Outlining Potential Biomarkers of Exposure and Effect to Critical Minerals: Nutritionally Essential Trace Elements and the Rare Earth Elements.

Emerging and low-carbon technologies and innovations are driving a need for domestic sources, sustainable use, and availability of critical minerals (CMs)-those vital to the national and economic security of the United States. Understanding the known and potential health effects of exposures to such mineral commodities can inform prudent and environmentally responsible handling and harvesting. We review the occurrence, use, predominant exposure pathways, and adverse outcome pathways (AOP) for human and fish receptors of those CMs that are nutritionally essential trace metals (specifically, cobalt, chromium, manganese, nickel, and zinc), as well as the rare earth elements. Biological responses to some elements having comparable biogeochemistry can sometimes be similar. Candidate quantifiable biomarkers for assessing potential AOP are conveyed.

Emerging investigator series: atmospheric cycling of indium in the northeastern United States.

Indium is critical to the global economy and is used in an increasing number of electronics and new energy technologies. However, little is known about its environmental behavior or impacts, including its concentrations or cycling in the atmosphere. This study determined indium concentrations in air particulate matter at five locations across the northeastern United States over the course of one year, in 1995. Historical records from a Massachusetts bog core showed that indium atmospheric concentrations in this region changed only modestly between 1995 and 2010. Atmospheric indium concentrations varied significantly both geographically and temporally, with average concentrations in PM3 of 2.1 ± 1.6 pg m-3 (1 standard deviation), and average particle-normalized concentrations of 0.2 ± 0.2 µg In per g PM3. Peaks in the particle-normalized concentrations in two New York sites were correlated with wind direction; air coming from the north contributed higher concentrations of indium than air coming from the west. This correlation, along with measurements of indium in zinc smelter emissions and coal fly ash, suggests that indium in the atmosphere in the northeastern United States comes from a relatively constant low-level input from coal combustion in the midwest, and higher but more sporadic contributions from the smelting of lead, zinc, copper, tin, and nickel north of the New York sample sites. Understanding the industrial sources of indium to the atmosphere and how they compare with natural sources can lead to a better understanding of the impact of human activities on the indium cycle, and may help to establish a baseline for monitoring future impacts as indium use grows.

The replacement of assertive outreach services by reinforcing local community teams: a four-year observational study.

BACKGROUND: The introduction of specialist Assertive Outreach (AO) teams has produced only modest differential findings from English studies compared to standard care. Providers have gradually closed AO services over the last 8 years. We previously studied outcomes at 12 months following the dismantling of two AO teams in London. We now report on the longer term outcomes for these patients. AIMS: To evaluate the longer term outcomes, activity and costs for patients receiving a less intensive service. METHODS: Observational service level evaluation of 112 patients comparing baseline of AO care with each year of routine care subsequent to the team closure. RESULTS: Patients transferred to standard teams reinforced with the Flexible Assertive Community Treatment (FACT) approach had significantly fewer admissions and bed days at each of the four subsequent years compared to baseline, offset by a significant rise in missed face-to-face appointments. There was no significant change in the use of crisis services. Predictably patients had significantly fewer contacts under standard care. CONCLUSIONS: AO patients are remarkably resilient to substantial reductions in the intensity of care. Reinforcing multi-disciplinary community mental health teams (CMHTs) with FACT appears to provide an integrated service that is clinically effective and an affordable alternative to orthodox AO teams.

The replacement of assertive outreach services by reinforcing local community teams: a replication study reporting comparative outcomes and patient reported experience.

BACKGROUND: This is the third in a series of papers on patient outcomes and other consequences of the withdrawal of specialist assertive outreach (AO) teams. We previously reported positive outcomes for patients receiving a less intensive service at up to four years, but had not systematically interviewed patients. AIMS: To test the generalizability of earlier findings through replication in another service. To complement the analysis of service utilisation with patient reported experience between the two treatment models. METHODS: Service level evaluation 12 months pre and post service change for 55 eligible AO patients. Thirty three consenting patients answered validated questionnaires. RESULTS: There were no statistically significant changes in hospital bed use comparing the year before and the year after the change (850-712 bed days, median 34-20). No significant change in crisis activity occurred despite a highly significant reduction in face to face contacts from a mean of 90-40. There were no significant changes in patient reported experience. CONCLUSIONS: Results are consistent with earlier studies. Reinforcing community mental health teams can provide an integrated service model that is clinically effective and equally acceptable to patients, making this a viable and affordable alternative to orthodox AO teams.

Retrospective cohort follow-up study of individuals detained under Section 136.

BACKGROUND: An original cohort study found that over half of the individuals detained under Section 136 (S136) of the Mental Health Act 1983 were discharged home after assessment, and nearly half were intoxicated. AIMS: To investigate whether the cohort was followed up by psychiatric services, characterise those repeatedly detained and assess whether substance use was related to these outcomes. METHOD: Data were retrospectively collected from the notes of 242 individuals, who presented after S136 detention to a place of safety over a 6-month period, and were followed up for 1 year. RESULTS: After 1 year, 48% were in secondary care. Those with psychosis were the most likely to be admitted. Diagnoses of personality disorder or substance use were associated with multiple detentions; however, few were in contact with secondary services. CONCLUSIONS: Crisis and long-term care pathways for these groups need to be developed to reduce repeated and unnecessary police detention. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

The precipitation of indium at elevated pH in a stream influenced by acid mine drainage.

Indium is an increasingly important metal in semiconductors and electronics and has uses in important energy technologies such as photovoltaic cells and light-emitting diodes (LEDs). One significant flux of indium to the environment is from lead, zinc, copper, and tin mining and smelting, but little is known about its aqueous behavior after it is mobilized. In this study, we use Mineral Creek, a headwater stream in southwestern Colorado severely affected by heavy metal contamination as a result of acid mine drainage, as a natural laboratory to study the aqueous behavior of indium. At the existing pH of ~3, indium concentrations are 6-29µg/L (10,000× those found in natural rivers), and are completely filterable through a 0.45µm filter. During a pH modification experiment, the pH of the system was raised to >8, and >99% of the indium became associated with the suspended solid phase (i.e. does not pass through a 0.45µm filter). To determine the mechanism of removal of indium from the filterable and likely primarily dissolved phase, we conducted laboratory experiments to determine an upper bound for a sorption constant to iron oxides, and used this, along with other published thermodynamic constants, to model the partitioning of indium in Mineral Creek. Modeling results suggest that the removal of indium from the filterable phase is consistent with precipitation of indium hydroxide from a dissolved phase. This work demonstrates that nonferrous mining processes can be a significant source of indium to the environment, and provides critical information about the aqueous behavior of indium.

Exposure Potential and Health Impacts of Indium and Gallium, Metals Critical to Emerging Electronics and Energy Technologies.

The rapid growth of new electronics and energy technologies requires the use of rare elements of the periodic table. For many of these elements, little is known about their environmental behavior or human health impacts. This is true for indium and gallium, two technology critical elements. Increased environmental concentrations of both indium and gallium create the potential for increased environmental exposure, though little is known about the extent of this exposure. Evidence is mounting that indium and gallium can have substantial toxicity, including in occupational settings where indium lung disease has been recognized as a potentially fatal disease caused by the inhalation of indium particles. This paper aims to review the basic chemistry, changing environmental concentrations, potential for human exposure, and known health effects of indium and gallium.

Atmospheric Deposition of Indium in the Northeastern United States: Flux and Historical Trends.

The metal indium is an example of an increasingly important material used in electronics and new energy technologies, whose environmental behavior and toxicity are poorly understood despite increasing evidence of detrimental health impacts and human-induced releases to the environment. In the present work, the history of indium deposition from the atmosphere is reconstructed from its depositional record in an ombrotrophic bog in Massachusetts. A novel freeze-coring technique is used to overcome coring difficulties posed by woody roots and peat compressibility, enabling retrieval of relatively undisturbed peat cores dating back more than a century. Results indicate that long-range atmospheric transport is a significant pathway for the transport of indium, with peak concentrations of 69 ppb and peak fluxes of 1.9 ng/cm2/yr. Atmospheric deposition to the bog began increasing in the late 1800s/early 1900s, and peaked in the early 1970s. A comparison of deposition data with industrial production and emissions estimates suggests that both coal combustion and the smelting of lead, zinc, copper, and tin sulfides are sources of indium to the atmosphere in this region. Deposition appears to have decreased considerably since the 1970s, potentially a visible effect of particulate emissions controls instated in North America during that decade.

A dismantling study of assertive outreach services: comparing activity and outcomes following replacement with the FACT model.

PURPOSE: Financial constraints and some disappointing research evaluations have seen English assertive outreach (AO) teams subject to remodelling, decommissioning and integration into standard care. We tested a specific alternative model of integrating the AO function from two AO teams into six standard community mental health teams (CMHT). The Flexible Assertive Community Treatment model (FACT) was adopted from the Netherlands (Van Veldhuizen, Commun Mental Health J 43(4):421-433, 2007; Bond and Drake, Commun Mental Health J 43(4):435-438, 2007). We aimed to demonstrate non-inferiority in clinical effectiveness and thereby show cost efficiencies associated with FACT. METHODS: Outcomes were compared in a mirror-image study of the 12 months periods pre- and post-service change with eligible individuals from the AO teams' caseloads (n = 112) acting as their own controls. We also conducted a cost-consequence analysis of the changes. Outcome data regarding admissions, use of crisis and home treatment, frequency of contact and DNA rate were extracted from the electronic patient record. RESULTS: The results show AO patients (n = 112) transferred to standard CMHTs with FACT had significantly fewer admissions and a halving of bed use (21 fewer admission and 2,394 fewer occupied bed days) whilst being in receipt of a less intensive service (2,979 fewer contacts). This was offset by significantly poorer engagement but not by increased use of crisis and home treatment services. CONCLUSIONS: Enhancing multi-disciplinary CMHTs with FACT provides a clinically effective alternative to AO teams. FACT offers a cost-effective model compared to AO.

Self-regulation of Candida albicans population size during GI colonization.

Interactions between colonizing commensal microorganisms and their hosts play important roles in health and disease. The opportunistic fungal pathogen Candida albicans is a common component of human intestinal flora. To gain insight into C. albicans colonization, genes expressed by fungi grown within a host were studied. The EFH1 gene, encoding a putative transcription factor, was highly expressed during growth of C. albicans in the intestinal tract. Counterintuitively, an efh1 null mutant exhibited increased colonization of the murine intestinal tract, a model of commensal colonization, whereas an EFH1 overexpressing strain exhibited reduced colonization of the intestinal tract and of the oral cavity of athymic mice, the latter situation modeling human mucosal candidiasis. When inoculated into the bloodstream of mice, both efh1 null and EFH1 overexpressing strains caused lethal infections. In contrast, other mutants are attenuated in virulence following intravenous inoculation but exhibited normal levels of intestinal colonization. Finally, although expression of several genes is dependent on transcription factor Efg1p during laboratory growth, Efg1p-independent expression of these genes was observed during growth within the murine intestinal tract. These results show that expression of EFH1 regulated the level of colonizing fungi, favoring commensalism as opposed to candidiasis. Also, different genes are required in different host niches and the pathway(s) that regulates gene expression during host colonization can differ from well-characterized pathways used during laboratory growth.

Nurses' knowledge of and attitude to electroconvulsive therapy.

UNLABELLED: The relationship between the nurse and patient is usually close. The nature of nursing means that nurses spend more hours with patients than other health care professionals. Therefore, nurses' knowledge of and attitude to electroconvulsive therapy (ECT) is important because it is likely formed through close contact with patients; conversely, nurses' knowledge and attitudes will be conveyed to patients. There have been several studies exploring the topic of nurses' knowledge of and attitudes to ECT, but results are contradictory. OBJECTIVES: To explore nurses' knowledge of and attitude to ECT and to find whether knowledge and experience of ECT correlated with more positive attitudes to the treatment. METHOD: This was a questionnaire study including 211 registered and student nurses working in a London Mental Health Trust. It included knowledge and attitude scales and questions about experience and demography. RESULTS: There was a highly significant correlation between knowledge of and more positive attitudes to ECT. The more years in mental health, higher grade, and the greater number of patients undergoing ECT they had had contact with correlated with more knowledge. The number of patients they had had contact with and the closeness of that contact correlated with more positive attitudes. Registered nurses had more knowledge and more positive attitudes than student nurses. CONCLUSION: The relationship between attitudes and knowledge is complex. However, for nurses to provide appropriate support to patients undergoing ECT, they need to gain knowledge and experience of the therapy early in their careers.