Assessing the environmental burdens of anaerobic digestion in comparison to alternative options for managing the biodegradable fraction of municipal solid wastes.

Biological treatment processes including anaerobic digestion (biogasification) and composting are increasingly being considered by waste management officials and planners as alternatives for managing the mainly organic residues of municipal solid wastes (MSW). The integrated waste management model which is based upon the application of life-cycle analysis was employed to compare the environmental burdens of landfilling, composting and anaerobic digestion of MSW at a mid-sized Canadian community. Energy consumption (or recovery), residue recoveries and emissions to air and water were quantified. Scenario comparisons were analyzed to demonstrate that the environmental burdens associated with anaerobic digestion are reduced in comparison with the alternative options. The major benefit occurs as a result of the electricity produced from burning the biogas and then supplying the 'green power' to the local electrical grid.

Gastroschisis and Hirschsprung's disease: a rare combination.

The authors report on a neonate with gastroschisis repaired at birth who later had abdominal distension, emesis, feeding intolerance, and an abnormal stooling pattern. Total colon and partial small bowel aganglionosis (TCAS), or Hirschsprung's disease, was diagnosed subsequently. This is the first report of this combination of gastrointestinal anomalies. J Pediatr Surg 36:638-640.

Evaluation of the effects of oxandrolone on malnourished HIV-positive pediatric patients.

OBJECTIVE: To determine the safety and efficacy of anabolic therapy to prevent or reverse wasting and malnutrition in human immunodeficiency virus (HIV)-infected pediatric patients. The anabolic steroid, oxandrolone, was evaluated because of its safe and effective use in other pediatric conditions. METHODS: Nine HIV-positive children who were malnourished or at risk for malnutrition (4 females, 5 males; 4-14 years of age) took oxandrolone for 3 months (.1 mg/kg/day orally). Quantitative HIV ribonucleic acid polymerase chain reaction and CD4(+) T-cell levels, complete blood cell count (CBC) and chemistry profile, endocrinologic studies, resting energy expenditure, respiratory quotient, nutritional measures, body composition assessment with quantitative computed tomography, and skinfold body composition measurements were determined before treatment, during treatment (3 months), and for 3 months after treatment. Statistical analyses were completed using the Friedman two-way analysis of variance and Spearman correlation tests. RESULTS: No adverse clinical or laboratory events or changes in Tanner staging or virilization occurred. Quantitative HIV ribonucleic acid polymerase chain reaction and CD4(+) T-cell levels did not change significantly. Insulin-like growth factor 1 increased, suggesting an anabolic effect of treatment. The rate of weight gain increased during treatment and was maintained after treatment. Linear growth continued and was maintained throughout treatment, whereas bone age did not increase significantly. Anthropometric assessments indicated an increase in muscle mass and a decrease in fat while patients were on treatment, and a mild decrease of muscle and increased fat posttreatment. Likewise, computed tomography scan results demonstrated similar changes in muscle mass. Resting energy expenditure and respiratory quotient remained stable throughout treatment and follow-up. No significant changes were seen in the quality of life questionnaire. CONCLUSIONS: Treatment with oxandrolone for 3 months in HIV-infected children was well-tolerated, safe, and associated with markers of anabolism. The latter effect was maintained partially for 3 months after discontinuation of a 3-month course of therapy. Additional studies are needed to assess the potential benefits and risks of a longer course of therapy or a higher dose of oxandrolone in HIV-infected children.

Gastrointestinal hemorrhage due to duodenal erosion by a biliary wallstent.

A self-expanding metallic stent (Wallstent) was used to relieve obstruction of the common bile duct in a young male with a desmoplastic small cell tumor of the abdomen. Two months after insertion and following a course of chemotherapy the lower end of the stent eroded the mucosa of the second part of the duodenum causing severe gastrointestinal hemorrhage which necessitated laparotomy and trimming of the stent. This complication may have been due to shrinking of the tumor as well as thrombocytopenia following chemotherapy.

Pediatric gastrointestinal endoscopy.

Development of smaller instruments and emergence of pediatric gastroenterology as a legitimate and growing subspecialty have been primary factors involved in effective utilization of gastrointestinal endoscopy in the care of infants and children. Endoscopic gastrointestinal procedures are now common in most major pediatric centers, and they can be safely performed on small infants, including newborns. This review of pediatric endoscopy presents many of the standard techniques that are applied in most pediatric centers in the United States. Some of the important issues and differences between pediatric and adult patients with gastrointestinal diseases are discussed.

Rectal mucosal major basic protein in infants with dietary protein-induced colitis.

Dietary protein-induced colitis is a frequent cause of rectal bleeding in infants. The exact pathogenic mechanism is unknown but the disorder has been thought to be due to an allergic response. Rectal mucosal edema and eosinophilia are typically found but there are no specific markers currently available. Because eosinophil degranulation, as evidenced by the release of major basic protein, has been implicated in hypersensitivity disorders, we aimed to assess major basic protein deposition as a marker of dietary protein-induced colitis occurring in young infants. Suction rectal biopsies from five infants aged 1 to 7 months with findings consistent with dietary protein-induced colitis were compared histologically with five age matched controls who underwent rectal biopsies to rule out Hirschsprung's disease. An established indirect immunofluorescent staining method was used to identify tissue major basic protein. Comparable rectal deposition of major basic protein was found for the controls and colitic patients. Mucosal eosinophilia but not mast cell content was more prominent in the colitic patients (P < .05) than in the controls. Some of the colitic infants had elevated serum IgE levels (1 of 5), positive RAST for milk (2 of 5), and peripheral blood eosinophilia (1 of 5). Our findings do not support the concept that dietary protein-induced colitis of infancy is due solely to an immediate hypersensitivity response. The results also indicate that major basic protein is probably not a marker or likely primary mediator of this disorder.

Psychosocial impacts in populations exposed to solid waste facilities.

This interdisciplinary study uses a parallel case study design to investigate psychosocial impacts in populations exposed to three solid waste facilities in Southern Ontario. Impacts are examined at three social scales: individual, social network and community levels. The objectives and design derive from a feasibility study recently completed by the same research team. A two stage approach is adopted. The first is an epidemiologic survey to determine the prevalence of psychosocial impacts in the populations within a prescribed area around each site. A disproportionate stratified (by distance) random sample of 250 households is surveyed at each site. Data on awareness, knowledge, concern and action regarding the site are also obtained. Scores on pre-validated health measurement scales will be compared with population norms to determine the frequency distribution above, within and below the range of normal. The second stage involves the use of qualitative methodologies to provide an in-depth analysis of the individual, social network and community level factors affecting psychosocial impacts and reactions to the situation. Depth interviews with a sub-sample of survey respondents explore individual perceptions, attitudes and actions. Focus groups composed of members of relevant organizations and discussion groups comprising non-members uncover social network and community perspectives in an interactional setting. Interviews and group sessions are taped and transcribed for content analysis of salient themes. Textual analysis of media reports and other relevant documentation provide insights regarding the informational environment and the community context of the issues.

Whey protein hydrolysate formula for infants with gastrointestinal intolerance to cow milk and soy protein in infant formulas.

Twenty-one infants less than 6 months of age with gastrointestinal symptoms of cow milk and/or soy protein-based infant formula intolerance (diarrhea in 14, hematochezia in 16, emesis in 8, failure to thrive in 4, and colic in 10) were treated clinically with a whey protein hydrolysate formula. Six patients improved when placed directly on the formula, and 15 remained asymptomatic or improved when given the whey hydrolysate formula following initial treatment with a casein hydrolysate or elemental formula. Eighteen had supporting evidence of an allergic basis for their symptoms, including a family history of allergies in 6, a clinical challenge with the offending formula in 1, laboratory tests consistent with atopy in 11, and/or rectal biopsy with histologic allergic features in 7. The whey hydrolysate formula may be an acceptable alternative to soy or casein hydrolysate formulas in most infants with gastrointestinal symptoms of cow milk and/or formula intolerance.

Aminotransferase as a prognostic index in infants with liver disease.

To assess the utility of the serum aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio in a group of infants with liver disorders, we retrospectively analyzed the charts of 73 infants with chronic liver disorders. Patients were considered as having either a good outcome (n = 40) or a poor outcome (n = 33), based upon the clinical course. AST and ALT in serum were measured simultaneously at the time of initial presentation and at various follow-up visits during the first 13 months after birth. At presentation (mean age 1.65 months), there was no difference in the AST/ALT ratios between the good (1.61 +/- 0.62; mean +/- SD) and poor (1.65 +/- 0.78) outcome groups (P = 0.81). However, over time, the AST/ALT ratio increased in patients in the poor-outcome group and decreased in patients in the good-outcome group. Calculating the AST/ALT ratio appears to be an easy, early, and reliable prognostic indicator for infants with hepatic disease, and may be a useful measure for evaluating liver-disease patients.

Sensitivity to change and the effect of mode of administration on health status measurement.

A measure of global health status, the McMaster Health Index Questionnaire (MHIQ), was assessed to determine two important measurement properties related to its reliability and validity--sensitivity to change and the effect of mode of administration. Ninety-six patients in a physiotherapy clinic were randomly assigned to three mode-of-administration study groups, administered the MHIQ at four points in time including at admission and discharge from the clinic, and assessed for change by their physiotherapist. MHIQ physical function, social function, and emotional function retest scores obtained by self-completion within a 1-week interval were most stable. Physical function scores by any of self-completion, telephone interview, or personal interview were sensitive to change, that is, they improved dramatically by the time of discharge from the clinic. Mode of administration did not affect the size of the change scores. Changes reflected by the physical function scores correlated with changes in physical function reported by a patient's physiotherapist. No systematic changes occurred with social and emotional function scores; this is not surprising in a group of patients with predominantly physical function problems.

Evaluation of placement and coordination of geriatric services using a health program evaluation grid.

This article describes how the Health Program Evaluation Grid method of clarifying program objectives was applied to an innovative program (PCS) set up to assist the placement of the elderly into appropriate long-term care programs/agencies. The advantages and disadvantages of the Grid method are outlined in terms of how the Grid may be used by program managers as their first step in evaluation of a health program for which they are responsible. The Grid method provided a basis for setting evaluation priorities for PCS, and methods of executing the highly ranked evaluation priorities were discussed. The use of the Grid in development of objectives for three other Ontario health programs assisted by the Department of Clinical Epidemiology and Biostatistics of McMaster University has shown further the usefulness of the approach.

Relationship between nuclear morphology and the phases of the cell cycle during cercarial development of the digenetic trematode Trichobilharzia ocellata.

During the proliferative phase of cercarial development in the digenetic trematode Trichobilharzia ocellata, nuclei varied in size, appearance of the chromatin, and intensity of Feulgen staining. On the basis of interphase nuclear morphology six nuclear classes were identified. Data from microspectrophotometric determinations and 3H-TdR labeling experiments were used to correlate each kind of interphase nucleus with a phase of the cell cycle. Marked variability in nuclear area developed between cells by time they reached late G1. Increases in nuclear area could not be correlated with the onset of DNA synthesis. Throughout all stages of development of T. ocellata cercariae, proliferating cells divide mitotically; meiotic divisions were never seen. Thus, the mode of reproduction appears to be asexual. No evidence was found to support previous suggestions of diploid parthenogenesis.

Cell cycle analysis in developing cercariae of Trichobilharzia ocellata (Trematoda: Schistosomatidae).

Cellular proliferation has been analyzed during cercarial development of the digenetic trematode Trichobilharzia ocellata. Prior to the tail-bud stage (about 1,000 cells), cells were actively involved in cellular proliferation. The mean cell cycle was 15.2 hr. The time for mitosis was 1.6 hr; for G1, 5.6 hr; for G2, 3.2 hr, and for the S phase, 4.8 hr. Beginning with the tail-bud stage, an increasing proportion of cells accumulate in the G1 phase. Cytological evidence of changes in the amount of cytoplasm per cell revealed that these noncycling cells were differentiating. During organ development and differentiation, the proportion of proliferating cells decreases and by the 2,000-celled stage proliferation ceases. Our results do not support a germinal lineage theory of cercarial development since none of the observed nuclear types could be unequivocally identified as belonging to the germ line.

Relative ribosomal RNA cistron multiplicity in oocytes and postembryonic stages of the eutelic nematode Panagrellus silusiae.

The number of ribosomal RNA cistrons has been measured in the total DNA extracted from L2 juvenile and adult stages of the free-living nematode Panagrellus silusiae. Saturation hybridization studies with homologous rRNA indicate that both stages have about 275 ribosomal genes per haploid equivalent. Using homologous 125I-labelled rRNA for in situ hybridization, the mean number of silver grains per DNA content for oocyte, hypodermis and gut nuclei was similar. The mean DNA contents of maturing oocyte, hypodermis and gut nuclei are about 20C, 2C, and 10C respectively. We conclude that rDNA amplication alone is insufficient to account for the variation in DNA content of oocytes and that postembryonic development in this eutelic organism occurs without a significant differential increase in the number of ribosomal cistrons per worm.