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The function of the red blood cell anion exchanger, AE1, in in vivo RBC development is investigated by gene targeting. Specifically, null mutation in mice is carried out by targeted gene disruption in embryonic stem cells. The hematological effects of AE1 deletion do not affect fetal loss of homozygotes. Instances of survival to adulthood and fertility are even reported. Results suggest that AE1 is vital to membrane lipid stability but its plasma membrane localization is not required for either terminal RBC differentiation or membrane skeleton assembly.

• Sweden and Denmark have each authorized 20 microbial plant protection products while Norway have only authorized four. • The paper explore possible explanations for these differences. • Regulatory and market differences could explain some of the differences. • The most important explanation are different safety judgments made in the authorization process. The EU has developed a Directive on Sustainable Use of Chemical Pesticides (2009/128/EC) (SUD) that aims to enhance the use of non-chemical alternatives to pesticides like microbial plant protection products (PPP). The number of authorized microbial PPP for plant protection has increased globally during the last decade. There is, however, variation between different countries. Sweden and Denmark have for example each authorized 20 microbial PPP while Norway has only authorized four microbial PPP. Norway has also received significantly fewer applications for authorization of microbial PPP than the other Scandinavian countries. We explore possible explanations for the observed differences. Our results show that that the regulations in the three countries had similar requirements for the authorisation of microbial PPP. The size of the market is somewhat smaller in Norway than in Sweden and Denmark, and could therefore explain some of the differences. We suggest, however, that the most important explanation is implementation differences in terms of different decisions made in the authorization process. By comparing the authorization process for three microbial PPP in the Scandinavian countries, we found that Norway used more time for the product authorization decisions. Norway assess the same types of microbial PPP more restrictively with respect to environmental aspects and especially human health risks. [ABSTRACT FROM AUTHOR]

Lower motor neurone facial paralysis (LMNFP) is often viewed by the general public and wider non-facial palsy fraternity as a cosmetic issue rather than a functional one. In this article, we sought to determine the severity and frequency of oro-motor dysfunction in LMNFP and assess the benefits of physical therapy and rehabilitation in this cohort. A prospective study at our institute was conducted for a one-year period (2015–2016), involving adult patients with LMNFP with significant oro-motor dysfunction. The exclusion criteria were (i) pre-existing oro-motor dysfunction, (ii) within six months of facial palsy onset. The assessment tools used were (i) The Facial Disability Index (FDI), (ii) IPREDD or Inventory of Patient-Reported Eating and Drinking Dysfunction for mastication and (iii) a bespoked Visual Analogue Scale (VAS) based on focus group discussions. Of the 183 new clinic referrals, FDI identified that 14% of patients with LMNFP had significant oro-motor dysfunction. IPREDD analysis showed that 74% of this cohort had masticatory problems, while the VAS indicated significant oro-motor dysfunction as well in those with LMNFP. Following speech and facial therapy, IPREDD-focused symptoms were reduced from 74% to 43% (shown to be significant), while VAS similarly showed a significant reduction in symptoms (two-tailed, paired Student's t -test p < 0.01). Oro-motor function is a significant sequel of facial paralysis. Facial rehabilitation, both physical and psychological, can help reduce patients' distress and improve oro-motor function, without the need for surgical intervention in the first instance. [ABSTRACT FROM AUTHOR]

Summary Introduction Clinical coding is often a mystery to us surgeons, but in actuality, it has a huge bearing on the financial sustainability of our services. Given the rapid innovations in plastic surgical procedures, clinical coders often struggle to decipher the extent of surgery. Meeting midway is the way forward here. Methods In a prospective audit over a six-month period, we analysed data from 2586 patients in our practice: a combination of general plastic surgery and specialist facial reanimation services. This involved comparing data from the first three months where coding was performed by clinical coders based on operating notes per se (phase I) and the subsequent three months when the operating surgeon filled in the OPCS 4.7 (version 2014) codes at the time of completing the operating notes; the clinical coders then vetted this information (phase II) as part of a sequential TBS coding system. Results In terms of outpatient income, there was a 3% increase in facial palsy income and 6% increase in general plastic services, but the most significant improvement was in terms of procedural income per case. General plastic surgery cases saw an increase of 49%, while facial palsy income increased by 58% over the same period. Greater insight into OPCS and HRG codes also allowed for the calculation of the actual tariffs for specific procedures. Conclusions Having the operating surgeon as the primary coder, using a template, with subsequent vetting by the clinical coders, improves data capture, and this in turn increases income. Future recommendations include the use of proforma-based operating notes for workhorse procedures. [ABSTRACT FROM AUTHOR]

We investigated re-establishment of fungal communities on eight former colliery sites in South Wales following revegetation 22–27 y earlier. Regraded bare coal-spoil was seeded to sheep-grazed grasslands, with saplings planted into coal-spoil for woodlands. Metabarcoding (28S rRNA, D1 region) of soil fungal populations showed that woodland and grassland habitats were clearly divergent but edaphic variables only weakly affected fungal community structure. Root-associated basidiomycetes dominated all habitats, with ectomycorrhizal fungi more abundant in woodlands and Clavariaceae/Hygrophoraceae (‘CHEG’ fungi) in grasslands. The composition of coal-spoil grassland communities resembled that of a typical upland grassland site, suggesting that propagule immigration was not a limiting factor. However, fungal biomass (ergosterol) was 3-fold lower, reflecting high bulk density and poor structure. Re-establishment of fungal communities in coal-spoil soils represents an important barometer of restoration success. From a fungal conservation perspective, such sites represent important refugia for waxcap fungi subject to habitat loss from agricultural intensification. [ABSTRACT FROM AUTHOR]

Strategic efforts expended towards identifying and evaluating ideas for a graduate student's thesis or dissertation can help prepare that student for a successful career as either a researcher or practitioner. Generating intriguing and novel ideas can help advance the field of leisure studies, yet the process of identifying great research ideas and questions is largely uncritiqued. This paper presents alternatives to the traditional “extend the research literature” approach, as a means of identifying research questions focusing more strategically on the diversity of information and process of observation and thinking. Graduate students upon beginning their studies can be mentored by faculty to explore ‘what's next’ by capitalizing on their ‘fresh eyes’ to generate novel ideas worth exploring. Some of these methods are akin to how persons and organizations develop ideas for new products and services. Consequently, these methods not only help students going into research-based careers but also those intending to work in professions outside of academia. [ABSTRACT FROM AUTHOR]

Norway has monitored the marine environment around the sunken Russian nuclear submarine Komsomolets since 1990. This study presents an overview of 25 years of Norwegian monitoring data (1990–2015). Komsomolets sank in 1989 at a depth of 1680 m in the Norwegian Sea while carrying two nuclear torpedoes in its armament. Subsequent Soviet and Russian expeditions to Komsomolets have shown that releases from the reactor have occurred and that the submarine has suffered considerable damage to its hulls. Norwegian monitoring detected 134 Cs in surface sediments around Komsomolets in 1993 and 1994 and elevated activity concentrations of 137 Cs in bottom seawater between 1991 and 1993. Since then and up to 2015, no increased activity concentrations of radionuclides above values typical for the Norwegian Sea have been observed in any environmental sample collected by Norwegian monitoring. In 2013 and 2015, Norwegian monitoring was carried out using an acoustic transponder on the sampling gear that allowed samples to be collected at precise locations, ∼20 m from the hull of Komsomolets. The observed 238 Pu/ 239,240 Pu activity ratios and 240 Pu/ 239 Pu atom ratios in surface sediments sampled close to Komsomolets in 2013 did not indicate any releases of Pu isotopes from reactor or the torpedo warheads. Rather, these values probably reflect the overprinting of global fallout ratios with fluxes of these Pu isotopes from long-range transport of authorised discharges from nuclear reprocessing facilities in Northern Europe. However, due to the depth at which Komsomolets lies, the collection of seawater and sediment samples in the immediate area around the submarine using traditional sampling techniques from surface vessels is not possible, even with the use of acoustic transponders. Further monitoring is required in order to have a clear understanding of the current status of Komsomolets as a potential source of radioactive contamination to the Norwegian marine environment. Such monitoring should involve the use of ROVs or submersibles in order to obtain samples next to and within the different compartments of the submarine. [ABSTRACT FROM AUTHOR]

Objectives Multiple myeloma (MM) primarily strikes older adults, but full-dose chemotherapy such as bortezomib (Velcade), cyclophosphamide and dexamethasone (VCD) is often excessively toxic to very old or frail adults and those with substantial comorbidities. We piloted dose-attenuated VCD (“VCD-Lite”) in such vulnerable adults with newly diagnosed MM (NDMM). Materials and Methods Subjects with NDMM and a high risk of therapy-related toxicity due to factors above received bortezomib 1.3 mg/m 2 subcutaneously, cyclophosphamide 300 mg/m 2 and dexamethasone 40 mg orally, all on days 1, 8, and 15 of a 28 day cycle for eight cycles, followed by indefinite, alternating bortezomib and lenalidomide maintenance. Toxicity, overall response rate (ORR), progression-free and overall survival (PFS and OS) were determined. The Cancer and Aging Research Group geriatric assessment (CARG GA) was administered at baseline in an exploratory manner as a predictor of severe toxicity. Results 14 patients went on the study, which was closed early due to slow accrual. Intention-to-treat ORR was 64%. 64% of patients experienced grade ≥ 3 adverse events, the majority of which were unlikely therapy-related. Median PFS was 24.2 months and OS 29.7 months, with 14%, 36% and 29% of patients discontinuing study drugs due to toxicity, MM progression and other reasons respectively. Baseline CARG GA was successfully completed by all subjects but one. Conclusion VCD-Lite is a viable option for vulnerable adults with NDMM. CARG GA is feasible. Further studies to optimize therapy and to explore CARG GA as a toxicity predictor are vital. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to use path analysis methods to determine if health literacy mediates the relationship between race and patient activation.Methods: We performed a secondary analysis of data from a randomized controlled trial in elderly, urban, minority patients using path analysis. Path analysis was used to evaluate the mediation of race on patient activation through different variables. Several models were tested for best fit for their effects on patient activation.Results: Across all models, significant mediation paths were identified from race to lower patient activation through health literacy. This relationship remained significant throughout alternative model testing for covariate combinations. The best-fit model included an indirect effect of sex on patient activation through health literacy indicating that the mediation effect of health literacy on patient activation was most profound for African American males. Health literacy had a bigger influence on patient activation for participants with a greater comorbidity than for those with fewer conditions. No significant direct effect was shown between race and patient activation in any of the models.Conclusion: Racial disparities in patient activation were fully mediated by health literacy skills.Practice Implications: Future interventions to improve racial disparities in patient activation need to be targeted at improving health literacy. [ABSTRACT FROM AUTHOR]

Background: Like all medical innovations, telestroke must demonstrate successful outcomes to achieve sustained growth and acceptance. Asserting that telemedicine is faster, employs the latest technology, or promotes a better use of limited resources is laudable but insufficient. An analysis of stroke treatment within a telemedicine network in 2013 showed that tissue-type plasminogen activator (tPA) could be safely and reliably administered within a practice-based model of telestroke care. Since then, hospital volume and tPA administration within this network have tripled. We hypothesize that a practice-based model of telestroke can maintain positive outcomes in the face of rapid growth.Methods: Data on tPA treatment times and outcomes after thrombolysis were gathered for 165 patients treated with alteplase between November 2012 and November 2014. Comparisons were made to a previous published study of 54 patients seen between October 2010 and October 2012 in the same network. Primary outcome measures were average door-to-needle (DTN) time for TPA administration and average call-to-needle (CTN) time.Results: Significant reductions were observed in median DTN (93 versus 75 minutes, P < .01) and median CTN (56 versus 41 minutes, P < .01). Quality outcome measures such as post-tPA symptomatic hemorrhage (2 [4%] versus 9 [5%], P = .23), length of stay (4 versus 4 days, P = .45), mortality (8 [15%] versus 16 [10%]; P = .32), and percentage of stroke patients treated remained stable.Conclusions: This study shows that a practice-based telemedicine system can produce meaningful improvement in markers of telestroke efficiency in the face of rapid growth of a telestroke network. [ABSTRACT FROM AUTHOR]

This paper reports the main results of the 2012 joint Norwegian–Russian expedition to investigate the radioecological situation of the Stepovogo Fjord on the eastern coast of Novaya Zemlya, where the nuclear submarine K-27 and solid radioactive waste was dumped. Based on in situ gamma measurements and the analysis of seawater and sediment samples taken around the submarine, there was no indication of any leakage from the reactor units of K-27. With regard to the radioecological status of Stepovogo Fjord, activity concentrations of all radionuclides in seawater, sediment and biota in 2012 were in general lower than reported from the previous investigations in the 1990s. However in 2012, the activity concentrations of 137 Cs and, to a lesser extent, those of 90 Sr remained elevated in bottom water from the inner part of Stepovogo Fjord compared with surface water and the outer part of Stepovogo Fjord. Deviations from expected 238 Pu/ 239,240 Pu activity ratios and 240 Pu/ 239 Pu atom ratios in some sediment samples from the inner part of Stepovogo Fjord observed in this study and earlier studies may indicate the possibility of leakages from dumped waste from different nuclear sources. Although the current environmental levels of radionuclides in Stepovogo Fjord are not of immediate cause for concern, further monitoring of the situation is warranted. [ABSTRACT FROM AUTHOR]

Objective: To provide a descriptive review of the epidemiology of search and rescue (SAR) incidents across Canada as documented in the Alpine Club of Canada (ACC) database.Methods: A retrospective, cross-sectional review of SAR reports collected by the ACC with incidents dating from January 1, 1970 to June 12, 2005, was analyzed.Results: The ACC database contained 1088 incidents with 1377 casualties. Casualties had 944 (68.6%; 95% CI, 64.2 to 73.1) injuries or illness, and 433 (31.4%; 95% CI, 28.6 34.6) fatalities. Males accounted for 76.1% of all casualties and 82.3% of the fatalities when sex was reported. A bimodal distribution of casualties was seen, with the peaks around February and August. Hiking and mountaineering resulted in more than half of all casualties that yielded any type of morbidity, whereas mountaineering and skiing, ski mountaineering, or snowboarding accounted for almost two thirds of all fatalities. Human error and slips and falls were the major contributors to the presumptive cause of incidents. The lower limb was the most common anatomic location of traumatic injury, accounting for 41.6% (95% CI, 37.6 to 45.9) of these injuries. Hypothermia, exhaustion, frostbite, and dehydration represented the majority of all nontraumatic conditions. British Columbia and Alberta accounted for 91.6% (95% CI, 86.0 to 97.5) of the incidents in the database.Conclusions: The study serves to illustrate trends in SAR epidemiology that may be encountered by SAR personnel within British Columbia and Alberta. Furthermore, it highlights the need for additional Canadian-based studies to better understand this area of prehospital medical encounters. [ABSTRACT FROM AUTHOR]

Summary Background Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea in Europe. Despite increased focus, its incidence and severity are increasing in many European countries. Aim We developed a series of consensus statements to identify unmet clinical needs in the recognition and management of CDI. Methods A consortium of European experts prepared a series of 29 statements representing their collective views on the diagnosis and management of CDI in Europe. The statements were grouped into the following six broad themes: diagnosis; definitions of severity; treatment failure, recurrence and its consequences; infection prevention and control interventions; education and antimicrobial stewardship; and National CDI clinical guidance and policy. These statements were reviewed using questionnaires by 1047 clinicians involved in managing CDI, who indicated their level of agreement with each statement. Findings Levels of agreement exceeded the 66% threshold for consensus for 27 out of 29 statements (93.1%), indicating strong support. Variance between countries and specialties was analysed and showed strong alignment with the overall consensus scores. Conclusion Based on the consensus scores of the respondent group, recommendations are suggested for the further development of CDI services in order to reduce transmission and recurrence and to ensure that appropriate diagnosis and treatment strategies are applied across all healthcare settings. [ABSTRACT FROM AUTHOR]

Abstract: We present a comparative study on 124 patients with hematologic malignancies who had undergone reduced-intensity conditioning and then received a transplant from an HLA-matched related (MRD), an HLA-matched unrelated (MUD), or an HLA-haploidentical related (HAPLO) donor. The conditioning regimen, which consisted of fludarabine, melphalan or busulfan, and alemtuzumab was administered to patients with lymphoid (n = 62) or myeloid disease (n = 62). Mycophenolate mofetil was used as prophylaxis for graft-versus-host disease (GVHD), and 38, 58, and 33 patients received transplants from MRD, MUD, and HAPLO donors, respectively. Only 2 patients experienced primary graft failure (GF) after melphalan-based regimen, whereas 8 of the 17 patients who received a transplant from HAPLO donors experienced a primary GF after busulfan-based regimen. The cumulative incidence of grade III to IV acute GVHD in engrafted patients who had received transplants from MRD, MUD, or HAPLO donors was 3%, 11%, and 27%, respectively, and the 2-year overall survival (OS) rates were 51%, 22%, and 23%, respectively. According to multivariate analysis, transplantation from either MUD or HAPLO donors compared with MRD were adverse factors that affected the OS (P = .006 and P = .002, respectively). In conclusion, the reduced-intensity regimen that included fludarabine, busulfan, or melphalan and alemtuzumab using only mycophenolate mofetil as the GVHD prophylaxis conferred favorable outcomes in the MRD group but lower survival rates in the MUD and HAPLO groups. The busulfan-based regimen led to a high incidence of GF in the HAPLO group, suggesting the need for modification or intensification of immunosuppression. [Copyright &y& Elsevier]

• The distribution of PFAS through surface soil, the vadose zone and to groundwater is characterized. • Measured PFAS soil levels are 1 to 2 orders of magnitude higher than global background soils. • PFAS levels are correlated to sludge loadings regardless of those patterns, crops, or down time. • The impact of PFAS from treated wastewater as irrigation is negligible. • PFOS and PFOA were detected in groundwater at 1 to 2 orders of magnitude higher than soils. The land application of digested sewage sludge (biosolids) is widely employed across the globe. Studies show that biosolids contain significant amounts of inorganic and organic materials, as well as emerging pollutants, including per- and polyfluorinated alkyl substances (PFAS). With the wide range of pollutants commonly reported in biosolids, the potential risks associated with long-term land application operations are concerning. In this study, PFAS in surface soils, deeper soils into the vadose zone, and immediately-underlying groundwater was measured at an agricultural station with a long record of biosolids applications plus irrigation using treated wastewater. Twelve PFAS homologues were detected in every near surface soil sampled 0–30 cm depth below ground surface with multiple PFAS (especially short-chain) distributed through the soil profile. Average measured concentrations of PFAS in these soils suggest the soil burden PFOS>PFDA>PFOA for all substations sampled, independent of the historical loading rates and patterns of agricultural operations on those substations. Measured concentrations of PFOA and PFOS in the soil profile (0–90 cm) suggest these compounds have migrated to deeper soil depths (up to 9 m below the surface) with quantifiable concentrations in the soil and the immediate underlying groundwater located approximately 17 m below. Estimates of the total mass of PFAS in surface soils were effectively made using PFAS levels reported in sludges from the USEPA NSSS combined with long-term loading rates on record at the substations. With the land application of biosolids in the USA regulated by the USEPA, additional and updated risk assessments and surveys to include emerging pollutants such as PFAS are needed to protect public health and the environment. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract: Background: Research on reactivity to alcohol and drug cues has either ignored affective state altogether or has focused rather narrowly on the role of negative affect in craving. Moreover, until recently, the relevant analyses of affect and craving have rarely addressed the ambivalence often associated with craving itself. The current study investigated how both negative and positive affect moderate approach and avoidance inclinations associated with cue-elicited craving in a clinical sample diagnosed with substance use disorders. Methods: One hundred forty-four patients (age range of 18–65, mean 42.0; n =92 males) were recruited from an inpatient detoxification unit for substance abuse. Participants completed a baseline assessment of both positive and negative affect prior to completing a cue-reactivity paradigm for which they provided self-report ratings of inclinations to approach (use) and avoid (not use) alcohol, cigarettes, and non-psychoactive control substances (food and beverages). Results: Participants with elevated negative affect reported significantly higher approach ratings for cigarette and alcohol cues, whereas those high in positive affect showed significantly higher levels of avoidance inclinations for both alcohol and cigarette cues and also significantly lower approach ratings for alcohol cues, all relative to control cues. Conclusions: Results for negative affect are consistent with previous cue reactivity research, whereas results for positive affect are unique and call attention to its clinical potential for attenuating approach inclinations to substance use cues. Further, positive affect was related to both approach and avoidance inclinations, underscoring the utility of a multidimensional conceptualization of craving in the analysis. [Copyright &y& Elsevier]