Phosphorus Retention and sorption by constructed wetland soils.

End of Project ReportPhosphorus plays a major role in the eutrophication of freshwater systems. Wetland systems either natural or constructed have an inherent ability to cycle and retain P. Physical, chemical and biological processes regulate P retention in wetland soils and sediments. Of those processes, sorption and precipitation are important in retaining P. Sorption is typically greater under aerobic soil/sediment conditions than anaerobic conditions. Under anaerobic conditions, Fe plays a major role in P dynamics, whereas Al is not affected by changes in redox. Precipitation of P as insoluble Ca bound P is a dominant transformation at high pH. Long-term P retention by wetland systems includes accretion and decomposition of organic and detrital material, and its associated P content. Case studies reviewed illustrated that P retention in natural and constructed wetland systems can vary by several orders of 30 magnitude depending on site-specific factors. The literature reviewed also indicates that using wetlands to retain P from agricultural practices is significant and variable

A Farm Scale integrated constructed wetland to treat farmyard dirty water.

End of Project ReportIn Ireland, the use of constructed wetlands to manage agricultural waters such as farm yard dirty water has been primarily based on an ecosystems approach. Integrated constructed wetlands, which are a design specific approach of conventional surface flow constructed wetlands, were first used in the Anne Valley, Waterford, Ireland (Harrington and Ryder, 2002). At present, 13 farms in the Anne Valley catchment use integrated constructed wetlands to manage farmyard dirty water (Harrington et al., 2004). Fundamental to their design is water quality improvement, landscape fit (designing the wetland into the topography of the landscape) and that the wetland provides an ecological habitat within the agricultural landscape. Typically, integrated constructed wetlands have greater land area requirements than conventional surface flow constructed wetlands in order to provide for these other fundamental ecological services. Few studies (Ryan, 1990) have addressed the issue of quality and quantity of farmyard dirty generated at farm-scales in Ireland. No studies were readily available documenting the effectiveness of a farm-scale constructed or integrated constructed wetland in Ireland to remove nutrients such as phosphorus (P) from dairy farmyard dirty water on a mass basis. To address such, the main objectives of this research were to (i) determine the quality and quantity of farmyard dirty water generated at a farm-scale (ii) determine the effectiveness of three treatment cells of an integrated constructed wetland to treat farmyard dirty, using the difference between input and output mass loadings, (iii) investigate if there were seasonal effects in the wetland’s performance to retain phosphorus, and (iv) assess the impact of the integrated constructed wetland on the receiving environment by monitoring soil-water parameter concentrations up gradient, down gradient and within the wetland system using piezometers at different soil depths.Teagasc Walsh Fellowship Programm

Factors affecting outcomes of open surgical repair of pararenal aortic aneurysms: A 10-year experience

PurposeFew large series document surgical outcomes for patients with pararenal abdominal aortic aneurysms (PAAAs), defined as aneurysms including the juxtarenal aorta or renal artery origins that require suprarenal aortic clamping. No standard endovascular alternatives presently exist; however, future endovascular branch graft repairs ultimately must be compared with the gold standard of open repair. To this end, we present a 10-year experience.MethodsBetween 1993 and 2003, 3058 AAAs were repaired. Perioperative variables, morbidity, and mortality were retrospectively assessed. Renal insufficiency was defined as a rise in the concentration of serum creatinine by ≥0.5 mg/dL. Factors predicting complications were identified by multivariate analyses. Morbidity and 30-day mortality were evaluated with multiple logistic regression analysis.ResultsOf a total of 3058 AAA repairs performed, 247 were PAAAs (8%). Mean renal ischemia time was 23 minutes (range, 5 to 60 minutes). Cardiac complications occurred in 32 patients (13%), pulmonary complications in 38 (16%), and renal insufficiency in 54 (22%). Multivariate analysis associated myocardial infarction with advanced age (P = .01) and abnormal preoperative serum creatinine (>1.5 mg/dL) (P = .08). Pulmonary complications were associated with advanced age (P = .03), renal artery bypass (P = .02), increased mesenteric ischemic time (P = .01), suprarenal aneurysm repair (P < .0008), and left renal vein division (P = .01). Renal insufficiency was associated with increased mesenteric ischemic time (P = .001), supravisceral clamping (P = .04), left renal vein division (P = .04), and renal artery bypass (P = .0002), but not renal artery reimplantation or endarterectomy. New dialysis was required in 3.7% (9/242). Abnormal preoperative serum creatinine (>1.5 mg/dL) was predictive of the need for postoperative dialysis (10% vs 2%; P = .04). Patients with normal preoperative renal function had improved recovery (93% vs 36%; P = .0002). The 30-day surgical mortality was 2.5% (6/247) but was not predicted by any factors, and in-hospital mortality was 2.8% (7/247). Median intensive care and hospital stays were 3 and 9 days, respectively, and longer stays were associated with age at surgery (P = .007 and P = .0002, respectively) and any postoperative complication.ConclusionsPAAA repair can be performed with low mortality. Renal insufficiency is the most frequent complication, but avoiding renal artery bypass, prolonged mesenteric ischemia time, or left renal vein transection may improve results

Experimental Oral Transmission of Chronic Wasting Disease to Reindeer (Rangifer tarandus tarandus)

Chronic wasting disease (CWD), a transmissible spongiform encephalopathy of cervids, remains prevalent in North American elk, white-tailed deer and mule deer. A natural case of CWD in reindeer (Rangifer tarandus tarandus) has not been reported despite potential habitat overlap with CWD-infected deer or elk herds. This study investigates the experimental transmission of CWD from elk or white-tailed deer to reindeer by the oral route of inoculation. Ante-mortem testing of the three reindeer exposed to CWD from white-tailed deer identified the accumulation of pathological PrP (PrPCWD) in the recto-anal mucosa associated lymphoid tissue (RAMALT) of two reindeer at 13.4 months post-inoculation. Terminal CWD occurred in the two RAMALT-positive reindeer at 18.5 and 20 months post-inoculation while one other reindeer in the white-tailed deer CWD inoculum group and none of the 3 reindeer exposed to elk CWD developed disease. Tissue distribution analysis of PrPCWD in CWD-affected reindeer revealed widespread deposition in central and peripheral nervous systems, lymphoreticular tissues, the gastrointestinal tract, neuroendocrine tissues and cardiac muscle. Analysis of prion protein gene (PRNP) sequences in the 6 reindeer identified polymorphisms at residues 2 (V/M), 129 (G/S), 138 (S/N) and 169 (V/M). These findings demonstrate that (i) a sub-population of reindeer are susceptible to CWD by oral inoculation implicating the potential for transmission to other Rangifer species, and (ii) certain reindeer PRNP polymorphisms may be protective against CWD infection

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Design and evalutation of an intercultural training program : impacts on student development

The following study evaluates the impacts intercultural training has on student development of global perspective and of intercultural competence, on social support networks of international students, and on internationalization goals at a community college in Southern California. Data reveals that participants in the extra-curricular student volunteer program benefit from a combination didactic-experiential training program that focuses on culture-general frameworks and provides tools for accessing culture-specific knowledge. Participants enter with high levels of openness and respect, and develop throughout the program, demonstrating increased cultural self-awareness, knowledge of cultural worldview frameworks, curiosity, and comfort with ambiguity. Students acquired role behaviors associated with multiple functional support network 4 systems. Internationalization efforts may be promoted through extra-curricular programs due to increased intercultural contact, stronger international student support systems, and through the actions of an interculturally inforn1ed group within the student body

Appraisal standards in occupational medicine

Following a series of serious misdemeanours by British doctors, the General Medical Council (GMC) has introduced a system of re-licensing called ‘revalidation’. Annual medical appraisal forms an important cornerstone of the proposed system, but specific guidance is lacking on the content of appraisal for occupational physicians, and the kinds of evidence that they might bring to critical reviews of performance. Two educational bodies, the Revalidation Committee of the Faculty of Occupational Medicine, Royal College of Physicians and the Education Panel of the Society of Occupational Medicine, have jointly developed a set of recommendations on appraisal to further the process. In this paper we summarize the background and present the guidelines promulgated by the Faculty and the Societ