An assessment of the accuracy of electrolyte concentrations in neonatal parental nutrition

Focal points Over a six-week period in January and February 2002, 2ml samples were removed from all neonatal PN bags dispensed Samples were submitted for analysis of sodium, potassium and magnesium in triplicate by the hospital's clinical chemistry department using a Vitros Codac 950AT, dry slide, automated analyser Only 19.3, 7.1 and 30.4 per cent of measured sodium, potassium and magnesium concentrations respectively deviated by £5 per cent from stated bag concentrations The results indicate that it is possible that some electrolyte concentrations included in neonatal PN vary significantly from stated values

Developing actions to minimise avoidable waste and its challenge to plant safety

Purpose: Considering the UK's limited capacity for waste disposal (particularly for hazardous/radiological waste) there is growing focus on waste avoidance and minimisation to lower the volumes of waste being sent to disposal. The hazardous nature of some waste can complicate its management and reduction. To address this problem there was a need for a decision making methodology to support managers in the nuclear industry as they identify ways to reduce the production of avoidable hazardous waste. The methodology we developed is called Waste And Sourcematter Analysis (WASAN). A methodology that begins the thought process at the pre-waste creation stage (i.e. Avoid). Design/methodology/ approach: The methodology analyses the source of waste, the production of waste inside the facility, the knock on effects from up/downstream facilities on waste production, and the down-selection of waste minimisation actions/options. WASAN has been applied to case studies with licencees and this paper reports on one such case study - the management of plastic bags in Enriched Uranium Residues Recovery Plant (EURRP) at Springfields (UK) where it was used to analyse the generation of radioactive plastic bag waste. Findings: Plastic bags are used in EURRP as a strategy to contain hazard. Double bagging of materials led to the proliferation of these bags as a waste. The paper reports on the philosophy behind WASAN, the application of the methodology to this problem, the results, and views from managers in EURRP. Originality/value: This paper presents WASAN as a novel methodology for analyzing the minimization of avoidable hazardous waste. This addresses an issue that is important to many industries e.g. where legislation enforces waste minimization, where waste disposal costs encourage waste avoidance, or where plant design can reduce waste. The paper forms part of the HSE Nuclear Installations Inspectorate's desire to work towards greater openness and transparency in its work and the development in its thinking.© Crown Copyright 2011.

Light Effects on Leaf Morphology in Water Hyacinth (Eichhornia crassipes)

Water hyacinth leaves in natural populations vary from being long and thin-petioled to being short with inflated petioles. A variety of factors has been used experimentally to alter water hyacinth leaf shape, but what controls the development of leaf morphology in the field has not been established. We measured photosynthetic photon flux density (PPFD) and spectral distribution of radiation in a natural water hyacinth population. PPFD in the center of the water hyacinth mat was reduced to 2.7% of full sunlight, and the red to far red (R:FR) ratio was reduced to 0.28. When shoot tips of plants were exposed to artificial light environments, only plants in the treatment with a R:FR ratio comparable to that in the natural population produced leaves with long, thin petioles. Shoot tips in full sun or covered with clear plastic bags or bags that reduced light quantity without greatly altering light quality produced shorter leaves with inflated petioles. We hypothesize that the altered light quality inside a mat is a major environmental control of water hyacinth leaf morphology.

Temporally dependent C, N, and P dynamics associated with the decay of Rhizophora mangle L. leaf litter in oligotrophic mangrove wetlands of the Southern Everglades

We performed two litter decomposition experiments using nearly-senesced red mangrove (Rhizophora mangle L.) leaves collected from an Everglades dwarf mangrove wetland to understand the short-term (3 weeks) and long-term (1 year) changes in mass, as well as C-, N-, and P-content of decomposing leaf litter. We expected that leaves decomposing in this oligotrophic environment would be short-term sources of C, N, and P, but potential long-term sinks for N and P. In May 1998, we conducted a 3-week leaching experiment, incubating fresh, individual leaves in seawater for up to 21 days. From May 1997 to May 1998, leaf litter in mesh bags decomposed on the forest floor at two dwarf mangrove sites. Leaching accounted for about 33% loss of dry mass from R. mangle leaves after 3 weeks. Leaching losses were rapid, peaking by day 2, and large, with leachate concentrations of total organic carbon (TOC) and total phosphorus (TP) increasing by more than an order of magnitude after 3 weeks. Mean leaf C:N increased from 105 to 115 and N:P increased from a mean of 74 to 95 after 21 days, reflecting the relatively large leaching losses of N and P. Loss of mass in the litterbags leveled off after 4 months, with roughly 60%dry mass remaining (DMR) after nearly 1 year of decomposition. The mass of carbon in each litterbag declined significantly after 361 days, but the mass of nitrogen and phosphorus doubled, indicating long-term accumulation of these constituents into the detritus. Subsequently, the leaf C:N ratio dropped significantly from 90 to 34 after 361 days. Following an initial 44-day increase, leaf N:P decreased from 222 to 144, reflecting high accumulation of P relative to N. A review of several estuarine macrophyte decomposition studies reveals a trend in nitrogen accumulation through time regardless of site, but suggests no clear pattern for C and P. We believe that the increase in litter P observed in this study was indicative of the P-limited status of the greater Everglades ecosystem and that decomposing mangrove litter may represent a substantial phosphorus pool in the system.

Belowground decomposition of mangrove roots in Florida coastal everglades

Mangrove root decomposition rates were measured by distributing mesh bags containing fine root material across six sites with different soil fertility and hydroperiod to compare ambient differences to substrate quality. Roots from a site with lower soil phosphorus concentration were used as a reference and compared to ambient roots at five other sites with increased phosphorus concentration. Four mesh bags of each root type (ambient versus reference), separated into four 10-cm replicate intervals, were buried up to 42 cm depth at each site and incubated for 250 d (initiation in May 2004). Mass loss of ambient mangrove roots was significant at all study sites and ranged from 17% to 54%; there was no significant difference with depth at any one site. Reference decomposition constants (−k) ranged from 0.0012 to 0.0018 d−1 among Taylor Slough sites compared to 0.0023–0.0028 d−1 among Shark River sites, indicating slower decomposition rates associated with lower soil phosphorous and longer flood duration. Reference roots had similar decomposition rates as ambient roots in four of the six sites, and there were no significant correlations between indices of root substrate quality and decomposition rates. Among these distinct landscape gradients of south Florida mangroves, soil environmental conditions have a greater effect on belowground root decomposition than root substrate quality.

First Women's March down Fifth Avenue

General note: Title and date provided by Bettye Lane.

Bag Lady

General note: Title and date provided by Bettye Lane.

Mary, a familiar homeless woman whose turf is 5th avenue and 14th street in NY

General note: Title and date provided by Bettye Lane.

Women's liberation demonstration

Inscriptions: Verso: [stamped] Credit must be given to Freda Leinwand from Monkmeyer Press Photo Service.

Women's liberation demonstration

Inscriptions: Verso: [stamped] Credit must be given to Freda Leinwand from Monkmeyer Press Photo Service.

The Philippines in the Paper Global Value Chain

This report uses the Duke CGGC Global Value Chain (GVC) framework to examine the role of the Philippines in the global paper industry and identify opportunities for upgrading. The Philippines’ paper sector is a domestically oriented industry that provides significant indirect employment opportunities for wide swaths of workers as well as indirect exports for sectors such as electronics, food and beverage, and cosmetics. However, the country’s overall participation in the paper GVC is limited, with raw material constraints hindering export development. Abaca pulp production, a niche product category that uses the Manila hemp plant to generate specialized outputs such as tea bags and bank notes, is the country’s most dependable export, but even with the export value of abaca pulp approaching an all-time high in 2014, the overall paper industry only generated US$127 million in export revenue, 54th among 193 countries in the world.

Cabazitaxel for Hormone-Relapsed Metastatic Prostate Cancer Previously Treated With a Docetaxel-Containing Regimen: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures cabazitaxel (Jevtana(®), Sanofi, UK) to submit evidence for the clinical and cost effectiveness of cabazitaxel for treatment of patients with metastatic hormone-relapsed prostate cancer (mHRPC) previously treated with a docetaxel-containing regimen. The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology based upon the company's submission to NICE. Clinical evidence for cabazitaxel was derived from a multinational randomised open-label phase III trial (TROPIC) of cabazitaxel plus prednisone or prednisolone compared with mitoxantrone plus prednisone or prednisolone, which was assumed to represent best supportive care. The NICE final scope identified a further three comparators: abiraterone in combination with prednisone or prednisolone; enzalutamide; and radium-223 dichloride for the subgroup of people with bone metastasis only (no visceral metastasis). The company did not consider radium-223 dichloride to be a relevant comparator. Neither abiraterone nor enzalutamide has been directly compared in a trial with cabazitaxel. Instead, clinical evidence was synthesised within a network meta-analysis (NMA). Results from TROPIC showed that cabazitaxel was associated with a statistically significant improvement in both overall survival and progression-free survival compared with mitoxantrone. Results from a random-effects NMA, as conducted by the company and updated by the ERG, indicated that there was no statistically significant difference between the three active treatments for both overall survival and progression-free survival. Utility data were not collected as part of the TROPIC trial, and were instead taken from the company's UK early access programme. Evidence on resource use came from the TROPIC trial, supplemented by both expert clinical opinion and a UK clinical audit. List prices were used for mitoxantrone, abiraterone and enzalutamide as directed by NICE, although commercial in-confidence patient-access schemes (PASs) are in place for abiraterone and enzalutamide. The confidential PAS was used for cabazitaxel. Sequential use of the advanced hormonal therapies (abiraterone and enzalutamide) does not usually occur in clinical practice in the UK. Hence, cabazitaxel could be used within two pathways of care: either when an advanced hormonal therapy was used pre-docetaxel, or when one was used post-docetaxel. The company believed that the former pathway was more likely to represent standard National Health Service (NHS) practice, and so their main comparison was between cabazitaxel and mitoxantrone, with effectiveness data from the TROPIC trial. Results of the company's updated cost-effectiveness analysis estimated a probabilistic incremental cost-effectiveness ratio (ICER) of £45,982 per quality-adjusted life-year (QALY) gained, which the committee considered to be the most plausible value for this comparison. Cabazitaxel was estimated to be both cheaper and more effective than abiraterone. Cabazitaxel was estimated to be cheaper but less effective than enzalutamide, resulting in an ICER of £212,038 per QALY gained for enzalutamide compared with cabazitaxel. The ERG noted that radium-223 is a valid comparator (for the indicated sub-group), and that it may be used in either of the two care pathways. Hence, its exclusion leads to uncertainty in the cost-effectiveness results. In addition, the company assumed that there would be no drug wastage when cabazitaxel was used, with cost-effectiveness results being sensitive to this assumption: modelling drug wastage increased the ICER comparing cabazitaxel with mitoxantrone to over £55,000 per QALY gained. The ERG updated the company's NMA and used a random effects model to perform a fully incremental analysis between cabazitaxel, abiraterone, enzalutamide and best supportive care using PASs for abiraterone and enzalutamide. Results showed that both cabazitaxel and abiraterone were extendedly dominated by the combination of best supportive care and enzalutamide. Preliminary guidance from the committee, which included wastage of cabazitaxel, did not recommend its use. In response, the company provided both a further discount to the confidential PAS for cabazitaxel and confirmation from NHS England that it is appropriate to supply and purchase cabazitaxel in pre-prepared intravenous-infusion bags, which would remove the cost of drug wastage. As a result, the committee recommended use of cabazitaxel as a treatment option in people with an Eastern Cooperative Oncology Group performance status of 0 or 1 whose disease had progressed during or after treatment with at least 225 mg/m(2) of docetaxel, as long as it was provided at the discount agreed in the PAS and purchased in either pre-prepared intravenous-infusion bags or in vials at a reduced price to reflect the average per-patient drug wastage.

Factors and mechanisms controlling soil organic carbon turnover in subsoils of agricultural sites

Two-third of the terrestrial C is stored in soils, and more than 50% of soil organic C (SOC) is stored in subsoils from 30 – 100 cm. Hence, subsoil is important as a source or sink for CO2 in the global carbon cycle. Especially the stable organic carbon (OC) is stored in subsoil, as several studies have shown that subsoil OC is of a higher average age than topsoil OC. However, there is still a lack of knowledge regarding the mechanisms of C sequestration and C turnover in subsoil. Three main factors are discussed, which possibly reduce carbon turnover rates in subsoil: Resource limitation, changes in the microbial community, and changes in gas conditions. The experiments conducted in this study, which aimed to elucidate the importance of the mentioned factors, focused on two neighbouring arable sites, with depth profiles differing in SOC stocks: One Colluvic Cambisol (Cam) with high SOC contents (8-12 g kg-1) throughout the profile and one Haplic Luvisol (Luv) with low SOC contents (3-4 g kg-1) below 30 cm depth. The first experiment was designed to gain more knowledge regarding the microbial community and its influence on carbon sequestration in subsoil. Soil samples were taken at four different depths on the two sites. Microbial biomass C (MBC) was determined to identify depth gradients in relation to the natural C availability. Bacterial and fungal residues as well as ergosterol were determined to quantify changes in the in the microbial community composition. Multi-substrate-induced-respiration (MSIR) was used to identify shifts in functional diversity of the microbial community. The MSIR revealed that substrate use in subsoil differed significantly from that in topsoil and also differed highly between the two subsoils, indicating a strong influence of resource limitations on microbial substrate use. Amino sugar analysis and the ratio of ergosterol to microbial biomass C showed that fungal dominance decreased with depth. The results clearly demonstrated that microbial parameters changed with depth according to substrate availability. The second experiment was an incubation experiment using subsoil gas conditions with and without the addition of C4 plant residues. Soil samples were taken from topsoil and subsoil of the two sites. SOC losses during the incubation, were not influenced by the subsoil gas conditions. Plant-derived C losses were generally stronger in the Cam (7.5 mg g-1), especially at subsoil gas conditions, than in the Luv (7.0 mg g-1). Subsoil gas conditions had no general effects on microbial measures with and without plant residue addition. However, the contribution of plant-derived MBC to total MBC was significantly reduced at subsoil gas conditions. This lead to the conclusion that subsoil gas conditions alter the metabolism of microorganisms but not the degradation of added plant residues is general. The third experiment was a field experiment carried out for two years. Mesh bags containing original soil material and maize root residues (C4 plant) were buried at three different depths at the two sites. The recovery of the soilbags took place 12, 18, and 24 months after burial. We determined the effects of these treatments on SOC, density fractions, and MBC. The mean residence time for maize-derived C was similar at all depths and both sites (403 d). MBC increased to a similar extent (2.5 fold) from the initial value to maximum value. This increase relied largely on the added maize root residues. However, there were clear differences visible in terms of the substrate use efficiency, which decreased with depth and was lower in the Luv than in the Cam. Hence freshly added plant material is highly accessible to microorganisms in subsoil and therefore equally degraded at both sites and depths, but its metabolic use was determined by the legacy of soil properties. These findings provide strong evidence that resource availability from autochthonous SOM as well as from added plant residues have a strong influence on the microbial community and its use of different substrates. However, under all of the applied conditions there was no evidence that complex substrates, i.e. plant residues, were less degraded in subsoil than in topsoil.

A review of one-step fluorescent cyanoacrylate techniques

A review of recent research in the use of one-step fluorescent cyanoacrylate techniques is presented. Advantages and disadvantages of such techniques in comparison to two-step processes are discussed. Further studies and new experimental data are presented to aid this review: three one-step cyanoacrylate products (Lumicyano, PolyCyano UV and PECA Multiband) containing a fluorescent dye were tested to evaluate their effectiveness in developing latent fingermarks on polyethylene bags by means of a pseudo operational trial. The results were compared to the traditional two-step process of cyanoacrylate fuming followed by staining with ethanol-based basic yellow 40 (BY40). The study was conducted using sequential treatments of an initial fuming cycle, a second cycle and finally BY40 staining. LumicyanoTM and PolyCyano UV performed similarly before BY40 staining, with both providing good contrast and visibility under fluorescence. PECA Multiband, however, did not develop as many fingermarks and proved to be problematic for the fuming cabinet. Subsequent BY40 staining of fingermarks developed by all three one-step processes enabled the visualisation of new fingermarks.

Processo de transição da pessoa estomizada da depêndencia de cuidado ao autocuidado: subsídios à enfermagem

Objetivou-se conhecer como a pessoa com estomia vivência o processo de transição da dependência de cuidados ao autocuidado à luz da Teoria das Transições de Meleis. Pesquisa exploratória, descritiva com abordagem qualitativa no Serviço de Estomaterapia do Hospital Universitário Dr Miguel Riet Corrêa Jr do Rio Grande/ RS/ Brasil com 27 pessoas com estomias definitivas por câncer. Os dados foram coletados nos mês de janeiro e fevereiro de 2014 por meio de entrevista com roteiro semiestruturado e submetidos à Análise de Conteúdo apoiada nas ideias da Teoria das Transições de Afaf I. Meleis. Constatou-se que a natureza da transição situou-se no processo tipo saúde/doença. A entrada no processo de transição deu-se a partir da consciência desencadeada pelo diagnóstico de câncer, reforçado pela cirurgia de estomização. O empenhamento surge ao dedicarem-se a construção do conhecimento para o autocuidado frente às mudanças na sua vida e na sua nova relação com seu corpo, mudando a visão de si, do mundo e dos outros. Destacou-se o espaço temporal como algo dinâmico e variavelmente indeterminável, sendo fundamental para que se organizem e reflitam acerca do seu novo viver, fortalecendo-se para que a transição progrida. Verificaram-se como fatores facilitadores do autocuidado a construção de um significado positivo à estomização, o preparo dessa experiência ainda no pré-operatório, a estabilidade emocional, a fé e a religiosidade e a sensação de normalidade adquirida a partir de uma imagem próxima da anterior. Referiram-se, ainda, ao fornecimento de forma gratuita pelo governo das bolsas coletoras, adjuvantes e acessórios e ao atendimento da equipe multiprofissional. Como fatores inibidores do processo de transição encontraram-se a visão distorcida de seu corpo, o despreparo para viver com a estomia, a instabilidade emocional, a desmotivação com afastamento de atividades prazerosas, o cuidado excessivo e/ou estendido e até mesmo a superproteção da família, as complicações como hérnias e prolapsos, a falta de atitudes positivas quanto à vida, a negação da bolsa coletora, as tentativas frustradas de omitir o uso da bolsa coletora, a falta do domínio do manuseio dos equipamentos, o afastamento do trabalho e as dificuldades financeiras. Além destas, o abandono do parceiro, atitudes negativas e estigmatizantes por parte da família e a baixa qualidade dos materiais fornecidos pelo governo. Como indicadores de resultados identificaram-se a confiança para realizar atividades anteriores, aceitação de sua situação, uma visão positiva de sua vida e da capacidade de compartilhar o seu cuidado com sua família. Considera-se a saída da transição quando este for capaz de dominar novas competências tanto para o cuidado físico ao realizar a troca da bolsa coletora quanto readequando sua imagem e autoconceito. Concluiu-se que o processo de transição da dependência de cuidados ao autocuidado da pessoa com estomia é complexo e carregado de subjetividades. É necessário que o enfermeiro estabeleça ações terapêuticas de enfermagem eficazes e eficientes, contribuindo para a promoção e reabilitação da saúde deste, auxiliando-o na aquisição de sua autonomia e independência, subsidiando seu autocuidado e bem-estar.