Chinese Medicine and Culture

Revisiting the Medical Work of George Soulié De Morant Jean Claude Dubois Chinese Medicine and Culture 2019 2(2):53-56 It is now time to revisit the medical work of George Soulié de Morant (1878–1955). Over the past 64 years, studies and research on acupuncture-moxibustion have undergone exceptional growth in China, and Western sinology has made remarkable progress. A careful rereading will bring a new light to this decisive work.

Studies on Xin'an Medicine (新安医学) since the Ming and Qing Dynasties Jian Wang, Yebo He Chinese Medicine and Culture 2019 2(2):57-61 This article reviews the studies on Xin'an medicine since the Ming and Qing dynasties and introduces the representative Xin'an physicians in different periods and their medical works as well as the efforts made by researchers and scholars in the 20th Century, aiming to interpret the historical values and impacts of Xin'an medicine and hence facilitate its development in future.

The importance of the Classics in the Transmission of Chinese Medicine to the West Sandra Hill Chinese Medicine and Culture 2019 2(2):62-65 This paper discusses the role of the classical texts (Neijing and Nanjing) in the transmission of Chinese medicine – in particular acupuncture – to the West. This is presented in the following sections: A short historical overview of acupuncture practice in the UK; Philosophy of health and nourishing life (Yang sheng养生); The body as a complex system; Mind-body connections and the future of medicine and the problem of qi (气).

Traditional Chinese Medicine in Malaysia: A Brief Historical Overview of the Associations Hon Foong Wong, Shih Chau Ng, Wen Tien Tan, Huiying Wang, Xun Lin, Si Woei Goh, Bao Ling Hoo, Chyong En Chai, Jun Liu Chinese Medicine and Culture 2019 2(2):66-68 The increasing number of TCM practitioners and herbal suppliers, both of which accelerated by the formation of various TCM institutions, substantiated the creation of regional traditional Chinese medicine (TCM) associations in post-World War II Malaya. In response to the restrictions and levies imposed by the British colonial government, these regional associations united and formed a national organisation now known as the Federation of Chinese Physicians and Medicine Dealers Association of Malaya (FCPMDAM). The current designated TCM practitioner body, the Malaysian Chinese Medical Association (MCMA) were also originally established to nurture local talents in the face of import restrictions. Owing to difference with MCMA, a separate association named the Federation of Chinese Physicians and Acupuncturists Associations of Malaysia (FCPAAM) was setup in 2003 to absorb self-studied and patrimonial-educated TCM practitioners.

Essays in the History of Medicine Lei Xu Chinese Medicine and Culture 2019 2(2):69-70 Professor Karl Sudhoff had spent most of his career time researching the history of medical development in medieval Europe. The book collects the source fragment of the evidence of Professor Sudhoff's job.

The Establishment and Spread of Acupuncture Model Based on Different Cultures Yu Zhang, Sheng Liu Chinese Medicine and Culture 2019 2(2):71-76 The Belt and Road (B and R) brings a historic opportunity for the Chinese medicine culture communication, especially the traditional acupuncture. The high rate of acupuncture cognitive barriers is one of the important factors among patients and service providers in “B and R” countries. The proposed project, to be conducted in “B and R” countries, has the following primary aims: (1) to assess acupuncture knowledge, attitudes, and perceptions; (2) to assess acupuncture knowledge, attitudes, and perceptions among clinic staff; and (3) to adapt, develop, and deliver acupuncture education programs for patients and clinic staff. The secondary aims are as follows: (4) to explore the barriers that impact acupuncture receiving intervention and medical service and (5) to explore ways to help service providers to provide acupuncture services to patients in acupuncture clinics based on different cultures. Through an iterative process of discussion and revision, we plan to develop a comprehensive acupuncture intervention program that is appropriate for the “B and R” countries setting and that can be tested for its effectiveness in a series of controlled trials in future research.

A Review on Ben Cao Gang Mu Ying Jiao Dui Zhao (《本草纲目影校对照》 A Contrast between the Photocopy and Collation of Compendium of Materia Medica) Shunong Shen Chinese Medicine and Culture 2019 2(2):77-79 Ben Cao Gang Mu Ying Jiao Dui Zhao (《本草纲目影校对照》 A Contrast between the Photocopy and Collation of Compendium of Materia Medica), completed by Zhang Zhibin and Zheng Jinsheng, is the latest variorum on Ben Cao Gang Mu (《本草纲目》 Compendium of Materia Medica). Adopting five different Jinling editions as the master copy, the book carefully collates the complex contents on the original book by contrasting the photocopies with the supplement and correction, which makes it easy to use. What is more, full-form punctuation is used to mark the reference books and proper nouns, which is a big success feat in the research history of Ben Cao Gang Mu.

Indigo Naturalis (青黛) Comes from Blue, but it Excels Blue Tianwen Yao, Baican Yang Chinese Medicine and Culture 2019 2(2):80-83 Indigo naturalis (青黛) is also called “indigo flower,” “bright cyan,” and “cyan clam powder.” The alias “indigo flower” shows its complex progress about producing dyes. The alias “bright cyan” vividly displays the visual characteristics of indigo naturalis. Its another alias “cyan clam powder” implies its properties, flavors, and particular morphologic characteristics. The name of “indigo naturalis” emphasizes its wide use in ancient times to paint their eyebrows. Indigo naturalis, which comes from the Persian Kingdom, wins the favor and praise of customers in the respects of dye and cosmetics in both Eastern and Western Regions. It not only shows the infinite charm of dye culture in the Western Regions and provides a visual sensation for people, but also adds new color for Chinese medicine culture.

Traditional Chinese medicine: How is it An Invaluable Intangible Cultural Heritage Anwen Zheng Chinese Medicine and Culture 2019 2(2):84-87 This article deals with the concept of intangible culture heritage and the reasons why traditional Chinese medicine (TCM) should be specially preserved. The potential value of TCM and the existing measures for carrying on the cultural heritage adopted by China are also explored in the article.

Making Sense of an Ancient Discipline in a Modern Time: How Tai Chi (太极) Practice Benefits the Body–Mind Meghdad Abdi Chinese Medicine and Culture 2019 2(2):88-92 Tai chi(太极) is an ancient Chinese traditional martial art that, today, is also practiced as a graceful and multifaceted form of exercise. It involves a series of movements performed in a slow, focused manner accompanied by deep breathing and expanded awareness of the body, mind, and surrounding environment. There is growing evidence that this mind–body practice has value in treating or preventing many health problems and you can get started even if you are not in top shape or the best of health. This paper is a review of the research that has been conducted internationally on the health-enhancing aspects of Tai Chi practice over the past few years. It is not possible to cover all areas of research in one paper; therefore, three important areas are chosen and discussed, namely, improving balance, strengthening the bones, reducing pain and the rest will be referred to in a future article.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Acupuncture and Meridian Studies

Treatment of Plantar Fasciitis with the Yuan-Luo Point Pair: A Clinical Case Report Publication date: Available online 3 June 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Jonathan Day Abstract This case report chronicles the treatment of a case of plantar fasciitis with acupuncture and tuina over six clinic visits. The patient was a 41-year-old female with plantar fasciitis for two months. A variety of acupuncture and electroacupuncture protocols were used at first, with no benefit. After the fourth and fifth visits, however, the patient experienced total relief of pain and a significant reduction in stiffness that persisted through her final visit two weeks later. These later treatments included the yuan-luo (origin-connecting) acupuncture point pair KI 3 and BL 58, which is one possible explanation for their effectiveness. The yuan-luo pair is a classical point combination with much theory behind it, yet no studies have been published regarding its practical uses in clinic. This case is an example of one practical application of the pair; further examples are needed.

The Analogy Between the Tradition Chinese Acupuncture and Phlebotomy in Medieval Bohemia Publication date: Available online 17 May 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Alexandr Ivanov

Complete Recovery Following Electroacupuncture Therapy in Refractory Unilateral Sensorineural Hearing Loss Publication date: Available online 26 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Warangkana Arpornchayanon, Supanimit Teekachunhatean Abstract Role of electroacupuncture (EA) in refractory unilateral sensorineural hearing loss (SNHL) remains unclear but might be promising for the Meniere's disease. Two cases of unilateral SNHL who were unresponsive to conventional treatment of sudden SNHL showed complete recovery after receiving EA therapy. The first case was a 46-year-old woman who received EA in the seventh month after the acute onset of sudden right hearing loss and tinnitus. She had mild-to-moderate degree of SNHL at high frequencies in the right ear with episodic vertigo. The second case was a 55-year-old woman who received EA in the sixth year after developing sudden SNHL in the right ear. Before the EA began, her pure tone average of the affected ear was 45 dB and the phonetically balanced score was 88%. The regimen for both patients included 12 sessions of EA over four weeks at the main acupoints (Tinggong (SI 19), Ermen (TE 21), Qimai (TE 18), Yifeng (TE 17), and Zhongzhu (TE 3)) on the affected ear and the bilateral adjuvant acupoints (Hegu (LI 4), Qihai (CV 6), Guanyuan (CV 4), Taixi (KI 3), and Taichong (LIV 3)). Both patients regained their normal hearing thresholds three weeks after the first EA. No adverse events were observed. Hence, EA may be a useful additional therapy in unilateral SNHL, even at the late phase when other treatments have failed because the possibility of Meniere's disease cannot be excluded.

Canine and Feline Patients Referred Exclusively for Acupuncture and Herbs: A Two-Year Retrospective Analysis Publication date: Available online 24 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Justin Shmalberg, Huisheng Xie, Mushtaq A. Memon Abstract Acupuncture and the administration of herbal supplements are increasingly used in veterinary practice, but no retrospective studies have examined patient characteristics and treatment interventions in a population of dogs and cats presenting exclusively for such therapies. This two-year retrospective analysis of 161 referrals to an integrative medicine service at an academic teaching hospital found that dogs were more frequently treated than cats (91.9% vs. 8.1%, respectively) and that small animal patients most frequently were presented for musculoskeletal (26.7%), neurologic (16.8%), oncologic (14.9%), and dermatologic (10.6%) conditions. Cats were older than treated dogs (12.7 ± 3.7 vs. 9.5 ± 4.3 years) and more likely to be treated for oncologic complaints (odds ratio = 5.6). Patients received acupuncture (95.4%), herbal supplements (76.4%), acupuncture with percutaneous electrical nerve stimulation (electroacupuncture, 26.1%), and/or cyanocobalamin injections at acupuncture points (aqua-acupuncture, 23.6%). Some differences were detected between treatment groups. This retrospective analysis provides a foundation for designing future prospective studies using acupuncture and herbs in dogs and cats.

Effects of Scalp Acupuncture on Functional Deficits Induced By Early Sensorimotor Restriction Publication date: Available online 24 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Angela K. Zanella, Jessié M. Gutierres, Felipe Stigger Abstract The aim of this study was to investigate the effects of scalp acupuncture and electrostimulation, combined or not, in a disuse model consisted of early sensorimotor restriction in rats. Male Wistar pups received sensorimotor restriction from the second postnatal day (P2) until P28. Animals were divided into five different groups (n = 6): control (CT), sensorimotor restricted (SR), acupuncture (AC), electrostimulation (EL), and electroacupuncture (AC+EL). Experimental animals received sham, acupuncture, or electrical stimulation, combined or not, of two scalp regions for 7 days (P29-P35). Before treatment period (P29) and after treatment (P36), animals were evaluated with the narrow suspended bar, horizontal ladder, and stride length tests. SR animals had worse performance in the narrow suspended and horizontal ladder tasks compared with SR animals at P29 (p ≤ 0.005). Significant improvements were observed in both tasks in AC, EL, and EL+AC groups comparing P29 and P36 (p < 0.001). Also, at P35, all treated animals performed significantly better motor tasks compared with SR group (p < 0.05). There was no difference between treated groups. Finally, acupuncture and electrical stimulation, combined or not, have beneficial effect on motor performance following early developmental disuse.

Wet Cupping—Traditional Hijamah Technique versus Asian Cupping Technique in Chronic Low Back Pain Patients: A Pilot Randomized Clinical Trial Publication date: Available online 24 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Sulaiman M. Al-Eidi, Ashry Gad Mohamed, Raid A. Abutalib, Abdullah M. AlBedah, Mohamed K.M. Khalil Abstract Background Low back pain is a common complaint worldwide. Wet cupping (Al-Hijamah) therapy, which is one of the common traditional therapies in Saudi Arabia, Asia, and some European countries, is usually used to relieve low back pain. However, the majority of high-quality wet cupping trials were conducted in Asia and Europe, where they use a different cupping technique compared to our local wet cupping technique in Saudi Arabia. Objectives The objective of the study was to evaluate the feasibility of comparing the effect of the traditional Hijamah and the Asian wet cupping techniques in the management of patients with chronic low back pain. Design This is a randomized clinical trial comparing traditional versus Asian wet cupping techniques for CLBP. Setting The study setting was the outpatient clinics in two secondary care hospitals in Saudi Arabia. Patients Seventy eligible participants with CLBP for at least three months were randomly allocated to either traditional cupping group (34) or the Asian cupping group (36). Intervention Participants were randomized to receive one session of wet cupping using either the Asian technique or traditional Hijamah technique. Cupping was done at four sites of the bilateral Bladder Meridian (BL 23, BL24, and BL25). Outcome measures The Numeric Rating Scale, Present Pain Intensity, and Oswestry Disability Questionnaire scores were measured immediately after intervention, at seven days, and 14 days after intervention. Results In both groups, there was a significant decrease in Numeric Rating Scale, Present Pain Intensity, and Oswestry Disability Questionnaire, immediately after intervention and at seven days, and 14 days after the intervention. However, there was no significant difference between the two groups across all the outcome measures up to 14 days after intervention. Conclusions The study did not show a superiority of one technique compared to the other. Longer follow-up periods and more than one cupping session may be needed to evaluate the difference, if any, between both techniques. Trial registration NCT02012205.

Transcutaneous Electrical Stimulation of PC5 and PC6 Acupoints Modulates Autonomic Balance in Heart Transplant Patients: A Pilot Study Publication date: Available online 23 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Beatriz R. Moreira, Alice P. Duque, Carole S. Massolar, Rodrigo de Lima Pimentel, Mauro F.F. Mediano, Tereza C.F. Guimarães, Luiz F. Rodrigues Abstract The increased resting heart rate (HR) in heart transplant patients is associated with enhanced metabolic demand, the potential for fatigue, and lower quality of life. In the present study, we hypothesized that transcutaneous electrical acupoint stimulation (TEAS) could modulate autonomic balance and reduce resting HR in these patients. A single-arm clinical trial was conducted with patients aged >18 years, at ambulatorial accompaniment after heart transplantation, who were submitted to a single TEAS (40 minutes at pericardium channel acupoints PC5 and PC6). The arterial blood pressure and RR interval were recorded from 20 minutes before to 20 minutes after TEAS. The RR intervals were used to calculate HR variability (HRV) and the sympathovagal index. Linear mixed models were used for comparing variables before, during, and after TEAS. The significance level was set as P < 0.05. TEAS acutely improved HRV in transplant patients and enhanced the sympathovagal index during its application. Significant increases in systolic and diastolic blood pressure and mean arterial pressure were observed at recovery, such as a slight, but significant, decrease in HR. In conclusion, TEAS at PC5 and PC6 acutely modulates HRV and hemodynamics in transplant patients.

Concurrent Effects of Dry Needling and Electrical Stimulation in the Management of Upper Extremity Hemiparesis Publication date: Available online 23 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Maryam S. Ghaffari, Ardalan shariat, Roshanak Honarpishe, Azadeh Hakakzadeh, Joshua A. Cleland, Sepehr Haghighi, Tohid S. Barghi Abstract Stroke is one of the leading causes of disability in western countries. A variety of rehabilitation programs for the treatment of patients after stroke have been proposed. We describe the outcomes of a 49-year-old female patient with a 5-year history of right upper extremity hemiparesis after stroke. Physical examination revealed a right wrist extensor strength grade of 1 according to the Medical Research Council Manual Muscle Testing scale, Stage 4 according to the Brunnstrom hand functional recovery, and Grade 1 in finger flexor and in wrist flexor according to the Modified Modified Ashworth Scale system of muscle spasticity. Magnetic resonance imaging taken immediately after the stroke was indicative of an abnormal signal in the left paraventricular and lentiform nucleus. After receiving a single session of dry needling and electrical stimulation, the patient had significant improvement including a strength grade of 3 for the right wrist extensor muscles, Stage 6 according to the Brunnstrom hand functional recovery, and Grade 0 in finger flexor and in wrist flexor according to the Modified Modified Ashworth Scale system of muscle spasticity. This case report found that dry needling combined with electrical stimulation may be effective in hand function recovery, wrist extensor muscles strength, and decreased wrist and finger spasticity.

Editorial Board Publication date: April 2019 Source: Journal of Acupuncture and Meridian Studies, Volume 12, Issue 2 Author(s):

The Effect of Manual Acupressure (Point BL32) on Pain Associated with Intramuscular Injections of Magnesium Sulfate Publication date: April 2019 Source: Journal of Acupuncture and Meridian Studies, Volume 12, Issue 2 Author(s): Seyed S. Najafi, Setareh Nazaribin, Marzieh Momennasab, Amin Kordi Yoosefinejad Abstract The aim of this study was determining the effect of acupressure on the severity of pain associated with intramuscular injections of magnesium sulfate administered by the Z-track technique in patients with eclampsia and preeclampsia. Forty-eight patients participated in this single-group clinical trial, which was conducted in three stages. For each patient, three intramuscular injections were administered by the Z-track technique. The first injection was administered by the conventional method. The second injection at a sham control point and the third injection using acupressure (BL32) were administered. Pain severity was measured on a visual analogue scale. The mean pain intensity was 7.22 in the first, 4.75 in the second and 1.94 in the third injections (p < 0.001). The results of the study showed that acupressure at the BL32 point before intramuscular injection of magnesium sulfate significantly reduced the injection-related pain.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Life Research

Health-related quality of life in injury patients: the added value of extending the EQ-5D-3L with a cognitive dimension Abstract Introduction The EQ-5D is frequently used to understand the development of health-related quality of life (HRQL) following injury. However, the lack of a cognition dimension is generally felt as disadvantageous as many injuries involve cognitive effects. We aimed to assess the added value of a cognitive dimension in a cohort of injury patients. Methods We analyzed EQ-5D-3L extended with cognition (EQ-5D + C) dimension responses of 5346 adult injury patients. We studied dimension dependency, assessed the additional effect of the cognitive dimension on the EQ-VAS, and, using the EQ-VAS as a dependent variable, determined the impact of EQ-5D and EQ-5D + C attributes in multivariate regression analyses. Results Extreme cognitive problems combined with no problems on other dimensions are uncommon, whereas severe problems on other dimensions frequently occur without cognitive problems. The EQ-VAS significantly decreased when cognitive problems emerged. Univariate regression analyses indicated that all EQ-5D + C dimensions were significantly associated with the EQ-VAS. Exploratory analyses showed that using any set of five of the six EQ-5D + C dimensions resulted in almost identical explained variance, and adding the remaining 6th dimension resulted in a similar additional impact. Conclusions The addition of the cognition dimension increased the explanatory power of the EQ-5D-3L. Although the increase in explanatory power was relatively small after the cognition dimension was added, the decrease of HRQoL (measured with the EQ-VAS) resulting from cognitive problems was comparable to the decreases resulting from other EQ-5D dimensions.

Do 8- to 18-year-old children/adolescents with chronic physical health conditions have worse health-related quality of life than their healthy peers? a meta-analysis of studies using the KIDSCREEN questionnaires Abstract Purpose This meta-analytic review aimed to estimate the magnitude of health-related quality of life (HrQoL) impairments, as assessed by the KIDSCREEN questionnaires, both self- and parent-reported, in 8- to 18-years-old children/adolescents with chronic health conditions. Methods To identify studies using the KIDSCREEN questionnaires, three electronic databases (PubMed, PsycINFO, EBSCOhost Psychology & Behavioral Sciences) were searched. The final search (February 14–15, 2018) revealed 528 non-duplicated articles, of which 23 papers (21 studies) directly compared the HrQoL of pediatric patients to community/healthy controls and were included in the meta-analysis. Pooled mean differences (MD) with 95% CIs were estimated using the inverse-variance random-effects method. Results Of the 21 studies, 16 used self-reports, one used parent-reports and four adopted a multi-informant approach. Self-reported data were retrieved from 20 studies (4852 cases/28,578 controls), and parent-reported data were retrieved from four studies (511 cases/433 controls). Pediatric patients presented significant HrQoL impairments in the domains of physical well-being (MD = − 4.84, 95% CI − 6.44/− 3.24 for self-reports; MD = − 6.86, 95% CI − 10.42/− 3.29 for parent-reports) and peers and social support (MD = − 1.29, 95% CI − 2.25/− 0.34 for self-reports; MD = − 3.90, 95% CI − 5.28/− 2.52 for parent-reports), compared to community/healthy peers. Between-studies heterogeneity was explained by diagnostic categories, instrument version and informants. Conclusions The identification of significant HrQoL impairments among pediatric patients, specifically in the physical and social domains, highlights the importance of routine psychosocial assessment and intervention in primary pediatric healthcare services. Specific recommendations include the use of profile measures, both self- and parent-reports, and the prioritization of oncology, endocrinology and neurology services.

The effect of nature exposure on the mental health of patients: a systematic review Abstract Background The effect of nature-based interventions on self-reported mental well-being in patients with physical disease is gaining increasing attention. However, there is a lack of randomized controlled trials investigating this area. Due to the massive costs in health care systems, there is a need for new strategies to address these issues and an urgent need for attention to this field. Nature-based interventions are low cost, easy to implement, and should get attention within the health care field. Therefore, the objective was to find the impact of nature interventions on mental well-being in humans with a physical disease. Methods In four major databases (PubMed, Cinahl, PsycINFO, and Cochrane Library), a systematic review of quantitative studies of nature's impact on self-reported mental health in patients with physical disease was performed. A total of 1909 articles were retrieved but only five met the inclusion criteria and were summarized. Results All five studies were quantitative, with a control group and a nature-based intervention. A source of heterogeneity was identified: the patients in one of the five studies were psychosomatic. In the four studies with somatic patients, significant benefit of nature on self-reported mental health outcomes was found; the only study that failed to show a significant benefit was the one with psychosomatic patients. Conclusion A significant effect of nature on mental well-being of patients with somatic disease was found. The result in patients with psychosomatic disease is inconclusive, and more studies in this category are needed. Further research on the effect of nature on mental health is merited, with special attention to standardizing intervention type and dose as well as outcome measures within each medical discipline.

The added value of the EQ-5D with a cognition dimension in injury patients with and without traumatic brain injury Abstract Purpose This study investigated the psychometric gain, if any, from the extension of the EQ-5D with a cognition bolt-on (EQ-5D + C) in a large cohort injury patients with and without traumatic brain injury (TBI). Methods Hospitalized adult injury patients filled out a survey 1 month after initial admission. The survey included the EQ-5D-3L, the cognition bolt-on item in EQ-5D format, and the visual analogue scale (EQ-VAS). We compared ceiling and other distributional effects between EQ-5D and EQ-5D + C and TBI and non-TBI group, and assessed convergent validity using the predictive association with EQ-VAS. Also, we assessed explanatory power using regression analysis, and classification efficiency using Shannon indices. Results In total, 715 TBI patients and 1978 non-TBI patients filled out the EQ-5D + C and EQ-VAS. Perfect health was reported by 7.9% (N = 214) on the EQ-5D, and 7.3% (N = 197) on the EQ-5D + C. Convergent validity was highest for EQ-5D + C in the TBI group (Spearman's rank correlation coefficient = − 0.736) and lowest for EQ-5D in the non-TBI group (Spearman's rank correlation coefficient = − 0.652). For both TBI and non-TBI groups, the explanatory power of EQ-5D + C was slightly higher than of EQ-5D (R2 = 0.56 vs. 0.53 for TBI; R2 = 0.47 vs. 0.45 for non-TBI). Absolute classification efficiency was higher for EQ-5D + C than for EQ-5D in both TBI groups, whereas relative classification efficiency was similar. Conclusions Psychometric performance in general of both the EQ-5D and EQ-5D + C was better in TBI patients. Adding a cognitive bolt-on slightly improved the psychometric performance of the EQ-5D-3L.

Longitudinal validity of the hemophilia caregiver impact measure Abstract Introduction The hemophilia caregiver impact (HCI) measure is a 36-item self-report tool that has documented reliability and validity in a large cross-sectional study, but its longitudinal construct validity is unknown. This study's objective was to evaluate the responsiveness of the HCI to clinically important change, and to provide interpretation guidelines. Methods This web-based study invited 458 hemophilia caregivers involved in the HCI's validation study to provide follow-up data. Measures included the HCI, and a Likert item querying Global Assessment of Change (GAC) for caregiver burden. Responsiveness was estimated using anchor- and distribution-based methods. The anchor-based method computed the minimally important difference (MID) by computing the mean change separately for those who reported lesser or more caregiver burden on the GAC. The distribution-based method computed the Modified Standardized Response Mean (MSRM) separately for people who reporting reduced or increased burden as compared to the 'same' groups. Results The study sample included 323 caregivers (71% response rate), with mean follow-up of 21.9 months. The HCI Burden Summary score and all negative-burden subscales but not the Positive Emotions subscale evidenced responsiveness to clinically important differences, showing statistically significant differences by transition group. The MIDs were relatively small mean changes over time (e.g., Burden Summary MID ranged from − 2.2 to 2.6, for reduced versus increased burden), and the MSRMs were small effect sizes. The Burden Summary score was equally sensitive to reduced versus increased burden (MSRM of − 0.32 and 0.35, respectively). Conclusions The HCI demonstrated longitudinal construct validity. The HCI shows promise for clinical hemophilia studies as a caregiver-based tool for evaluating treatments.

Quality of life of cancer patients living in Trinidad and Tobago Abstract Purpose To determine quality of life (QoL) of cancer patients in The Republic of Trinidad and Tobago using the European Organization for Research and Treatment of Cancer Care Quality of Life Instrument (EORTC QLQ-C30) and examine relationships between QoL and socioeconomic and medical variables. Method A cross-sectional study, consisting of 480 cancer patients being managed at the National Radiotherapy Centre, was conducted. One-way, multiple analysis of variance (MANOVA) with post hoc testing was used to analyze relationships between socioeconomic and medical variables and scales on the EORTC QLQ-C30. Stepwise linear regression was used to evaluate which independent variables contributed to the global QoL and function scores. Results Participants were of mean age 64.1 ± 12.1 years (males) and 56.7 ± 16.6 years (females). Mean values for global QoL and function scales were below 75. Persons in younger age groups had significantly better physical and cognitive function scores (p < 0.05). Males had higher emotional function scores than females (p < 0.05). Persons with higher income and education had better scores on all function scales, except social, and less symptoms (p < 0.05). Persons receiving chemotherapy had more nausea/vomiting, appetite loss, and constipation (p < 0.05). Conclusion Age, income, education, and cancer treatment were factors most associated with scores on the EORTC QLQ-C30. Further research is required in this population to examine these variables in more depth and explore methods to improve QoL of cancer patients in this population.

Comparison between the EQ-5D-3L and the SF-6D quality of life (QOL) questionnaires in patients with chronic obstructive pulmonary disease (COPD) undergoing lung volume reduction surgery (LVRS) Abstract Purpose Lung volume reduction surgery (LVRS) has been shown to improve lung function, but also improve the overall quality of life (QOL). The aim of this study is to compare two QOL questionnaires-EuroQol Questionnaire (EQ-5D-3L) and 36-item Short Form Health Survey (SF-36) in patients post-LVRS. Methods All patients undergoing LVRS for severe chronic obstructive pulmonary disease (COPD) at a single center of excellence were analyzed (n = 94). Baseline demographic and clinical outcomes were characterized. Both EQ-5D-3L and SF-36 questionnaires were administered to all patients at baseline (n = 94) and at the end of 1 year (n = 89) post-surgery. SF-36 was converted to Short Form six-dimensions (SF-6D) using standard algorithm. Correlation, discrimination, responsiveness and differences across the two questionnaires were examined. Results The mean age of patients enrolled in the cohort was 66 years. There was significant increase in forced expiratory volume (FEV1, 43%), forced vital capacity (FVC 46%), diffusion capacity (DLCO 15%), 6 min walk distance test (6MWD 21%) and a significant decrease in residual volume (RV 23%) at the end of 1-year follow-up. The overall mean utility index significantly improved for both SF-6D and EQ-5D-3L questionnaires at the end of follow-up (p = 0.0001). However, the magnitude of percentage increase was higher with EQ-5D-3L compared to SF-6D (32% vs. 13%). Stronger correlations confirmed convergent validity at the end of 1-year follow-up between similar domains. Both questionnaires failed to discriminate between different levels of disease severity post-LVRS in patients with severe COPD. Conclusions Both questionnaires responded similarly in patients with COPD post-LVRS. Combining results from QOL questionnaire(s) along with symptoms of disease and history of exacerbation may be a possible solution for identifying disease severity in old and sick patients unwilling/unable to come to hospital for a pulmonary function test post-LVRS.

The association of age, literacy, and race on completing patient-reported outcome measures in pediatric oncology Abstract Purpose Age is often used to determine when children can begin completing patient-reported outcome (PRO) instruments or transition to adult instruments. This study's purpose was to determine relationships between literacy, age, and race and their influence on a child's ability to understand and complete a PRO instrument. Methods The Wide Range Achievement Test was used to evaluate literacy in children and young adults with cancer, participating in a cognitive interview for the Pediatric PRO-CTCAE instrument. 140 participants (7–20 years) were recruited from 8 sites. Logistic regression and multivariable liner regression were used to examine relationships among key variables. Results Higher literacy scores were significantly associated with fewer PRO-CTCAE items being identified as "hard to understand" (p = 0.017). Literacy scores increased with age, but older participants were more likely to fall behind expected reading levels compared with US norms. A 1-year increase in age was associated with a 19% increase in the likelihood for being below the expected WRAT word reading score (OR 1.19; 95% CI 1.06–1.33, p = 0.003). No associations were found between race and literacy. Conclusions Wide variations in literacy were noted across age groups. All participants were able to complete the Pediatric PRO-CTCAE, although most 7 year olds (63%) required reading assistance. Those with lower literacy skills were able to understand items suggesting that multiple factors may be involved in comprehension (developmental stage, concentration, vocabulary, or prior health experiences). Risk for falling below expected literacy levels increased with age implying a need for literacy consideration for cancer patients.

Comparison of EQ-5D-5L and SPVU-5D for measuring quality of life in patients with venous leg ulcers in an Australian setting Abstract Purpose Given the importance of measuring health-related quality of life (HRQoL) for cost–utility studies, this study aimed to determine the validity and responsiveness of two preference-based HRQoL instruments, the EuroQol-five dimensions-five levels questionnaire (EQ-5D-5L) and the Sheffield Preference-based Venous Ulcer questionnaire (SPVU-5D) in patients with venous leg ulcers (VLUs) in an Australian setting. Methods This study analysed de-identified data collected from 80 patients with VLUs recruited by a prospective study in Brisbane, Queensland, Australia. Patients were asked to complete EQ-5D-5L and SPVU-5D surveys at baseline, 1-month, 3-month and 6-month follow-up as part of the prospective study. Baseline data and follow-up data were pooled to test the construct validity and level of agreement of the two instruments. Follow-up data were used to test the responsiveness. Results The ceiling effects were negligible for EQ-5D-5L and SPVU-5D utility scores. Both instruments were able to discriminate between healed VLU and unhealed VLU and showed great responsiveness when healing status changed over time. Weak to strong correlations were found between dimensions of EQ-5D-5L and SPVU-5D. The utility scores produced from EQ-5D-5L were generally lower. Conclusions This study found that both EQ-5D-5L and SPVU-5D were valid and responsive in detecting change of VLU healing status among a small Australian population. Both instruments may be used in economic evaluation studies that involve patients with healed or unhealed VLUs. However, given the limitations presented in this study, further research is necessary to make sound recommendations on the preferred instrument in economic evaluation of VLU-related interventions.

Ethnic background and children's oral health-related quality of life Abstract Purpose Ethnic background is known to be related to oral health and socioeconomic position (SEP). In the context of patient-centered oral health care, and the growing number of migrant children, it is important to understand the influence of ethnic background on oral health-related quality of life (OHRQoL). Therefore, we aimed to identify the differences in children's OHRQoL between ethnic groups, and the contribution of oral health status, SEP, and immigration characteristics. Methods This study was part of the Generation R Study, a prospective cohort study conducted in Rotterdam, the Netherlands. In total, 3121 9-year-old children with a native Dutch (n = 2510), Indonesian (n = 143), Moroccan (n = 104), Surinamese (n = 195), or Turkish (n = 169) background participated in the present study. These ethnicities comprise the most common ethnic groups in the Netherlands. OHRQoL was assessed using a validated short form of the child oral health impact profile. Several regression models were used to study an association between ethnic background and OHRQoL, and to identify potential mediating factors. Results Turkish and Surinamese ethnic background were significantly associated with lower OHRQoL. After adjusting for mediating factors, only Surinamese children had a significantly lower OHRQoL than Dutch children (β:− 0.61; 95% CI− 1.18 to –0.04). Conclusions Our results show that Turkish and Surinamese children have a significantly lower OHRQoL than native Dutch children. The association was partly explained by oral health status and SEP, and future studies are needed to understand (cultural) the determinants of ethnic disparities in OHRQoL, in order to develop effective oral health programs targeting children of different ethnic groups.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Oecologia

Species with moderate intraspecific trait variability are locally abundant within an environmentally heterogeneous subtropical forest Abstract Species with large intraspecific trait variability (ITV) have larger niche breadth than species with low ITV and thus are expected to be more abundant at the local scale. However, whether the positive ITV–abundance relationship holds in heterogeneous local environments remains uncertain. Using an individual-based trait dataset encompassing three leaf traits (leaf area, specific leaf area, and leaf dry mass content) of 20,248 individuals across 80 species in an environmentally heterogeneous subtropical forest in eastern China, ITV for each trait of each species was estimated by rarefaction. Resource-based niche breadth and marginality (the absolute distance between the mean resource states used by a species and the mean plot-wise resource states) were estimated simultaneously by the K–S method and the outlying mean index, respectively. Species with moderate ITV were often locally abundant, while species with large or small ITV were locally rare. This unimodal relationship between ITV and species abundance persisted when traits were analyzed separately and for all tree size classes. There was also a hump-backed relationship between niche breadth and marginality, and ITV was positively associated with niche breadth. The combined results suggest either a trade-off between the benefit from expanding niche breadth to adapt to multiple habitats and the disadvantage of reducing competitive ability, or a scarcity of favorable resources. Our results do not support the traditional thought that ITV positively correlates with species abundance in heterogeneous local environments. Instead, our study suggests that moderate—rather than large—intraspecific trait variability increases species abundance at local scales.

The paradox of nest reuse: early breeding benefits reproduction, but nest reuse increases nest predation risk Abstract Many animals build new nests every breeding season instead of saving time by reusing old ones. One hypothesis is that nest reuse leads to increased predation risk if predators memorize nest locations and revisit these sites. Here we examine patterns in the prevalence of facultative nest reuse. Further, we relate nest reuse and timing of breeding to nest predation risk, clutch size and nestling survival. We analyse 1570 breeding attempts of the Eurasian sparrowhawk (Accipiter nisus) from Denmark (1977–1997) and from two sites in Norway (1985–2017). The probability of reuse varied between study areas, increased in replacement clutches, and was lower in adults compared to 1-year-old breeders. Pairs reusing nests laid their first egg on average 2.6 ± 1.0 SE days later than those building new nests, suggesting they are compensating for an already late breeding schedule. Indeed, reuse increased nest predation risk, but we discovered no other productive effects of reuse. In non-predated nests, late breeders had both smaller clutches and lower nestling survival. We propose that nest predation is a contributing driver to the behaviour of building a new nest each year, whereas nest reuse is a strategy to compensate for delayed onset of breeding, mainly used by inexperienced males.

Long-term acclimation to near-future ocean acidification has negligible effects on energetic attributes in a juvenile coral reef fish Abstract Increased levels of dissolved carbon dioxide (CO2) drive ocean acidification and have been predicted to increase the energy use of marine fishes via physiological and behavioural mechanisms. This notion is based on a theoretical framework suggesting that detrimental effects on energy use are caused by plasma acid–base disruption in response to hypercapnic acidosis, potentially in combination with a malfunction of the gamma aminobutyric acid type A (GABAA) receptors in the brain. However, the existing empirical evidence testing these effects primarily stems from studies that exposed fish to elevated CO2 for a few days and measured a small number of traits. We investigated a range of energetic traits in juvenile spiny chromis damselfish (Acanthochromis polyacanthus) over 3 months of acclimation to projected end-of-century CO2 levels (~ 1000 µatm). Somatic growth and otolith size and shape were unaffected by the CO2 treatment across 3 months of development in comparison with control fish (~ 420 µatm). Swimming activity during behavioural assays was initially higher in the elevated CO2 group, but this effect dissipated within ~ 25 min following handling. The transient higher activity of fish under elevated CO2 was not associated with a detectable difference in the rate of oxygen uptake nor was it mediated by GABAA neurotransmitter interference because treatment with a GABAA antagonist (gabazine) did not abolish the CO2 treatment effect. These findings contrast with several short-term studies by suggesting that end-of-century levels of CO2 may have negligible direct effects on the energetics of at least some species of fish.

Volatiles of pathogenic and non-pathogenic soil-borne fungi affect plant development and resistance to insects Abstract Plants are ubiquitously exposed to a wide diversity of (micro)organisms, including mutualists and antagonists. Prior to direct contact, plants can perceive microbial organic and inorganic volatile compounds (hereafter: volatiles) from a distance that, in turn, may affect plant development and resistance. To date, however, the specificity of plant responses to volatiles emitted by pathogenic and non-pathogenic fungi and the ecological consequences of such responses remain largely elusive. We investigated whether Arabidopsis thaliana plants can differentiate between volatiles of pathogenic and non-pathogenic soil-borne fungi. We profiled volatile organic compounds (VOCs) and measured CO2 emission of 11 fungi. We assessed the main effects of fungal volatiles on plant development and insect resistance. Despite distinct differences in VOC profiles between the pathogenic and non-pathogenic fungi, plants did not discriminate, based on plant phenotypic responses, between pathogenic and non-pathogenic fungi. Overall, plant growth was promoted and flowering was accelerated upon exposure to fungal volatiles, irrespectively of fungal CO2 emission levels. In addition, plants became significantly more susceptible to a generalist insect leaf-chewing herbivore upon exposure to the volatiles of some of the fungi, demonstrating that a prior fungal volatile exposure can negatively affect plant resistance. These data indicate that plant development and resistance can be modulated in response to exposure to fungal volatiles.

Soil-mediated impacts of an invasive thistle inhibit the recruitment of certain native plants Abstract Invasive plants may outcompete and replace native plant species through a variety of mechanisms. Recent evidence indicates that soil microbial pathways such as pathogen accumulation may have a considerable role in facilitating competition between native and invasive plants. To assess microbe-mediated pathways of invasion, we tested the impacts of invaded and non-invaded field soils on plant establishment using naturally occurring populations of the common Eurasian invader Cirsium arvense (Canada thistle) in Southern Ontario, Canada. Linked field and greenhouse experiments were used to quantify differences in the germinability and early growth rates of native plant species, depending on exposure to the microbial community in invaded or non-invaded soils. The invaded microbial community significantly reduced early growth rates for two of the seven native species surveyed, and decreased seed germination for another. In contrast, the germination and growth of invasive Cirsium were not affected by its own soil microbial community. These results demonstrate that the invasion of C. arvense can reduce the performance of some native plant species through changes to the soil microbial community. Different effects on different species suggest that this invader may also change the relative importance of certain natives in the invaded community. If these effects influence plant abundance in the field, microbially mediated interactions in the soil may aid the invasion of C. arvense and facilitate the disruption of invaded communities.

Interspecific competition for frugivores: population-level seed dispersal in contrasting fruiting communities Abstract Indirect interactions among plant species mediated by frugivorous animals can be central to population and community dynamics, since the successful seed dispersal of species may depend on facilitative or competitive interactions with heterospecific plants. Yet, empirical evidence on these interactions is very scarce and mostly available at small spatial scales, within populations. Because lipid-rich fruits are known to be preferred by migratory birds, here we test our prediction of competitive inferiority of a carbohydrate-rich fruited species (the hawthorn Crataegus monogyna) compared to lipid-rich co-fruiting species in a Mediterranean region where the bulk of seed dispersal relies on migratory birds. We assessed avian seed dispersal in both relative (fruit removal rate) and absolute terms (seed dispersal magnitude) in seven hawthorn populations distributed across an altitudinal gradient encompassing three contrasting fruiting contexts: hawthorn is scarce in the lowlands, common in the midlands, and the dominant fruit species in the highlands. We found evidence of seed dispersal reduction due to interspecific competition in the lowland populations, where lipid-rich fruits dominate. Besides, DNA barcoding analysis of bird-dispersed seeds revealed that only a small subset of the local frugivore assemblages consumed hawthorn fruits in the lowland communities. Instead, the consumers of hawthorn fruits resembled the local frugivore assemblages where hawthorn fruits were more dominant and frugivore choices more limited. Our study suggests mechanisms by which the rarity or dominance of plant species might be jointly influenced by environmental constraints (here, precipitation along the altitudinal gradient) and frugivore-mediated indirect interactions among plants hindering or facilitating seed dispersal.

Foraging strategies of individual silky pocket mice over a boom–bust cycle in a stochastic dryland ecosystem Abstract Small mammals use multiple foraging strategies to compensate for fluctuating resource quality in stochastic environments. These strategies may lead to increased dietary overlap when competition for resources is strong. To quantify temporal contributions of high (C3) versus low quality (C4) resources in diets of silky pocket mice (Perognathus flavus), we used stable carbon isotope (δ13C) analysis of 1391 plasma samples collected over 2 years. Of these, 695 samples were from 170 individuals sampled ≥ 3 times across seasons or years, allowing us to assess changes in dietary breadth at the population and individual levels across a boom–bust population cycle. In 2014, the P. flavus population increased to 412 captures compared to 8 captures in prior and subsequent years, while populations of co-occurring small mammals remained stable. As intraspecific competition increased, the population-wide dietary niche of P. flavus did not change, but individual specialization increased significantly. During this period, ~ 27% (41/151) of individuals sampled specialized on C3 resources, which were abundant during the spring and previous fall seasons. Most of the remaining individuals were C3–C4 generalists (64%) (96/151), and only 9% (14/151) specialized on C4 resources. In 2015, P. flavus population density and resource availability declined, individual dietary breadth expanded (84% generalists), no C3 specialists were found, and specialization on C4 resources increased (16%). Our results demonstrate a high degree of inter-individual plasticity in P. flavus foraging strategies, which has implications for how this species will respond to environmental change that is predicted to decrease C3 resources in the future.

Low levels of intraspecific trait variation in a keystone invertebrate group Abstract The trait-based approach to ecology promises to provide a mechanistic understanding of species distributions and ecosystem functioning. Typically, trait analyses focus on average species trait values and assume that intraspecific variation is small or negligible. Recent work has shown, however, that intraspecific trait variation can often contribute substantially to total trait variation. Whilst many studies have investigated intraspecific variation in plants, very few have done so for invertebrates. There is no research on the level of intraspecific trait variation in ants (Hymenoptera: Formicidae), despite the fact that there is a growing body of literature using ant morphological trait data and demonstrating that these insects play important roles in many ecosystems and food webs. Here, we investigate the intraspecific variability of four commonly used ant morphological traits from 23 species from the Maloti-Drakensberg Mountains of southern Africa. In total, we measured 1145 different individuals and made 6870 trait measurements. Intraspecific variation accounted for only 1–4% of total trait variation for each of the four traits we analysed. We found no links between intraspecific variation, phylogeny and elevation. On average, six individuals generated robust species means but under biased sampling scenarios 20 individuals were needed. The low levels of intraspecific morphological variation that we find suggest that the approach of using mean species traits is valid, in this fauna at least. Regardless, we encourage ant trait ecologists to measure greater numbers of individuals, especially across gradients, to shed further light on intraspecific variation in this functionally important group of insects.

The importance of productivity and seasonality for structuring small rodent diversity across a tropical elevation gradient Abstract Photosynthetic productivity is a key determinant of the abundance and distribution of biodiversity around the world. The effect of this productivity on the distribution patterns of mammals is frequently invoked; however, it is seldom measured directly. In this study, we used Sherman live traps set in dry and rainy seasons across a 2300-m elevation gradient in southwestern Mexico to assess small rodent species distributions, and to relate these patterns to habitat structure, climate, and a well-accepted measure of photosynthetic productivity: the normalized difference vegetation index (NDVI). While habitat structure and climate helped explain some of the patterns observed, NDVI proved to be the most important contributing variable for most of the distribution models. We also found that partitioning the gradient-distribution model by trapping season revealed strong differences in terms of the effect of NDVI and the other explanatory variables. For example, lower elevations were associated with seasonal and year-round reductions in rodent diversity and were composed almost exclusively of granivore-based species assemblages. By contrast, the middle and upper elevations were more species rich, less affected by seasonality, and characterized by omnivorous species. Our results suggest that the positive productivity–diversity relationship found may be due, at least in part, to increased food resources and niche opportunities at more productive elevations. Increased diversity at the higher elevations may also be partially due to reductions in competition that result from productivity increases, as well as from the broader spectrum of feeding guild representation that it and the lack of seasonality allow.

Seed mass equalises the strength of positive and negative plant–plant interactions in a semi-arid grassland Abstract The interplay and balance between positive and negative interactions are important and recurrent topics in plant ecology. If facilitation occurs because benefactors ameliorate stress, such balance may be driven by seed mass because stress tolerance and competitive ability of plants, particularly seedlings, are positively correlated with seed mass. Thus, small-seeded, stress-intolerant species may require facilitation, but not large-seeded ones. This would equalise the magnitudes of opposite-signed interactions because in small-seeded species, positive effects of facilitators and negative effects of competitors should be strong, while both effects should be weak in large-seeded species. To test this idea, we assessed the effects of interactions with four associated species on different components of the performance of ten focal species. As expected, the largest facilitative and competitive effects were recorded in small-seeded species, and positive interactions had similar magnitudes to negative ones for any given seed mass, especially when performance was integrated into lifelong fitness. Furthermore, the fact that small-seeded species seem to be strongly facilitated may explain why they are not outcompeted by large-seeded species. This is an alternative to other hypotheses explaining the coexistence of plants with different-sized seeds. The close balance between opposite-signed interactions in the presence of stress may also explain why interactions have strong effects on individuals (that interact with only a few species), but seemingly weaker effects on populations, where interactions between many species would cancel out.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Clean Technologies and Environmental Policy

The role of clean technology research in disaster debris management

Waste energy recovery improves price competitiveness of artificial forage from rapeseed straw Abstract Increasingly frequent droughts are causing repeated shortages of forage and are creating imbalances in the livestock economy in many parts of the world. More and more rapeseed is being cultivated for biodiesel production, and its straw has to be removed from fields to minimize disease vectors. Despite good drought resistance, rapeseed straw cannot replace forage because of its poor palatability. Our work objective was to design a pilot plant that would be the first of its kind to turn rapeseed straw into artificial forage on a commercial scale and would enable a first techno-economical assessment. Rapeseed straw is intracellularly disintegrated (by steam explosion technology which uses waste heat from a biogas station to minimize the energy demands) and subsequently enzymatically hydrolysed. A series of in vitro and in vivo analyses of nutrition quality were accompanied by a cost breakdown. The findings obtained in pilot scale dimensions revealed for the first time that rapeseed straw can be turned into artificial forage that has, according to the world standard forage price indicator, a relative feed value rated at the same level as alfalfa hay. However, despite energy savings, the cost of processing makes the cost of the artificial forage about 61% higher than conventional forage of the same quality. On the other hand, the potential for further reduction of production costs has been identified. It can be assumed that the price competitiveness can be achieved during extended periods of drought. Graphical abstract

Startup, performance, and microbial communities of an anammox reactor inoculated with indigenous sludge for the treatment of high-salinity and mesophilic underground brine Abstract Anaerobic ammonium oxidation (anammox) has been implemented as a cost-effective nitrogen removal process in wastewater treatment. To apply the process to saline wastewater treatment at temperatures below 30 °C, the effectiveness of marine anammox bacteria has been demonstrated in a pilot-scale reactor. Nevertheless, mesophilic conditions, often found in underground brine containing high NH4+ concentrations, have yet to employ an anammox process. The objective of this study was to enrich anammox bacteria capable of removing nitrogen from underground brine possessing a salinity of 3% and at a temperature over 30 °C. To select a promising inoculum, biomass from a brine settling tank in a natural gas plant was subjected to quantifying transcripts of anammox 16S rRNA and hydrazine oxidoreductase (hzo) genes by quantitative reverse transcription polymerase chain reaction. A fixed-bed column anammox reactor was fed with the selected inoculum and operated feeding underground brine mixed with NaNO2 solution at a temperature of 38 °C. As a result, a nitrogen removal rate (NRR) of 1.42 kg-N/m3/day was obtained on day 167. An average NRR of 1.21 kg-N/m3/day and nitrogen removal efficiency of 88% were maintained for 50 days. Amplicon sequencing based on the 16S rRNA revealed that anammox bacteria which are phylogenetically close to Candidatus Kuenenia were successfully enriched in the reactor. These results indicate that nonmarine anammox bacteria can be active and predominant under both high-salinity and mesophilic conditions, making it a likely candidate for effective nitrogen removal from underground and waste brine. Graphical abstract

The suitability of Polish lignite for gasification Abstract The article discusses the impact of the lithotype of lignite on the suitability for gasification in CO2 atmosphere. The research was aimed at determining the influence of lithotype, petrographic composition, and physical and chemical properties of coal on the composition and release of syngas. The examined coals were humic coals. The first step was to determine the impact of lithotype on the degree of carbon conversion at a temperature of up to 815 °C. The gasification process was conducted in the temperature range of 600–1100 °C. During the experiment, two gas samples, used for determining the chemical content of gas, were collected at 950 and 1050 °C, respectively. What is more, continuous monitoring of the gas density during the gasification was carried out. Depending on the lithotype, the content of ash, moisture, and the degree of coalification, the intensity of gas release is different for different temperatures. In addition, it has been found that coals with a high content of poorly gelified xylite and a low ash content are the fastest reacting and the most responsive. The importance of this research lies in determining that the gasification of coal with a low degree of coalification requires technologies carried out at reactor temperatures above 1000 °C. Graphical abstract

Waste-to-energy is compatible and complementary with recycling in the circular economy Abstract This paper reviews the role of conventional waste-to-energy, i.e. incineration of (mainly) municipal solid waste with energy recovery, in the circular economy. It shows that, although waste-to-energy figures on a lower level in the European waste hierarchy than recycling, it plays, from an overall sustainability point of view, an essential, complementary and facilitating role within the circular economy. First of all, waste-to-energy combusts (or should combust) only waste that is non-recyclable for economic, technical or environmental reasons. This way waste-to-energy is compatible with recycling and only competes with landfill, which is lower in the waste hierarchy. Furthermore, waste-to-energy keeps material cycles, and ultimately the environment and humans largely free from toxic substances. Finally, waste-to-energy allows recovery of both energy and materials from non-recyclable waste and hence contributes to keeping materials in circulation. These arguments are elaborated and illustrated with many examples. This paper also points out the pitfalls of a circular economy if it merely focuses on material cycles, disregarding economic, environmental, social and health aspects of sustainability. Graphical abstract

Eco-efficiency and techno-economic analysis for maleic anhydride manufacturing processes Abstract Maleic anhydride may be obtained from different technological routes, being the selective oxidation of benzene and oxidation of butane the only ones that are currently in operation and, hence, represent competitive alternatives. In this paper, the said technologies are compared with regard to their economics and ecological performances in order to assert which one corresponds to the cleanest technology. The economics of each process was estimated on the basis of their respective cash flows, while the environmental comparison was carried out through the Eco-efficiency Comparison Index method by estimating six different categories of eco-indicators and seven life cycle metrics. To the best of our knowledge, such technologies have not been compared in terms of a joint evaluation of life cycle and eco-efficiency metrics, let alone considering the design of their respective utility plants. Finally, a sensitivity analysis was performed in order to analyze how the heuristic parameters for the utility plants considered in this work affect the estimation of the said indicators. The butane technology was shown to be more sustainable than the benzene process, since it was approximately 72% more profitable and 38% more eco-efficient than the latter. Graphical abstract

Enhancing the dewaterability of anaerobically digested sludge using fibrous materials recovered from primary sludge: demonstration from a field study Abstract Sludge dewatering is an important process for determining the operation cost of sludge disposal. Hence, improving the dewaterability of anaerobically digested sludge containing high water content is of paramount significance. For this challenge, we developed a novel process in which fibrous materials initially collected from a primary sedimentation tank, namely recovered fibers, were used as an auxiliary agent to improve the dewaterability of anaerobically digested sludge. The objective of this study was to investigate the feasibility of using the developed process to improve sludge dewaterability. Three fibrous materials individually recovered from the respective primary sedimentation tanks in different wastewater treatment plants (WWTPs) were used to investigate sludge dewaterability, organic C compositions, and calorific values. The recovered fibers showed comparable compositions irrespective of the WWTP. Six different WWTP sludge samples after anaerobic digestion were continuously supplied to three different dewatering devices, i.e., screw press, centrifuge, and belt press machines, with or without the supply of recovered fibers. Irrespective of the type of a dewatering device, the supply of recovered fibers mixed with the tested sludge samples at a feed ratio of 0.18–0.20 g-fibers/g-sludge (dry weight) reduced the amount of polymer flocculant by 13–50%, thereby displaying the superiority of the addition of recovered fibers. Furthermore, at fiber feed ratios of 0.20 g-fibers/g-sludge and 0.40 g-fibers/g-sludge when the rates of sludge supply and polymer flocculant were kept constant, the corresponding water contents in the dewatered sludge cakes decreased to about 74–76% and 69–72%, respectively. The consistent results regardless of the dewatering device or sludge sample showed the significance of the addition of recovered fibers for improvement in sludge dewaterability. Graphical abstract

A circular economy and industrial ecology toolbox for developing an eco-industrial park: perspectives from French policy Abstract The twentieth century was characterized by an increase in research studies concerning the interactions between economic system growth and environmental deterioration issues. Faced with this background, circular economy (CE) and its industrial ecology (IE) pillar seem to be an efficient way to achieve sustainable development within the industrial sector. IE consists of optimizing the networking among industries by using energy and material exchange, which are generated from by-products and waste stocks. It aims to improve the environmental potentialities of integrated clusters called eco-industrial parks (EIPs). Policy in the European Union countries and in French territories has positively influenced such EIP implementation by the establishment of a set of measures to develop the industrial symbiosis performances. The present paper reviews the key drivers to identify the methods and tools to integrate the life cycle thinking approach that defines the following five phases: design, layout, commercialization, operating and renewal phases. A toolbox for developing an EIP from scratch according to French policy is developed and discussed. This study defines a framework involving a factual eco-industrial park and network. The industrial application is a new EIP, namely "Les Portes du Tarn". It is located in the south of France and acts as an experimental field. The paper provides current results for commercialization and operating, including a model of an organizational process, a decision-making process, information technology tools and systems to manage sustainable development. It highlights the CE and IE challenges surrounding enhancing the social acceptability of an industrial park project through adaptation of a relevant governance model and establishment of a continuing collaborative context and trust relationship between diverse actors. The first candidate companies' achievements are discussed and demonstrate the first benefits of toolbox. The paper delivers a toolbox, feedback and some good practices to support the development of EIP project from greenfield. Graphical abstract

The impacts of the sulphur emission regulation on the sulphur emission abatement innovation system in the Baltic Sea region Abstract According to the Porter hypothesis, regulations on environmental emissions under certain conditions can promote eco-innovation. This is why the technological innovation systems (TIS) theory sees regulatory pressure as a major system function critical in the take-off phase. In other words, the design and timing of any regulation may be decisive for the regulatory outcome. The research seeks to provide empirical evidence on how the Baltic Sea Sulphur Emission Control Area (SECA) has impacted the technological innovation system within the Baltic Sea Region maritime sectors. The results (1) show that regulatory compliance gave a knowledge development that has made it possible for clean-tech companies to engage in entrepreneurial activities that created new markets, (2) empirically support the TIS theory and the Porter hypothesis, and (3) provide qualitative evidence on how businesses see environmental regulation. Graphical abstract The innovation system for ship sulphur emission abatement.

Prediction of the resource-efficient potential of Turkish manufacturing industry: a country-based study Abstract As an emerging country, there is a rapid industrial development and associated excessive resource consumption in Turkey. In this case, the dissemination of cleaner production activities based on the principle of minimum resource consumption and waste generation should be regarded as the priority target to ensure efficient use of the resources, enhance the manufacturing industry's competitiveness, and reduce environmental impacts. In this paper, the potential of resource efficiency in Turkish manufacturing industry was predicted. Input saving potential in each industry and aggregate manufacturing was predicted under three different scenarios: business-as-usual, realistic, and ideal. While we used industry saving rate obtained from the field surveys in business-as-usual scenario, we used (in)efficiency scores obtained from Stochastic Frontier Analysis (SFA) conducted for the entire manufacturing industry as well as for the five selected sectors and sub-sectors by using the firm-level panel data Turkish manufacturing from 2008 to 2012 together with the sectoral saving rates. The potential of resource efficiency is estimated for five sectors: (10) Manufacture of food products, (13) Manufacture of textiles, (20) Manufacture of chemicals and chemical products, (23) Manufacture of other nonmetallic mineral products, and (24) Manufacture of basic metals. Then, it is generalized to whole Turkish manufacturing industry. The calculations were performed in both monetary and quantitative terms for energy and water inputs but only in monetary terms for raw material inputs. It is estimated that the Turkish manufacturing industry's monetary-saving potential ranges from $8.8 billion/year to $14.5 billion/year based on the three scenarios specified for all inputs. In addition, according to the realistic scenario, 44.5% of total monetary-saving potential stems from SME savings (47.3% raw material, 41.8% energy, and 9.8% water). Besides, TR10 (Istanbul) and TR42 (Kocaeli, Sakarya, Düzce, Bolu, Yalova) regions have highest raw material and energy-saving potential, respectively. According to the realistic scenario, their share of the total saving value stood at 27% and 14%, respectively. Also, TR63 (Hatay, Kahramanmaraş, Osmaniye) and TR22 (Balıkesir, Çanakkale) regions have the highest water-saving potentials. To the best of our knowledge, this study is the first attempt in examining resource efficiency in the Turkish manufacturing industry in the broadest scope. Moreover, the methodology used in this work is said to be first and unique. We believe this methodology will open new avenues to the new researches both in Turkey and other countries. Graphical abstract

Alexandros Sfakianakis
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alsfakia@gmail.com