Treatment Facilities Research Articles

Physical rehabilitation program for cardiorespiratory health and quality of life among breast cancer survivors in UAE: a randomized control trial

BackgroundBreast cancer treatment has improved significantly, contributing to a 5-year relative survival rate of 99% for localized cases. However, post-treatment survivors are reported to have significantly poor cardiovascular fitness which affects their health-related quality of life (HRQoL). In the United Arab Emirates (UAE), evidence for practice addressing post-treatment concerns is scarce.ObjectiveTo analyse the changes in cardiorespiratory fitness and HRQoL domains for breast cancer survivors in the UAE using a 2-month physical rehabilitation program.Methodology: DesignParallel-group, randomized controlled trialParticipants and SettingThe study included breast cancer survivors who were treated with chemotherapy and/or radiotherapy, aged 18–65 years, and able to provide informed consent. Participants were recruited by referral from Al Tawam Hospital, a national referral center for oncology, and Dubai Hospital.InterventionsThe intervention group (IG) received a 2-month supervised physical rehabilitation program focusing on aerobic training with 2 supervised sessions and 3 at-home sessions per week. The sessions were held at Thumbay Physical Therapy and Rehabilitation Hospital. The control group (CG) received standard care at their treatment facility. Randomization for subject allocation was double-blinded (conducted by a third party not involved in the research).OutcomeThe changes in cardiorespiratory fitness were assessed by measuring peak oxygen uptake (VO2peak) during a 2 km walk test using Cosmed fitmate Pro and Peak Expiratory Flow Rate (PEFR) was assessed using a peak flow meter. The HRQoL was measured by the QLQ-C30 questionnaire. Outcomes were measured at baseline, post-intervention, and 3 months post-intervention. Allocation of intervention was not blinded due to the nature of the intervention; however, the outcome accessors were blinded.ResultsA total of 62 breast cancer survivors were randomly allocated to the intervention group (n = 31) and the control group (n = 31). Data from all participants who completed the 5-month trial was analyzed. The intervention group showed a significant improvement from baseline to follow-up in terms of cardiorespiratory fitness: VO2peak increased by 8.3 ± 4.6 ml/kg/min and PEFR by 81 ± 2.73 L/min, while the control group demonstrated a decrease of 1.1 ± 2.1 ml/kg/min and 4 ± 2.48 L/min, respectively (between-group difference, p < 0.001 for both measures). The intervention program was also significantly effective in improving HRQoL in all functional domains except cognitive and social, and there was a notable reduction in the symptoms of fatigue, dyspnea, pain, and sleep disturbances (p < 0.05).ConclusionsThe intervention group showed significant improvement in cardiorespiratory fitness and multiple domains of HRQoL among breast cancer survivors in the UAE, which were sustained at 3 months.Clinical Trials Registration NumberClinical Trials.gov NCT06013527. Registered on 28 August 2023.

Surgical Management of Endometrial Intraepithelial Neoplasia at Military Treatment Facilities: A Multicenter Retrospective Study.

Endometrial intraepithelial neoplasia (EIN), also known as atypical endometrial hyperplasia (AEH), is a precursor lesion of endometrial carcinoma (EC). In endometrial cancer patients, lymph node assessment with biopsy during hysterectomy is part of surgical staging. However, routine lymph node assessment for EIN is inconsistently utilized. This study aims to investigate the surgical management of EIN in the military to inform best-practice guidelines tailored for the Military Health System to avoid delays in care, manage cost, ensure military readiness and optimize clinical outcome. We performed a retrospective chart review of patients with EIN treated at 2 military treatment facilities over a 10-year period between July 1, 2013 and July 1, 2023. Pathology reports were queried to identify patients with a preoperative diagnosis of EIN. Patients not surgically managed were excluded. Statistical analysis was performed using chi-squared test and Wilcoxon rank-sum test. Independent associations were investigated using logistic regression modeling. There were 95 evaluable patients with an EIN diagnosis, including 43 (45.3%) patients upstaged to EC based on final pathology (95% CI: 35.0-55.8). Older patients diagnosed with EIN ≥65 years old and those with endometrial thickness ≥15 mm exhibited the highest risk for upstaging EIN to an EC diagnosis. Of the 50 patients who underwent lymph node assessment, none had positive lymph nodes. Patients diagnosed with EIN via hysteroscopy vs. an endometrial biopsy had the lowest risk of being upstaged to EC. Upstaging from EIN to EC occurred in 45.3% of the 95 patients emphasizing the value of performing surgicopathologic staging in this setting. In contrast, none of the 50 EIN patients who underwent lymph node resection had positive lymph nodes indicating morbidity risk with low likelihood of clinical benefit. We identified risk factors for upstaging to EC, including age ≥65 years and endometrial thickness ≥15 mm, and confirmed the diagnostic superiority of hysteroscopy. These findings have informed clinical practice guideline recommendations for the surgical management of EIN in the Military Health System.

Tuberculosis service delivery challenges and their mitigations during the COVID-19 pandemic in Tanzania: a qualitative study

ObjectiveTo describe challenges posed by COVID-19 on tuberculosis (TB) commodity supply, care cascade, active case finding and responses taken by healthcare workers (HCWs) and community health workers (CHWs) during the...

Adsorption of heavy metals onto food wastes: a review

There has been an increase in the production of food waste materials worldwide due to rapid population growth. The ineffective and sometimes unscientific and ad hoc disposal of these food waste materials has led to environmental pollution. Studies have reported the occurrence of heavy metals in water resources poses serious health threats to the environment and human health. Heavy metals are documented to be recalcitrant to conventional water treatment facilities since they are non-biodegradable. The use of food waste-based adsorbents provides an alternative solution for the adsorption of heavy metals in water resources, with concomitant benefit of valorization of otherwise waste materials. Therefore, this study examined the applications of food waste-based adsorbents for the removal of heavy metal ions. The study adopted a literature-based approach which involved reviewing published papers from selected science databases. The results indicate that these bioadsorbents have great removal efficiencies for different heavy metals with, rice husks and sugarcane bagasse demonstrating special sorption properties, especially for chromium and lead metal ions, respectively. The adsorption data were mostly best described by the Langmuir and Freundlich isotherm models, suggesting a monolayer coverage with similar sites and a heterogeneous surface, respectively. Further, the kinetic studies indicated that the adsorption processes largely followed a pseudo second-order model, showing chemisorption-mediated rate-limiting steps. However, regardless of these encouraging results attained, the use of food waste-based adsorbents has limitations such as variation in the composition and the structure. This leads to inconsistencies in adsorption efficiencies, regenerations and reuse, and reduced removal capacities. There is also the possibility of leaching of heavy metals from the adsorbents which may in-turn cause secondary pollution. Sustainability investigations such as life cycle assessment, cost-benefit analysis, pilot-scale studies and optimization studies present areas for future research.

The growing problem of waste bioplastics disposal, and a way to tackle it.

Biodegradable plastics will grow significantly in the coming years thanks to their potential for renewability and circularity, particularly in certain European countries. Despite being a niche, their disposal is already emerging as a challenge. Insufficient public awareness is a partial cause, with people being unaware or confused on how to deal with them. Other problems are inherent to the way organic waste treatment plants work. There is indeed a stark contrast between standard biodegradability tests and actual conditions at treatment facilities, often dismissed or ascribed to the negligence of plant operators. If bioplastics are really to be deployed on a large scale, a joint technological effort is essential to properly manage their end-of-life. This contribution briefly summarises the scenario of bioplastic use in the world, the European legislation on the matter (or lack thereof), and the difficulties that waste management plants face with these materials, with a focus on a reference case - Italy - and with an international perspective. Finally, we explore how hydrothermal treatments are emerging in the scientific literature as a possible solution to some of these problems, as they can solubilise most bioplastics and facilitate their treatment in the most updated organic waste treatment plants, which couple anaerobic digestion and composting.

Study of waste management treatment facilities using advanced Membrane Bio Reactor (MBR) technology

&lt;p&gt;Sewage treatment plays a crucial role in sustainable urban and industrial development. This study focuses on the generation and treatment of sewage from residential, institutional, commercial, and industrial sources, distinguishing between grey water and black water. While grey water is relatively easier to treat, conventional practices in India merge both streams for processing. This research evaluates the application of advanced Membrane Bio Reactor (MBR) technology in a Sewage Treatment Plant (STP) at an industrial township in Andhra Pradesh, India, to achieve Zero Liquid Discharge (ZLD). The study demonstrates the significant efficiency of MBR technology in removing contaminants, with Biochemical Oxygen Demand (BOD) reduced from 350 mg/L to 20 mg/L, Chemical Oxygen Demand (COD) from 650 mg/L to 50 mg/L, and Total Suspended Solids (TSS) from 150 mg/L to 4 mg/L. Additionally, oil and grease levels decreased from 19 mg/L to 4 mg/L, and total nitrogen dropped from 45 mg/L to 10 mg/L. These results affirm the effectiveness of MBR in producing high-quality treated water suitable for irrigation and toilet flushing. The research involved systematic sampling of influent and effluent wastewater over a set period, employing analytical methods like spectrophotometry and chromatography. Key operational parameters such as flux rate, transmembrane pressure (TMP), sludge retention time (SRT), and hydraulic retention time (HRT) were monitored to optimize efficiency. Comparative analysis with conventional treatment methods highlights MBR’s advantages, including superior pollutant removal, reduced footprint, and lower energy consumption. Real-time sensors and lab-scale MBR setups were used for continuous data collection and statistical analysis, confirming MBR’s effectiveness in sustainable wastewater treatment.&lt;/p&gt;

Nutrient Removal and Biochemical Content Yield of Chloroidium ellipsoideum Cultivation in Domestic Wastewater Environment

Abstract Various wastewater and substrates are used as media to preserve existing water reserves for algae cultivation and to eliminate or reduce the cost of chemicals used. In this study, the growth, biochemical content, nutrient removal capacity, and antioxidant activity of Chloroidium ellipsoideum isolated from Lake Sapanca was investigated, using the wastewater as a culture medium taken from the Karaman Wastewater Treatment Facility, located within the borders of Sakarya province. While Bg11 medium was used as a control in the study, the growth of C. ellipsoideum was followed for 7 days in wastewater as diluted and undiluted environments with Bg11 medium. Algae grown in the Bg11:Ww had the highest dry biomass amount, and total protein and total carbohydrate percentages. While the most effective removal of nitrate-nitrogen was observed in the Ww, the most effective removal of orthophosphate was observed in Bg11:Ww. The total phenolic content of C. ellipsoideum grown in three environments was determined as 29.2 mg GAE g−1 in Bg11, 18 mg GAE g−1 in Bg11:Ww and 22.4 mg GAE g−1 in Ww. Additionally, antioxidant activity was determined to be related to the amount of total phenolic substances. As a result, this study has demonstrated its usability in algae production by supporting the wastewater environment with standard nutrient media in attempts to improve the high costs of algae cultivation.

Nationwide Survey of Oral Function Management in Patients With Neuromuscular Intractable Diseases in Japan.

We investigated the current situation and problems associated with dental treatment for patients with neuromuscular intractable diseases at medical institutions in Japan. Questionnaires were sent to 658 dental medicine institutions nationwide.Between October 25 and December 31, 2021, we targeted dental hospitals, dental and oral surgery departments from university hospitals, and dental treatment facilities registered with the Japanese Society of Disability Dentistry that had pediatric dentistry, disability dentistry, or eating function therapy departments. A questionnaire survey was conducted on the following topics: whether or not the dental clinic had experience in treating patients with neuromuscular disorders, breakdown of diseases and annual number of patients, oral symptoms, treatment content, frequency of hospital visits, problems faced by patients and their families in terms of dental treatment, and points that dental healthcare professionals pay particular attention to when treating patients. Responses were received from 215 facilities. Muscular dystrophy was the most common disease affecting patients who were treated in the course of a year, accounting for approximately 40% of the total. The most common oral symptom was periodontitis, and the treatment for it consisted of oral care (including removal of tartar and plaque), performed in approximately half of the patients, followed by general dental treatment and swallowing training. Oral care was carried out regularly. The main problems faced by the patients were difficulties with self-care on the part of the patients and their families, and difficulties with attending hospital appointments due to a lack of social support. Lack of acceptance at local dental clinics was also mentioned. Treatment considerations that required particular attention from the medical staff were the most frequent, with the most common being adequate positioning to prevent aspiration and ensure appropriate suction. In addition, a third party was requested to accompany the patient when attending hospital appointments, and vital signs were checked during treatment. Many patients with neuromuscular syndromes have oral diseases such as periodontitis and dental caries, as well as dysphagia, and require the intervention of dentists. However, dental professionals may not always be prepared to accept these patients. It is urgent for dentists to deepen their knowledge about the appropriate treatment for these patients and build a system capable of accepting them, while maintaining close cooperation with the medical profession.

Drinking Water Quality Assessment and Its Effects on Residents Health in India

The availability of safe drinking water stands as a major problem in India because dangerous substances including fluoride, arsenic, nitrates and microbial pathogens threaten human health. This research examines drinking water quality throughout urban and rural territories to determine major pollutants together with their health effects. The research shows that waterborne diseases spread due to microbial contamination yet fluoride and arsenic exposure produces chronic skeletal and neurological disorders. High nitrate concentrations found primarily in agricultural areas create a danger of infantile methemoglobinemia development. The Jal Jeevan Mission government initiative faces public health risks because of poor implementation and insufficient water treatment facilities. The study demands improved regulation policies and decentralized filtration systems and community-based interventions to reduce health threats to people. The Indian population requires a combined intersectoral strategy that combines technological progress with policy reforms to achieve universal access to safe sustainable drinking water.

Solutions for Energy and Raw Material Recovery from Sewage Sludge Within the Concept of Circular Economy

Wastewater treatment plants traditionally dispose of sludge using the method of landfilling and incineration, with both being carbon-intensive and environmentally harmful. Converting sludge into energy or reusable materials avoids landfills or incineration, helping reduce the volume of waste and associated pollution. Sludge treatment with energy recovery can offset fossil fuel use, further reducing the carbon footprint of sewage treatment processes. This research explores ways to recover energy from sewage sludge, a byproduct of wastewater treatment that is often considered waste. Transforming sludge into valuable resources aligns with the principles of the circular economy, where waste streams are repurposed, minimizing environmental impact and enhancing resource efficiency. In this paper, a method is presented to reduce the volume of wastewater sludge by drying it in a hot flue gas stream at 700 °C. The energy of the exhaust gas is recovered in an organic Rankine cycle system, which powers the wastewater treatment facilities themselves, making them more self-sustaining.

Potential military applications for a new freeze‐dried plasma

AbstractHemorrhage is a leading cause of potentially preventable death in both military and civilian trauma. Current resuscitation approaches minimize crystalloids and emphasize plasma and other blood components to achieve a balanced transfusion as early as possible after injury. Owing to the nature of military operations, military medical systems must contend with great distances, degraded infrastructure, and harsh environments, as well as combat and humanitarian assistance and disaster relief (HADR) scenarios. These factors limit both patient movement and the ability to deliver blood products to the point of need. Current projections are that future military scenarios will have longer times to reach a medical treatment facility than experienced in recent conflicts, increasing the need for logistically efficient blood products. Freeze‐dried plasma (FDP) is rapidly available, easy to use, and shelf‐stable at room temperature, making it easier to deliver at the point of need in challenging military environments. For the past 30 years, FDP has been available in only a few countries. Where it has been available, it has become the preferred plasma for austere or military expeditionary settings. Recently, a new FDP, OctaplasLG Powder, was approved in 17 countries worldwide and for emergency use by the Canadian and United States militaries. It is expected that FDP will soon become available to many more militaries. This review discusses the importance of plasma, reassesses the potential military uses of FDP across the range of military operations, and provides a brief discussion of OctaplasLG Powder.

Exploring the Determinants of Treatment Completion Among Youth Who Received Medication-Assisted Treatment in the United States.

An effective treatment for Opioid Use Disorder is Medication-Assisted Treatment (MAT). However, in the United States (US), this is still being underutilized by youth. Research indicates the need to develop strategies to reduce treatment barriers among these youth. Thus, we explored the rates of treatment completion and dropout among youth receiving MAT in US substance use treatment facilities and examined factors associated with treatment completion and dropout. This study used the 2019 Treatment Episode Data Set-Discharges. Our analysis was restricted to youth (12-24 years) who primarily used heroin at admission. Log-binomial regression was used to examine various determinants of treatment completion and dropout, guided by Andersen's Behavioral Model. The final sample size was 4917. Among youth reporting heroin use with receipt of MAT, those showing a higher likelihood of treatment completion than dropout were males [ARR: 1.23; 95% CI: 1.088-1.381; p = 0.0008], had 1-7 times [ARR: 1.33; 95% CI: 1.115-1.584; p = 0.0015] and 8-30 times self-help group participation [ARR: 1.50; 95% CI: 1.246-1.803; p < 0.0001], had co-occurring mental and substance use disorders [ARR: 1.28; 95% CI: 1.133-1.448, p < 0.0001], were admitted to detoxification [ARR: 2.80; 95% CI: 2.408-3.255; p < 0.0001] and residential/rehabilitation settings [ARR: 2.05; 95% CI: 1.749-2.400; p < 0.0001], and were located in the Midwest/West [ARR: 1.18; 95% CI: 1.030-1.358; p = 0.0173]. Conversely, other races (excluding Whites and Blacks/African Americans) [ARR: 0.75; 95% CI: 0.609-0.916; p = 0.0051], those who used MAT [ARR: 0.81; 95% CI: 0.694-0.946; p = 0.0077], and youth in the South [ARR: 0.45; 95% CI: 0.369-0.549; p < 0.0001] were less likely to report treatment completion than dropout. The majority of youth receiving MAT dropped out of treatment. We identified various factors that should be prioritized to address youth underutilization of MAT in the US.

“More Than Just a Therapist”: Psychotherapist Perspectives of the Impact of Boundary-Setting on Therapeutic Alliances in Youth Residential Treatment Facilities

ABSTRACT Although it is widely known that therapeutic alliances are important for client outcomes, less is known about how to foster a strong therapeutic alliance between psychotherapists and youth clients in residential treatment. Therapeutic alliances depend on appropriate psychotherapist-client boundaries; however, psychotherapist boundaries with youth clients are complicated by residential settings due to psychotherapists navigating many roles. This paper explores psychotherapists’ perspectives on adhering to the following psychotherapist boundaries outlined by the American Counseling Association Codes of Ethics: dual roles, psychological separateness, and therapist neutrality. Interviews were conducted with 10 psychotherapists and coded using thematic content analysis. Results suggest that these types of boundaries are challenged with youth clients in residential treatment; however, psychotherapists shared mixed opinions on the impact of not adhering to the aforementioned boundaries on their therapeutic alliances with youth clients. Psychotherapists within state-funded facilities compared to private facilities mentioned additional challenges to boundary-setting and building therapeutic alliances with their youth clients. State-funded facilities have fewer concrete resources, greater youth client needs, fewer staff, and staff with less training, resulting in psychotherapists taking on more roles to supplement these gaps. Findings warrant further investigation of evidence-based best practices on boundary-setting among psychotherapists in youth residential treatment facilities.

Predictors of treatment attrition among individuals in substance use disorder treatment: A machine learning approach.

Predictors of treatment attrition among individuals in substance use disorder treatment: A machine learning approach.

Implication of Admission Eosinophil Count and Prognosis of Coronavirus Disease 2019 (COVID-19) in Elderly Patients With COPD: A Territory-Wide Cohort Study.

This study aims to investigate the association between elderly patients with COPD with different blood eosinophil on admission and those without COPD and the prognosis of COVID-19. A territory-wide retrospective study was conducted to investigate the association between elderly COPD patients with different blood eosinophil on admission and the prognosis of COVID-19. Elderly patients admitted to public hospitals and community treatment facility in Hong Kong for COVID-19 from January 23, 2020, to September 31, 2021, were included in the study. Severe diseases were defined as those who develop respiratory complications, systemic complications and death. Among the 1925 patients included, 133 had COPD. Forty had admission blood eosinophil count ≥ 150 cells/μL, and 93 had blood eosinophil count < 150 cells/μL. Patients with COPD and admission blood eosinophil count ≥ 150 cells/μL, but not those with admission blood eosinophil count < 150 cells/μL, had severe COVID-19 with the development of respiratory and systemic complications. They were more likely to develop respiratory failure (OR = 5.235, 95% CI = 2.088-13.122, p < 0.001) and require invasive mechanical ventilation (OR = 2.433, 95% CI = 1.022-5.791, p = 0.045) and intensive care unit admission (OR = 2.214, 95% CI = 1.004-4.881, p = 0.049). Our study suggested that the blood eosinophil count on admission could have significant prognostic implications among elderly patients with COPD. Patients with COPD and admission blood eosinophil count ≥ 150 cells/μL, but not those with admission blood eosinophil count < 150 cells/μL, have significantly increased risks of developing respiratory and systemic complications from COVID-19, when compared with non-COPD patients.

Neck Dissection and Survival Among Head and Neck Cancer Patients Undergoing Adjuvant Immunotherapy.

Some studies suggest that neck dissection (ND) should be avoided in candidates for immunotherapy because lymph nodes are primary sites for immunotherapy activation. Our study investigates ND utilization and associated differences in overall survival (OS) among patients with head and neck cancer (HNC) undergoing adjuvant immunotherapy. The 2013-2018 National Cancer Database was retrospectively reviewed for patients with HNC undergoing surgery with curative intent, and adjuvant immunotherapy. Multivariable binary logistic and Cox regression models adjusted for patient demographics, clinicopathologic features, and treatment. Of 1335 patients satisfying inclusion criteria, 679 (50.9%) patients underwent ND: 94 (13.8%) had pN0, 109 (16.1%) had pN1, 411 (60.5%) had pN2, 60 (8.8%) had pN3, and 5 (0.7%) had pNx classification. On multivariable binary logistic regression, academic treatment facility, cT4, and cN1-3 classification were associated with higher odds of undergoing ND (p < 0.05); salivary, sinonasal, oropharyngeal, hypopharyngeal, and laryngeal primary sites were associated with decreased odds (p < 0.05). Compared with those undergoing neck observation, patients undergoing ND had worse OS (49.4% vs. 61.5%, p < 0.001) on Kaplan-Meier but not multivariable Cox (adjusted hazard ratio [aHR] 1.00, 95% confidence interval [CI] 0.82-1.24, p = 0.968) regression. Compared with adjuvant immunotherapy alone, the addition of radiotherapy (aHR 0.64, 95% CI 0.44-0.93) and chemoradiotherapy (aHR 0.56, 95% CI 0.37-0.86) were associated with higher OS (p < 0.025). ND was utilized in approximately 51% of patients with HNC undergoing adjuvant immunotherapy. ND was not associated with worse OS, possibly related to the high rate of pN1-3 classification. 4.

Prevalence of osteosarcoma and investigation of risk factors in military working dogs: a retrospective study using data from the Deceased Military Working Dog Database.

Prevalence of osteosarcoma and investigation of risk factors in military working dogs: a retrospective study using data from the Deceased Military Working Dog Database.

Use of COPRAS decision model for the selection of best treatment alternatives in removing micropollutants: Diclofenac example.

Use of COPRAS decision model for the selection of best treatment alternatives in removing micropollutants: Diclofenac example.

Suicidal Ideation, Cognitive Control, and Sleep in Veterans in a Residential Treatment Facility: A Pilot Study.

Sleep disorder symptoms are associated with suicidal ideation, and wakefulness in the middle of the night is associated with an increased risk for suicide, potentially due to deficits in cognitive control. Little is known about daily-level associations among sleep and suicide or about the role of cognitive control in these associations. Veterans (n = 32) with past-month suicidal ideation in a residential treatment unit were assessed for 28 days using the suicide visual analogue scale (S-VAS) to assess suicidal urges, a daily sleep diary, and self-reported cognitive control. Wakefulness in the middle of the night (1-4 a.m.) was associated with the most severe suicidal ideation. Nocturnal wakefulness and sleep quality were each associated with next-day suicidal ideation intensity. Self-reported cognitive control deficits were associated with more intense suicidal ideation. The association between nocturnal wakefulness and suicidal ideation was partially accounted for by self-reported impulsive behavior (7% of variance). Veterans reported the highest suicidal ideation in the middle of the night. These findings suggest the importance of assessing sleep, suicidal ideation, and cognitive control among veterans and the need to consider nocturnal wakefulness as an indicator of heightened risk for suicide among veterans.

What apps and websites do those in treatment for substance-related problems use to help them in their recovery? A cross-sectional study of products and use patterns.

What apps and websites do those in treatment for substance-related problems use to help them in their recovery? A cross-sectional study of products and use patterns.