Association between Appendectomy and Demyelinating Disorders in Subjects 40 Years and Older.

BACKGROUND: The association between appendectomy and multiple sclerosis (MS) is unknown. In this study, we explored the association between appendectomy and MS and neuromyelitis optica spectrum disorder (NMOSD). PATIENTS AND METHODS: MS and NMOSD patients older than 40 were identified from neurology records from hospitals in Malaysia. The diagnoses were based on the Revised McDonald (2010) and Wingerchuk (2015) criteria. Controls were sampled from Malaysia's normal population. Individuals were interviewed telephonically or face-to-face. The age inclusion criterion (over 40) differentiated high or low lifetime risk of appendicitis, as appendicitis incidence is rare after 40. RESULTS: 49 MS, 71 NMOSD, and 880 controls met the inclusion criteria. Seventy-two individuals (9 MS, 4 NMOSD, 59 control) had undergone appendectomy. Appendectomy rates were 18.37% in the MS group (95% CI 7.5-29.2%), 5.6% in the NMOSD group (0.3%, 11%), and 6.7% among controls (5.1%, 8.4%), (MS vs NMOSD P = 0.036, MS vs controls P = 0.007). Binary regression analysis showed that MS was an independent risk factor for appendectomy (OR 2.938, 95% CI 1.302, 6.633, P = 0.009). NMOSD showed no association with appendectomy. CONCLUSION: MS is positively associated with appendectomy, unlike ulcerative colitis, which is negatively associated. We hypothesize that there is a commonality in the microflora in persons who have had these two illnesses.

Leaching of additives from construction materials to urban storm water runoff.

Urban water management requires further clarification about pollutants in storm water. Little is known about the release of organic additives used in construction materials and the impact of these compounds to storm water runoff. We investigated sources and pathways of additives used in construction materials, i.e., biocides in facades' render as well as root protection products in bitumen membranes for rooftops. Under wet-weather conditions, the concentrations of diuron, terbutryn, carbendazim, irgarol 1051 (all from facades) and mecoprop in storm water and receiving water exceeded the predicted no-effect concentrations values and the Swiss water quality standard of 0.1 microg/L. Under laboratory conditions maximum concentrations of additives were in the range of a few milligrams and a few hundred micrograms per litre in runoff of facades and bitumen membranes. Runoff from aged materials shows approximately one to two orders of magnitude lower concentrations. Concentrations decreased also during individual runoff events. In storm water and receiving water the occurrence of additives did not follow the typical first flush model. This can be explained by the release lasting over the time of rainfall and the complexity of the drainage network. Beside the amounts used, the impact of construction materials containing hazardous additives on water quality is related clearly to the age of the buildings and the separated sewer network. The development of improved products regarding release of hazardous additives is the most efficient way of reducing the pollutant load from construction materials in storm water runoff.

Developing an integrated Memory Assessment and Support Service for people with dementia.

This paper describes the development of an integrated Memory Assessment and Support Service guided by best practice principles offered by a National Dementia Strategy (Department of Health). Previous service provision is outlined and comparisons made from both quantitative and qualitative evaluation data to consider the effectiveness of the new service. Conclusions and recommendations are offered to assist others with similar practice development requirements.

Biocides used in building materials and their leaching behavior to sewer systems.

There is increasing concern about diffuse pollution of aquatic systems by biocides used in urban areas. We investigated sources and pathways of biocides significant for the pollution of storm water runoff. Main sources seem to be building envelopes, i.e. facades (paints, plasters) and roof sealing membranes. First results from a defined urban catchment drained by a separated sewer system without any agricultural activities reveal a substantial occurrence. Even after the first flush, concentrations of terbutryn, carbendazim, mecoprop as well as Irgarol 1051 and its metabolite exceeded the Swiss water quality standard of 0.1 microg/L. In laboratory experiments, leaching of mecoprop used as a root protection agent in bitumen sheets for roof waterproofing was determined. The concentrations differed in 16 different sheets two orders of magnitude, depending on the product composition. Using optimized products, it is expected to be the most efficient and sustainable way to reduce the environmental impact. To understand transport dynamics and environmental risk, further storm water events will be analyzed. Based on the ongoing project URBIC, first measures will be proposed to limit the release to surface and ground water.

Developing common learning: the new generation project undergraduate curriculum model.

This paper describes the curriculum model developed for an ambitious interprofessional education programme for health and social care professions implemented in two universities in the south of England (the New Generation Project). An outline of how the New Generation Project has interpreted the meaning of interprofessional learning is presented first. This is followed by an outline of the structure of the programme, describing both learning in common and interprofessional learning components. The pedagogies underpinning this curriculum initiative are presented and an integrated pedagogical model, facilitated collaborative interprofessional learning, is proposed. The New Generation Project curriculum is then discussed as an extension of an established typology of interprofessional education.