Online ratings and narrative comments of American Head and Neck Society surgeons.

BACKGROUND: We analyzed online rating scores and comments of head and neck surgeons to understand factors that contribute to higher ratings. METHODS: Numerical ratings and comments for American Head and Neck Society physicians were extracted from Healthgrades, Vitals, RateMDs, and Yelp, with narrative comments categorized based on content. Physician practice location, education, and residency training were also compiled. RESULTS: Patient ratings were significantly higher with supportive staff and affable physician demeanor but showed significant drops with longer wait times and difficulties scheduling appointments or follow-ups. Physician education and postgraduate training did not significantly affect ratings. CONCLUSION: Online ratings and comments correlated to modifiable factors in clinical practice and may be informative in understanding patient needs.

A review of the toxicology of oil in vertebrates: what we have learned following the Deepwater Horizon oil spill.

In the wake of the Deepwater Horizon (DWH) oil spill, a number of government agencies, academic institutions, consultants, and nonprofit organizations conducted lab- and field-based research to understand the toxic effects of the oil. Lab testing was performed with a variety of fish, birds, turtles, and vertebrate cell lines (as well as invertebrates); field biologists conducted observations on fish, birds, turtles, and marine mammals; and epidemiologists carried out observational studies in humans. Eight years after the spill, scientists and resource managers held a workshop to summarize the similarities and differences in the effects of DWH oil on vertebrate taxa and to identify remaining gaps in our understanding of oil toxicity in wildlife and humans, building upon the cross-taxonomic synthesis initiated during the Natural Resource Damage Assessment. Across the studies, consistency was found in the types of toxic response observed in the different organisms. Impairment of stress responses and adrenal gland function, cardiotoxicity, immune system dysfunction, disruption of blood cells and their function, effects on locomotion, and oxidative damage were observed across taxa. This consistency suggests conservation in the mechanisms of action and disease pathogenesis. From a toxicological perspective, a logical progression of impacts was noted: from molecular and cellular effects that manifest as organ dysfunction, to systemic effects that compromise fitness, growth, reproductive potential, and survival. From a clinical perspective, adverse health effects from DWH oil spill exposure formed a suite of signs/symptomatic responses that at the highest doses/concentrations resulted in multi-organ system failure.

Copper toxicity in Bristol Bay headwaters: Part 1-Acute mortality and ambient water quality criteria in low-hardness water.

The world-class Alaskan Bristol Bay salmon fishery and vast deposits of copper (Cu) and other metals in the watershed warrant further investigation into the potential toxicity of Cu to salmonids under the low water-hardness conditions that occur in the watershed. Therefore we investigated the acute toxicity of Cu to rainbow trout (Oncorhynchus mykiss) and fathead minnows (Pimephales promelas) in low-hardness water (∼ 30 mg/L as CaCO3 ) formulated in the laboratory and collected from the Bristol Bay watershed. The median lethal concentration (LC50) for rainbow trout exposed to Cu in low-hardness laboratory water was 16 µg Cu/L (95% confidence intervals [CIs]: 12, 21; dissolved Cu, filtered to 0.45 µm). The LC50 values for fathead minnows exposed to Cu in low-hardness laboratory water or site water were 29 and 79 µg Cu/L (95% CIs: 23, 35 and 58, 125; dissolved Cu), respectively. The biotic ligand model (BLM) LC50 estimates for these bioassays were 1.3 to 2.3 times higher than the actual LC50 values. We also calculated and analyzed acute Cu water quality criteria, also known as criterion maximum concentration (CMC), using hardness-based methods and the BLM for water samples collected throughout the Bristol Bay watershed in 2007. Biotic ligand model CMCs ranged from 0.05 to 17.5 µg Cu/L and hardness-based CMCs ranged from 2.3 to 6.1 µg Cu/L for the 65 samples analyzed. Our results show the need for site-specific research and subsequent water quality guidelines in low-hardness aquatic habitats. Environ Toxicol Chem 2019;38:190-197. © 2018 SETAC.

Copper toxicity in Bristol Bay headwaters: Part 2-Olfactory inhibition in low-hardness water.

We investigated the olfactory toxicity of copper (Cu) to rainbow trout in low-hardness (27 mg/L as CaCO3 ) water formulated in the laboratory over a 120-h period using a flow-through design. The fish's response to an alarm cue (e.g., reduction in activity) was recorded to determine the exposure concentrations and durations that inhibited olfactory detection of the cue after 3, 24, 48, and 96 h of Cu exposure and after 24 h of clean water recovery following the 96-h exposure period. Exposures were conducted with a range of Cu concentrations from 0.13 (control) to 7.14 µg Cu/L (dissolved Cu). We observed a dose-dependent response in olfactory inhibition with a 20% reduction in the probability of responding to the alarm cue, relative to controls, at 2.7 and 2.4 µg Cu/L after 24 or 96 h of exposure, respectively. Olfactory inhibition manifested between 3 and 24 h of exposure. Our 24- and 96-h 20% olfactory inhibition estimates fell between the criteria derived using the biotic ligand model (BLM; criterion maximum concentration [CMC] and criterion continuous concentration [CCC] values were 0.63 and 0.39 µg Cu/L, respectively) and water hardness-based criteria (CMC and CCC values were 3.9 and 2.9 µg Cu/L, respectively). Therefore, the hardness-based criteria do not appear to be protective and the BLM-derived criteria do appear to be protective against Cu-induced olfactory inhibition given our test water chemistry. Neither the hardness-based criteria nor the BLM-derived criteria appear to be protective against our estimated Cu behavioral avoidance response concentrations at 24- and 96-h exposures (0.54 and 0.50 µg Cu/L, respectively). Environ Toxicol Chem 2019;38:198-209. © 2018 SETAC.

Characterization of dissolved and particulate phases of water accommodated fractions used to conduct aquatic toxicity testing in support of the Deepwater Horizon natural resource damage assessment.

In response to the Deepwater Horizon oil spill, the Natural Resource Trustees implemented a toxicity testing program that included 4 different Deepwater Horizon oils that ranged from fresh to weathered, and 3 different oil-in-water preparation methods (including one that used the chemical dispersant Corexit 9500) to prepare a total of 12 chemically unique water accommodated fractions (WAFs). We determined how the different WAF preparation methods, WAF concentrations, and oil types influenced the chemical composition and concentration of polycyclic aromatic hydrocarbons (PAHs) in the dissolved and particulate phases over time periods used in standard toxicity tests. In WAFs prepared with the same starting oil and oil-to-water ratio, the composition and concentration of the dissolved fractions were similar across all preparation methods. However, these similarities diverged when dilutions of the 3 WAF methods were compared. In WAFs containing oil droplets, we found that the dissolved phase was a small fraction of the total PAH concentration for the high-concentration stock WAFs; however, the dissolved phase became the dominant fraction when it was diluted to lower concentrations. Furthermore, decreases in concentration over time were mainly related to surfacing of the larger oil droplets. The initial mean diameters of the droplets were approximately 5 to 10 µm, with a few droplets larger than 30 µm. After 96 h, the mean droplet size decreased to 3 to 5 µm, with generally all droplets larger than 10 µm resurfacing. These data provide a detailed assessment of the concentration and form (dissolved vs particulate) of the PAHs in our WAF exposures, measurements that are important for determining the effects of oil on aquatic species. Environ Toxicol Chem 2017;36:1460-1472. © 2017 SETAC.

Characterization of oil and water accommodated fractions used to conduct aquatic toxicity testing in support of the Deepwater Horizon oil spill natural resource damage assessment.

The Deepwater Horizon blowout resulted in the release of millions of barrels of crude oil. As part of the Trustees' Natural Resource Damage Assessment, a testing program was implemented to evaluate the toxicity of Deepwater Horizon oil and oil/dispersant mixtures to aquatic organisms from the Gulf of Mexico. Because of the variety of exposures that likely occurred, the program included 4 Deepwater Horizon oils, which encompassed a range of weathering states, and 3 different oil-in-water mixing methods, for a total of 12 unique water accommodated fractions (WAFs). The present study reports on the chemical characteristics of these 4 Deepwater Horizon oils and 12 WAFs. In addition, to better understand exposure chemistry, an examination was conducted of the effects of WAF preparation parameters-including mixing energy, starting oil composition, and oil-to-water mixing ratios-on the chemical profiles and final concentrations of these 12 WAFs. The results showed that the more weathered the starting oil, the lower the concentrations of the oil constituents in the WAF, with a shift in composition to the less soluble compounds. In addition, higher mixing energies increased the presence of insoluble oil constituents. Finally, at low to mid oil-to-water mixing ratios, the concentration and composition of the WAFs changed with changing mixing ratios; this change was not observed at higher mixing ratios (i.e., >1 g oil/L). Ultimately, the present study provides a basic characterization of the oils and WAFs used in the testing program, which helps to support interpretation of the more than 500 Deepwater Horizon Natural Resource Damage Assessment toxicity testing results and to enable a comparison of these results with different tests and with the field. Environ Toxicol Chem 2017;36:1450-1459. © 2016 SETAC.

Pacific lamprey (Entosphenus tridentatus) ammocoetes exposed to contaminated Portland Harbor sediments: Method development and effects on survival, growth, and behavior.

Many anthropogenic disturbances have contributed to the decline of Pacific lampreys (Entosphenus tridentatus), but potential negative effects of contaminants on lampreys are unclear. Lamprey ammocoetes are the only detritivorous fish in the lower Willamette River, Oregon, USA, and have been observed in Portland Harbor sediments. Their long benthic larval stage places them at risk from the effects of contaminated sediment. The authors developed experimental methods to assess the effects of contaminated sediment on the growth and behavior of field-collected ammocoetes reared in a laboratory. Specifically, they developed methods to assess individual growth and burrowing behavior. Burrowing performance demonstrated high variability among contaminated sediments; however, ammocoetes presented with noncontaminated reference sediment initiated burrowing more rapidly and completed it faster. Ammocoete reemergence from contaminated sediments suggests avoidance of some chemical compounds. The authors conducted long-term exposure experiments on individually held ammocoetes using sediment collected from their native Siletz River, which included the following: contaminated sediments collected from 9 sites within Portland Harbor, 2 uncontaminated reference sediments collected upstream, 1 uncontaminated sediment with characteristics similar to Portland Harbor sediments, and clean sand. They determined that a 24-h depuration period was sufficient to evaluate weight changes and observed no mortality or growth effects in fish exposed to any of the contaminated sediments. However, the effect on burrowing behavior appeared to be a sensitive endpoint, with potentially significant implications for predator avoidance. Environ Toxicol Chem 2016;35:2092-2102. © 2016 SETAC.

Ecological risk assessment and natural resource damage assessment: synthesis of assessment procedures.

The Society of Environmental Toxicology and Chemistry (SETAC) convened an invited workshop (August 2008) to address coordination between ecological risk assessment (ERA) and natural resource damage assessment (NRDA). Although ERA and NRDA activities are performed under a number of statutory and regulatory authorities, the primary focus of the workshop was on ERA and NRDA as currently practiced in the United States under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). This paper presents the findings and conclusions of the Synthesis Work Group, 1 of 3 work groups convened at the workshop. The Synthesis Work Group concluded that the different programmatic objectives and legal requirements of the 2 processes preclude development of a single, integrated ERA/NRDA process. However, although institutional and programmatic impediments exist to integration of the 2 processes, parties are capitalizing on opportunities to coordinate technical and scientific elements of the assessments at a number of locations. Although it is important to recognize and preserve the distinctions between ERA and NRDA, opportunities for data sharing exist, particularly for the characterization of environmental exposures and derivation of ecotoxicological information. Thus, effective coordination is not precluded by the underlying science. Rather, willing participants, accommodating schedules, and recognition of potential efficiencies associated with shared data collection can lead to enhanced coordination and consistency between ERA and NRDA.

Influence of flow-through and renewal exposures on the toxicity of copper to rainbow trout.

We examined changes in water chemistry and copper (Cu) toxicity in three paired renewal and flow-through acute bioassays with rainbow trout (Oncorhynchus mykiss). Test exposure methodology influenced both exposure water chemistry and measured Cu toxicity. Ammonia and organic carbon concentrations were higher and the fraction of dissolved Cu lower in renewal tests than in paired flow-through tests. Cu toxicity was also lower in renewal tests; 96 h dissolved Cu LC(50) values were 7-60% higher than LC(50)s from matching flow-through tests. LC(50) values in both types of tests were related to dissolved organic carbon (DOC) concentrations in exposure tanks. Increases in organic carbon concentrations in renewal tests were associated with reduced Cu toxicity, likely as a result of the lower bioavailability of Cu-organic carbon complexes. The biotic ligand model of acute Cu toxicity tended to underpredict toxicity in the presence of DOC. Model fits between predicted and observed toxicity were improved by assuming that only 50% of the measured DOC was reactive, and that this reactive fraction was present as fulvic acid.

Associating ecosystem service losses with indicators of toxicity in habitat equivalency analysis.

Habitat equivalency analysis (HEA) was developed as a tool to scale mitigation or restoration when habitat is contaminated by hazardous substances or has been otherwise harmed by anthropogenic activities. Applying HEA involves balancing reductions in habitat quality against gains from restoration actions, and quantifying changes in habitat quality in terms of ecological services. We propose a framework for developing ecological service definitions and measures that incorporate knowledge about the impacts of chemical contaminants on biota. We describe a general model for integrating multiple lines of evidence about the toxicity of hazardous substances to allow mapping of toxicological inputs to ecological service losses. We provide an example of how this framework might be used in a HEA that quantifies ecological services provided by estuarine sediments contaminated with polycyclic aromatic hydrocarbons.

Reduced growth of rainbow trout (Oncorhynchus mykiss) fed a live invertebrate diet pre-exposed to metal-contaminated sediments.

Juvenile rainbow trout (Oncorhynchus mykiss) were fed live diets of Lumbriculus variegatus cultured in metal-contaminated sediments from the Clark Fork River Basin (MT, USA), an uncontaminated reference sediment, or an uncontaminated culture medium. Fish were tested in individual chambers; individual growth as well as the nutritional quality and caloric value of each trout's consumed diet were determined. Growth was measured following 14, 28, 42, 56, and 67 d of exposure. A subset of fish was sampled at 35 d for whole-body metals. Metals (whole body, digestive tract, and liver) and histology were measured at the end of the test. We observed significant growth inhibition in trout fed the contaminated diets; growth inhibition was associated with reductions in conversion of food energy to biomass rather than with reduced food intake. Growth inhibition was negatively correlated with As in trout tissue residues. Histological changes in contaminated treatments included hepatic necrosis and degenerative alterations in gallbladder. The present study provides evidence that metal-contaminated sediments can pose a hazard to trout health through a dietary exposure pathway.

Polychlorinated biphenyl source attribution in Green Bay, Wisconsin, USA, using multivariate similarity among congener profiles in sediment samples.

Polychlorinated biphenyl (PCB) congener concentrations measured in 1,189 sediment samples from Green Bay (MI/WI, USA), Lake Michigan (MI/WI, USA), and the Fox River (WI, USA) were analyzed statistically to evaluate whether PCB congener profiles in outer Green Bay are more similar to those observed in inner Green Bay or Lake Michigan. Similarities among PCB profiles were assessed with complementary multivariate analysis techniques: Principal component analysis (PCA), cluster analysis, and classification trees. The PCA indicated that profiles in outer Green Bay are distinct from those of inner Green Bay or Lake Michigan but are more similar to those of inner Green Bay. The outer bay profiles are dissimilar to profiles that would result from a simple process of mixing contaminated sediments from the inner bay with Lake Michigan sediments and, therefore, support the conclusion that contaminants in outer Green Bay come from discharges of the Fox River. Several classification trees based on small sets of congener proportions defined simple rules that consistently distinguished the regional profiles. Application of these rules to classify the outer bay samples suggests that the profiles of less than 7% of outer bay samples are similar to Lake Michigan profiles. These results are interpreted with respect to physical transport and chemical weathering processes that may account for the observed differences.

Association between contaminant tissue residues and effects in aquatic organisms.

Associations between tissue residues and toxicity to aquatic organisms were examined to evaluate the applicability of the critical body residue (CBR) approach across different chemical classes. Chemical classes and mode of action categories evaluated included narcotics (polar and nonpolar), excitatory agents, AChE inhibitors, reactives/irritants, CNS seizure agents, aryl hydrocarbon (Ah) receptor agonists, and inorganic metals and organometals. This evaluation indicated that empirical data do not support broad application of the CBR concept across chemical classes. This conclusion is particularly important for polar and nonpolar narcotics because the CBR concept was specifically developed for these chemical classes. The variability observed in tissue residues between chemicals within a given mode-of-action class appears to be generally of the same order of magnitude as the variability of aqueous measures of toxicity such as LC50 values (Table 3; Fig. 10). This observation suggests that either (a) the reported tissue residues were dependent on the aqueous dosing regime; (b) the tissue measurements do not accurately reflect the internal dose at target organs with substantially greater precision than water exposure measurements; or (c) many of the same sources of variability associated with aqueous exposures, such as chemical structure, individual species sensitivity, biotransformation processes, and lipid content, also apply to tissue-based measures of exposure. An additional source of uncertainty of CBRs is whether a chemical has been correctly assigned to a mode of action category. [figure: see text] The CBR approach outlined by McCarty (1986, 1987) and McCarty et al. (1993) underlines an important concept in aquatic toxicology, i.e., that internal chemical dose is the true measure of toxicity for many chemicals rather than imputed dose based on aqueous exposure. Nevertheless, without more refined and accurate examination of that actual internal dose and without additional consideration of differences in sensitivity between species, differences in toxic potency between chemicals, and differences in toxicity of environmentally modified or biotransformed compounds, the CBR approach may not offer practical advantages over conventional media-based exposure assessment.

Determining ecological equivalence in service-to-service scaling of salt marsh restoration.

The amount of ecological restoration required to mitigate or compensate for environmental injury or habitat loss is often based on the goal of achieving ecological equivalence. However, few tools are available for estimating the extent of restoration required to achieve habitat services equivalent to those that were lost. This paper describes habitat equivalency analysis (HEA), a habitat-based "service-to-service" approach for determining the amount of restoration needed to compensate for natural resource losses, and examines issues in its application in the case of salt marsh restoration. The scientific literature indicates that although structural attributes such as vegetation may recover within a few years, there is often a significant lag in the development of ecological processes such as nutrient cycling that are necessary for a fully functioning salt marsh. Moreover, natural variation can make recovery trajectories difficult to define and predict for many habitat services. HEA is an excellent tool for scaling restoration actions because it reflects this ecological variability and complexity. At the same time, practitioners must recognize that conclusions about the amount of restoration needed to provide ecological services equivalent to those that are lost will depend critically on the ecological data and assumptions that are used in the HEA calculation.

Scientific and societal considerations in selecting assessment endpoints for environmental decision making.

It is sometimes argued that, from an ecological point of view, population-, community-, and ecosystem-level endpoints are more relevant than individual-level endpoints for assessing the risks posed by human activities to the sustainability of natural resources. Yet society values amenities provided by natural resources that are not necessarily evaluated or protected by assessment tools that focus on higher levels of biological organization. For example, human-caused stressors can adversely affect recreational opportunities that are valued by society even in the absence of detectable population-level reductions in biota. If protective measures are not initiated until effects at higher levels of biological organization are apparent, natural resources that are ecologically important or highly valued by the public may not be adequately protected. Thus, environmental decision makers should consider both scientific and societal factors in selecting endpoints for ecological risk assessments. At the same time, it is important to clearly distinguish the role of scientists, which is to evaluate ecological effects, from the role of policy makers, which is to determine how to address the uncertainty in scientific assessment in making environmental decisions and to judge what effects are adverse based on societal values and policy goals.