Influence of sediment quality and microbial community on the functioning capacity of a constructed wetland treating alkaline leachate after 5.5 years in operation.

Constructed wetlands (CWs) have been demonstrated as a cost-effective alternative to chemical treatment systems for mine waters, with the microbial communities attributed to promoting carbonation and aiding pH neutralization. However, few data are available for the long-term use of CWs treating alkaline leachates nor the activity of microbes within them. To investigate the feasibility of CW to buffer alkaline pH, a pilot-scale wetland was implemented in 2015 to treat alkaline bauxite residue leachate. After 5.5 years, samples of supernatant water and sediment were taken at 0.5 m increments along the 11 m long wetland. Waters were analysed for pH, EC and metal(loid) content, while sediment was subjected to physico-chemical assessment and element fractionation. Microbial biomass and community were assessed by phospholipid fatty acid analysis (PLFA) and functionality by the Rapid Automated Bacterial Impedance Technique (RABIT). Evidence presented demonstrates that the CW operating for 66 months effectively treats bauxite residue leachate, with reduced influent pH from 11.5 to 7.8. Trace element analysis revealed effective reduction in Al (94.9 %), As (86.7 %) and V (57.6 %) with substrate analysis revealing a frontloading of elevated pH and trace element content in the first 5 m of the wetland. Sediment Al, As and V were present mostly (>94 % of total) in recalcitrant forms. Sediment Na was mostly soluble (48-62 %), but soils were not sodic (ESP < 15 %). Investigations into the microbial community revealed greatest biomass was in the first 5 m of the wetland, where pH, EC and metal contents were greatest. Microbial respiration using endemic Phragmites australis as a substrate demonstrates an ability to cycle recalcitrant carbon sources within a CW system. These novel microbial findings highlight the need for further investigation into the microbial communities in alkaline CWs.

Measuring labor input on pasture-based dairy farms using a smartphone.

With the cessation of milk quotas in the European Union, dairy herd sizes increased in some countries, including Ireland, with an associated increase in labor requirement. Second to feed costs, labor has been identified as one of the highest costs on pasture-based dairy farms. Compared with other European Union countries, Ireland has historically had low milk production per labor unit; thus, optimization of labor efficiency on farm should be addressed before or concurrently with herd expansion. The objective of this study was to quantify current levels of labor input and labor efficiency on commercial pasture-based dairy farms and to identify the facilities and management practices associated with increased labor efficiency. Thirty-eight dairy farms of varying herd sizes, previously identified as labor-efficient farms, were enrolled on the study and data were collected over 3 consecutive days each month over a 12-mo period, starting in May 2015 and finishing in August of 2016. This was achieved through the use of a smartphone application. For analysis purposes, farms were categorized into 1 of 3 herd size categories (HSC): farms with <150 cows (HSC 1), 150-249 cows (HSC 2), or ≥250 cows (HSC 3). Overall farm labor input increased with HSC with 3,015, 4,499, and 6,023 h worked on HSC 1, 2, and 3, respectively. A higher proportion of work was carried out by hired staff as herd size increased. Labor efficiency was measured as total hours input to the dairy enterprise divided by herd size. Labor efficiency improved as herd size increased above 250 cows with 17.3 h/cow per yr observed for HSC 3; labor efficiency was similar for HSC 1 and 2, at 23.8 and 23.3 h/cow per yr, respectively. A large range of efficiency was observed within HSC. The labor requirements had a distinct seasonal pattern across the 3 HSC with the highest input observed in springtime (February to April) primarily due to calving and calf-care duties, milking, and winter feeding. The lowest input was observed in wintertime (November to January) when cows were dry. Particular facilities and management practices were associated with efficiency within certain tasks, the most notable in regard to milking and winter feeding practices. Additionally, the most efficient farms used contractors to perform a higher proportion of machinery work on farm than the least efficient farms.

Effects of pulmonary rehabilitation on exercise capacity and disease impact in patients with chronic obstructive pulmonary disease and obesity.

OBJECTIVES: To explore the influence of obesity on outcomes of exercise capacity and disease impact in patients with chronic obstructive pulmonary disease (COPD) in response to pulmonary rehabilitation (PR) and to compare outcomes to those of normal weight and overweight counterparts. DESIGN: Secondary data analysis of clinical database. SETTING: St. James's Hospital, Dublin, Ireland. PARTICIPANTS: 155 participants with a primary diagnosis of COPD who completed a PR programme between 2012 and 2014. MAIN OUTCOME MEASURES: Exercise capacity evaluated using the Six Minute Walk Test (6MWT) and the COPD Assessment Test (CAT) evaluated disease impact. RESULTS: Walking distance in the 6MWT improved significantly [mean difference of 55m (95% CI: 42 to 68; p<0.001)] and similarly [F(2, 92)=1.434, p=0.24] across all BMI categories, although the level of improvement reached clinical significance in the normal/underweight and overweight categories only. Disease impact on the CAT score improved across all body mass index (BMI) classifications by 2.3 points (95% CI: 0.9 to 3.6; p<0.050) which reached clinical significance and did not vary across BMI categories [F(2, 80)=0.534, p=0.58]. CONCLUSION: Exercise capacity and self-report disease impact of individuals with COPD improved similarly in response to PR irrespective of BMI.

Effect of biomass concentration on methane oxidation activity using mature compost and graphite granules as substrata.

Reported methane oxidation activity (MOA) varies widely for common landfill cover materials. Variation is expected due to differences in surface area, the composition of the substratum and culturing conditions. MOA per methanotrophic cell has been calculated in the study of natural systems such as lake sediments to examine the inherent conditions for methanotrophic activity. In this study, biomass normalised MOA (i.e., MOA per methanotophic cell) was measured on stabilised compost, a commonly used cover in landfills, and on graphite granules, an inert substratum widely used in microbial electrosynthesis studies. After initially enriching methanotrophs on both substrata, biomass normalised MOA was quantified under excess oxygen and limiting methane conditions in 160ml serum vials on both substrata and blends of the substrata. Biomass concentration was measured using the bicinchoninic acid assay for microbial protein. The biomass normalised MOA was consistent across all compost-to-graphite granules blends, but varied with time, reflecting the growth phase of the microorganisms. The biomass normalised MOA ranged from 0.069±0.006µmol CH4/mg dry biomass/h during active growth, to 0.024±0.001µmol CH4/mg dry biomass/h for established biofilms regardless of the substrata employed, indicating the substrata were equally effective in terms of inherent composition. The correlation of MOA with biomass is consistent with studies on methanotrophic activity in natural systems, but biomass normalised MOA varies by over 5 orders of magnitude between studies. This is partially due to different methods being used to quantify biomass, such as pmoA gene quantification and the culture dependent Most Probable Number method, but also indicates that long term exposure of materials to a supply of methane in an aerobic environment, as can occur in natural systems, leads to the enrichment and adaptation of types suitable for those conditions.

Acquired Anterior Laryngeal Web in a Shotgun Injury.

We report the first case of an anterior laryngeal web post gunshot wound in the modern literature. A 27 year-old man suffered a close range shotgun injury to his neck. He presented with stridor and a large open neck wound. Emergency tracheostomy was required. A postoperative fibreoptic laryngoscopy revealed anterior glottic web formation. This case report highlights the difficulties in managing acquired anterior laryngeal webs and reviews the only other case in the in the literature from 1915.

Trans-cervical, trans-tracheal approach to proximal tracheo-oesophageal fistula: a novel technique.

Esophageal atresia and tracheo-esophageal fistula (TEF) occur in 1/2400-4500 births. Whilst the diagnosis of esophageal atresia is readily made shortly after birth, patients with an isolated H type TEF can present with varying degrees of symptomatology which can pose a diagnostic challenge. A combination of contrast esophagogram and endoscopic evaluastion is the most commonly employed localization strategy. Despite accurate pre-operative localization, intra-operative identification of the TEF can prove substantially more challenging. The authors of this report describe a novel approach in the management of a proximal TEF, which allows direct visualization and cannulation via a trans-cervical, trans-tracheal approach.

A case of quinsy following high-pressure water jet injury.

High-pressure water injuries of the oropharynx are uncommon but can cause significant injury and airway compromise when they occur. A small number of cases of high-pressure water injury of the oropharynx have been presented in the literature, detailing a range of effects and outcomes. We describe the first reported case of high-pressure water injury of the oropharynx associated with peritonsillar abscess (quinsy) requiring surgical drainage.

Novel use of a supraclavicular transverse cervical artery customised perforator flap: a paediatric emergency.

Perforation of the piriform fossa is a rare, potentially life-threatening paediatric emergency. Prompt diagnosis and early operative intervention is key to patient survival, yet restoring aerodigestive continuity can pose a significant reconstructive challenge. A seven-month old baby girl presented to an emergency department acutely unwell with a twenty-four-hour history of haemoptysis, cough and worsening respiratory distress. A contrast swallow demonstrated extension of contrast into the retropharyngeal region necessitating immediate surgical intervention. A 3.0 cm×1.0 cm perforation within the left posterolateral piriform fossa was identified. The defect was repaired with a supraclavicular transverse cervical artery customised perforator flap. This was inset into the piriform fossa luminal defect as a life-saving procedure. Following a stormy post-operative course, the child was discharged home on day 28 of admission and admitted electively 6 weeks later for division of flap pedicle. This case highlights the novel use of this fasciocutaneous island flap to reconstruct an extensive, potentially fatal, piriform fossa defect in an acute paediatric setting. This simple flap design offers timely mobilisation, reliable blood supply, adequate tenuity and surface area, to reconstruct this extensive defect as a life-saving intervention in a profoundly septic child.

Ectopic olfactory neuroblastoma: report of four cases and a review of the literature.

Our objective is to present a short series of four rare cases of ectopic olfactory neuroblastoma. Our methods present four case reports of ectopic olfactory neuroblastoma and a review of the literature for management and treatment of this disease. The results indicate short case series reports of ectopic olfactory neuroblastoma arising from the anterior ethmoidal sinuses, the nasopharynx, the lateral nasal wall and the floor of the nose. The discussion focuses on likely origins of ectopic olfactory neuroblastoma, its clinical features and management. We conclude that ectopic olfactory neuroblastoma is a rare disease. Treatment principles are the same for non-ectopic disease and guided by extension into adjacent structures such as the orbit or anterior cranial fossa and usually involves surgery with or without adjuvant radiotherapy.

Challenging the use of the lymphocyte to white cell count ratio in the diagnosis of infectious mononucleosis by analysis of a large cohort of Monospot test results.

OBJECTIVE: We investigated the hypothesis that a lymphocyte/white cell count ratio should be used as a diagnostic indicator of infectious mononucleosis. DESIGN: Retrospective study to compare lymphocyte counts and white blood cell counts, against the criterion standard, the mononucleosis spot test. SETTING: Department of Otolaryngology, Mater Misericordiae University Hospital, Dublin, Ireland. PARTICIPANTS: We reviewed 1000 patients who had Monospot assays, 500 positive and 500 negative. MAIN OUTCOME MEASURES: The lymphocyte counts and white blood cell ratio was calculated and compared with the monospot result to calculate the sensitivity and specificity at various ratios. RESULTS: The lymphocyte counts and white blood cell ratio was significantly different in the positive and negative monospot groups (P < 0.05). The mean lymphocyte counts and white blood cell ratio in the positive group was 0.49 and the mean lymphocyte to white cell count ratio in the monospot negative group was 0.29.A ratio of 0.35 had a specificity of 72% and a sensitivity of 84% for the detection of glandular fever. A higher ratio will give a greater specificity, but a lower sensitivity, and vice versa. CONCLUSIONS: The mean lymphocyte to white cell count ratio is not sufficient to diagnose or exclude infectious mononucleosis. Thus, this study does not confirm the conclusions of earlier studies.

Prospective, blinded trial of whole-body magnetic resonance imaging versus computed tomography positron emission tomography in staging primary and recurrent cancer of the head and neck.

OBJECTIVES: To compare the use of computed tomography - positron emission tomography and whole-body magnetic resonance imaging for the staging of head and neck cancer. PATIENTS AND METHODS: From January to July 2009, 15 consecutive head and neck cancer patients (11 men and four women; mean age 59 years; age range 19 to 81 years) underwent computed tomography - positron emission tomography and whole-body magnetic resonance imaging for pre-therapeutic evaluation. All scans were staged, as per the American Joint Committee on Cancer tumour-node-metastasis classification, by two blinded consultant radiologists, in two sittings. Diagnoses were confirmed by histopathological examination of endoscopic biopsies, and in some cases whole surgical specimens. RESULTS: Tumour staging showed a 74 per cent concordance, node staging an 80 per cent concordance and metastasis staging a 100 per cent concordance, comparing the two imaging modalities. CONCLUSION: This study found radiological staging discordance between the two imaging modalities. Whole-body magnetic resonance imaging is an emerging staging modality with superior visualisation of metastatic disease, which does not require exposure to ionising radiation.

Complementary medicine use in patients with head and neck cancer in Ireland.

The objectives of the study were: first, to determine the prevalence of traditional medicine (TM) and complementary and alternative medicine (CAM) use in head and neck cancer patients in Ireland; second, to educate ourselves on the plethora of CAM/TM options available to patients outside the dominion of conventional medicine. The study design consisted of a cross-sectional survey carried out in three head and neck cancer centres. Self-administered questionnaires were distributed to 110 head and neck cancer patients attending the three cancer centres and data were collected for statistical analysis. A total of 106 patients completed the questionnaire; 21.7% of the participants used CAM/TM since their diagnosis with head and neck cancer. CAM/TM usage was higher in female (34.3%) than in male patients (16.2%). CAM/TM use was more common in the 41-50-year age group, in patients with higher educational levels and those holding strong religious beliefs, and also in married than single patients. The most common types of CAM/TM used were spiritual and laying on of hands. The most common reasons reported for using CAM/TM were to counteract the ill effects of treatment and increase the body's ability to fight cancer. Sources of information on CAM/TM were friends (65%), family (48%) and media (21%). This survey reveals a high prevalence of CAM/TM use in head and neck cancer patients, hence emphasising the need for otolaryngologists to educate themselves on the various therapies available to be able to provide informative advice. There is an urgent need for evidence-based investigation of various CAM/TM therapies currently offered to patients.

Sentinel lymph node biopsy in node-negative squamous cell carcinoma of the oral cavity and oropharynx.

OBJECTIVES: Considerable controversy exists regarding the merits of elective neck dissection in patients with early stage oral cavity and oropharyngeal squamous cell carcinoma. It is highly desirable to have a method of identifying those patients who would benefit from further treatment of the neck when they are clinically node-negative. The purpose of the present study was to examine the use of sentinel lymph node biopsy in identifying occult neck disease in a cohort of patients with node-negative oral cavity and oropharyngeal squamous cell carcinoma. DESIGN: We evaluated a total of 13 patients with oral cavity and oropharyngeal cancer who were clinically and radiologically node-negative. RESULTS: A sentinel lymph node was found in all 13 patients, revealing metastatic disease in five patients, four of whom had one or more positive sentinel lymph nodes. There was one false negative result, in which the sentinel lymph node was negative for tumour whereas histological examination of the neck dissection specimen showed occult disease. CONCLUSION: In view of these findings, we would recommend the use of sentinel lymph node biopsy in cases of oral cavity and oropharyngeal squamous cell carcinoma, in order to aid the differentiation of those patients whose necks are harbouring occult disease and who require further treatment.

A novel process for the removal of aniline from wastewaters.

The aim of this research was to develop a solid regenerable catalytic adsorbent capable of removing aniline from aqueous solutions. A H-Beta zeolite was first loaded with copper in an ion-exchange process to enhance its catalytic activity. Experimental results indicated an aniline adsorption level of approximately 106-114 mg g(-1) for each of the unmodified H-Beta, the 0.5% (w/w) Cu-Beta or the 1.4 % (w/w) Cu-Beta zeolites. The adsorption processes followed the Langmuir model and the level of aniline adsorbed was largely unaffected by a change in temperature. Assessment of the aqueous stability of the exchanged copper on the Beta zeolites indicated minimum copper leaching in the range pH 5-11 thus providing a stable working pH range for both the 0.5% (w/w) and 1.4% (w/w) Cu-Beta adsorbent materials. Catalytic oxidation studies on the adsorbed aniline indicated that the presence of copper in the zeolites significantly enhanced the degradation of aniline to predominantly carbon dioxide, water and nitrogen. Five successive adsorption/catalytic oxidation cycles did not diminish the aniline adsorption capacity of the copper loaded zeolites but there was a small loss in the efficacy of the catalytic oxidation of the adsorbed aniline by the end of the 5th cycle.

Does the addition of sublingual gland excision to submandibular duct relocation give better overall results in drooling control?

UNLABELLED: Submandibular duct relocation plus or minus excision of the sublingual glands are relatively simple procedures with low morbidity. Between 1981 and 2005, 71 submandibular duct relocation and 29 submandibular duct relocation plus excision of the sublingual glands procedures were conducted. OBJECTIVES: To compare both procedures including operative time, length of hospital stay, postoperative complications, drooling scores and parental satisfaction. STUDY DESIGN: Prospective study. SETTING: Paediatric tertiary referral centre. PARTICIPANTS: Patients referred with excessive drooling after failure of conservative methods. EXCLUSION CRITERIA: patients with recurrent aspiration pneumonias or dental caries. Two patients were lost to follow up and excluded from the study. RESULTS: Operative time and length of hospital stay were increased in the submandibular duct relocation plus sublingual gland excision group. Drooling scores and parental satisfaction results were excellent, 93% of parents in the submandibular duct relocation group and 89% of parents in the duct relocation plus sublingual glands excision were satisfied and would recommend the procedure. There was no statistical difference (P = 0.643) in drooling scores between the two procedures. Postoperative morbidity was higher with the addition of sublingual gland excision, with postoperative haemorrhage occurring in 13.7% and 36% of parents expressing concern over postoperative pain, compared with 3% postoperative haemorrhage rate with submandibular duct relocation and only 12% of parents expressing the same concerns. CONCLUSION: We conclude that both procedures are effective in drooling control, but the addition of sublingual gland excision increases morbidity and we are no longer excising these glands with submandibular duct relocation.

A comparative analysis of anterior versus posterior squamous cell carcinoma of the tongue: a 10-year review.

INTRODUCTION: The study sought to compare and contrast squamous cell carcinoma (SCC) of the anterior mobile tongue with SCC of the tongue base, with emphasis on clinical presentation, management and outcome. METHODS: This was a retrospective, comparative analysis of patients treated for SCC of the tongue over a 10-year period. Cox's regression model was used to assess the effect of tumour site on survival. RESULTS: The study included 142 patients, of whom 86 were treated for SCC of the anterior tongue and 56 for tongue base lesions. Patients with carcinoma of the anterior tongue tended to present with a visible lump or ulceration of the tongue, whereas the majority of patients with tongue base SCC presented with pain. Sixty per cent of anterior tongue lesions were early stage (I or II) at initial presentation as compared with 21 per cent of tongue base lesions. CONCLUSION: Patients with anterior tongue lesions had a better prognosis, but this was not statistically significant when adjusted for stage.

Parotid masses in patients with previous ear surgery.

This paper describes three cases of patients presenting with lumps in their parotid gland, the origin of which was difficult to define. In each case the past medical history revealed that the patients had undergone previous ipsilateral middle ear surgery. We highlight the fact that where there has been previous incisions in the skin about the ear, there is a risk of epidermal inclusion cysts in the parotid gland. These cysts can occur many years after the initial surgery and therefore may not be identified as an obvious origin to lumps in the parotid gland. Rarely as this series highlights there may also be extension of a cholesteatoma (a collection of keratin which arises from the eardrum and extends into the middle ear space) from the mastoid bone to the parotid gland. We recommend formal ear examination where there is a history of previous ear surgery and an ipsilateral parotid gland lump is present.