Options for closing the phosphorus cycle in agriculture : assessment of options for Northwest Europe and the Netherlands

This study assessed which options are available for closing the feed-manure phosphorus cycle in agriculture and their contribution to the reduction of the P surplus and P use efficiency. This was assessed at a national scale for the Netherlands as well as a regional scale for Northwest Europe. No export of animal products, with as a consequence the reduction in livestock numbers, is most effective in reducing external P inputs. An effective option that is easier to implement is the reduction in P excretion through changes in the feed intake. For Nortwest Europe the combination of all five options can lead to a reduction of external P inputs of about 50%. For the Netherlands the combination of the options result in a reduction in external P inputs of 35% and a reduction of the manure export of 26%. The effectiveness of large scale manure treatment in the Netherlands is limite

HUMeral Shaft Fractures: MEasuring Recovery after Operative versus Non-operative Treatment (HUMMER): A multicenter comparative observational study

Background: Fractures of the humeral shaft are associated with a profound temporary (and in the elderly sometimes even permanent) impairment of independence and quality of life. These fractures can be treated operatively or non-operatively, but the optimal tailored treatment is an unresolved problem. As no high-quality comparative randomized or observational studies are available, a recent Cochrane review concluded there is no evidence of sufficient scientific quality available to inform the decision to operate or not. Since randomized controlled trials for this injury have shown feasibility issues, this study is designed to provide the best achievable evidence to answer this unresolved problem. The primary aim of this study is to evaluate functional recovery after operative versus non-operative treatment in adult patients who sustained a humeral shaft fracture. Secondary aims include the effect of treatment on pain, complications, generic health-related quality of life, time to resumption of activities of daily living and work, and cost-effectiveness. The main hypothesis is that operative treatment will result in faster recovery. Methods/design. The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, AO type 12A or 12B. Treatment decision (i.e., operative or non-operative) will be left to the discretion of the treating surgeon. Critical elements of treatment will be registered and outcome will be monitored at regular intervals over the subsequent 12 months. The primary outcome measure is the Disabilities of the Arm, Shoulder, and Hand score. Secondary outcome measures are the Constant score, pain level at both sides, range of motion of the elbow and shoulder joint at both sides, radiographic healing, rate of complications and (secondary) interventions, health-related quality of life (Short-Form 36 and EuroQol-5D), time to resumption of ADL/work, and cost-effectiveness. Data will be analyzed using univariate and multivariable analyses (including mixed effects regression analysis). The cost-effectiveness analysis will be performed from a societal perspective. Discussion. Successful completion of this trial will provide evidence on the effectiveness of operative versus non-operative treatment of patients with a humeral shaft fracture. Trial registration. The trial is registered at the Netherlands Trial Register (NTR3617)

Reliability and Reproducibility of the OTA/AO Classification for Humeral Shaft Fractures

Objectives: This study aimed to determine interobserver reliability and intraobserver reproducibility of the OTA/AO classification for humeral shaft fractures, and to evaluate differences between fracture types, fracture groups, and surgical specializations. Methods: Thirty observers (25 orthopaedic trauma surgeons and 5 general orthopaedic surgeons) independently classified 90 humeral shaft fractures according to the OTA/AO classification. Patients of 16 years and older were included. Periprosthetic, recurrent, and pathological fractures were excluded. Radiographs were provided in random order, and observers were blinded to clinical information. To determine intraobserver agreement, radiographs were reviewed again after 2 months in a different random order. Agreement was assessed using kappa statistics. Results: Interobserver agreement for the 3 fracture types was moderate (κ = 0.60; 0.59-0.61). It was substantial for type A (κ = 0.77; 0.70-0.84) and moderate for type B (κ = 0.52; 0.46-0.58) and type C fractures (κ = 0.46; 0.42-0.50). Interobserver agreement for the 9 fracture groups was moderate (κ = 0.48; 95% CI, 0.48-0.48). Orthopaedic trauma surgeons had better overall agreement for fracture types, and general orthopaedic surgeons had better overall agreement for fracture groups. Observers classified 64% of fractures identically in both rounds. Intraobserver agreement was substantial for the 3 types (κ = 0.80; 0.77-0.81) and 9 groups (κ = 0.80; 0.77-0.82). Intraobserver agreement showed no differences between surgical disciplines. Conclusions: The OTA/AO classification for humeral shaft fractures has a moderate interobserver and substantial intraobserver agreement for fracture types and groups

Phosphorus flows and balances of the European Union Member States

Global society faces serious “phosphorus challenges” given the scarcity, essentiality, unequal global distribution and, at the same time, regional excess of phosphorus (P). Phosphorus flow studies can be used to analyze these challenges, providing insight into how society (re)uses and loses phosphorus, identifying potential solutions. Phosphorus flows were analyzed in detail for EU-27 and its Member States. To quantify food system and non-food flows, country specific data and historical context were considered. The sectors covered were crop production (CP), animal production (AP), food processing (FP), non-food production (NF) and consumption (HC). The results show that the EU-27 imported 2392 Gg P in 2005, half of which accumulated in agricultural soils (924 Gg) and half was lost as waste (1217 Gg). Net accumulation was 4.9 kg P/ha/year ranging between + 23.2 (Belgium) and - 2.8 (Slovakia). From the system losses, 54% was lost from HC in diverse waste flows and 28% from FP, mainly through incinerated slaughter residues. The largest HC losses (655 Gg) were wastewater (55%), food waste (27%), and pet excreta (11%). Phosphorus recycling rates were 73% in AP, 29% in FP, 21% in HC and ~ 0% in NF. The phosphorus use efficiencies showed that, relative to sector input, about 70% was taken up by crops (CP), 24% was retained in animals (AP), 52% was contained in food products (FP), 76% was stored in non-food materials (NF), and 21% was recycled (HC). Although wide-ranging variation between countries, generally phosphorus use in EU-27 was characterized by relatively (1) large dependency on (primary) imports, (2) long-term accumulation in agricultural soils, especially in west European countries, (3) leaky losses throughout entire society, especially emissions to the environment and sequestered waste, (4) little recycling with the exception of manure, and (5) low use efficiencies, because of aforementioned issues, providing ample opportunities for improvement

Potential demand for recoverable resources from Indonesian wastewater and solid waste

Projected population growth and urbanization will become a challenge for finite natural resources, their distribution and local availability. At the same time, 2.5 billion people do not have access to sanitation facilities. Indonesia is one of these rapidly growing countries with a poorly developed municipal wastewater and solid waste sector. Without an integrating concept to recover and reuse resources, "waste flows" are discarded and their potential value is ignored. Therefore, the Indonesian backlog may be an opportunity, since it allows for direct introduction of a circular resource approach. To foster a sustainable municipal wastewater and solid waste management, the 20 years' demand forecast of recoverable resources (phosphorus, compost, duckweed, plastic and paper) was analyzed. Phosphorus, compost and duckweed analysis was based on nutritional demand and not on market demand. Demand for recoverable plastic and paper related to the potential substitution of conventionally manufactured products. Phosphorus and compost demand analysis was based on (1) fertilizer requirements of 68 crops (staple food, horticulture and plantation), and (2) anticipated increase in production area of these crops. Duckweed demand as a protein-rich fish feed was analyzed based on the forecasted demand from aquaculture (tilapia and carp). The potentially recoverable (waste) plastic and paper to substitute conventional manufactured products were based on extrapolation of past trends in plastic and paper production in Indonesia. The potential contribution of recoverable products to the forecasted demand for 2035 was assessed for phosphorus (15%), compost (35%), duckweed (7%), plastic (66%) and paper (18%). A geographical discrepancy between potential recovery and demand location for phosphorus and compost was found. Therefore, the locations of potential markets should be considered in the planning and selection of wastewater and solid waste facilities. The presented methodology to assess the potential demand for recoverable resources from wastewater and solid waste may be applied in other countries as well

Biventricular dysfunction predicts major adverse outcomes in tetralogy of Fallot

Cardiolog