Coagulation removal of dissolved organic matter (DOM) in nanofiltration concentrate of biologically treated landfill leachate by ZrCl4: Performance, mechanism and coagulant recycling.

Coagulation treatment is often applied for removing the residual refractory dissolved organic matter (DOM) in biologically treated landfill leachate nanofiltration concentrate (LLNC) before discharge or further desalination treatment. However, the DOM removal efficiency by traditional coagulant needs to be improved, and two problems including the coagulant loss and difficulty in disposal of coagulation sludge need to be resolved. Based on this practical demand, a new coagulant ZrCl4 was adopted for LLNC treatment for the first time. The results showed that, ZrCl4 was better than the traditional coagulants (FeCl3 and AlCl3) for DOM removal. Under the optimal condition of pH 6.0 and ZrCl4 dosage of 5.0 mM, the DOC content, UV254 and chromaticity of the LLNC reduced by 73.32%, 83.17% and 93.59%, respectively. All of the coagulants tested in this study could efficiently remove the hydrophobic and high molecular organics. There was an obvious difference between them for removal of hydrophobic, and small or medium molecular organics, and ZrCl4 was more effective. This might be due to the stronger negative charge neutralization capacity and larger floc size of ZrCl4, which was beneficial for DOM combination and adsorption. The loss of zirconium was only 2.11%, which was much lower than that of iron and aluminum. Furthermore, being recycled for 3 times after coagulant regeneration, the recovered zirconium coagulant showed no obvious difference with the original ZrCl4 for DOM removal, indicating the disposal problem of the produced coagulation sludge can be resolved. This study could provide a promising method for LLNC treatment.

Wait times for endoscopic sinus surgery influence patient-reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria.

BACKGROUND: Previous studies on the impact of wait times for endoscopic sinus surgery (ESS) in medically recalcitrant chronic rhinosinusitis (rCRS) have not examined its influence on the 5 distinct symptoms domains of the 22-item Sino-Nasal Outcome Test (SNOT-22), and have not applied evidence-based surgical indications. Our primary study objective was to investigate the impact of ESS wait times on postoperative SNOT-22 global and symptom domain scores in patients with rCRS deemed "appropriate" surgical candidates. METHODS: This was a retrospective analysis of adult patients with rCRS undergoing ESS, categorized as "appropriate" surgical candidates. Primary outcome measure was change in SNOT-22 global/symptom domain score (preoperative - 6-month postoperative). Correlational analyses were performed between wait time and change in SNOT-22 global and symptom domain scores. For significant negative correlations, the threshold wait time to generate a worsening in health-related quality-of-life (HRQoL) equivalent to the mean clinically important difference (MCID) was calculated. RESULTS: A total of 104 patients with a mean ± standard deviation (SD) wait time of 310.8 ± 155.9 days were analyzed. Postoperative SNOT-22 global and symptom domain scores significantly improved postoperatively. Wait time for ESS was negatively correlated with change in SNOT-22 global, rhinologic, extranasal rhinologic, and ear/facial domain scores (p < 0.05), and a wait time threshold of 287, 452, 421, and 381 days corresponded to a decrease equivalent to the MCID, respectively. CONCLUSION: We identified less improvement in HRQoL after ESS with increasing surgical wait time. Moreover, prolonged wait times may result in less improvement in disease-specific symptoms, but do not appear to worsen psychological or sleep dysfunction.

Analysis of health-related quality-of-life outcomes and their predictive factors in pediatric patients who undergo otoplasty.

BACKGROUND: There are limited data on the effect of otoplasty on health-related quality of life in children with prominent ears. Predictors of health-related quality-of-life outcomes in otoplasty have not been well studied. METHODS: In this retrospective cohort study, 79 patients aged 18 years and younger who underwent otoplasty, and their parents, were asked to complete a survey, which included the Glasgow Children's Benefit Inventory and the Pediatric Quality of Life Inventory, to assess the parent-reported health-related quality-of-life changes and the current health-related quality of life, respectively. Other collected data included demographics, medical history, preoperative psychosocial experiences, motivations and expectations for surgery, postoperative complications, and general satisfaction. RESULTS: Fifty patients (63 percent) replied. Of those, 88 percent reported being more satisfied with the appearance of their ears after otoplasty and 93 percent would choose to have this procedure again if given a second chance. The mean Glasgow Children's Benefit Inventory total score was 24.4 and the mean Pediatric Quality of Life Inventory total score was 94.3 for the Child Self-Report and 93.3 for the Parent Proxy-Report, indicating a positive health-related quality-of-life outcome. Linear regression analysis showed that history of teasing and expectations of a "life-changing" event were significant predictors of the Glasgow Children's Benefit Inventory total score (p<0.01). CONCLUSIONS: In this study, parents reported a significant improvement in their children's health-related quality of life following otoplasty. The children themselves also reported having a generally high health-related quality of life after surgery. Possible positive predictive factors to consider include preoperative psychosocial status and expectations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review.

OBJECTIVE: To systematically review the outcomes of tongue-tie division procedures in patients with ankyloglossia with the goal of (1) deriving clinically oriented insights into the effect of tongue-tie division procedures and (2) identifying needs in knowledge to stimulate further research. DATA SOURCES: Medline, EMBASE, and Cochrane databases were searched without any limitations, for studies published between 1966 and June 2012. REVIEW METHODS: Studies were included (level 4 evidence or above) if subjects of any age had ankyloglossia and underwent tongue-tie release. Outcome measures of interest were any subjective or objective measures of breastfeeding and speech outcomes, or reports of adverse events. RESULTS: In all, 378 abstracts were generated from the literature searches; 20 studies met the criteria for data extraction and analysis. Of those, 15 studies were observational and 5 were randomized controlled trials. Tongue-tie division provided objective improvements in the following: LATCH scores (3 studies); SF-MPQ index (2 studies); IBFAT (1 study); milk production and feeding characteristics (3 studies); and infant weight gain (1 study). Subjective improvements were also noted in maternal perception of breastfeeding (14 studies) and maternal pain scores (4 studies). No definitive improvements in speech function were reported. The only significant adverse events were recurrent tongue-ties that required repeat procedures. CONCLUSION: Ankyloglossia is a well-tolerated procedure that provides objective and subjective benefits in breastfeeding; however, there was a limited number of studies available with quality evidence. There are no significant data to suggest a causative association between ankyloglossia and speech articulation problems. Aspects of ankyloglossia that would benefit from further research are described, and recommendations for tongue-tie release candidacy criteria are provided.