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Purpose: We performed an economic evaluation, from a societal perspective, to examine the cost-utility and cost-effectiveness of a wearable multimodal seizure detection device: NightWatch.Methods: We collected data between November 2018 and June 2020 from the PROMISE trial (NCT03909984), including children aged 4-16 years with refractory epilepsy living at home. Caregivers completed questionnaires on stress, quality of life, health care consumption and productivity costs after two-month baseline and two-month intervention with NightWatch. We used costs, stress levels and quality-adjusted life years (QALYs) to calculate incremental cost-effectiveness ratios (ICERs). Missing items were handled by mean imputation. Sensitivity analyses were performed to examine the robustness of the results including bootstrap sampling.Results: We included 41 children (44% female; mean age 9.8 years, standard deviation (SD) 3.7 years). Total societal costs of the baseline period (T1) were on average €3,238 per patient, whereas after intervention (T2) this reduced to 2,463 (saving €775). The QALYs were similar between both periods (mean QALY 0.90 per participant, SD at T1 0.10, SD at T2 0.13). At a ceiling ratio of €50.000, NightWatch showed a 72% cost-effective probability. Univariate sensitivity analyses, on the perspective and imputation method, demonstrated result robustness.Conclusion: Our study suggests that NightWatch might be a cost-effective addition to current standard care for children with refractory epilepsy living at home. Further research with an additional target group for a large timeframe may support the findings of this research. [ABSTRACT FROM AUTHOR]

A study analyzes the case of a large Chinese family with X-linked nonsyndromic hearing loss (NSHL) and identifies missense mutations in the PRPS1 gene of the family members. It demonstrates that the mutations cause loss of function in the enzyme phosphoribosyl pyrophosphate (PRPP) synthetase 1, thereby resulting in the X-linked sensorineural deafness, which involves the DFN2 locus.

Purpose: To determine the burden of non-epilepsy drugs on people with epilepsy, using administrative health care data.Methods: The Achmea Health Insurance Database (AHID) contains health claims data from 25 % of the Dutch population. From the AHID, we selected all policyholders with coverage for at least one full calendar year between 2006-2009. We included adults with diagnostic codes for epilepsy and randomly selected two frequency-matched controls per case. We labeled drugs dispensed at least twice per calendar year as chronic and excluded antiseizure medications. We estimated and compared the prevalence of chronic medication use, number of chronic medications used, number of prescriptions dispensed, Rx Risk comorbidity index, and drug burden index (DBI) between people with epilepsy and controls.Results: Non-epilepsy chronic medication use was more frequent in people with epilepsy than controls (67 % versus 59 %, p < 0.001). People with epilepsy had an increased DBI (average 0.19 versus 0.10, p < 0.001), used more chronic medications (median 2 versus 1, p < 0.001) and had more prescriptions dispensed (median 7 versus 3, p < 0.001). The DBI and number of unique chronic medications were higher among older (>60 years) than younger (<60 years) subjects in cases and controls. Non-epilepsy chronic medication use was more prevalent in people with epilepsy across all therapeutic drug classes and most comorbidities measured using the Rx Risk score.Conclusion: Chronic non-epilepsy medication use is more prevalent among people with epilepsy. The medication burden is higher among elderly with epilepsy and could partially explain the lower quality of life of people with epilepsy with comorbidities. [ABSTRACT FROM AUTHOR]

Résumé La dysplasie fibreuse des os est une affection osseuse bénigne rare, congénitale mais non héréditaire, caractérisée par la prolifération médullaire localisée d'un tissu fibreux en remplacement de l'os normal. Elle résulte d'une mutation post-zygotique de GNAS, activatrice de la protéine G. Elle peut entraîner des douleurs osseuses, des déformations et des fractures. La lésion peut être unique (forme monostotique), multiple (formes polyostotiques), ou associée à d'autres atteintes, notamment cutanées et endocriniennes formant alors le syndrome de McCune-Albright (triade associant classiquement dysplasie fibreuse, tâches café-au-lait et puberté précoce). Le diagnostic se fait sur l'imagerie et si nécessaire sur l'examen anatomopathologique associé à la recherche génétique de la mutation de GNAS. Le pronostic est globalement bon dans les formes monostotiques ; les formes polyostotiques peuvent se compliquer de multiples fractures avec en conséquence un handicap fonctionnel. Le traitement repose tout d'abord sur la prise en charge de la douleur ; par ailleurs, diverses études non contrôlées ont montré l'intérêt des bisphosphonates sur les douleurs osseuses mais probablement aussi sur l'amélioration des images radiologiques ; une étude randomisée contre placebo n'a pas démontré l'efficacité des bisphosphonates par voie orale et la voie intraveineuse est à privilégier. D'autres thérapeutiques sont à l'étude (en particulier tocilizumab et dénosumab) mais des études contrôlées sont nécessaires. Une prise en charge endocrinologique est bien sûr nécessaire en cas de syndrome de McCune-Albright, notamment en cas de puberté précoce. Enfin, une prise en charge orthopédique spécialisée sera indispensable pour la prévention et le traitement des complications fracturaires. En conclusion, une prise en charge multidisciplinaire et un suivi rigoureux, validé par l'HAS en 2012, sont indispensables. Abstract Fibrous dysplasia of bone (FD) is a rare congenital but not heritable bone disease, that is characterized by the replacement of normal bone structure with abnormal fibro-osseous connective tissue. This disease is caused by activating mutation of GNAS. FD may cause bone pain, bone deformity and fractures. It can affect one bone (monostotic FD) or multiple bones (polyostotic FD). FD may either occur as an isolated condition or as part of the McCune-Albright syndrome (MAS), which is characterized by the following triad: FD, hyperfunctioning endocrinopathies (mainly peripheral precocious puberty), and/or café-au-lait spots. Diagnosis relies on bone imaging and if necessary on pathological examination on bone biopsy with GNAS mutation search. The prognosis is usually good in monostotic disease; polyostotic diseases can lead to bone pain and fractures with significant disabilities. Treatment starts with the management of pain; moreover, various uncontrolled studies have shown the interest of bisphosphonates on bone pain but probably also on the improvement of radiological images; a randomized placebo-controlled study did not demonstrate the efficacy of oral bisphosphonates so the preferred route is intravenous. Other therapeutics are being studied (in particular Tocilizumab and Denosumab) but controlled studies are needed. Endocrinological management is of course necessary in cases of McCune-Albright syndrome, especially in cases of precocious puberty. Finally, specialized orthopedic care will be essential for the prevention and treatment of fracture complications. [ABSTRACT FROM AUTHOR]

The risk of epileptic seizures seems increased in several systemic autoimmune disorders including systemic lupus erythematosus, type 1 diabetes mellitus, myasthenia gravis, celiac disease, rheumatoid arthritis, Hashimoto's encephalopathy, psoriasis, multiple sclerosis, neuromyelitis optica, and bullous pemphigoid. Immune dysfunction may be partly responsible for this association. Elevated levels of pro-inflammatory cytokines, autoantibodies seen in these autoimmune disorders and antibodies against neuronal antigens may contribute to the etiopathogenesis of seizures and epilepsy associated to immune conditions. Other unknown factors, the effect of different co-morbid conditions of epilepsy as well as shared risk factors such as common etiological factors, environmental triggers, or a common genetic predisposition may also explain the association. We review different autoimmune disorders which may present with co-morbid seizures and discuss possible underlying mechanisms of this co-occurrence focusing on a potential role of immune system dysfunction. [ABSTRACT FROM AUTHOR]

Background: Specific nutrients have been associated with hearing status, but associations between healthful dietary patterns and risk of hearing loss have not been prospectively evaluated.Objective: We sought to prospectively examine the relations between adherence to the Alternate Mediterranean diet (AMED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternative Healthy Eating Index-2010 (AHEI-2010), and risk of hearing loss.Methods: We conducted a longitudinal cohort study (1991-2013) of 81,818 women in the Nurses' Health Study II, aged 27-44 y at baseline. We assessed diet every 4 y with the use of food frequency questionnaires and calculated AMED, DASH, and AHEI-2010 adherence scores. Baseline and updated information from validated biennial questionnaires was used in Cox proportional hazards regression models to examine independent associations between adherence scores and risk of self-reported moderate or worse hearing loss.Results: During >1 million person-years of follow-up, 2306 cases of moderate or worse hearing loss were reported. Higher cumulative average AMED and DASH scores were significantly inversely associated with risk of hearing loss. For women with scores in the highest compared with the lowest quintile, the multivariable-adjusted relative risks (MVRRs) of hearing loss were 0.70 (95% CI: 0.60, 0.82) (P-trend <0.001) for AMED and 0.71 (95% CI: 0.61, 0.83) (P-trend <0.001) for DASH. Higher recent AHEI-2010 score was also associated with lower risk [MVRR = 0.79 (95% CI: 0.69, 0.91); P-trend <0.001]. Among participants with additional hearing-related information (n = 33,102), higher cumulative average adherence scores for all 3 dietary patterns were associated with lower risk; the MVRR was 0.63 (95% CI: 0.49, 0.81) for AMED, 0.64 (95% CI: 0.50, 0.83) for DASH, and 0.71 (95% CI: 0.56, 0.89) for AHEI-2010.Conclusion: Adherence to healthful dietary patterns is associated with lower risk of hearing loss in women. Consuming a healthy diet may be helpful in reducing the risk of acquired hearing loss. [ABSTRACT FROM AUTHOR]

Background Context: The results of meta-analyses are frequently reported, but understanding and interpreting them is difficult for both clinicians and patients. Statistical significances are presented without referring to values that imply clinical relevance.Purpose: This study aimed to use the minimal clinically important difference (MCID) to rate the clinical relevance of a meta-analysis.Study Design: This study is a review of the literature.Patient Sample: This study is a review of meta-analyses relating to a specific topic, clinical results of cervical arthroplasty.Outcome Measure: The outcome measure used in the study was the MCID.Methods: We performed an extensive literature search of a series of meta-analyses evaluating a similar subject as an example. We searched in Pubmed and Embase through August 9, 2016, and found articles concerning meta-analyses of the clinical outcome of cervical arthroplasty compared with that of anterior cervical discectomy with fusion in cases of cervical degenerative disease. We evaluated the analyses for statistical significance and their relation to MCID. MCID was defined based on results in similar patient groups and a similar disease entity reported in the literature.Results: We identified 21 meta-analyses, only one of which referred to MCID. However, the researchers used an inappropriate measurement scale and, therefore, an incorrect MCID. The majority of the conclusions were based on statistical results without mentioning clinical relevance.Conclusions: The majority of the articles we reviewed drew conclusions based on statistical differences instead of clinical relevance. We recommend introducing the concept of MCID while reporting the results of a meta-analysis, as well as mentioning the explicit scale of the analyzed measurement. [ABSTRACT FROM AUTHOR]

Background: Higher intake of certain vitamins may protect against cochlear damage from vascular compromise and oxidative stress, thereby reducing risk of acquired hearing loss, but data are limited. Objective: We prospectively examined the relation between carotenoids, vitamin A, vitamin C, vitamin E, and folate intake and risk of self-reported hearing loss in women. Design: This prospective cohort study followed 65,521 women in the Nurses' Health Study II from 1991 to 2009. Baseline and updated information obtained from validated biennial questionnaires was used in Cox proportional hazards regression models to examine independent associations between nutrient intake and self-reported hearing loss. Results: After 1,084,598 person-years of follow-up, 12,789 cases of incident hearing loss were reported. After multivariable adjustment, we observed modest but statistically significant inverse associations between higher intake of β-carotene and β-cryptoxanthin and risk of hearing loss. In comparison with women in the lowest quintile of intake, the multivariable-adjusted RR of hearing loss among women in the highest quintile was 0.88 (95% CI: 0.81, 0.94; P-trend < 0.001) for β-carotene and 0.90 (95% CI: 0.84, 0.96; P-trend < 0.001) for β-cryptoxanthin. In comparison with women with folate intake 200-399 µg/d, very low folate intake (<200 µg/d) was associated with higher risk (RR: 1.19; 95% CI: 1.01, 1.41), and higher intake tended to be associated with lower risk (P-trend = 0.04). No significant associations were observed for intakes of other carotenoids or vitamin A. Higher vitamin C intake was associated with higher risk; in comparison with women with intake <75 mg/d, the RR among women with vitamin C intake ≥1000 mg/d (mainly supplemental) was 1.22 (95% CI: 1.06, 1.42; P-trend = 0.02). There was no significant trend between intake of vitamin E intake and risk. Conclusion: Higher intakes of β-carotene, β-cryptoxanthin, and folate, whether total or from diet, are associated with lower risk of hearing loss, whereas higher vitamin C intake is associated with higher risk. [ABSTRACT FROM AUTHOR]

Background: Acquired hearing loss is common and often disabling, yet limited prospective data exist on potentially modifiable risk factors. Evidence suggests that higher intake of fish and long-chain omega-3 (n23) polyunsaturated fatty acids (PUFAs) may be associated with a lower risk of hearing loss, but prospective information on these relations is limited. Objective: We prospectively examined the independent associations between consumption of total and specific types of fish, long-chain omega-3 PUFAs, and self-reported hearing loss in women. Design: Data were from the Nurses' Health Study II, a prospective cohort study. The independent associations between consumption of fish and long-chain omega-3 PUFAs and self-reported hearing loss were examined in 65,215 women followed from 1991 to 2009. Baseline and updated information was obtained from validated biennial questionnaires. Cox proportional hazards regression models were used to estimate multivariable-adjusted RRs and 95% CIs. Results: After 1,038,093 person-years of follow-up, 11,606 cases of incident hearing loss were reported. Consumption of 2 or more servings of fish per week was associated with a lower risk of hearing loss. In comparison with women who rarely consumed fish (<1 serving/mo), the multivariable-adjusted RR for hearing loss among women who consumed 2-4 servings of fish per week was 0.80 (95% CI: 0.74, 0.88) (P-trend < 0.001). When examined individually, higher consumption of each specific fish type was inversely associated with risk (P-trend ≤ 0.04). Higher intake of long-chain omega-3 PUFAs was also inversely associated with risk of hearing loss. In comparison with women in the lowest quintile of intake of long-chain omega-3 PUFAs, the multivariable-adjusted RR for hearing loss among women in the highest quintile was 0.85 (95% CI: 0.80, 0.91) and among women in the highest decile was 0.78 (95% CI: 0.72, 0.85) (P-trend < 0.001). Conclusion: Regular fish consumption and higher intake of long-chain omega-3 PUFAs are associated with lower risk of hearing loss in women. [ABSTRACT FROM AUTHOR]

Abstract: Microbial electrolysis cells (MECs) can be used to simultaneously convert wastewater organics to hydrogen and precipitate struvite, but scale formation at the cathode surface can block catalytic active sites and limit extended operation. To promote bulk phase struvite precipitation and minimize cathode scaling, a two-chamber MEC was designed with a fluidized bed to produce suspended particles and inhibit scale formation on the cathode surface. MEC operation elevated the cathode pH to between 8.3 and 8.7 under continuous flow conditions. Soluble phosphorus removal using digester effluent ranged from 70 to 85% with current generation, compared to 10–20% for the control (open circuit conditions). At low current densities (≤2 mA/m2), scouring of the cathode by fluidized particles prevented scale accumulation over a period of 8 days. There was nearly identical removal of soluble phosphorus and magnesium from solution, and an equimolar composition in the collected solids, supporting phosphorus removal by struvite formation. At an applied voltage of 1.0 V, energy consumption from the power supply and pumping (0.2 Wh/L, 7.5 Wh/g-P) was significantly less than that needed by other struvite formation methods based on pH adjustment such as aeration and NaOH addition. In the anode chamber, current generation led to COD oxidation (1.1–2.1 g-COD/L-d) and ammonium removal (7–12 mM) from digestate amended with 1 g/L of sodium acetate. These results indicate that a fluidized bed cathode MEC is a promising method of sustainable electrochemical nutrient and energy recovery method for nutrient rich wastewaters. [Copyright &y& Elsevier]

Abstract: Aim of the study: To assess differences in patient satisfaction between a complaints procedure designed towards the needs of complainants (referred to here as the ‘Committee’) and a procedure that primarily aims at improving the professional quality of health care (referred to here as the ‘Board’). Method: Patients' experiences and satisfaction were assessed through a questionnaire completed by 80 patients complaining to a Board and 335 to a complaints Committee. Only complainants with a complaint that was judged to be founded or partially founded were included. Results: Only half of the complainants reported being satisfied with the procedure they underwent. After controlling for differences in respondent characteristics, satisfaction with the Board was higher than with the Committee. The level of variance explained, however, was low (3%). The majority of respondents reported favourably on procedural aspects, for example, the impartiality of the procedure, and empathy demonstrated for their situation. Only a minority of complainants in both procedures believed that changes would be made as a result of their complaint. Discussion: The absence, in the eyes of most complainants, of tangible results of filing a complaint in both rather formal procedures may serve as an explanation for both the low level of overall satisfaction and the fact that the procedure which was developed specifically for patients did not perform better. To resolve the problem of low satisfaction with complaints handling, procedures should be developed that offer a basic degree of procedural safety. But this procedural safety should not stand in the way of what complainants really want: changes for the better. [Copyright &y& Elsevier]

Abstract: Microbial electrolysis cells (MECs) can be used to treat wastewater and produce hydrogen gas, but low cost cathode catalysts are needed to make this approach economical. Molybdenum disulfide (MoS2) and stainless steel (SS) were evaluated as alternative cathode catalysts to platinum (Pt) in terms of treatment efficiency and energy recovery using actual wastewaters. Two different types of wastewaters were examined, a methanol-rich industrial (IN) wastewater and a food processing (FP) wastewater. The use of the MoS2 catalyst generally resulted in better performance than the SS cathodes for both wastewaters, although the use of the Pt catalyst provided the best performance in terms of biogas production, current density, and TCOD removal. Overall, the wastewater composition was more of a factor than catalyst type for accomplishing overall treatment. The IN wastewater had higher biogas production rates (0.8–1.8 m3/m3-d), and COD removal rates (1.8–2.8 kg-COD/m3-d) than the FP wastewater. The overall energy recoveries were positive for the IN wastewater (3.1–3.8 kWh/kg-COD removed), while the FP wastewater required a net energy input of −0.7–−1.2 kWh/kg-COD using MoS2 or Pt cathodes, and −3.1 kWh/kg-COD with SS. These results suggest that MoS2 is the most suitable alternative to Pt as a cathode catalyst for wastewater treatment using MECs, but that net energy recovery will be highly dependent on the specific wastewater. [Copyright &y& Elsevier]

Abstract: An energy efficient method of concurrent hydrogen gas and struvite (MgNH4PO4·6H2O) production was investigated based on bioelectrochemically driven struvite crystallization at the cathode of a single chamber microbial electrolysis struvite-precipitation cell (MESC). The MESC cathodes were either stainless steel 304 mesh or flat plates. Phosphate removal ranged from 20% to 40%, with higher removals obtained using mesh cathodes than with flat plates. Cathode accumulated crystals were verified as struvite using a scanning electron microscope capable of energy dispersive spectroscopy (SEM–EDS). Crystal accumulation did not affect the rate of hydrogen production in struvite reactors. The rate of struvite crystallization (g/m2-h) and hydrogen production (m3/m3-d) were shown to be dependent on applied voltage and cathode material. Overall energy efficiencies (substrate and electricity) were high (73±4%) and not dependent on applied voltage. These results show that MESCs may be useful both as a method for hydrogen gas and struvite production. [Copyright &y& Elsevier]

Abstract: Microbial fuel (MFCs) and electrolysis cells (MECs) can be used to recover energy directly as electricity or hydrogen from organic matter. Organic removal efficiencies and values of the different energy products were compared for MFCs and MECs fed winery or domestic wastewater. TCOD removal (%) and energy recoveries (kWh/kg-COD) were higher for MFCs than MECs with both wastewaters. At a cost of $4.51/kg-H2 for winery wastewater and $3.01/kg-H2 for domestic wastewater, the hydrogen produced using MECs cost less than the estimated merchant value of hydrogen ($6/kg-H2). 16S rRNA clone libraries indicated the predominance of Geobacter species in anodic microbial communities in MECs for both wastewaters, suggesting low current densities were the result of substrate limitations. The results of this study show that energy recovery and organic removal from wastewater are more effective with MFCs than MECs, but that hydrogen production from wastewater fed MECs can be cost effective. [ABSTRACT FROM AUTHOR]

Abstract: Cervical artificial discs are frequently implanted. Clinical data are frequently presented. However, biomechanical data are scarce. The literature is extensively reviewed following general rules for systemic review. The manufacturers of cervical artificial discs are requested for information. Only 10 articles were suitable for review. Together with some information of the manufacturer, data of 5 out of 8 discs can be provided. Comparison is not possible since testing methods differ. Before introduction of a new device biomechanical data should be provided. This should be done after standardized testing and presentation of the results. Only then comparison is possible as is a responsible choice for our patients. [Copyright &y& Elsevier]

Smoking during pregnancy may lead to low birthweight and behavioral alterations in the offspring. In this study, the effects of developmental nicotine exposure on the somatic growth of the offspring and the behavioral performance in the open-field test were examined. Sprague–Dawley female rats were implanted with nicotine (35 mg for 21-day time release; NIC 35) or placebo pellets on gestational day (GD) 8 (postblastocyst implantation). A normal control group with no pellet implant was also included. There was a significantly higher maternal weight gain in the placebo group possibly due to a larger litter size. However, there were no significant differences in body weights among all three treatment groups for male and female offspring. The amount of activity, measured by the total number of crossings in the open-field test, indicated a gender difference in baseline level and pattern of ambulatory activity, with less activity (lower number of crossings) in male offspring and an increase in the activity of the female offspring as a function of testing day. The increase in the ambulatory activity of the female offspring was observed in the placebo and normal, but not the NIC 35 group suggesting that developmental nicotine exposure interferes with open-field activity, and this behavioral alteration is gender related. [Copyright &y& Elsevier]

The compound 3β-(4′-chlorophenyl)-2β-(3′-phenylisoxazol-5′-yl)tropane (CPPIT or RTI 177) is a 2β-heterocyclic substituted cocaine congener with high in vitro selectivity and affinity for the dopamine transporter relative to serotonin and norepinephrine transporters. The aim of the present study was to evaluate the in vivo selectivity of [11C]-β-CPPIT and to determine whether [11C]-β-CPPIT may be a suitable alternative to existing DAT PET radioligands. [11C]-β-CPPIT was prepared by N-alkylation of the free amine with [11C]methyl iodide. In mouse brain, the striatal binding of [11C]-β-CPPIT was reduced significantly by preinjecting the dopamine reuptake antagonist GBR 12909 (5 mg/kg). By contrast, radioactivity uptake in the brain was not affected significantly by the preinjection of citalopram (5 mg/kg) and desipramine (5 mg/kg), inhibitors for the serotonin and norepinephrine transporters, respectively. No effect was also observed by pretreatment with ketanserin (2.5 mg/kg) a compound with high affinity for the 5-HT2A-receptor and the vesicular monoamine transporter. In a PET study with six healthy volunteers high striatal uptake was observed. The distribution pattern of [11C]-β-CPPIT was similar to the known distribution of the dopamine transporter in the human brain. Compared to 123I labeled β-CIT, the rate of metabolic degradation of [11C]-β-CPPIT was almost twofold slower suggesting that bioisosteric heterocyclic substitution of the ester group at the 2β-position of the tropane ring does have an influence on the rate of metabolism of [11C]-β-CPPIT. The rank order of the distribution volumes obtained via the one-tissue compartment model is also similar to the reported distribution of DAT. These preliminary results suggest that [11C]-β-CPPIT may be a useful PET radioligand for the visualization and quantification of dopamine transporters in man. [Copyright &y& Elsevier]

An expert committee was formed to reach consensus on the use of Tilt Table Testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous ones. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to perform (1) additional provocation tests, such as the active standing test carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, NIRS, end-tidal CO 2 or neuro-endocrine tests; (3) tailor-made provocation procedures in those with a specific and consistent trigger of TLOC. TTT and other provocative cardiovascular autonomic tests are indicated if the initial evaluation does not yield a definite or highly likely diagnosis, but raises a suspicion of (1) reflex syncope, (2) the three forms of orthostatic hypotension (OH), i.e. initial, classic and delayed OH, as well as delayed orthostatic blood pressure recovery, (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT is to teach patients with reflex syncope and OH to recognise hypotensive symptoms and to perform physical counter manoeuvres. [ABSTRACT FROM AUTHOR]

Bioelectrochemical sensor (BES) technologies have been developed to measure soluble carbon concentrations in wastewater. However, architectures and analytical methods developed in controlled laboratory environments fail to predict BES behavior during field deployments at water resource recovery facilities (WRRFs). Here, we examine the possibilities and obstacles associated with integrating BESs into environmental sensing networks and machine learning algorithms to monitor the biodegradable carbon dynamics and microbial metabolism at WRRFs. This approach highlights the potential of BESs to provide real-time insights into full-scale biodegradable carbon consumption across WRRFs. [Display omitted] • Bioelectrochemical sensor architectures can enable precise carbon monitoring. • Carbon monitoring sensitivity and anode-respiring biofilm stability exhibit a tradeoff. • WRRFs can integrate BES and ML methods to overcome carbon monitoring limitations. [ABSTRACT FROM AUTHOR]

An abstract of the article "Production Control I: The Key to Profits," by D. A. Roland and colleagues is presented.

To reduce intra-plant nutrient cycling, and recover phosphorus (P) fertilizers from nutrient-rich sidestreams, wastewater utilities increasingly elect to employ struvite precipitation processes without a clear understanding of the inherent tradeoffs associated with specific design and operating decisions. Specifically, the impact of reactor conditions on struvite crystallization rate, and distribution between formation of fines particles and secondary growth onto large diameter seed crystals represent critical knowledge gaps limiting the predictive capabilities of existing process models. In this work, the relative impacts of initial supersaturation (S i ), and seed loading, on P removal kinetics, and struvite solids distribution were investigated. In experiments conducted at different levels of initial supersaturation (1.7–2.4) and seed loading (0–25 g L −1 ), struvite fines represented the majority of phosphate solids formed in 10 of 12 conditions. While total P removal was dependent on S i , and primarily attributed to formation of fines, the concentration of struvite seed granules had a significant impact on the rate of P removal. Struvite seed granules increased the rate of precipitation by reducing induction time of primary nucleation of struvite fines. Secondary crystal growth represented the majority of struvite solids formed at high seed loading and low S i , but presented the tradeoff of low total removal and low rate of removal. To convey the significance of these findings on process modeling, we show how a prominent kinetic model with a first-order dependency on solid struvite concentration over-predicts P removal rate when total mass is dominated by large diameter seeds (0.9 mm). This works reveals the critical role of struvite fines in P removal, and highlights the need to account for their production and kinetic importance in struvite process design and operation. [ABSTRACT FROM AUTHOR]

Objectives: Music-induced hearing loss (MIHL), an unconsciously self-inflicted public health concern, could evolve into an epidemic because of the appeal of loud music. After media attention about a previous hearing-loss survey with Music Television (MTV.com), we hypothesized that a repeat survey could compare awareness and behavior trends. Study design: We incorporated the 2002 survey into the new 73-question instrument presented to random visitors on the MTV.com website in 2007. A P < .05 value was used for independent t and z- tests. Results: A total of 2500 completed surveys were analyzed. Hearing loss was considered a problem by 32% of respondents compared with other health issues such as drug/alcohol use (62%). However, nearly half of the respondents admitted experiencing symptoms such as tinnitus or hearing loss after loud music exposure. Health care providers were the least likely source of MIHL awareness despite the respondents favoring provider education for hearing protection behavior modification. Conclusion: Most respondents still could not recall learning about prevention of potential hearing loss, although the media has become the most informative source. Most respondents indicated that they would adopt protective ear behavior if made aware of hearing loss risk, especially if informed by health care professionals, revealing an educational opportunity. [Copyright &y& Elsevier]