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Functional tests such as Motor Function Measure-32 (MFM-32), supine to stand, ascend/descend stairs permit the assessment of task-specific motor function in neuromuscular disease (NMD). The 6-min walk test (6MWT), though functional, is primarily used to assess endurance and disease progression in children with neuromuscular disorders. Barriers to 6MWT administration, in this population, can include reduced attention span due to age and inability to tolerate test length due to weakness. We propose task-specific functional deficits are related to endurance. Additionally, the 2-min walk test (2MWT) could effectively replace the 6MWT in this population. Seventy-seven participants, ages 5-18, with a variety of neuromuscular disorders performed the 6MWT, timed functional tests (TFT), and the MFM-32. Correlation and paired t-test analyses were used to compare the distance walked in the first 2 min (2MWD) to the distance walked in the entire 6 min (6MWD) and to the functional outcome measures above. The 2MWD strongly correlated with 6MWD and the other outcome measures. Paired t-test analysis also showed that the 2MWD did not differ from the distance walked in the last 2 min of the 6MWT. Although equivalence testing could not reject the claim that this difference exceeded the upper practical limit of 9.5 m, it only showed a modest overestimation of the 4-6MWD compared with the 2MWD. Together, our results support the ability of the 2MWD to predict the 6MWD, specifically in the pediatric neuromuscular disease population.

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Bibliometric analysis highlights key topics and publications that have shaped the understanding and management of esophageal cancer (EC). Here, the 100 most cited manuscripts in the field of EC are analyzed. The Thomson Reuters Web of Science database with the search terms 'esophageal cancer' or 'esophageal carcinoma' or 'oesophageal cancer' or 'oesophageal carcinoma' or 'gastroscopy' was used to identify all English language full manuscripts for the study. The 100 most cited papers were further analyzed by topic, journal, author, year, and institution. A total of 121,556 eligible papers were returned and the median (range) citation number was 406.5 (1833 to 293). The most cited paper focused on the role of perioperative chemotherpy in EC (1833 citations). Gastroenterology published the highest number of papers (n = 15, 6362 citations) and The New England Journal of Medicine received the most citations (n = 12, 12125 citations). The country and year with the greatest number of publications were the USA (n = 50), and 1998, 1999, and 2000 (n = 7). The most ubiquitous topic was the pathology of EC (n = 66) followed by management of EC (n = 54), and studies related to EC prognosis (n = 44). The most cited manuscripts highlighted the pathology, management, and prognosis of EC and this bibliometirc review provides the most influential references serving as a guide to popular research themes.

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Consistency in gold chloride staining is essential for anatomical analysis of sensory nerve endings. The gold chloride stain for this purpose has been modified by many investigators, but often yields inconsistent staining, which makes it difficult to differentiate structures and to determine nerve ending distribution in large tissue samples. We introduce additional steps and major changes to the modified Gairns' protocol. We controlled the temperature and mixing rate during tissue staining to achieve consistent staining and complete solution penetration. We subjected samples to sucrose dehydration to improve cutting efficiency. We then exposed samples to a solution containing lemon juice, formic acid and paraformaldehyde to produce optimal tissue transparency with minimal tissue deformity. We extended the time for gold chloride impregnation 1.5 fold. Gold chloride was reduced in the labrum using 25% formic acid in water for 18 h and in the capsule using 25% formic acid in citrate phosphate buffer for 2 h. Citrate binds gold nanoparticles, which minimizes aggregation in the tissue. We stored samples in fresh ultrapure water at 4° C to slow reduction and to maintain color contrast in the tissue. Tissue samples were embedded in Tissue Tek and sectioned at 80 and 100 µm instead of using glycerin and teasing the tissue apart as in Gairns' modified gold chloride method. We attached sections directly to gelatin subbed slides after sectioning with a cryostat. The slides then were processed and coverslipped with Permount. Staining consistency was demonstrated throughout the tissue sections and neural structures were clearly identifiable.

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Various techniques have been used to repair lumbar hernias. We describe here a sutureless repair with a flat 'memory ring' patch performed as a day case.

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The work presented herein was completed in an effort to characterize the forces influencing ventilation in gravity sewers and to develop a mathematical model, based on conservation of momentum, capable of accounting for friction at the headspace/pipe interface, drag at the air/water interface, and buoyancy caused by air density differences between a sewer headspace and ambient. Experiments were completed on two full scale sewer reaches in Australia. A carbon monoxide-based tracer technique was used to measure the ventilation rate within the sewer headspaces. Additionally, measurements of pressure, relative humidity, and temperature were measured in the ambient air and sewer headspace. The first location was a five kilometre long sewer outfall beginning at a wastewater treatment plant and terminating at the ocean. The second location was a large gravity sewer reach fitted with ventilation fans. At the first location the headspace was entirely sealed except for openings that were controlled during the experiments. In this situation forces acting on the headspace air manifested mostly as a pressure distribution within the reach, effectively eliminating friction at the pipe wall. At the second location, air was forced to move near the same velocity as the wastewater, effectively eliminating drag at the air/water interface. These experiments allowed individual terms of the momentum equation to be evaluated. Experimental results were compared to the proposed mathematical model. Conclusions regarding model accuracy are provided along with model application guidance and assumptions.

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Sewage plants can experience dimethyl sulphide (DMS) odour problems by at least one mg/L dimethylsulphoxide (DMSO) waste residue in plant influent, through a DMSO/DMS reduction mechanism. This bench-scale batch study simulates in bottles the role of poor aeration in wastewater treatment on the DMSO/DMS and sulphate/H2S reduction. The study compares headspace concentrations of sulphide odorants developed by activated sludge (closed bottles, half full) after six hours under anoxic versus anaerobic conditions, with 0 versus 2 mg/L DMSO addition. Anoxic sludge (0.1 - 2 mg/L dissolved oxygen, DO) with DMSO resulted in about 50 ppmv DMS and no other sulphide, while DMSO-free sludge was free of detectable sulphides. Anaerobic sludge (no measurable DO to the point of sulphate reduction) with DMSO resulted in 22/4/37 ppmv of H2S/methanethiol (MT)/DMS, while DMSO-free sludge resulted in 44/8/2 ppmv of H2S/MT/DMS. It is concluded that common "anoxic" aeration tank zones with measurable DO in bulk water but immeasurable DO inside sludge flocs (nitrate reducing) experience DMSO reduction to DMS that is oxidation resistant and becomes the most important odorant. Under anaerobic conditions, H2S from sulphate reduction becomes an additional important odorant. A strategy is developed that allows operators to determine from the quantity of different sulphides whether the DMSO/DMS mechanism is important at their wastewater plant.

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Biosolids odour emissions can affect the ability of wastewater utilities to implement beneficial biosolids processing and reuse programs. Communities often become more sensitised and vocal about biosolids issues, once they experience odours emanating from a nearby site. Odour impacts from biosolids, including potential human health effects, have been targeted recently by many national and local newspapers, citizens' groups, and regulatory agencies, who have raised significant concerns, ranging from viable disposal methods/sites to outright bans. Many national and local regulatory agencies in the United States are considering biosolids disposal bans in their communities because of misinformation, poor science, and citizen pressure, but primarily because of odour impact concerns. The wastewater industry has a relatively poor understanding of the operations and treatment parameters that influence biosolids odour emissions. Thus, wastewater treatment plants are often unable to control the odour quality of the biosolids that are delivered into communities. A research study to demonstrate the influence of anaerobic digestion, mechanical dewatering, and storage design and operating parameters on the odour quality of the final product was performed and is the subject of this paper. Established and new sampling and analytical methods were used to measure biosolids odour emissions from 11 test sites in North America. By determining the impacts of these control variables on biosolids odour quality, design and operations of anaerobic digestion systems might be enhanced. This paper also summarises a corollary study performed as part of the WERF research study that addresses the health effects of biosolids odours.

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Odour emissions and corrosion concerns can be a constant focus for many wastewater treatment and collection system owners, usually from the first day that their collection systems begin operation. Many sewer systems are reaching the end of their useful life, or have experienced either odour or corrosion issues. This paper shows a link between odour generation and corrosion potential, and how modelling can be used to assist in odour/corrosion assessments of existing wastewater collection systems. A model has been developed that is capable of predicting liquid-phase sulphide generation and subsequent release to overlying sewer headspace as hydrogen sulphide (H2S), where it can be the source of either odour or corrosion problems. This paper presents an overview of the model, and uses a case study involving both odour and corrosion issues to demonstrate the utility in modelling. The model was used to identify potential locations within the system where odour/corrosion may be problematic, as well as assisting in the evaluation of potential odour control alternatives.

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As neighbouring areas continue to encroach upon wastewater treatment plants, there is an increasing need for odour control to mitigate potential negative offsite odorous impacts. One technology that is gaining widespread acceptance is biotechnology, which utilises the inherent ability of certain microorganisms to biodegrade offensive odorous compounds. Two main advantages of this form of treatment over other odour control technologies include the absence of hazardous chemicals and relatively low operation and maintenance requirements. The purpose of this paper is to provide information related to odour control design criteria used in sizing/selecting biotechnology-based odour control technologies, and to provide odour removal performance data obtained from several different biotechnology-based odour control systems. CH2M HILL has collected biotechnology-based odour control performance data over the last several years in order to track the continued performance of various biofilters and biotowers over time. Specifically, odour removal performance data have been collected from soil-, organic- and inorganic-media biofilters and inert inorganic media biotowers. Results indicate that biotechnology-based odour control is a viable and consistent technology capable of achieving high removal performance for odour and hydrogen sulphide. It is anticipated that the information presented in this paper will be of interest to anyone involved with odour control technology evaluation/selection or design review.

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A project has been carried out by Oak Ridge National Laboratory (ORNL) to estimate the concentrations of radionuclides in the environment resulting from the release of radioactive materials in the liquid waste effluents from the Rancho Seco Nuclear Power Plant (RSNPP) and to estimate possible radiation doses to man resulting from current environmental concentrations. To accomplish the objectives of this project, ORNL staff members conducted an environmental sampling program around the plant site during November and December 1984. Elevated levels of some anthropogenic radionuclides were found in the immediate environment of the plant. This radioactive contamination occurs primarily along streams receiving effluent from the plant and in fields irrigated with water from these streams. The primary contaminants are 137Cs and 134Cs, with lesser amounts of 60Co and 58Co. The ingestion of fish was the single most important pathway identified in this analysis. However, all specific pathways of exposure and usage factors were not precisely known for a complete dose assessment of current and potential use of contaminated water and soil around the RSNPP. The liquid effluent radionuclide releases from the RSNPP pose no significant health hazard to persons living near the RSNPP.

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To assess whether Health Risk Appraisal (HRA), a computer-scored lifestyle analysis questionnaire, can result in significant changes in health behavior, a controlled clinical trial with one-year follow-up was conducted among entering freshmen at an urban state university. Three hundred fifty entering freshmen were each assigned to one of four groups: HRA with feedback, HRA without feedback, initial control, and final control. Twenty-two per cent of the nonsmokers in the no-feedback group, as compared with 5% in the feedback group, acquired the habit of cigarette smoking (p less than 0.001). Furthermore, 26% of the smokers in the feedback group, as compared with 6% in the no-feedback group, were able to quit smoking (p less than 0.05). Among those unable to quit smoking, 59% in the feedback group, as compared with 19% in the no-feedback group, were able to reduce their cigarette consumption by more than six cigarettes per day (p less than 0.01). Health Risk Appraisal, when accompanied by feedback counseling, was an effective health promotion tool to help prevent nonsmokers from acquiring the habit and to modify cigarette smoking behavior among college freshmen.

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The effect of an outpatient clinical pharmacy program on selected therapeutic outcomes of 39 antihypertensive- and 16 warfarin-treated study patients in a hospital-based group medical practice was evaluated by retrospective medical record audit and compared to two control groups. Results revealed that a significantly greater number of drug discontinuations (p less than 0.05) and changes (p less than 0.005) were documented in the medical records of study patients. Hypertensive study patients who received the services of pharmacists had poorer blood pressure control at the beginning of the study (p less than 0.05) but were as equally well controlled as control patients by the conclusion of the study. Compared with control patients, warfarin-treated study patients were better controlled at the end of the study (p less than 0.05). The participation of pharmacists in the care of hypertensive and anticoagulated patients appears to result in acceptable therapeutic outcomes.

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For unknown reasons, physicians often ignore unsolicited clinical data. This is thought to impair the quality of medical care and the efficacy of screening programs. To investigate this problem the authors followed 156 consecutive hypercalcemic patients for nine to 15 months. Twenty-eight were lost to follow-up, and the hypercalcemia was ignored in 26. Calcium tests were repeated for 102, and hypercalcemia was confirmed in 53. Of these, 39 were and 14 were not further investigated. Analysis by logistic regression revealed a highly significant relationship between the degree of hypercalcemia and the likelihood that calcium testing would be repeated or that abnormal levels would be further investigated. The authors conclude that, contrary to common opinion, when physicians ignore abnormal laboratory values they are making complex clinical judgments based on the degree of abnormality, the likelihood that further investigation will affect therapy, and the cost of the risk associated with further investigation. Evaluation and attempts to modify this behavior should take into account the complexity of these decisions.

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Evaluation and treatment of emergency room patients complaining of sore throats are complicated by an unknown probability of follow-up. Tompkins' analysis of cost-effective sore throat management strategies was modified by adding an expression for variable follow-up rate. The original analysis specified a culture range when the probability of streptococcal infection was between 0.05 and 0.20, while the expanded analysis demonstrates that this range decreases with decreasing follow-up. For follow-up rates of 0.70 or less, all patients would be in either the treatment or no treatment group. This analysis demonstrates the importance of follow-up in out-patient decision making, and illustrates the methodology for including follow-up (and similar factors) in our analyses.

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Experiences in implementing a pharmacy clinic in a hospital-based primary-care group medical practice are described. A clinic was instituted through the joint support and active participation of the hospital administration and the departments of pharmacy and medicine. In the clinic, pharmacists monitored, assessed, and intervened in the drug therapy needs of patients who requested care or were referred by their primary-care physicians. Pharmacists provided services in 1751 patient visits during the first year of the clinic's operation. Clinic volume increased from two to 17 patients per session. Analysis of these patient visits showed that the pharmacists: (1) assessed physical signs in 60% of the patients, (2) ordered laboratory tests in 30%, (3) found a problem with the drug therapy in approximately one third of the patients, (4) detected new medical complaints in 4% of the patients, (5) initiated change in the drug regimen in 10% of the patient visits, and (6) referred almost 15% of the patients to new sources of care. In this clinic, pharmacists supplemented, not supplanted, the services of physicians for ambulatory patients.

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