and monolayer chemisorption. As well, environmental factors including dissolved organic matter (DOC), pH, and polymer weathering also impacted adsorption. This work provides new insights regarding the adsorption of organic pollutants to better understand the risk of MPs in drinking water sources.

ContextSalt and water homeostasis is regulated hormonally, so polyuria can result from endocrine disease directly or via secondary effects. These mechanisms are not consistently considered in primary care management of nocturia.ObjectiveTo conduct a systematic review (SR) of nocturia in endocrine disease and reach expert consensus for primary care management.Evidence acquisitionFour databases were searched from January 2000 to April 2020. A total of 4382 titles and abstracts were screened, 36 studies underwent full-text screening, and 14 studies were included in the analysis. Expert and public consensus was achieved using the nominal group technique (NGT).Evidence synthesisTwelve studies focused on mechanisms of nocturia, while two evaluated treatment options; none of the studies took place in a primary care setting. NGT consensus identified key clinical evaluation themes, including the presence of thirst, a medical background of diabetes mellitus or insipidus, thyroid disease, oestrogen status, medications (fluid loss or xerostomia), and general examination including body mass index. Proposed investigations include a bladder diary, renal and thyroid function, calcium, and glycated haemoglobin. Morning urine osmolarity should be examined in the context of polyuria of >2.5 l/24 h persisting despite fluid advice, with urine concentration >600 mOsm/l after fluid restriction excluding diabetes insipidus. Treatment should involve education, including adjustment of lifestyle and medication where possible. Any underlying endocrine disorder should be managed according to local guidance. Referral to endocrinology is needed if there is hyperthyroidism, hyperparathyroidism, or morning urine osmolarity ConclusionsEndocrine disease can result in nocturia via varied salt and water regulation pathways. The aim of management is to identify and treat causative factors, but secondary effects can restrict improvements in nocturia.Patient summaryPeople with altered hormone function can suffer from severe sleep disturbance because of a need to pass urine caused by problems in controlling water and salt levels. An expert panel recommended the best ways to assess and treat these problems on the basis of the rather small amount of up-to-date published research available.

Patients with nocturia are commonly referred to urology clinics, including many for whom a nonurological medical condition is responsible for their symptoms. The PLanning Appropriate Nocturia Evaluation and Treatment (PLANET) study was established to develop practical approaches to equip healthcare practitioners to deal with the diverse causes of nocturia, based on systematic reviews and expert consensus. Initial assessment and therapy need to consider the possibility of one or more medical conditions falling into the “SCREeN” areas of Sleep medicine (insomnia, periodic limb movements of sleep, parasomnias, and obstructive sleep apnoea), Cardiovascular (hypertension and congestive heart failure), Renal (chronic kidney disease), Endocrine (diabetes mellitus, thyroid disease, pregnancy/menopause, and diabetes insipidus), and Neurology. Medical and medication causes of xerostomia should also be considered. Some key indicators for these conditions can be identified in urology clinics, working in partnership with the primary care provider. Therapy of the medical condition in some circumstances lessens the severity of nocturia. However, in many cases there is a conflict between the two, in which case the medical condition generally takes priority on safety grounds. It is important to provide patients with a realistic expectation of therapy and awareness of limitations of current therapeutic options for nocturia.Patient summaryNocturia is the symptom of waking at night to pass urine. Commonly, this problem is referred to urology clinics. However, in some cases, the patient does not have a urological condition but actually a condition from a different speciality of medicine. This article describes how best the urologist and the primary care doctor can work together to assess the situation and make sensible and safe treatment suggestions. Unfortunately, there is sometimes no safe or effective treatment choice for nocturia, and treatment needs to focus instead on supportive management of symptoms.

To date, no standardized methods have been proposed for conducting microplastic analyses in treated drinking waters, resulting in challenges associated with direct comparisons among studies. This study compares known methods for collecting and extracting microplastics from drinking waters: an in-laboratory (in-lab) filtration method and an in-line filtration method (i.e., water filtered on-site without an intermediate storage and/or transportation step). In-lab methods have been the predominant method for sample collection in drinking water matrices, and in-line methods are emerging due to the potential to sample large volumes of water on site and minimize contamination from airborne particles, but the two methods have yet to be directly compared using real samples. In response, this study evaluates both methods in terms of recovering spiked reference microplastics, collecting microplastics from tap water samples using the same water volume, and quantifying the removal of microplastics through a full-scale ultrafiltration system. In-line filtration was shown to have higher recoveries for all the reference microplastics examined (+37 % for PVC fragments, +23 % for PET fragments, +22 % for nylon fibers and +7 % for PET fibers) and a greater potential to reduce microplastic contamination. It also resulted in lower standard deviations for total microplastic counts in the tap water and UF influent and effluent samples. The filtration capacity of the proposed in-line filtration method could exceed 350 L of treated water, but this is highly dependent on the water quality. This study therefore supports the use of in-line filtration methods towards the standardization of microplastic collection procedures in drinking water.