Earthworm-Collembola interactions affecting water-soluble nutrients, fauna and physiochemistry in a mesocosm manure-straw composting experiment.

A mesocosm fermentation experiment was undertaken to investigate interactions between Eisenia fetida and Collembola affecting composting processes. Earthworms, Collembola, respiration, water soluble nutrients and compost characteristics (near infrared spectra - NIRS) were monitored on four occasions over 136 days. Earthworms were the main drivers of early changes in composts, increasing the general abundance of Collembola, although responses varied with species. Earthworms accelerated substrate mineralisation and release of soluble nutrients whilst also changing compost characteristics. Collembola alone had little direct effect on soluble nutrient concentrations or respiration; they did however alter compost characteristics (NIR spectra). Earthworm-Collembola interactions affecting respiration and soluble nutrients were mainly antagonistic in the early stages of composting but synergistic in later stages. In the later stages of composting, the higher abundance of Collembola when combined with earthworms resulted in greater concentrations of soluble nitrate and phosphate. These findings emphasise the importance in vermicomposting practice of different invertebrate groups having access to feedstock at appropriate stages of the process. The high concentrations of soluble nutrients released during vermicomposting indicate the need for control measures to avoid off-site pollution and loss of this resource.

A circular economic approach to the phytoextraction of Zn from basic oxygen steelmaking filtercake using Lemna minor and CO2.

Two billion tonnes of alkaline metallurgical waste is generated per year as a product of industry, mining, and metal processing. Filtercake is one such residue formed as a bi-product of steelmaking. Metal rich bi-products can be both an environmental concern and potential resource. High concentrations of heavy metals, if accessed, could be utilised and reprocessed reducing both pollution and the demand for raw metal ores. Phytoextraction is one such method of recovering metals from contaminated mediums. Research interest in Lemna sp. has grown due to their phytoremediation potential. Facilitated by rapid growth and accumulation of nutrients and metals, Lemna minor has been described as one of the most effective macrophytes for remediating contaminated water. The present study outlines a system using L. minor to extract Zn from filtercake when submerged in static water. To facilitate phytoremediation, CO2 carbonation can be employed to solubilise elements and utilise this greenhouse gas, another a bi-product of steel industry. The addition of CO2 to vessels of water containing filtercake lowered the pH from as high as 8.8 to 5.6 and significantly increased Zn in solution compared to vessels receiving no CO2. Results suggest the potential of L. minor to accumulating 68.7 kg Zn per year from 20.5 Mt. filtercake ha-1. This system facilitates a circular economy with re-use of multiple existing bi-products. In addition, the potential employment of biomass in biofuel production and use of remediated filtercake in carbon sequestration adds further environmental and socio-economic impact. The extent to which the approach was consistent with circular economy was discussed and its wider integration considered.

Deep seam and minesoil carbon sequestration potential of the South Wales Coalfield, UK.

Combustion of coal for energy generation has been a significant contributor to increased concentrations of atmospheric carbon dioxide. It is of interest to evaluate the potential of former coalfields for mitigating these increases by carbon sequestration and to compare different options to achieving this end. Here, carbon sequestration in residual coal seams and through reclamation of spoil tips is compared, and their carbon dioxide storage potential in the South Wales Coalfield estimated. Coal seam sequestration estimates come from an established methodology and consider the total unmined coal resource below 500 m deep with potential for carbon sequestration. The most likely effective deep seam storage capacity is 104.9 Mt carbon dioxide, taking account of reservoir conditions and engineering factors. Whilst many spoil tips in South Wales have been reclaimed, the focus has not been on carbon sequestration potential. Estimates of minesoil restoration sequestration capacity were based on a survey of restored minesoil and vegetation carbon stocks, mainly on sites 20-30 years after restoration; data from this survey were then extrapolated to the coalfield as a whole. Minesoil storage is estimated at 1.5 or 2.5 Mt (+2.2 Mt in tree biomass) carbon dioxide based on average grassland or woodland measurements, respectively; modelled data predicted equilibrium values of 2.9 and 2.6 Mt carbon dioxide respectively in grassland or woodland minesoils. If all sites achieved close to the maximum capacity in their land use class, minesoil storage capacity would increase to 2.1 or 3.9 Mt carbon dioxide, respectively. Combining the best woodland minesoil and standing biomass values, sequestration capacity increases to 7.2 Mt carbon dioxide. The wider social, economic, environmental and regulatory constraints to achieving this sequestration for each approach are discussed. Coal seam sequestration has a much higher capacity but sequestration in mine sites is less costly and has fewer regulatory constraints. Findings indicate a significant combined potential for carbon sequestration in the South Wales Coalfield and highlight challenges in achieving this potential. On a global scale, ex-coalfield sequestration could contribute to broader efforts to mitigate emissions.

When to use single-inhaler triple therapy in COPD: a practical approach for primary care health care professionals.

While single-inhaler triple therapy (SITT) devices were not available when the Global Initiative for Chronic Obstructive Lung Disease strategy and National Institute for Health and Care Excellence guidelines were developed, two devices are now available in the UK. This paper offers practical, patient-focused advice to optimize placement of SITT in the management of COPD. A survey of UK health care professionals (HCPs) identified issues around, and attitudes toward, SITT, which informed a multidisciplinary expert panel's discussions. The survey confirmed the need to clarify the place of SITT in COPD management. The panel suggested three criteria, any one of which identifies a high-risk patient where escalation to triple therapy from monotherapy or double combination treatment is appropriate: 1) at least two exacerbations treated with oral corticosteroids, antibiotics, or both in the previous year; 2) at least one severe exacerbation that required hospital admission in the previous year; 3) one exacerbation a year on a repeated basis for 2 consecutive years. Appropriate non-pharmacological management is essential for all patients and should be considered before stepping up treatment. Regular review is essential. During each review, HCPs should consider stepping treatment up or down. If patients exacerbate despite adhering to triple therapy, an individualized approach should be considered if the inhaled corticosteroid (ICS) confers benefit or causes side effects. In this situation, the blood eosinophil count could aid decision making. ICSs should be continued when the history suggests that asthma overlaps with COPD. Training, counseling, and education should be individualized. HCPs should consider referral: 1) when there is limited response to treatment and persistent exacerbations; 2) where there is diagnostic uncertainty or suspected comorbidity; 3) whenever they feel "out of their depth." Overall, the panel concurred that when used correctly, SITT has the potential to improve adherence, symptom control, and quality of life, and reduce exacerbations. Studies using real-world evidence need to confirm these benefits.

Vulnerability of tropical forest ecosystems and forest dependent communities to droughts.

Energy captured by and flowing through a forest ecosystem can be indexed by its total Net Primary Productivity (NPP). This forest NPP can also be a reflection of its sensitivity to, and its ability to adapt to, any climate change while also being harvested by humans. However detecting and identifying the vulnerability of forest and human ecosystems to climate change requires information on whether these coupled social and ecological systems are able to maintain functionality while responding to environmental variability. To better understand what parameters might be representative of environmental variability, we compiled a metadata analysis of 96 tropical forest sites. We found that three soil textural classes (i.e., sand, sandy loam and clay) had significant but different relationships between NPP and precipitation levels. Therefore, assessing the vulnerability of forests and forest dependent communities to drought was carried out using data from those sites that had one of those three soil textural classes. For example, forests growing on soil textures of sand and clay had NPP levels decreasing as precipitation levels increased, in contrast to those forest sites that had sandy loam soils where NPP levels increased. Also, forests growing on sandy loam soil textures appeared better adapted to grow at lower precipitation levels compared to the sand and clay textured soils. In fact in our tropical database the lowest precipitation level found for the sandy loam soils was 821 mm yr(-1) compared to sand at 1739 mm yr(-1) and clay at 1771 mm yr(-1). Soil texture also determined the level of NPP reached by a forest, i.e., forest growing on sandy loam and clay reached low-medium NPP levels while higher NPP levels (i.e., medium, high) were found on sand-textured soils. Intermediate precipitation levels (>1800-3000 mm yr(-1)) were needed to grow forests at the medium and high NPP levels. Low thresholds of NPP were identified at both low (∼750 mm) and high precipitation (>3500 mm) levels. By combining data on the ratios of precipitation to the amount of biomass produced in a year with how much less precipitation input occurs during a drought year, it is possible to estimate whether productivity levels are sufficient to support forest growth and forest dependent communities following a drought. In this study, the ratios of annual precipitation inputs required to produce 1 Mg ha(-1) yr(-1) biomass by soil texture class varied across the three soil textural classes. By using a conservative estimate of 20% of productivity collected or harvested by people and 30% precipitation reduction level as triggering a drought, it was possible to estimate a potential loss of annual productivity due to a drought. In this study, the total NPP unavailable due to drought and harvest by forest dependent communities per year was 10.2 Mg ha(-1) yr(-1) for the sandy textured soils (64% of NPP still available), 8.4 Mg ha(-1) yr(-1) for the sandy loam textured soils (60% available) and 12.7 Mg ha(-1) yr(-1) for the clay textured soils (29% available). Forests growing on clay textured soils would be most vulnerable to drought triggered reductions in productivity so NPP levels would be inadequate to maintain ecosystem functions and would potentially cause a forest-to-savanna shift. Further, these forests would not be able to provide sufficient NPP to satisfy the requirements of forest dependent communities. By predicting the productivity responses of different tropical forest ecosystems to changes in precipitation patterns coupled with edaphic data, it could be possible to spatially identify where tropical forests are most vulnerable to climate change impacts and where mitigation efforts should be concentrated.

Breathing exercises for asthma: a randomised controlled trial.

BACKGROUND: The effect of breathing modification techniques on asthma symptoms and objective disease control is uncertain. METHODS: A prospective, parallel group, single-blind, randomised controlled trial comparing breathing training with asthma education (to control for non-specific effects of clinician attention) was performed. Subjects with asthma with impaired health status managed in primary care were randomised to receive three sessions of either physiotherapist-supervised breathing training (n = 94) or asthma nurse-delivered asthma education (n = 89). The main outcome was Asthma Quality of Life Questionnaire (AQLQ) score, with secondary outcomes including spirometry, bronchial hyper-responsiveness, exhaled nitric oxide, induced sputum eosinophil count and Asthma Control Questionnaire (ACQ), Hospital Anxiety and Depression (HAD) and hyperventilation (Nijmegen) questionnaire scores. RESULTS: One month after the intervention there were similar improvements in AQLQ scores from baseline in both groups but at 6 months there was a significant between-group difference favouring breathing training (0.38 units, 95% CI 0.08 to 0.68). At the 6-month assessment there were significant between-group differences favouring breathing training in HAD anxiety (1.1, 95% CI 0.2 to 1.9), HAD depression (0.8, 95% CI 0.1 to 1.4) and Nijmegen (3.2, 95% CI 1.0 to 5.4) scores, with trends to improved ACQ (0.2, 95% CI 0.0 to 0.4). No significant between-group differences were seen at 1 month. Breathing training was not associated with significant changes in airways physiology, inflammation or hyper-responsiveness. CONCLUSION: Breathing training resulted in improvements in asthma-specific health status and other patient-centred measures but not in asthma pathophysiology. Such exercises may help patients whose quality of life is impaired by asthma, but they are unlikely to reduce the need for anti-inflammatory medication.

Plant accumulation of potentially toxic elements in sewage sludge as affected by soil organic matter level and mycorrhizal fungi.

Leek (Allium ameloprasum) was grown in pot trials in two clay loams of contrasting organic contents, with and without indigenous mycorrhizal propagules. Sewage sludges containing varying levels of Cd, Cu and Zn were added. Extractable soil metals, plant growth, major nutrient content and accumulation of metals, and soil microbial indices were investigated. The aim was to establish whether soil organic content and mycorrhizal status affected plant and microbial exposure to these metals. Extractable metals were higher and responses to inputs more pronounced in the arable, lower organic matter soil, although only Cd showed a soil difference in the CaCl2 fraction. There were no metal toxic effects on plants and some evidence to suggest that they promoted growth. Uptake of each metal was higher in the larger plants of the grassland, higher organic matter soil. Inoculation with arbuscular mycorrhizal fungi increased root Cd and Zn concentrations. With the exception of Cd (roots) and Zn (shoots), higher inputs of sludge metals did not increase plant metals. Zn and Cu, but not Cd, concentrations were higher in roots than in shoots.

Effect of soil on microbial responses to metal contamination.

An experiment was conducted to investigate microbial responses to metal inputs in five soils with varying clay and organic contents; one soil had also a higher pH. These soils were treated with a low metal, sewage sludge control or with this sludge contaminated to achieve Cu=112, Ni=58 and Zn=220 mg kg(-1) in medium and Cu=182, Ni=98 and Zn=325 mg kg(-1) in high metal soils. CO(2) evolution rates were measured at 1 week and at 4-5-day intervals thereafter until the end of the incubation (7 weeks). Extractable metals (CaCl(2) and water), biomass C, metabolic quotient, ergosterol, bacterial-fungal phospholipid fatty acid (PLFA-3 weeks only) ratio and mineral N were measured at 3 and 7 weeks. Metal inputs caused a marked increase in metal availability in the slightly acidic sandy loams, a smaller increase in slightly acidic clays and had little effect in the alkaline loam. After an initial increase in CO(2) evolution with metal inputs in all soils, the high metal treatment alone caused a significant decrease at later stages, mainly in sandy loams. Although biomass C and metabolic quotient decreased in all soils with higher metal inputs, the effect was more pronounced in the sandy loams. Metal inputs increased ergosterol and decreased bacterial-fungal PLFA ratios in most soils. Larger mineral N contents were found in all high metal soils at 3 weeks but, after 7 weeks, metals caused a significant decrease in sandy loams. CaCl(2) and water-extractable Cu, Ni and Zn contents were closely correlated with microbial indices in sandy loam but not in clay soils. Overall, the effect of treatments on microbial and extractable metal indices was greater in loams. Within a single series, higher organic soils showed less pronounced responses to metal inputs, although this trend was not always consistent.

As-required versus regular nebulized salbutamol for the treatment of acute severe asthma.

Current British guidelines for the administration of beta2-agonists in acute severe asthma recommend regular nebulized therapy in hospitalized patients, followed by as-required (p.r.n.) use via hand-held devices after discharge. Since beta2-agonists do not possess anti-inflammatory activity in vivo, and are thus unlikely to influence the rate of recovery from an asthma exacerbation, it was hypothesized that patients given the short-acting beta2-agonist salbutamol on an as-required basis after admission to hospital would recover as quickly as those on regular treatment, but with potential reductions in the total dose delivered. Forty-six patients with acute severe asthma were randomly assigned to either regular prescriptions of nebulized salbutamol or to usage on a p.r.n. basis, from 24 h after hospital admission. The primary outcome measures were length of hospital stay, time to recovery, and frequency of salbutamol nebulization from 24 h after admission to discharge. Secondary outcome measures were treatment side-effects (tremor, palpitations), and patient satisfaction. Length of hospital stay was reduced in those patients allocated to p.r.n. salbutamol (geometric mean (GM) 3.7 days) versus regular salbutamol (GM 4.7 days). Time taken for peak expiratory flow to reach 75% of recent best was the same in both groups. There was a highly significant reduction in the number of times nebulized therapy was delivered to the p.r.n. group (GM 7.0, range 1-30) compared with the regular treatment group (GM 14.0, range 4-57; p=0.003; 95% confidence interval for ratio of GMs 1.29-3.09). In addition, patients reported less tremor (p=0.062) and fewer palpitations (p=0.049) in the p.r.n. group. Of the patients in the p.r.n. group who had received regular nebulized therapy on previous admissions (n=12), all preferred the p.r.n. regimen. Prescribing beta2-agonists on a p.r.n. basis from 24 h after hospital admission is associated with reduced amount of drug delivered, incidence of side-effects, and possibly length of hospital stay. This has implications for the efficient use of healthcare resources.

A surgical approach for patients with endstage emphysema.

For patients with emphysema who experience deteriorating lung function and concomitant comorbidity, there has been little to offer apart from best supportive care and more recently pulmonary rehabilitation. The early promise of lung transplantation for these patients has failed to materialize--a shortage of donors has meant that younger patients are more likely to receive donor lungs. A renewed interest in lung volume reduction surgery (LVRS) appears to offer hope for selected patients. This article looks at the history of LVRS and illustrates its benefits with a case study. However, if LVRS is a clinically significant approach to the treatment of emphysemic patients, then it requires careful clinical trials so that its benefits and costs can be fully evaluated.

Pattern of injuries in survivors of a helicopter crash.

The pattern of injuries caused when a helicopter crashed after an uncontrolled descent of approximately 15 m is described. Eleven patients were admitted to hospital for further treatment and observation, and 7 were treated in the Accident and Emergency Department. One-third of the victims sustained injuries to the dorsolumbar spine. Some conditions which could improve flight safety are discussed.

Pattern of injuries in survivors of a helicopter crash

The pattern of injuries caused when a helicopter crashed after an uncontrolled descent of approximately 15 m is described. Eleven patients were admitted to hospital for further treatment and observation, and 7 were treated in the Accident and Emergency Departament. One-third of the victims sustained injuries to the dorsolumbar spine. Some conditions which could improve flight safety are discussed

The geometric knee replacement in polyarthritis.

The British Orthopaedic Association assessment questionnaire for knee replacements was adapted to allow comparison of the severity of underlying polyarthritis with the benefits of geometric knee replacement in a retrospective study of 150 knees between six months and six years after operation. Total or partial relief of pain was achieved in 81 per cent of the operation, and changes in mobility occurred in fewer patients. Late sepsis remained a serious complication of nine per cent of the operations and one patient died from septicaemia. Late sepsis was associated with previous synovectomy or osteotomy. Retropatellar pain rarely interfered with the mobility of the patient. There was no association of operations that failed with a high erythrocyte sedimentation rate, a high platelet count, a low haemoglobin level or with a strongly positive rheumatoid factor but pain in the contralateral knee was associated with a diminished functional capacity.