Moving beyond access: Towards a quality-orientated substance abuse treatment system in South Africa

There is growing concern about the increased demand for and limited access to substance abuse treatment in South Africa. The government has responded by allocating more money to the delivery of substance abuse treatment, expanding the number of state-funded treatment slots, and training additional health and social workers to deliver these services, particularly in provinces where the prevalence of substance-related problems is high, such as the Western Cape. While these efforts should be commended and continued, steps to improve service availability have occurred without adequate consideration of the quality of services provided. This is not surprising, as there is little or no routine monitoring and evaluation of substance abuse services in the country. It is also disquieting, as access to treatment is necessary but not sufficient for positive treatment outcomes

Avoid adding insult to injury - correct management of sick female endurance athletes

Objectives. To evaluate the efficacy of Ringer’s lactate, isotonic saline and hypertonic saline on the clinical and biochemical recovery of athletes with exercise-associated hyponatraemic encephalopathy caused by fluid overload. Methods. We retrospectively reviewed serial blood sodium concentrations (Na+) and qualitative signs of recovery and time to recovery in two healthy menstruant females hospitalised with dilutional exercise-associated hyponatraemic encephalopathy after withdrawal from the 2011 Comrades Marathon (89 km) and Argus Cycle Tour (109 km). Results. Improvements in blood Na+ did not occur with intravenous administration of Ringer’s lactate solution, but did occur with administration of isotonic and hypertonic saline. Qualitative improvements in mental status were not quantitatively related to the biochemical value of blood Na+ or subsequent return to normonatraemia. Conclusions. Hyponatraemia should be suspected in all female athletes presenting to the medical area of endurance races with vomiting, altered mental status and a history of high fluid intake. If a diagnosis of exercise-associated hyponatraemia with cerebral encephalopathy is confirmed, the treatment of choice is administration of an intravenous bolus of hypertonic saline. Administration of Ringer’s lactate should be discouraged, as this does not correct Na+ and appears to delay recovery

The physical and chemical reclamation and recycling of elements from black aluminium furnace residues

Dross is the inevitable waste product generated by the world-wide primary and secondary aluminium industries. Around 3.5 million tonnes of white dross and 0.85 million tonnes of black dross are produced per year. Drosses are classified depending on metal content. White dross contains 40% and black dross contains 10% of aluminium. About half of the white dross is currently landfilled along with almost all of the black dross, and the annual cost to the UK industry of landfilling this waste is about £90 million per year. There is no commercially viable method of recovering the aluminium, which is potentially recyclable from these drosses, and no current conventional process has the custom-built capability to avoid their disposal to landfill. The practice of landfilling aluminium dross has raised problems for both industry and environment, because of potential leaching of heavy metals into groundwater from the landfill. The black dross has been physically and chemically characterised. The results show that the dross contains mostly metallic aluminium, aluminium nitride, alumina, sodium chloride, potassium chloride and silica with almost 50% of the dross being a mixture of sodium chloride and potassium chloride. A counter current leaching process has been developed to recycle the salts back to the secondary furnace. The environmental impact of black dross has been investigated using simulated landfill conditions. Leachability studies were carried out using water, and other leach media to model the following conditions: humic acid-containing systems, acid rain (pH 2.5), and acetic acid solutions (pH 5). Up to 60% of the dross was leached out in all media with the production of the saline solution providing the major impact. Only small amounts of aluminium were leached out under all these condition. No leachability behaviour was detected once the black dross was washed. So landfilling washed black dross can minimise both environmental and economical problems. Black dross residue, after washing with water, is enriched with alumina. Added value chemicals (of >95% purity) including aluminium hydroxide, alumina, aluminium chloride, aluminium nitrate, aluminium sulphate and aluminium carboxylates have been prepared using the washed black dross. Preliminary calculations have shown that the technology developed to recycle black dross to added-value chemicals is economically viable. A methodology has been developed which enables low grade alumnium waste, black dross, to be treated, commercially viable chemicals to be prepared, reagent use to be minimised through recycle and the diversion of millions of tonnes of furnace residue from landfill.EThOS - Electronic Theses Online ServiceCentre for Environmental Research through a DTI/EPSRC/WMR3 programmeGBUnited Kingdo

Redescription of Serpinema octorugatum (Baylis, 1933) (Nematoda:Camallanidae) from the Malayan box turtle Cuora amboinensis (Daudin)(Chelonia: Bataguridae)

We redescribe the camallanid nematode Serpinema octorugatum (Baylis, 1933) from the box turtle Cuora amboinensis (Daudin) collected in Malaysia. In this redescription, we amend the original description by noting that there are only four cephalic papillae and that there are five pairs of post-anal papillae, and propose that the name of this species be corrected from S. octorugatus to S. octorugatum. Additionally, we removed the tissues overlying the buccal capsule and have used SEM studies to show that the peribuccal shields extend laterally from the buccal capsule, forming a surface possibly used in muscle attachment. Furthermore, we show that the supposedly noncuticularised cylinder connecting the buccal capsule to the oesophagus in the Camallanidae is part of the buccal capsule and is, therefore, likely to be cuticularised. We also examine morphological measurements of taxonomic interest for correlations with total body length and find that many characters traditionally used for inter-and intraspecific comparisons are correlated with total body length in adult female worms. This suggests that comparisons between samples of adult female worms that do not account for the potential effect of total body length may be misleading. However, we show that some features of taxonomic interest are not correlated with total body length

Lymph node-derived donor encephalitogenic CD4+ T cells in C57BL/6 mice adoptive transfer experimental autoimmune encephalomyelitis highly express GM-CSF and T-bet

Experimental autoimmune encephalomyelitis (EAE) is a relevant animal model for the human demyelinating inflammatory disorder of the central nervous system (CNS), multiple sclerosis (MS). Induction of EAE by adoptive transfer allows studying the role of the donor T lymphocyte in disease pathogenesis. It has been challenging to reliably induce adoptive transfer EAE in C57BL/6 (H-2b) mice. The goal of this study was to develop a reproducible and high yield protocol for adoptive transfer EAE in C57BL/6 mice. A step-wise experimental approach permitted us to develop a protocol that resulted in a consistent relatively high disease incidence of ~70% in recipient mice. Donor mice were immunized with myelin oligodendrocyte glycoprotein (MOG)p35-55 in complete Freund's adjuvant (CFA) followed by pertussis toxin (PT). Only lymph node cells (LNC) isolated at day 12 post immunization, and restimulated in vitro for 72 hours with 10 μg/mL of MOGp35-55 and 0.5 ng/mL of interleukin-12 (IL-12) were able to transfer disease. The ability of LNC to transfer disease was associated with the presence of inflammatory infiltrates in the CNS at day 12. Interferon gamma (IFNγ) was produced at comparable levels in cell cultures prepared from mice at both day 6 and day 12 post immunization. By contrast, there was a trend towards a negative association between IL-17 and disease susceptibility in our EAE model. The amount of GM-CSF secreted was significantly increased in the culture supernatants from cells collected at day 12 post immunization versus those collected at day 6 post-immunization. Activated CD4+ T cells present in the day 12 LNC cultures maintained expression of the transcription factor T-bet, which has been shown to regulate the expression of the IL-23 receptor. Also, there was an increased prevalence of MOGp35-55-specific CD4+ T cells in day 12 LNC after in vitro re-stimulation. In summary, encephalitogenic LNC that adoptively transfer EAE in C57BL/6 mice were not characterized by a single biomarker in our study, but by a composite of inflammatory markers. Our data further suggest that GM-CSF expression by CD4+ T cells regulated by IL-23 contributes to their encephalitogenicity in our EAE model

Application of gold and palladium nanoparticles supported on polymelamine microspheres in the oxidation of 1-phenylethanol and some other phenyl substituted alcohols

Melamine formaldehyde and melamine resorcinol formaldehyde microspheres were decorated with Au and Pd nanoparticles and applied as heterogeneous catalysts in the oxidation of 1-phenylethanol. The catalysts showed similar activities irrespective of the support employed. Moderate conversion activities of 48–50% were achieved when using acetonitrile as solvent; however, when employing water as solvent, the supported catalysts formed a three-phase, emulsion system which facilitated the catalytic conversion of 1-phenylethanol to acetophenone at much higher conversions of around 83%. The oxidant, TBHP, decomposed rapidly in acetonitrile, whilst it remained stable in aqueous solution, leading to the enhanced activities observed when using water as solvent. These systems also proved to be recyclable for up to five cycles, with only slight loss of activity observed; this can be attributed to the physical loss of catalyst during the workup procedure conducted between each cycle

Bilateral Remote Ischemic Conditioning in Children:a two-center, double-blind, randomized controlled trial in young children undergoing cardiac surgery

Objective: The study objective was to determine whether adequately delivered bilateral remote ischemic preconditioning is cardioprotective in young children undergoing surgery for 2 common congenital heart defects with or without cyanosis.Methods: We performed a prospective, double-blind, randomized controlled trial at 2 centers in the United Kingdom. Children aged 3 to 36 months undergoing tetralogy of Fallot repair or ventricular septal defect closure were randomized 1:1 to receive bilateral preconditioning or sham intervention. Participants were followed up until hospital discharge or 30 days. The primary outcome was area under the curve for high-sensitivity troponin-T in the first 24 hours after surgery, analyzed by intention-to-treat. Right atrial biopsies were obtained in selected participants.Results: Between October 2016 and December 2020, 120 eligible children were randomized to receive bilateral preconditioning (n = 60) or sham intervention (n = 60). The primary outcome, area under the curve for high-sensitivity troponin-T, was higher in the preconditioning group (mean: 70.0 ± 50.9 μg/L/h, n = 56) than in controls (mean: 55.6 ± 30.1 μg/L/h, n = 58) (mean difference, 13.2 μg/L/h; 95% CI, 0.5-25.8; P = .04). Subgroup analyses did not show a differential treatment effect by oxygen saturations (pinteraction = .25), but there was evidence of a differential effect by underlying defect (pinteraction = .04). Secondary outcomes and myocardial metabolism, quantified in atrial biopsies, were not different between randomized groups.Conclusions: Bilateral remote ischemic preconditioning does not attenuate myocardial injury in children undergoing surgical repair for congenital heart defects, and there was evidence of potential harm in unstented tetralogy of Fallot. The routine use of remote ischemic preconditioning cannot be recommended for myocardial protection during pediatric cardiac surgery

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy