Estimating Environmental Conditions Affecting Protozoal Pathogen Removal in Wetland Systems Using a Multi-Scale, Model-Based Approach

Cryptosporidium parvum, Giardia lamblia, and Toxoplasma gondii are waterborne protozoal pathogens distributed worldwide and empirical evidence suggests that wetlands reduce the concentrations of these pathogens under certain environmental conditions. The goal of this study was to evaluate how protozoal removal in surface water is affected by the water temperature, turbidity, salinity, and vegetation cover of wetlands in the Monterey Bay region of California. To examine how protozoal removal was affected by these environmental factors, we conducted observational experiments at three primary spatial scales: settling columns, re-circulating wetland mesocosm tanks, and an experimental research wetland (Molera Wetland). Simultaneously, we developed a protozoal transport model for surface water to simulate the settling columns, the mesocosm tanks, and the Molera Wetland. With a high degree of uncertainty expected in the model predictions and field observations, we developed the m odel within a Bayesian statistical framework. We found protozoal removal increased when water flowed through vegetation, and with higher levels of turbidity, salinity, and temperature. Protozoal removal in surface water was maximized (~0.1 hr-1) when flowing through emergent vegetation at 2% cover, and with a vegetation contact time of ~ 30 minutes compared to the effects of temperature, salinity, and turbidity. Our studies revealed that an increase in vegetated wetland area, with water moving through vegetation, would likely improve regional water quality through the reduction of fecal protozoal pathogen loads

Does the Addition of Point-of-Care Testing Alter Antibiotic Prescribing Decisions When Patients Present with Acute Sore Throat to Primary Care? A Prospective Test of Change

This is the final version. Available on open access from MDPI via the DOI in this recordData Availability Statement: The data used in this study are not publicly available due to data privacy restrictions on other health-related issues of the participating individuals.Accurate clinical diagnosis of patients presenting to primary care settings with acute sore throat remains challenging, often resulting in the over-prescribing of antibiotics. Using point-of-care tests (POCTs) to differentiate between respiratory infections is well-accepted, yet evidence on the application within primary care is sparse. We assessed the application of testing patients (n = 160) from three family practices with suspected Streptococcal infections using rapid molecular tests (ID NOW Strep A2, Abbott). In addition to comparing clinical evaluation and prescription rates with either usual care or testing, patients and staff completed a questionnaire about their experience of molecular POCT in primary care. The immediate availability of the result was important to patients (100%), and staff (≈90%) stated that molecular testing improved the quality of care. Interestingly, only 22.73% of patients with a Centor score > 2 tested positive for Strep A and, overall, less than 50% of Centor scores 3 and 4 tested positive for Strep A with the ID NOW testing platform. The addition of rapid molecular POCTs to clinical assessment resulted in a 55-65% reduction in immediate and deferred antibiotic prescriptions. The intervention was popular with patients and medical staff but was associated with increased cost and a longer appointment length

Application of two-photon absorption laser induced fluorescence to validate actinometry measurements of absolute atomic oxygen number density based on improved EEDFs obtained from PIC simulations.

Actinometry is a non-invasive optical technique that allows absolute atomic oxygen density determination within a plasma provided certain conditions are met. However, the technique is sensitive to to the accuracy of the Electron Energy Distribution Function (EEDF). A Maxwellian distribution is often used for actinometry calculations, but this is typically just an approximation. A Particle in Cell (PIC) code is used to try and generate a more accurate EEDF to improve the actinometry results. To do this the electron density in the plasma is measured using a hairpin probe and compared to the electron density predicted by the PIC code. The code is adjusted to get a reasonable agreement with the hairpin probe electron densities. The corresponding EEDF from the PIC code is then used in the actinoometry model to calculate the atomic oxygen density in the plasma. The actinometry results are compared to oxygen density measurements made using Two-photon Absorption Laser Induced Fluorescence to validate the actinometry results

Health professionals' perspectives on psychological distress and meeting patients' support needs in rheumatology care settings:A qualitative study

BackgroundPatients with inflammatory rheumatic diseases (IRDs) face challenges including pain, fatigue and disease flares. Evidence suggests their levels of anxiety and depression are higher compared to the general population. Rheumatology teams report psychologically distressed patients have additional support needs and require more clinical time. Little is currently known about models of support and their integration into care pathways.AimTo understand rheumatology health professionals' perspectives on patients' psychological distress and ways to meet support needs.MethodsThe study used a qualitative design, with data collected in telephone semi-structured interviews. Inductive thematic analysis was used to analyse the data.ResultsFifteen interviews were conducted. Two main themes with sub-themes represent the data: Theme 1: ‘No one shoe fits all’—the many manifestations of distress in patients (sub-themes: recognising distress, dealing with distress, dealing with life events alongside an IRD) and Theme 2: ‘If rheumatology could be interwoven with psychological principles’—the need to attend to the psychological impact of IRDs, alongside the physical impact (sub-themes: priority given to physical health, working together to help patients in distress, how should patient distress be measured?, the need for extra time and resources).ConclusionDistress can be obvious or hidden, cause issues for patients and health professionals and lead to poor engagement with care provision. Health professionals described the powerful link between physical and mental distress. This study suggests psychological support provision should be embedded within the rheumatology team and that patients' emotional wellbeing should be given equal priority to their physical wellbeing

Patellar and hamstring autografts are associated with different jump task loading asymmetries after ACL reconstruction

© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd After anterior cruciate ligament reconstruction (ACLR), there is a higher re-injury rate to the contralateral limb in athletes who undergo surgery using a bone-patellar-tendon-bone (BPTB) autograft than using a semitendinosus and gracilis hamstring tendon (HT) autograft. This may be influenced by differing lower-limb loading asymmetries present when athletes of each graft type return to play (RTP). The aim of this study was to compare bilateral countermovement jump (CMJ) phase-specific impulse asymmetries between athletes with BPTB and HT autografts 9 months post-ACLR, and to identify the relationship between impulse and isokinetic strength asymmetries. Male field sport athletes with a BPTB (n = 22) or HT (n = 22) autograft were tested approximately 9 months post-ACLR. An uninjured control group (n = 22) was also tested on a single occasion. Phase-specific bilateral absolute impulse asymmetries were calculated during the CMJ and compared between groups using Kruskal-Wallis and post-hoc testing. A linear regression model was used to assess the relationship between impulse asymmetries and isokinetic concentric knee extensor strength asymmetries. BPTB athletes demonstrated greater impulse asymmetries than HT athletes during the eccentric (P = 0.01) and concentric (P = 0.008) phases of the jump. Isokinetic strength asymmetry was a significant predictor of CMJ concentric impulse asymmetry in both BPTB (r2 = 0.39) and HT athletes (r2 = 0.18) but not eccentric impulse asymmetry in any group. The greater loading asymmetries demonstrated by BPTB than HT athletes 9 months after ACLR may contribute to the differing incidence rates of contralateral ACL injury. The findings suggest that graft-specific loading asymmetries should be targeted during rehabilitation prior to RTP

The effect of autograft type on progression of phase-specific loading asymmetries in the counter-movement jump from six to nine months post-ACLR

Hamstring tendon (HT) and bone-patellar tendon-bone autografts are associated with different strength and jump impulse asymmetries after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate graft-specific effects on changes in isokinetic strength and bilateral countermovement jump (CMJ) phase-specific impulse asymmetries during late-stage rehabilitation post-ACLR. Male athletes (n=44) with either a HT or BPTB autograft completed testing at 6 and 9 months post-surgery. Autograft type did not influence progression of isokinetic strength, eccentric deceleration or concentric impulse asymmetry. Asymmetries in concentric impulse, knee flexor strength and knee extensor strength decreased over the three-month period. Changes in strength asymmetry had little or no ability to explain changes in jump impulse asymmetry

The Value of the Vestibular/Ocular Motor Screening (VOMS) in Evaluating Adolescent Patients with Concussions

OBJECTIVE To determine the VOMS can differentiate between typical and protracted recoveries in adolescent patients

‘It Ain’t What You Do It’s the Way That You Do It’: Lessons for Health Care From Decommissioning of Older People’s Services

Public sector organisations are facing one of the most difficult financial periods in history and local decision-makers are tasked with making tough rationing decisions. Withdrawing or limiting services is an emotive and complex task and something the National Health Service has always found difficult. Over time, local authorities have gained significant experience in the closure of care homes – an equally complex and controversial issue. Drawing on local knowledge and best practice examples, this article highlights lessons and themes identified by those decommissioning care home services. We believe that such lessons are relevant to those making disinvestment decisions across public sector services, including health-care. The study employed semi-structured interviews with 12 Directors of Adult Social Services who had been highlighted nationally as having extensive experience of home closures. Interviews were conducted over a 2-week period in March 2011. Results from the study found that having local policy guidance that is perceived as fair and reasonable was advocated by those involved in home closures. Many local policies had evolved over time and had often been developed following experiences of home closures (both good and bad). Decisions to close care home services require a combination of strong leadership, clear strategic goals, a fair decision-making process, strong evidence of the need for change and good communication, alongside wider stakeholder engagement and support. The current financial challenge means that public sector organisations need to make tough choices on investment and disinvestment decisions. Any such decisions need to be influenced by what we know constitutes best practice. Sharing lessons and experiences within and between sectors could well inform and develop decision-making practices

Cryptosporidium and Giardia in Humans, Domestic Animals, and Village Water Sources in Rural India.

Cryptosporidium parvum and Giardia lamblia are zoonotic enteric protozoa of significant health concern where sanitation, hygiene, and water supplies are inadequate. We examined 85 stool samples from diarrhea patients, 111 pooled fecal samples by species across seven domestic animal types, and water from tube wells (N = 207) and ponds (N = 94) across 60 villages in coastal Odisha, India, for Cryptosporidium oocysts and Giardia cysts to measure occurrence, concentration/shedding, and environmental loading rates. Oocysts/cysts were detected in 12% of diarrhea patients. Detection ranged from 0% to 35% for Cryptosporidium and 0% to 67% for Giardia across animal hosts. Animal loading estimates indicate the greatest contributors of environmental oocysts/cysts in the study region are cattle. Ponds were contaminated with both protozoa (oocysts: 37%, cysts: 74%), as were tube wells (oocysts: 10%, cysts: 14%). Future research should address the public health concern highlighted from these findings and investigate the role of domestic animals in diarrheal disease transmission in this and similar settings