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Evidence is emerging that early onset bipolar disorder and the duration of the delay to first treatment are both risk factors for poor treatment outcome. We report on the incidence and implications of these two risk factors in patients from the United States (US) versus Europe.

Age of onset and age at first treatment for depression or mania was assessed in 967 outpatients with bipolar disorder who gave informed consent for participation and filling out a detailed questionnaire. Age at onset and treatment delay were compared in the 675 patients from the US and 292 from the Netherlands and Germany (abbreviated as Europe). Both were then graphed and analyzed.

Age of onset of bipolar disorder was earlier in the US than in Europeans by an average of 6-7 years with similar results in those with first onsets of depression or of mania. Delay to first treatment was strongly inversely related to age of onset and was twice as long in the US than in Europe, and especially different for mania in adolescents. The longer delay to treatment in the US was not solely due to earlier age of onset.

Treatment delay is a remedial risk factor and could be shortened with better recognition of the higher incidence of early onset bipolar disorder in the US, which also associated with more genetic and environmental vulnerability factors compared to Europe. New treatment and research initiatives are needed to address these liabilities so that children with bipolar achieve more positive long-term outcomes.

Treatment delay is a remedial risk factor and could be shortened with better recognition of the higher incidence of early onset bipolar disorder in the US, which also associated with more genetic and environmental vulnerability factors compared to Europe. New treatment and research initiatives are needed to address these liabilities so that children with bipolar achieve more positive long-term outcomes.Stenotrophomonas can survive in a wide range of environments and is considered an opportunistic pathogen. Because of its intrinsic resistance to beta-lactams, this genus is considered irrelevant in studies addressing the environmental spread of antimicrobial resistance genes of medical importance. Consequently, studies on environmental Stenotrophomonas carrying acquired carbapenemase-encoding genes are scarce, though not inexistent. Here, we investigated the frequency and diversity of Stenotrophomonas spp. carrying genes encoding carbapenemases of medical relevance in coastal waters with distinct pollution degrees over one year. Among 319 isolates recovered, 220 (68.9%) showed blaKPC. The frequency of blaKPC-positive Stenotrophomonas spp. was not correlated with thermotolerant counts in coastal waters evaluated. All isolates were susceptible to minocycline, levofloxacin, and trimethoprim-sulfamethoxazole. PFGE typing of 101 blaKPC-positive isolates revealed 55 pulsotypes with 5 subtypes, all of which carried the blaKPC-2 variant. Interspecies differentiation of pulsotypes' representatives revealed 55 isolates belonging to the S. maltophilia complex (91.7%) and 5 S. acidaminiphila (8.3%). The blaKPC-2 gene was more frequently harbored on transposable elements found in enterobacteria of clinical origin, especially Tn4401b. Even though beta-lactams are no therapeutic options to treat Stenotrophomonas infections, the occurrence of a highly relevant antimicrobial resistance determinant harbored on mobile genetic elements in a diverse collection of these ubiquitous microorganisms is noteworthy. Therefore, Stenotrophomonas may act as acceptor, stable reservoirs, and potential vectors of antimicrobial resistance in environmental settings, especially aquatic matrices, and should not be neglected.Per- and polyfluoroalkyl substances (PFAS) have emerged as a major concern in aquatic systems worldwide due to their widespread applications and health concerns. Perfluorooctanoic acid (PFOA) is one of the most-detected PFAS. Yet, a cost-effective technology has been lacking for the degradation of PFAS due to their resistance to conventional treatment processes. click here To address this challenge, we prepared a novel adsorptive photocatalyst, referred to Fe/TNTs@AC, based on low-cost commercial activated carbon (AC) and TiO2. The composite material exhibited synergistic adsorption and photocatalytic activity and enabled a novel "concentrate-&-destroy" strategy for rapid and complete degradation of PFOA in water. Fe/TNTs@AC was able to adsorb PFOA within a few minutes, thereby effectively concentrating the target contaminant on the photoactive sites. Subsequently, Fe/TNTs@AC was able to degrade >90% of PFOA that was preconcentrated on the solid in 4 h under UV irradiation (254 nm, 21 mW cm‒2), of which 62% was completely mineralized to F-. The efficient photodegradation also regenerated Fe/TNTs@AC, eliminating the need for expensive chemical regenerants, and after six cycles of adsorption/photodegradation, the material showed no significant drop in adsorption capacity or photocatalytic activity. Simulations based on the density functional theory (DFT) revealed that Fe/TNTs@AC adsorbs PFOA in the side-on parallel mode, facilitating the subsequent photocatalytic degradation of PFOA. According to the DFT analysis, scavenger tests, and analysis of degradation intermediates, PFOA decomposition is initiated by direct hole oxidation, which activates the molecule and leads to a series of decarboxylation, C-F bond cleavage, and chain shortening reactions. The innovative "concentrate-&-destroy" strategy may significantly advance conventional adsorption or photochemical treatment of PFAS-contaminated water and holds the potential to degrade PFOA, and potentially other PFAS, more cost-effectively.Reliable and accurate oxygen-input control, which is critical to maintaining efficient nitrogen removal performance for partial nitritation-anammox (PN-A) process, remains one of the main operational difficulties. In this study, a novel, yet simple system (a simple process for autotrophic nitrogen-removal, SPAN) with precise oxygen-input control was developed to treat ammonium-rich wastewater via PN-A process. SPAN brings oxygen to biomass by circulating water and creating water spray (shower) at the water-air interface, and effectively balances the activities of core functional microorganisms through precise oxygen-input control. The oxygen-input rate is decided by the water circulation rate and shower rate and is measurable and predictable. Therefore, the required amount of oxygen for ammonium oxidation can be precisely delivered to the biomass by adjusting the circulation rate and shower rate. The results of two parallel SPAN reactors demonstrated that during long-term operation, the required oxygen input was precisely and reliably controlled.