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An increased fertilizer application for agricultural purposes has resulted in increased nitrate (NO3−) levels in surface water and groundwater around the globe, highlighting demand for a low-maintenance NO3− treatment technology that can be applied to nonpoint sources. Ion exchange (IEX) is an effective NO3− treatment technology and research has shown that bioregeneration of NO3− laden resins has the potential to minimize operational requirements and brine waste production that often prevents IEX application for decentralized treatment. In this work, batch denitrification experiments were conducted using solutions with low IEX selectivity capable of supporting the growth of denitrifying bacteria, while minimizing NO3− desorption from resins, encouraging resin-phase denitrification. Although only 15% of NO3− was desorbed by the low selectivity solution, this initial desorption started a cycle in which desorbed NO3− was biologically transformed to NO2−, which further desorbed NO3− that could be biotransformed. Denitrification experiments resulted in a 43% conversion rate of initially adsorbed NO3−, but biotransformations stopped at NO2− due to pH limitations. The balance between adsorption equilibria and biotransformation observed in this work was used to propose a continuous-flow reactor configuration where gradual NO3− desorption might allow for complete denitrification in the short retention times used for IEX systems. HIGHLIGHTS Microorganisms preferentially transformed aqueous-phase NO3−, and no indicators of resin-phase NO3− transformation were observed.; Aqueous- and resin-phase ion concentrations are driven toward an equilibrium state that is dependent on ion selectivities.; The balance between adsorption equilibria and biotransformations is relevant to the implementation of a continuous-flow BIEX reactor.;

Introduction: The World Health Organisation defines paediatric palliative care (PPC) as caring for the child's body, mind, and spirit, and giving support to the family. In life-limiting conditions it is important that palliative support can be provided even when curative attempts are being utilised. In Papua New Guinea, as in other low- and middle-income countries there is a lack of services and training on PPC. This study aims to describe the characteristics of children with palliative care needs and to assess the perspectives of their parents and health care workers., Methods: A descriptive qualitative study was carried out over 5 months in 2022 at the Port Moresby General Hospital children's wards. Clinical information was gathered from the admission charts of children with life threatening and life limiting conditions and a recorded interview was carried out with the children's parents. A focus group interview with 10 experienced nurses caring for these children was video recorded. The recorded interviews were subjected to thematic analysis., Results: Twenty children and their parents were included in this study. Nine had a cancer diagnosis and 11 had a chronic progressive condition. The common clinical characteristics of children with palliative care needs were pain (n = 9) and shortness of breath (n = 9), and most children had more than one symptom. Several themes were identified in the parent interviews. Most parents could not name their child's diagnosis, but they were able to correctly describe their child's condition using their own terms. Most parents felt involved in their child's management and were satisfied with the care provided. Parents were psychologically affected by their child's situation but were hopeful that God and the medicines would heal their child. Ten nurses were involved in a focus-group interview. Most nurses' understanding of palliative care was from experience not from formal training, but most felt confident in identifying the physical, emotional, and spiritual needs of the children. Understanding of analgesia was limited, as was the availability of appropriate medications included in the WHO Analgesic Ladder., Conclusion: There is a need for a systematic approach to palliative care in Papua New Guinea. Palliative care can be integrated into an overall approach to quality of paediatric care. It is relevant to a broad section of children with severe chronic or malignant conditions and can be carried out with limited resources. It does require some resources, further training and education, and increased provision of basic drugs for symptom control., (© 2023. The Author(s).)

Background: The first documented outbreak of dengue which included cases with haemorrhage occurred in Papua New Guinea in 2016., Aim: To document the presentation and outcome of children with dengue in Port Moresby., Methods: This prospective cross-sectional descriptive study was conducted in Port Moresby General Hospital during a 6-month period from 6 January to 6 July 2016. Altogether, 165 children aged 1-14 years who met the WHO criteria for probable dengue were assessed and treated. Clinical features, presence of warning signs and signs of severe dengue, date of onset, management and outcome were recorded. Blood specimens were collected for serological testing and full blood count., Results: The median age was 6 years (interquartile range 3-8). Eighty-eight (53%) children had no warning signs and were managed as outpatients. Of the 165 patients, 42 (25%) had abdominal pain, 28 (17%) had bleeding and 3 (2%) had clinical evidence of fluid accumulation. The median (IQR) lowest platelet count in those tested was 34 × 10 9 /L (22-54). Two children were transfused with packed red blood cells and one received a platelet transfusion. No child developed dengue shock and none died. Non-structural protein 1 (NS1) and dengue IgM were positive in 122/144 (85%) and 36/111 (32%) of blood samples, respectively. 150/151 blood samples tested for dengue were positive on one or more tests., Conclusion: There is the potential for future outbreaks of increased severity in Papua New Guinea. Surveillance, mosquito reduction initiatives and health education programmes are needed to reduce the impact of future outbreaks.