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Background: Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address the significant socioeconomic and societal challenge related to the transition process. This protocol paper describes the development of two MILESTONE transition-related measures: The Transition Readiness and Appropriateness Measure (TRAM), designed to be a decision-making aide for clinicians, and the Transition Related Outcome Measure (TROM), for examining the outcome of transition.Methods: The TRAM and TROM have been developed and were validated following the US FDA Guidance for Patient-reported Outcome Measures which follows an incremental stepwise framework. The study gathers information from service users, parents, families and mental health care professionals who have experience working with young people undergoing the transition process from eight European countries.Discussion: There is an urgent need for comprehensive measures that can assess transition across the CAMHS/AMHS boundary. This study protocol describes the process of development of two new transition measures: the TRAM and TROM. The TRAM has the potential to nurture better transitions as the findings can be summarised and provided to clinicians as a clinician-decision making support tool for identifying cases who need to transition and the TROM can be used to examine the outcomes of the transition process.Trial Registration: MILESTONE study registration: ISRCTN83240263 Registered 23-July-2015 - ClinicalTrials.gov NCT03013595 Registered 6 January 2017. [ABSTRACT FROM AUTHOR]

The development of a second malignancy after the diagnosis of childhood acute lymphoblastic leukemia (ALL) is a rare event. Certain second malignancies have been linked with specific elements of leukemia therapy, yet the etiology of most second neoplasms remains obscure and their optimal management strategies are unclear. This is a first comprehensive report of non-Hodgkin lymphomas (NHLs) following pediatric ALL therapy, excluding stem-cell transplantation. We analyzed data of patients who developed NHL following ALL diagnosis and were enrolled in 12 collaborative pediatric ALL trials between 1980-2018. Eighty-five patients developed NHL, with mature B-cell lymphoproliferations as the dominant subtype (56 of 85 cases). Forty-six of these 56 cases (82%) occurred during or within 6 months of maintenance therapy. The majority exhibited histopathological characteristics associated with immunodeficiency (65%), predominantly evidence of Epstein-Barr virus-driven lymphoproliferation. We investigated 66 cases of post-ALL immunodeficiency-associated lymphoid neoplasms, 52 from our study and 14 additional cases from a literature search. With a median follow-up of 4.9 years, the 5-year overall survival for the 66 patients with immunodeficiency-associated lymphoid neoplasms was 67.4% (95% confidence interval [CI], 56-81). Five-year cumulative risks of lymphoid neoplasm- and leukemia-related mortality were 20% (95% CI, 10.2-30) and 12.4% (95% CI, 2.7-22), respectively. Concurrent hemophagocytic lymphohistiocytosis was associated with increased mortality (hazard ratio, 7.32; 95% CI, 1.62-32.98; P = .01). A large proportion of post-ALL lymphoid neoplasms are associated with an immunodeficient state, likely precipitated by ALL maintenance therapy. Awareness of this underrecognized entity and pertinent diagnostic tests are crucial for early diagnosis and optimal therapy., (© 2023 by The American Society of Hematology.)

Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports., Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at., Findings to Date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be 'markedly ill', 'severely ill' or 'among the most extremely ill' by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year., Future Plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared., Trial Registration Number: NCT03013595., Competing Interests: Competing interests: SPS is part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West Midlands (NIHR CLAHRC WM), now recommissioned as NIHR Applied Research Collaboration West Midlands. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. PS is the co-inventor of the HealthTrackerTM and is the Chief Executive Officer and shareholder in HealthTracker Ltd. FF is a Chief Technical Officer and AK is the Chief Finance Officer employed by HealthTracker Ltd respectively. FCV publishes the Dutch translations of ASEBA, from which he receives remuneration. AM was a speaker and advisor for Neurim, Shire, Infectopharm and Lilly (all not related to transition research)., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Although 70% of autistic children and young people meet criteria for co-occurring psychiatric conditions, there are few screening measures specifically for autistic individuals. We describe the development and validation of the Assessment of Concerning Behavior (ACB), an instrument co-developed with the autistic community to assess mental health and problematic/risky behaviors. Items include descriptions to facilitate symptom recognition by autistic people, and carers/professionals. The ACB was completed by 255 parents, 149 autistic children and young people and 30 teachers. Internal consistency, stability and validity was assessed. The ACB parent-version fit a two-factor model (internalizing and externalizing problems) and showed adequate test-retest reliability, internal consistency and construct validity. The ACB is a promising new measure for research and clinical use in autism.

Microcosm and field investigation were conducted to examine the effects of heavy metals on the decomposition and accumulation of organic carbon in contaminated Mersey estuarine floodplain, northwest England. The results show that inhibition of microbially mediated decomposition of organic matter occurred in the water-inundated soils. However, individual heavy metals had differential effects on the inhibition of soil organic matter decomposition with arsenic and copper being much stronger, as compared to other investigated heavy metals. The weak inhibitory effects of chromium on organic matter decomposition was due to the conversion of highly toxic Cr(VI) to less toxic Cr(III) under reducing conditions. Lead also had a weaker capacity to inhibit organic matter decomposition due to its low solubility. It was surprising that the same phenomenon was not clearly observed during the field examination. The inhibitory effects of heavy metals on soil organic matter decomposition could be curtained under field conditions. pH, Eh and EC played more important roles, as compared to soil-borne heavy metals, in affecting the soil carbon dynamics in the contaminated Mersey estuarine floodplain., (Copyright © 2020. Published by Elsevier B.V.)

Objective: Young people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16-18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person's readiness for transition, and their outcomes at the transfer boundary., Design: MILESTONE prospective study., Setting: Eight European Union (EU) countries participating in the EU-funded MILESTONE study., Participants: The first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people., Results: The development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported., Conclusion: The TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person., Trial Registration Number: ISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results., Competing Interests: Competing interests: PS is the co-inventor of the HealthTracker and is the Chief Executive Officer and shareholder in HealthTracker. FF is a Chief Technical Officer and KL is a Project Manager employed by HealthTracker. FV is the Dutch distributor of ASEBA from which he receives remuneration. SPS is part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care WM (NIHR CLAHRC WM)., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Batch experiments were conducted using two biochar materials produced from different feedstocks to examine the behavior of solution-borne nitrate in the presence and absence of three model low-molecular weight organic acids (LMWOAs). The results showed that the biochar materials alone were not able to remove the solution-borne nitrate. LMWOAs caused protonation of the biochar surfaces and consequently enabled the biochar materials to adsorb nitrate from the solution. Different types of LMWOA had different capacities to immobilize solution-borne nitrate. Over 80% of the solution-borne nitrate could be removed within 72 h in the presence of citric acid or malic acid. By comparison, removal rate of nitrate was lower in the presence of oxalic acid, possibly due to competition of oxalate ion with nitrate for the available adsorption sites on the biochar surfaces. Nitrate adsorption onto the MSP700 biochar in the presence of all three-LMWOAs followed first order and second order kinetics, suggesting that the immobilization of nitrate involved complex interplay of physisorption and chemisorption. Nitrate adsorption onto RH700 biochar in citric and malic acid treatment systems followed second order kinetics. In the presence of oxalic acid for both biochar materials, nitrate adsorption showed perfect correlation R 2  = 1 for both models., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The effects of softwood-derived biochar materials on the chemical behaviour of environmental contaminants in soils were examined in two microcosm scenarios. Addition of the biochar materials into an alkaline sandy soil significantly reduced NH 3 volatilization and made it available for conversion into NO 3 - via nitrification. This process could be enhanced by an increased application rate of biochar produced at a higher pyrolysis temperature. Under the alkaline conditions encountered in the experiment, the biochar surfaces tended to be negatively charged which disfavours the adsorption of NO 3 - . Therefore, in a fully open system, the addition of biochar materials was likely to contribute to nitrate leaching from the fertilized alkaline sandy soil. The effects of the biochar materials on the immobilization of Fe 2+ generated via anaerobic iron reduction in the inundated contaminated soil were not observed, except for the treatment with a higher dose of biochar material produced under pyrolysis temperature at 700 °C after the 240th h of incubation. Arsenic showed similar behaviour to Fe. Zn tended to have a higher affinity to the biochar, as compared to Mn. Immobilization of Pb occurred regardless of whether or not the biochar is present., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Biochar materials originated from sewage sludge may contain elevated levels of potentially toxic elements. There was a lack of information on the mobility of biochar-borne elements, as driven by low-molecular-weight organic acids (LMWOAs) contained in plant root exudates. A batch experiment was conducted to examine the effects of three common LMWOAs on the release of major elements and trace elements with a focus on various potentially toxic trace elements. The results showed that substantial amounts of Al, Mn, Fe, K, Na and Mg were extracted from two sewage sludge-derived biochar materials by the LMWOAs. A much higher release rate of potentially toxic trace elements was observed in the presence of LMWOAs, as compared to reported data using extractants not encountered in root exudates. The LMWOA-driven releasibility of various potentially toxic trace elements was in the following decreasing order: Zn > Ni > Pb > Cu > Cr >Co = Cd. Other trace elements that are subject to mobilization in the presence of LMWOAs included B, Ba, In, Li and Sr except Ba under oxalic acid extraction. Among the three LMWOAs, oxalic acid showed a generally stronger capacity to mobilize these metals. The findings obtained from this study provides new information that can be used for better evaluating the phyto-availability of trace elements bound to sewage sludge-originated biochar materials., (Copyright © 2018 Elsevier Inc. All rights reserved.)

A batch experiment was conducted to examine the effects of biochar on the behaviour of soil-borne arsenic and metals that were mobilized by three low-molecular-weight organic acids. In the presence of citric acid, oxalic acid and malic acid at a molar concentration of 0.01M, the surface of biochar was protonated, which disfavours adsorption of the cationic metals released from the soil by organic acid-driven mobilization. In contrast, the oxyanionic As species were re-immobilized by the protonated biochar effectively. Biochar could also immobilize oxyanionic Cr species but not cationic Cr species. The addition of biochar increased the level of metals in the solution due to the release of the biochar-borne metals under attack by LMWOAs via cation exchange. Biochar could also have the potential to enhance reductive dissolution of iron and manganese oxides in the soil, leading to enhanced release of trace elements bound to these oxides. The findings obtained from this study have implications for evaluating the role of biochar in immobilizing trace elements in rhizosphere. Adsorption of cationic heavy metals on biochar in the presence of LMWOAs is unlikely to be a mechanism responsible for the impeded uptake of heavy metals by plants growing in heavy metal-contaminated soils., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Chronic myeloid leukaemia is a relatively rare condition, though it has stimulated widespread interest as a consequence of both the stem cell basis and the success of rationally designed therapies. This review will outline some of the issues involving the aetiology of the disease and how this relates to current and future therapies.

A gram-negative bacillus was isolated from a batch of fruit-flavored bottled water, which had spoiled as a result of bacterial overgrowth (>10(6) CFU/ml). The spoilage organism was extremely difficult to identify phenotypically and was poorly identified as Pasturella sp. (78.7% identification profile) employing the API 20NE identification scheme, which gave the profile 5040000. Molecular identification through PCR amplification of a partial region of the 16S rRNA gene followed by direct automated sequencing of the PCR amplicon allowed identification of the organism. Due to the sequence identity (100%) between the spoilage organism and a reference strain in GenBank, the spoilage isolate was considered to be an Asaia sp., a recently described genus and member of the acetic acid bacteria. This is the first report of Asaia sp. causing spoilage of a foodstuff and highlights the benefits of molecular identification techniques based on 16S rRNA gene sequences in the identification of unusual spoilage organisms.

Pseudomonas aeruginosa remains an important agent of opportunistic infection in patients, particularly those with respiratory complications and burns. One natural niche of this organism is water and water-associated facilities, hence the aim of this study was to examine specimens from recreational and hydrotherapy pools in Northern Ireland over a two-year period. Water specimens (n = 3,510) were obtained from three amenity categories, namely, 13 hydrotherapy pools (specimen number [n] = 323), 51 Jacuzzis/spas (n = 1,397) and 68 swimming pools (n = 1,790). Specimens (100 ml) were filtered through a cellulose acetate (0.45 micron pore size) gridded filter and the membrane was placed on Pseudomonas CFC agar (Oxoid CM559 + SR103) and incubated at 37 degrees C for 48 +/- 2 h. Colonies that clearly showed pyocyanin production or met other identification criteria were considered P. aeruginosa. Of the amenities examined 4/13 hydrotherapy pools (30.8%), 37/51 Jacuzzis/spas (72.5%) and 26/68 swimming pools (38.2%) were positive for P. aeruginosa. The most heavily contaminated amenity category was the Jacuzzi/spa, where 34.7% and 12% of private and public sites respectively were positive for P. aeruginosa at a level of greater than 1,000 cfu 100 ml-1. Approximately twice as many samples were positive in private Jacuzzis/spas compared to publicly operated facilities. There was a similar trend with respect to public and private hydrotherapy pools, though bacterial counts did not exceed 1,000 cfu 100 ml-1. Recreational and therapeutic amenities involving the use of water may be a potential source of P. aeruginosa for susceptible patient groups, including patients with cystic fibrosis and bronchiectasis. This may vary depending on amenity type and public/private ownership of such amenities.

Although operation frequently is carried out in cases of excessive uterine bleeding of benign origin, particularly if fibrous tumor is present, in many cases major surgical intervention could be averted by adequate conservative therapy. The authors have given Ergotrate(R) over long periods with good results in many cases and have noted no severe side effects. If this therapy fails, diagnostic dilatation and curettement sometimes reveals and removes the cause of bleeding. If infection is a factor, use of sulfonamides or antibiotics sometimes has dramatic effect.