Multi-objective utilization of wood waste recycled from construction and demolition (C&D): Products and characterization.

Producing energy and higher value bio-products from waste materials has been proposed as an economically viable opportunity in the renewable energy sector. However, several challenges associated with the integrated biomass conversion processes remain to be resolved. The present study introduces a multi-faceted plant production of thermal energy and biochar from construction and demolition (C&D) wood chips. The overarching objective of the study is to reduce waste materials while simultaneously producing a self-independent clean thermal energy resource along with value-added co-products such as biochar, biogases and/or activated carbon. The combined thermal energy and slow pyrolysis unit relies on 95% of its energy from waste wood chips to produce thermal energy and high value carbon products. The system not only supplies the energy required for the indirect pyrolysis unit but also provides a major portion of thermal energy demanded for the site. A multi-purpose objective of wood waste management, energy production from waste material, high-quality biochar from waste wood (over 80% carbon), and carbon offsets is demonstrated through the utilization of this plant by addressing some of the major previously problems and challenges faced. The information is useful for techno-economic and life cycle analysis in the next study.

Industry challenge to best practice risk communication.

UNLABELLED: Effective food safety and food defense risk communication helps to inform consumers without causing panic and alarm. The Risk Communication Team of the Natl. Center for Food Protection and Defense has developed a list of 11 best practices recommended for effective risk communication. These practices, designed for a food defense crisis, are currently applied to food safety issues, since fortunately a food defense crisis has yet to occur. IFT examined the utility of these best practices and the limitations on their use during food safety and food defense crises by academics, trade associations, and the government. It was hypothesized that legal and business considerations as well as the nature of the event would determine the implementation of the best practices. Through the use of focus group meetings, it was discovered that there was a low level of awareness of the best practices. However, stakeholders practiced some aspects of the recommended practices. Participants felt some of the practices were related and could be consolidated. They also agreed that a food defense event will increase the urgency of the communication and include players not typically involved in food safety issues. The challenges reported by the stakeholders varied, but legal liability, as well as the impact their communications could have on an industry, were often cited. From the government perspective, their need to act within their authorities drove some of their actions with respect to communication. Determining the differences in communication limitations during food safety against food defense events can provide key information to further developing and refining risk communications and specific messages targeted for a food defense incident. PRACTICAL APPLICATION: Effective food safety and food defense risk communication helps to inform consumers without causing panic and alarm. Determining the differences in communication limitations during food safety against food defense events can provide key information to further developing and refining risk communications and specific messages targeted for a food defense incident.

Sensitivity of PCR targeting Mycobacterium ulcerans by use of fine-needle aspirates for diagnosis of Buruli ulcer.

In a previous study, we reported that the sensitivity of PCR targeting the IS2404 insertion sequence of Mycobacterium ulcerans was 98% when it was applied to 4-mm punch biopsy samples of Buruli lesions. Fine-needle aspiration (FNA) is a less traumatic sampling technique for nonulcerated lesions, and we have studied the sensitivity of PCR using FNA samples. Fine-needle aspirates were taken with a 21-gauge needle from 43 patients diagnosed clinically with M. ulcerans disease. Four-millimeter punch biopsies were obtained for microscopy, culture, and PCR targeting the IS2404 insertion sequence. The sensitivity of PCR using samples obtained by FNA was 86% (95% confidence interval [95% CI], 72 to 94%) compared with that for PCR using punch biopsy samples. In this study, the sensitivities of culture and microscopy for punch biopsy samples were 44% (95% CI, 29 to 60%) and 26% (95% CI, 14 to 41%), respectively. This demonstrates that PCR on an FNA sample is a viable minimally invasive technique to diagnose M. ulcerans lesions.

[Ophthalmological screening via a hospital boat: field study for planning future health care services in remote villages at the Volta Lake in Ghana]. / Ophthalmologisches Screening mit einem Hospitalschiff: Feldstudie zur strategischen Planung der zukünftigen augenärztlichen Versorgung in abgelegenen Dörfern am Voltastausee in Ghana.

BACKGROUND: A maiden voyage on a hospital boat was carried out to determine the spectrum of ophthalmological diseases in a rural and secluded area on the Volta Lake in Ghana in order to improve future health care services. PATIENTS AND METHODS: Portable water, electricity, and an operating theatre were available on the hospital boat. Visual acuity was determined using Snellen E charts, and Lea boards were used in children up to the age of 4 years. The anterior segments were examined using hand held slit lamps. After pupil dilation indirect binocular ophthalmoscopy was performed and tonometry was carried out using a Perkins tonometer RESULTS: A total of 1,246 citizens were examined. The mean age was 23.7 years and the mean visual acuity was 6/6 (log MAR 0.0+/-0.3. The main cause of blindness was a cataract with 45.8%, followed by pathological conditions of the optic disc with 29.2%. CONCLUSIONS: The hospital boat is suitable for screening and for carrying out minor extraocular operations. Looking just at the technical aspect, it is possible to perform major intraocular operations on the hospital boat. However, due to the lack of immediate follow-up visits, it is advisable to carry out major operations in the next eye clinic on shore.

[Intravitreal administration of triamcinolone and bevacizumab for pigment epithelial detachment in conjunction with AMD]. / Intravitreales Triamcinolon und Bevacizumab bei Pigmentepithelabhebung im Rahmen der AMD.

BACKGROUND: The effect of the vascular endothelial growth factor (VEGF) inhibitors triamcinolone and bevacizumab (Avastin) on serous pigment epithelial detachment (PED) related to age-dependent macular degeneration (AMD) was analysed retrospectively. PATIENTS AND METHODS: Data of 45 patients (45 eyes) were evaluated: 11 patients received an intravitreal injection with triamcinolone and 16 with bevacizumab. The remaining 18 patients received no therapy. Visual acuity (VA), height of the PED, retinal thickness and the cystoid component of the PED were compared after 6 months follow-up. RESULTS: Over 90% showed a stabilisation or improvement in VA after bevacizumab therapy; 63% of those who received triamcinolone showed VA stabilisation. Patients who received no therapy had a significant decrease in VA. CONCLUSIONS: Our data seem to implicate that VA outcome is much better after bevacizumab treatment. VA outcome seems to correlate with the cystoid component of the foveal oedema rather than with the height of PED. A greater number of patients with a longer period of follow-up are necessary to confirm these results.

[Comparison of ILM peeling with and without the use of indocyanine green. Functional results for idiopathic macular hole after pars plana vitrectomy]. / Vergleich des ILM-Peelings mit und ohne Einsatz von Indozyaningrün. Funktionelle Ergebnisse bei idiopathischem Makulaforamen nach Pars-plana-Vitrektomie.

BACKGROUND: Pars plana vitrectomy with internal limiting membrane (ILM) peeling is the best known therapy for idiopathic macular holes. Indocyanine green (ICG) is useful for staining the ILM, although there is a dose related toxic effect on the inner retinal layers. We compared outcome results with and without the use of ICG. METHOD: Data from 61 patients with idiopathic macular holes, who underwent macular hole surgery were analyzed retrospectively. ICG was used on 36 eyes while for 25 eyes it was not used. After calculating logMAR, differences in visual acuity between both groups were analyzed for significance using the Mann-Whitney-U-Test. RESULTS: The logMAR for the entire group was 0.71+/-0.30 (20/100) preoperatively, after 1 month 0.71+/-0.36 (20/100), after 3 months 0.57+/-0.26 (20/80), after 6 months 0.54+/-0.38 (20/66) and after 12 months 0.36+/-0.32 (20/50). There were no significant differences between groups. CONCLUSION: There seem to be no significant differences in the development of visual acuity and the occlusion rate between patients treated with or without the use of ICG.

Surgical outcome of radical retropubic prostatectomy is not adversely affected by preexisting three-piece inflatable penile implant.

OBJECTIVES: We report on our surgical findings and outcome of radical retropubic prostatectomy (RRP) in patients who have had three-piece inflatable penile implants. METHODS: We looked at the retrospective data of 6 patients who have undergone RRP for cancer of the prostate after a prior insertion of a three-piece inflatable penile implant. We looked at the data involving operating time, blood loss, infection of the penile implant, damage to the penile implant, surgical margins of the prostate, damage to other pelvic structures, length of hospital stay, time interval between penile implant and RRP, technique of placing of the reservoir during the penile implant surgery. RESULTS: The RRP procedures all went well, with no injury to the preexisting penile implants. There was also no compromise in the surgery for the cancer treatment, or injury to other pelvic organs. CONCLUSIONS: With increasing treatment of men with erectile dysfunction and also with increasing early diagnosis of cancer of the prostate, we are going to be seeing increasing numbers of patients who have had inflatable penile implants who subsequently need RRP for treatment of cancer of the prostate. We feel the surgery can be accomplished without any complication to the implant or compromise to the cancer surgery or injury to other pelvic organs.

Prostate fossa packing: a simple, quick and effective method of achieving hemostasis in suprapubic prostatectomy.

INTRODUCTION: Suprapubic prostatectomy remains a very common surgical treatment for bladder outlet obstruction from an enlarged prostate in the developing world. It is a technically simple procedure which can be learned by nonurologists who perform the bulk of these procedures in the developing world. Intraoperative and postoperative bleeding, however, can be a problem. We describe our experience with prostatic fossa packing at the time of the procedure, as a very simple, quick and effective technique for maximal hemostasis. MATERIAL AND METHODS: We have used this technique for several years at our institution and the results have been excellent. However, the major advantages of this technique became highlighted when the primary author visited Eritrea on a medical mission trip and used it in 42 consecutive cases. We looked at the hemorrhagic complications, both intraoperatively and postoperatively, infections and other complications related to the technique. RESULTS: The 42 patients were typical of the patients that are seen in the developing world for suprapubic prostatectomy. The age range was 49-102 years. 75% had indwelling urethral catheters secondary to urinary retention. The duration of the catheters was from 2 weeks to 10 months. All the patients who had the indwelling catheters had bacteriuria. 56% had associated bladder calculi and 25% had associated inguinal hernias. The average surgical time was 45 min. The average intraoperative blood loss was estimated at 160 ml. There were no blood transfusions. There were no infections and there were no complications related to the packing. CONCLUSION: Packing of the prostatic fossa at the time of enucleation of the adenoma is a very simple, quick and effective way to achieve hemostasis in suprapubic prostatectomy. It is also very easy to learn. With this technique we have achieved zero rate of transfusion and no infections. The surgical time is also reduced. We have had no morbidities associated with this technique and highly recommend it.

Sequelae of parenteral drug abuse involving the external genitalia.

UNLABELLED: Intravenous drug abuse continues to be a major social problem in the USA. Many drug abusers eventually run out of usual intravenous sites and begin to utilize more unusual sites. Some of these sites include the cervical veins and the superficial dorsal vein of the penis. Sometimes the vein is missed and there is extravasation of the drug subcutaneously or intracorporeally. Acute cavernositis, priapism, penile subcutaneous hematoma, penile ulcerations and corporal fibrosis as well as Fournier's gangrene are some of the sequelae of these adventures. We describe our experience with these situations and review the management of penile ulcers. MATERIAL AND METHODS: Six patients who were seen in our general urology practice in Washington, D.C., with parenteral drug abuse involving the external genitalia were studied. RESULTS: Complications of acute cavernositis, priapism and penile ulcers were observed in this group. CONCLUSION: It is essential to be aware that these habits occur as well as some of the complications outlined here. We review the management of penile ulcers.

Intravenous ketorolac significantly reduces the pain of office transrectal ultrasound and prostate biopsies.

INTRODUCTION: Campbell's' Urology, 8th edition, indicates that office transrectal ultrasound (TRUS) and prostate biopsies require no anesthesia. This is however in contradistinction from the experience of patients who have had the procedure. A study was conducted to evaluate whether 60 mg of intravenous Ketorolac before the procedure makes it more tolerable. MATERIAL AND METHODS: A prospective study was performed involving 24 patients who were randomized into two groups. One group was given 60 mg of Ketorolac intravenously before the procedure and the control group received no analgesia. RESULTS: The two groups were comparable in age and the indications for the TRUS and prostate biopsies. The number of biopsy cores tolerated and taken was significantly less in the control group than in the group that was given intravenous Ketorolac. The degree of pain in the group that had intravenous Ketorolac was significantly less than in the no analgesia group. CONCLUSION: TRUS with prostate biopsies is a painful procedure. Intravenous Ketorolac significantly reduces the pain involved in the procedure and allows patients to tolerate it better for a more complete procedure.

Functional analysis of chemically synthesized derivatives of the human CC chemokine CCL15/HCC-2, a high affinity CCR1 ligand.

The CCL15 is a human CC chemokine that activates the receptors, CCR1 and CCR3. Unlike other chemokines, it contains an unusually long N-terminal domain of 31 amino acids preceding the first cysteine residue and a third disulfide bond. To elucidate the functional role of distinct structural determinants, a series of sequential amino-terminal truncated and point-mutated CCL15 derivatives as well as mutants lacking the third disulfide bond and the carboxy-terminal alpha-helix were synthesized using 9-fluorenylmethoxycarbonyl (Fmoc) chemistry. We demonstrate that a truncation of 24 amino acid residues (delta24-CCL15) converts the slightly active 92-residue delta0-CCL15 into a potent agonist of CC chemokine receptor 1 (CCR1) and a weak agonist of CCR3 in cell-based assays. The biological activity decreases from delta24-CCL15 to delta29-CCL15, and re-increases from delta29-CCL15 to delta30-CCL15. Thus, an exocyclic N-terminal region of only one amino acid residue is sufficient for efficient CCR1 activation. As none of the peptides investigated except for delta24-CCL15 activates CCR3, we suggest that CCR1 is the major receptor for CCL15 in vivo. Further we demonstrate that the third disulfide bond of CCL15 and an exchange of tyrosine in position 70 by a leucine residue, which is conserved in CXC chemokines, do not alter the interaction with CCR1. In contrast, a CCL15 derivative lacking the carboxy-terminal alpha-helix exhibits a complete loss of tertiary structure and hence loss of CCR1 agonistic and binding activity. This study demonstrates that specific protein residues in chemokines, which contribute to receptor-ligand interaction, vary significantly between chemokines and cannot be extrapolated using data from functionally related chemokines.

Priapism associated with intracavernosal injection of cocaine.

We describe a case of priapism associated with intracavernosal injection of cocaine and our treatment approach and discuss the pathophysiologic mechanisms of cocaine-induced priapism and offer a physiologic approach to its management.

Use of sildenafil in penile implant patients.

OBJECTIVE: To determine whether Sildenafil use in the patients with penile implants provided additional sexual satisfaction. MATERIAL AND METHODS: 12 patients who had had insertion of inflatable penile implants were given oral Sildenafil in the period following implantation. They were assessed for sexual satisfaction before and after oral Sildenafil use. The assessment was done using questions 7, 8, 13 and 14 of the International Index of Erectile Function (IIEF) questionnaire. These four questions of the IIEF questionnaire address the domain of satisfaction in male sexual behavior. Each person answered these questions using a scale of 1 (almost never or never) to 5 (almost always or always). The main answer to each question after Sildenafil was compared to the mean answer before. RESULTS: There was a significant increase in the mean answer score to each of these questions. CONCLUSION: Supplemental Sildenafil can increase the sexual satisfaction of patients with inflatable penile implants.

Crisis intervention workers in New South Wales: knowledge, skills, qualities and preparation.

Ninety-five mental health workers employed by 13 randomly selected crisis intervention and extended hours teams in NSW responded to a questionnaire designed to elicit information concerning the perceived competencies required for crisis intervention. The findings reported and underscore the need for specialized knowledge and skills to address the problems presented by mentally ill clients in crisis. Assessment of suicide risk, being able to work as part of a team, and knowledge of crisis intervention strategies were perceived as the most important competencies required. It is suggested that these competencies are gained through initial induction programmes, 'on-the-job' experience, and clinical supervision rather than previous experience in the mental health field. The lists of competencies provided will be of interest to those involved in the development of induction and continuing education programmes for crisis intervention workers and in the selection of staff for positions in crisis intervention.

Identification of carcinoembryonic antigen-producing cells circulating in the blood of patients with colorectal carcinoma by reverse transcriptase polymerase chain reaction.

BACKGROUND: Application of the reverse transcriptase polymerase chain reaction (RT-PCR) to identification of circulating tumour cells in colorectal cancer. AIMS: To assess whether circulating malignant cells in patients with colorectal liver metastasis could be identified by RT-PCR recognition of mRNA coding for the tumour marker carcinoembryonic antigen (CEA). PATIENTS: A total of 31 with colorectal liver metastases and 22 no-cancer controls. METHODS: Specific cDNA primers for CEA transcripts were used to apply RT-PCR to tissue biopsy specimens, colon carcinoma cell lines, and peripheral blood samples from patients with colorectal liver metastases. A strongly CEA-expressive HT115 colorectal carcinoma cell line was used to spike blood samples from no-cancer control subjects. RESULTS: The limit for detection of CEA cDNA by Southern blotting using HT115 cells was 50 cells per 14 ml of spiked blood. There was a significant difference (p = 0.007) in RT-PCR positive expression between patients with liver metastasis (26/31) compared with controls (5/22). There was no significant relation between the prevalence of CEA cDNA amplification and serum CEA level or metastasis volume in patients with liver metastasis. CONCLUSIONS: This is the first study to suggest that identification of circulating colorectal cancer cells using RT-PCR for detection of CEA cDNA is feasible.

Penile prosthesis in the management of priapism.

Priapism is the abnormal persistence of erection, painful and not sexually induced. Many cases resolve spontaneously, but if it persists for a long time there is anoxic injury and fibrosis of the corporal tissues and the sequelae is impotence. The main problem with priapism is pain and the probability of a resultant impotence. We have managed 2 patients with recurrent priapism with insertion of penile prosthesis with satisfactory results.