Anthropogenic lead isotopes in Antarctica

We report the first measurements of Pb isotopes in Antarctic snow, which show that even recent snow containing 2.3 pg/g is highly polluted with anthropogenic Pb. This follows from a comparison of isotope abundances of Pb in surface snow and terrestrial dust extracted from ancient Antarctic ice (Dome C, depth 308 m, approximate age 7,500 a BP), the latter being distinctly more radiogenic. This result is independent of geochemical arguments based on measurements of Al, Na and SO_4. South America is suggested as a likely source of this anthropogenic Pb. The presence of significantly less radiogenic Pb in the snow adjacent to two Antarctic base stations indicates that there is contamination from station emissions, although emission from Australia is an alternative explanation for a site 33 km from Dumont d'Urville

The Dutch multicenter experience of the Endo-Sponge treatment for anastomotic leakage after colorectal surgery

Anastomotic leakage is a feared complication following colorectal surgery and is associated with early and long-term morbidity and mortality. The presacral cavity as the result of leakage can be treated with an endo-sponge (B-Braun Medical). The aim of this study was to assess the effectiveness of endo-sponge treatment of the presacral cavity as the result of anastomotic leakage in the Netherlands. Between July 2006 and April 2008, 16 patients (M/F = 9:7) with median age 64 years (range 19-78 years) who underwent surgery for rectal cancer (n = 13) or ulcerative colitis (n = 3) were treated with the endo-sponge treatment after anastomotic leakage. Of the 16 patients, eight patients started with the endo-sponge treatment within 6 weeks after the initial surgery. In these patients the endo-sponge was placed after a median of 24 days (range 13-39 days) following surgery. In the remaining eight patients the endo-sponge treatment was started later than 6 weeks after the initial surgery. In this group there was a median of 74 days (range 43-1,602 days) between surgery and the start of endo-sponge placement. There was closure in six out of eight patients (75%) in the group that started with the endo-sponge treatment within 6 weeks of surgery compared with three out of eight patients (38%) in the group that started later (p = 0.315). Closure was achieved in a median of 40 (range 28-90) days with a median number of 13 sponge replacements (range 8-17). Endo-sponge placement can be helpful in the treatment for anastomotic leakage after colorectal surgery and might prevent a chronic presacral sinus. However, it is not yet clear if this new treatment modality results in quicker healin

Hydrodynamics and seed dispersal in the lower Amazon.

The transport of seeds by water, i.e. hydrochory, is a key mechanism of long-distance dispersal constrained by the attributes of the seed and hydrodynamics. In the freshwater Amazon estuary, river hydrodynamics are influenced by seasonal changes in precipitation and tidal cycles. It is not known to what extent a hydrodynamic model may be able to predict seed dispersal. Here we parameterised a simulation model (SisBaHia) to estimate maximum seed dispersal distances per tidal cycle, which were then compared with data from in situ seed dispersal experiments. The study was conducted along a 27-km stretch of a tributary of the Amazon estuary, using the seeds of a widely distributed riparian tree?Carapa guianensis (Meliaceae). Based on the simulation model, maximum potential seed dispersal distance was higher in the rainy season (c. 8.7 km) when compared with the dry season (5.6 km), for one tidal cycle (12 hr). The seeds of C. guianensis were dispersed further during the ebb than flood tide during the rainy season, the period of seed dispersal. Average dispersal distances observed in seed dispersal experiments conducted during the rainy season, and those predicted by SisBaHia for the same period were within the same order of magnitude. The results of this study confirm that the period of higher precipitation provides favourable hydrological conditions for hydrochory in the Amazon river-estuary complex. The fact that the time taken for the tide to fall is longer in relation to the time taken for it to rise also favours the arrival of the seeds in the main channel of the Amazon, thereby increasing the probability of long-distance dispersal events

Integrating interconception care in preventive child health care services:The Healthy Pregnancy 4 All program

BackgroundMost parents with young children pay routine visits to Well-Baby Clinics, or so-called Preventive Child Health Care (PCHC) services. This offers a unique opportunity to promote and deliver interconception care. This study aimed to integrate such care and perform an implementation evaluation.MethodsIn seven Dutch municipalities, PCHC professionals were instructed to discuss the possibility of an interconception care consultation during each routine six-months well-baby visit. The primary outcome of this study was coverage of the intervention, quantified as the proportion of visits during which women were informed about interconception care. Secondary outcomes included adoption, fidelity, feasibility, appropriateness, acceptability and effectiveness of the intervention, studied by surveying PCHC professionals and women considering becoming pregnant.ResultsThe possibility of interconception care was discussed during 29% (n = 1,849) of all visits, and 60% of the PCHC physicians adopted the promotion of interconception care by regularly informing women. About half of the PCHC professionals and most women judged integration of interconception care in PCHC appropriate and acceptable. Estimated feasibility was poor, since 13% of the professionals judged future integration in daily practice as probable. The uptake of interconception care consultations was low (n = 4 consultations).ConclusionsPromotion of interconception care was achieved in approximately one-third of the routine PCHC consultations and appeared promising with regards to adoption, appropriateness and acceptability. However, concerns on feasibility and uptake of interconception care consultations in daily practice remain. Suggestions for improvement may include further integration of interconception care health promotion in routine PCHC consultations, while allocating sufficient resources

Beta decay of 115-In to the first excited level of 115-Sn: Potential outcome for neutrino mass

Recent observation of beta decay of 115-In to the first excited level of 115-Sn with an extremely low Q_beta value (Q_beta ~ 1 keV) could be used to set a limit on neutrino mass. To give restriction potentially competitive with those extracted from experiments with 3-H (~2 eV) and 187-Re (~15 eV), atomic mass difference between 115-In and 115-Sn and energy of the first 115-Sn level should be remeasured with higher accuracy (possibly of the order of ~1 eV).Comment: 9 pages, 3 figures; talk at the NANP'05 Conferenc

Diagnostic criteria and symptom grading for delayed gastric conduit emptying after esophagectomy for cancer : international expert consensus based on a modified Delphi process

Delayed gastric conduit emptying (DGCE) after esophagectomy for cancer is associated with adverse outcomes and troubling symptoms. Widely accepted diagnostic criteria and a symptom grading tool for DGCE are missing. This hampers the interpretation and comparison of studies. A modified Delphi process, using repeated web-based questionnaires, combined with live interim group discussions was conducted by 33 experts within the field, from Europe, North America, and Asia. DGCE was divided into early DGCE if present within 14 days of surgery and late if present later than 14 days after surgery. The final criteria for early DGCE, accepted by 25 of 27 (93%) experts, were as follows: >500 mL diurnal nasogastric tube output measured on the morning of postoperative day 5 or later or>100% increased gastric tube width on frontal chest x-ray projection together with the presence of an air-fluid level. The final criteria for late DGCE accepted by 89% of the experts were as follows: the patient should have 'quite a bit' or 'very much' of at least two of the following symptoms; early satiety/fullness, vomiting, nausea, regurgitation or inability to meet caloric need by oral intake and delayed contrast passage on upper gastrointestinal water-soluble contrast radiogram or on timed barium swallow. A symptom grading tool for late DGCE was constructed grading each symptom as: 'not at all', 'a little', 'quite a bit', or 'very much', generating 0, 1, 2, or 3 points, respectively. For the five symptoms retained in the diagnostic criteria for late DGCE, the minimum score would be 0, and the maximum score would be 15. The final symptom grading tool for late DGCE was accepted by 27 of 31 (87%) experts. For the first time, diagnostic criteria for early and late DGCE and a symptom grading tool for late DGCE are available, based on an international expert consensus process.Peer reviewe

Performance Scores in General Practice: A Comparison between the Clinical versus Medication-Based Approach to Identify Target Populations

CONTEXT: From one country to another, the pay-for-performance mechanisms differ on one significant point: the identification of target populations, that is, populations which serve as a basis for calculating the indicators. The aim of this study was to compare clinical versus medication-based identification of populations of patients with diabetes and hypertension over the age of 50 (for men) or 60 (for women), and any consequences this may have on the calculation of P4P indicators. METHODS: A comparative, retrospective, observational study was carried out with clinical and prescription data from a panel of general practitioners (GPs), the Observatory of General Medicine (OMG) for the year 2007. Two indicators regarding the prescription for statins and aspirin in these populations were calculated. RESULTS: We analyzed data from 21.690 patients collected by 61 GPs via electronic medical files. Following the clinical-based approach, 2.278 patients were diabetic, 8,271 had hypertension and 1.539 had both against respectively 1.730, 8.511 and 1.304 following the medication-based approach (% agreement = 96%, kappa = 0.69). The main reasons for these differences were: forgetting to code the morbidities in the clinical approach, not taking into account the population of patients who were given life style and diet rules only or taking into account patients for whom morbidities other than hypertension could justify the use of antihypertensive drugs in the medication-based approach. The mean (confidence interval) per doctor was 33.7% (31.5-35.9) for statin indicator and 38.4% (35.4-41.4) for aspirin indicator when the target populations were identified on the basis of clinical criteria whereas they were 37.9% (36.3-39.4) and 43.8% (41.4-46.3) on the basis of treatment criteria. CONCLUSION: The two approaches yield very "similar" scores but these scores cover different realities and offer food for thought on the possible usage of these indicators in the framework of P4P programmes

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

\ua9 The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. BACKGROUND: Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. METHODS: This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. RESULTS: Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. CONCLUSION: The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy

Learning object relationships which determine the outcome of actions

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