Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being

OBJECTIVE: To assess the prevalence, severity, and correlates of chronic pain in a community-based sample of men with spinal cord injury (SCI). DESIGN: Survey. SETTING: Community. PARTICIPANTS: Seventy-seven men with SCI randomly selected from a sampling frame solicited from the community. METHOD: Participants completed standardized questionnaires assessing many areas of life, were interviewed in their homes, and underwent a physical examination at a hospital. There they were interviewed by an anesthesiologist regarding chronic pain, and a nurse administered objective pain measures. RESULTS: Seventy-five percent of the men reported chronic pain. Chronic pain was associated with more depressive symptoms, more perceived stress, and poorer self-assessed health. Greater intensity of pain was related to less paralytic impairment, violent etiology, and more perceived stress. Area of the body affected by pain was related to independence and mobility. CONCLUSIONS: Because of the high prevalence of chronic pain in the population with SCI and its relation to disability, handicap, and quality of life, health care providers need to give this issue the same priority given to other SCI health issues. Analysis of individual pain components provides better information than assessing overall pain. It is futile to treat SCI pain without giving full attention to subjective factors.     

Social support and the well-being of persons with spinal cord injury living in the community.

100 men and 40 women (all aged 19–77 yrs) with spinal cord injury completed a social support questionnaire, the Center for Epidemiologic Studies Depression Scale, the Life Satisfaction Index Form A, and a single-item self-assessment of health status. A physician assessed the presence or absence of urinary tract infection from laboratory findings and determined the absence, presence, and severity of pressure ulcers from physical examination. Amount of social support was positively related to life satisfaction and physical well-being. Satisfaction with one's support network was associated negatively with depressive symptomatology and positively with life satisfaction. There were significant differences in the correlations between life satisfaction and total social support for men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors

The prevalence and correlates of pressure ulcers in terms of their number, severity, and anatomical location were studied in a community-based sample of 100 men and 40 women with spinal cord injury. Thirty-three percent (n = 46) presented with one or more ulcers of at least one stage I severity when visually examined. Twenty-one individuals had more than one ulcer, the maximum number of ulcers being seven. Of 87 ulcers for which severity ratings were available, 30 (34.5%) were stage I, 33 (37.9%) were stage II, and 24 (27.6%) were either stage III or IV. Individuals with an ulcer exhibited more paralysis and were more dependent on others in activities of daily living. A greater proportion of blacks had more severe ulcers (stages III and IV) than their white counterparts. Persons with more severe ulcers incurred their injury later in life, and had significantly lower mean scores on the Occupation and Mobility dimensions of the Craig Handicap Assessment and Reporting Technique. The findings suggest that factors governing initial development of a pressure ulcer differ in part from those responsible for an ulcer progressing in severity.     

Depressive symptomatology in persons with spinal cord injury who reside in the community

Depressive symptomatology was studied in a community-based sample of 100 men and 40 women with spinal cord injury. The mean for the Center for Epidemiologic Studies Depression Scale was higher than that reported previously for the general population, and the mean for women was higher than that for men. Findings from the Mobility dimension of the Craig Handicap Assessment and Reporting Technique (CHART) suggested that differences between men and women in degree of mobility within home and community partly mediate the gender difference in depressive symptomatology. Other CHART dimensions, Social Integration and Occupation, were inversely related with depression scores, although these dimensions did not differentiate men and women. A statistically significant relationship was not obtained between depression and disability, assessed by a self-report version of the Functional Independence Measure, or between depression and impairment, reflected by the ASIA Total Motor Index Score. Depression was not related with the presence of either pressure ulcers or presumptive evidence of urinary tract infection.     

Sequential anaerobic–aerobic treatment of sulphur rich phenolic leachates

Sequential biological anaerobic–aerobic treatment of oil shale ash dump leachate was studied using laboratory-scale reactors and bioassays. The COD of the leachate was 2·0–3·0 g dm^?3. The leachate was known to contain several phenolic compounds and to have a high sulphur concentration. The proportion of the leachate in the feed of the biological process was gradually increased during a 309 day test period. With 100% leachate in the feed, COD removal was 35% in the anaerobic stage while in the combined process the COD and BOD₇ removals were up to 75% and 99%, respectively. The removal of total phenols was insignificant in the anaerobic stage, while up to 85% removal was obtained by the combined anaerobic–aerobic process. In the anaerobic stage, degradation of organic compounds was mainly a result of sulphide production. The results demonstrated that the leachates were amenable to biological treatment.     

Group II phospholipase A2 in sera of febrile patients with microbiologically or clinically documented infections

Group II phospholipase A2 (PLA2-II) is an inflammatory enzyme, which has been shown to be an acute-phase protein and to correlate with the severity of sepsis. In a prospective study, the concentration of PLA2-II in the sera of 46 patients with sepsis and nonseptic bacterial and viral infections was measured by a fluoroimmunoassay. The serum concentration of PLA2-II in patients with infections (median, 164.5 micrograms/L; range, 5.07-1,740 micrograms/L) was elevated 46-fold above normal concentrations (median, 3.61 micrograms/L; range, 1.32-25.25 micrograms/L). The concentration of PLA2-II was higher in patients with sepsis (median, 284.5 micrograms/L; range, 12.95-1,574 micrograms/L) and nonseptic bacterial infections (median, 210.6 micrograms/L; range, 5.07-1,740 micrograms/L) than in those with viral infections (median, 46.78 micrograms/L; range 11.46-275.9 micrograms/L) (P = .0042). The concentration of PLA2-II correlated well with the concentration of C-reactive protein (CRP) (r = .613, P = .0001) but not with the concentration of pancreatic PLA2 (r = .089, P = .365). Measuring the serum concentration of PLA2-II is useful as an adjunct to the determination of CRP concentrations for differentiating bacterial from viral infection.     

One-stage H2 and CH4 and two-stage H2 + CH4 production from grass silage and from solid and liquid fractions of NaOH pre-treated grass silage

In the present study, mesophilic CH₄ production from grass silage in a one-stage process was compared with the combined thermophilic H₂ and mesophilic CH₄ production in a two-stage process. In addition, solid and liquid fractions separated from NaOH pre-treated grass silage were also used as substrates. Results showed that higher CH₄ yield was obtained from grass silage in a two-stage process (467 ml g⁻¹ volatile solids (VS)_original) compared with a one-stage process (431 ml g⁻¹ VS_original). Similarly, CH₄ yield from solid fraction increased from 252 to 413 ml g⁻¹ VS_original whereas CH₄ yield from liquid fraction decreased from 82 to 60 ml g⁻¹ VS_original in a two-stage compared to a one-stage process. NaOH pre-treatment increased combined H₂ yield by 15% (from 5.54 to 6.46 ml g⁻¹ VS_original). In contrast, NaOH pre-treatment decreased the combined CH₄ yield by 23%. Compared to the energy value of CH₄ yield obtained, the energy value of H₂ yield remained low. According to this study, highest CH₄ yield (495 ml g⁻¹ VS_original) could be obtained, if grass silage was first pre-treated with NaOH, and the separated solid fraction was digested in a two-stage (thermophilic H₂ and mesophilic CH₄) process while the liquid fraction could be treated directly in a one-stage CH₄ process.     

Evaluation of kinetic coefficients using integrated monod and haldane models for low-temperature acetoclastic methanogenesis

The integrated Monod and Haldane models were used to evaluate the kinetic coefficients and their standard deviations using the methane accumulation curves of low-temperature acetoclastic methanogenesis. The linear and exponential approximations and the limitations of their applicability were deduced from the integrated models. The samples of lake sediments and biomass taken from a low-temperature upflow anaerobic sludge blanket (UASB) reactor were used as inoculum in batch assays for acetate methanation. In comparison, the Monod and Haldane models were applied to evaluate the kinetic coefficients for mesophilic acetoclastic methanogenesis accomplished by the pure culture of Methanosarcina barkeri strain MS. The Monod and Haldane models and their approximations were fitted by using non-linear regression. For the wide range of initial acetateconcentrations (4.2-84 mM: 5-100 mM) applied to the UASB biomass at 11 and 22 degrees C and for the lake sediment samples at 6 and 15 degrees C, a better fit was obtained with the Haldane models and their exponential approximations, respectively. For the lake sediments the values of inhibition coefficients decreased at decreasing temperatures. At the highest temperature of 30 degrees C no difference was found between the Haldane and Monod models and the simpler Monod model should be preferred. The values of the maximum growth rate of biomass were highest at 30 degrees C (lake sediment) and 22 degrees C (the UASB biomass) being in a range presented in the literature for mesophilic acetoclastic methanogenesis.     

Semi-continuous anaerobic digestion of solid poultry slaughterhouse waste: effect of hydraulic retention time and loading

We studied the effect of hydraulic retention time (HRT) and loading on anaerobic digestion of poultry slaughterhouse wastes, using semi-continuously fed, laboratory-scale digesters at 31 degrees C. The effect on process performance was highly significant: Anaerobic digestion appeared feasible with a loading of up to 0.8 kg volatile solids (VS)/m3 d and an HRT of 50-100 days. The specific methane yield was high, from 0.52 to 0.55 m3/kg VS(added). On the other hand, at a higher loading, in the range from 1.0 to 2.1 kg VS/m3 d, and a shorter HRT, in the range from 25 to 13 days, the process appeared inhibited and/or overloaded, as indicated by the accumulation of volatile fatty acids and long-chain fatty acids and the decline in the methane yield. However, the inhibition was reversible. The nitrogen in the feed, ca. 7.8% of total solids (TS), was organic nitrogen with little ammonia present, whereas in the digested material ammonia accounted for 52-67% (up to 3.8 g/l) of total nitrogen. The TS and VS removals amounted to 76% and 64%, respectively. Our results show that on a continuous basis under the studied conditions and with a loading of up to 0.8 kg VS/m3 d metric ton (wet weight) of the studied waste mixture could yield up to 140 m3 of methane.     

Biological nitrogen removal from municipal landfill leachate: low-cost nitrification in biofilters and laboratory scale in-situ denitrification

The slow leaching of nitrogen from solid waste in landfills, resulting in high concentrations of ammonia in the landfill leachate, may last for several decades. The removal of nitrogen from leachate is desirable as nitrogen can trigger eutrophication in lakes and rivers. In the present study, a low-cost nitrification-denitrification process was developed to reduce nitrogen load especially in leachates from small landfills. Nitrification was studied in laboratory and on-site pilot aerobic biofilters with waste materials as filter media (crushed brick in upflow filters and bulking agent of compost in a downflow filter) while denitrification was studied in a laboratory anoxic/anaerobic column filled with landfill waste. In the laboratory nitrification filters, start-up of nitrification took less than 3 weeks and over 90% nitrification of leachate (NH4-N between 60 and 170mg N l(-1), COD between 230 and 1,300 mg l(-1)) was obtained with loading rates between 100 and 130 mgNH4-N l(-1) d at 25 degrees C. In an on-site pilot study a level of nitrification of leachate (NH4-N between 160 and 270 mg N l(-1), COD between 1,300 and 1,600 mg l(-1)) above 90% was achieved in a crushed brick biofilter with a loading rate of 50mg NH4-N l(-1) d even at temperatures as low as 5-10 degrees C. Ammonium concentrations in all biofilter effluents were usually below the detection limit. In the denitrification column. denitrification started within 2 weeks and total oxidised nitrogen in nitrified leachate (TON between 50 and 150mg N l(-1)) usually declined below the detection limit at 25 degrees C, whereas some ammonium, probably originating from the landfill waste used in the column, was detected in the effluent. No adverse effect was observed on the methanation of waste in the denitrification column with a loading rate of 3.8 g TON-N/t-TS(waste) d. In conclusion, nitrification in a low-cost biofilter followed by denitrification in a landfill body appears applicable for the removal of nitrogen in landfill leachate in colder climates.