Campus source to sink wastewater surveillance of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Wastewater-based surveillance (WBS) offers an aggregate, and cost-effective approach for tracking infectious disease outbreak prevalence within communities, that provides data on community health complementary to individual clinical testing. This study reports on a 16-month WBS initiative on a university campus in England, UK, assessing the presence of SARS-CoV-2 in sewers from large buildings, downstream sewer locations, raw wastewater, partially treated and treated effluents. Key findings include the detection of the Alpha (B.1.1.7) variant in wastewater, with 70 % of confirmed campus cases correlating with positive wastewater samples. Notably, ammonium nitrogen (NH4-N) levels showed a positive correlation (ρ = 0.543, p < 0.01) with virus levels at the large building scale, a relationship not observed at the sewer or wastewater treatment works (WWTW) levels due to dilution. The WWTW was compliant to wastewater standards, but the secondary treatment processes were not efficient for virus removal as SARS-CoV-2 was consistently detected in treated discharges. Tools developed through WBS can also be used to enhance traditional environmental monitoring of aquatic systems. This study provides a detailed source-to-sink evaluation, emphasizing the critical need for the widespread application and improvement of WBS. It showcases WBS utility and reinforces the ongoing challenges posed by viruses to receiving water quality.

Non-invasive deep tissue imaging of iodine modified poly(caprolactone-co-1-4-oxepan-1,5-dione) using X-ray.

When biodegradable polyester devices, like sutures and screws, are implanted into the body, it is very challenging to image them in deep tissue, monitor their degradation, and detect defects. We report our recent findings on non-invasive deep tissue imaging of polyester degradation, stability and integrity using an iodinated-polycaprolactone (i-P(CLcoOPD)) X-ray imaging contrast agent. The results of experiments performed with i-P(CLcoOPD) demonstrate the feasibility to quantify in-situ polyester degradation in vitro and in vivo using rats. We also demonstrate that X-ray imaging could be used to identify and quantify physical defects, such as cracks, in polymeric implants using rabbit animal models. This approach enables non-invasive monitoring of polyester materials and is expected to become an important technology for improving the imaging of polymers at clinically relevant depths.

Comparison of pollutant emission control strategies for cadmium and mercury in urban water systems using substance flow analysis.

The European Union (EU) Water Framework Directive (WFD) requires Member States to protect inland surface and groundwater bodies but does not directly stipulate how the associated environmental quality standards should be achieved. This paper develops and assesses the performance of a series of urban emission control strategies (ECS) with an emphasis on the scientific and technological benefits which can be achieved. Data from the literature, in combination with expert judgement, have been used to develop two different semi-hypothetical case cities (SHCC), which represent virtual platforms for the evaluation of ECS using substance flow analysis (SFA). The results indicate that the full implementation of existing EU legislation is capable of reducing the total emissions of cadmium (Cd) and mercury (Hg) by between 11% and 20%. The ability to apply voluntary reduction practices is shown to be particularly effective for Cd with the potential to further lower the overall emissions by between 16% and 27%. The most efficient protection of the receiving surface water environment is strongly influenced by the city characteristics with the introduction of stormwater treatment practices being particularly effective for one city (59% reduction of Hg; 39% reduction of Cd) and the other city being most influenced by the presence of efficient advanced wastewater treatment processes (63% reduction of Hg; 43% reduction of Cd). These reductions in receiving water loads are necessarily accompanied by either increases in stormwater sediment loadings (2.6-14.9 kg/year or 0.6-2.4 kg/year for Hg) or wastewater sludge loadings (45.8-57.2 kg/year or 42.0-57.4 kg/year for Cd).

Risk prioritisation of stormwater pollutant sources.

This paper describes the development of a pollutant risk prioritisation methodology for the comparative assessment of stormwater pollutants discharged from differing land use types and activities. Guidelines are presented which evaluate available data with respect to 'likelihood of occurrence' and 'severity of impact'. The use of the developed approach is demonstrated through its application to total suspended solids, biochemical oxygen demand, lead and cadmium. The proposed benchmarking scheme represents a transparent and auditable mechanism to support the synthesis of data from a variety of sources and is sufficiently flexible to incorporate the use of chemical, physical and/or ecological data sets. Practitioners involved in developing and implementing pollutant mitigation programmes are assisted in two key ways. Firstly through enabling the risks to receiving waters from diffuse pollution on a source-by-source and/or pollutant-by-pollutant basis at a catchment scale to be comparatively assessed and prioritised. Secondly, the methodology informs the selection of appropriate diffuse pollution control strategies.

Water management in cities of the future using emission control strategies for priority hazardous substances.

Cities of the future face challenges with respect to the quantity and quality of water resources, and multiple managerial options need to be considered in order to safeguard urban surface water quality. In a recently completed project on 'Source control options for reducing emissions of Priority Pollutants' (ScorePP), seven emission control strategies (ECSs) were developed and tested within a semi-hypothetical case city (SHCC) to evaluate their potential to reduce the emission of selected European priority hazardous substances (PHSs) to surface waters. The ECSs included (1) business-as-usual, (2) full implementation of relevant European (EU) directives, (3) ECS2 in combination with voluntary options for household, municipalities and industry, (4) ECS2 combined with industrial treatment and best available technologies (BAT), (5) ECS2 in combination with stormwater and combined sewer overflow treatment, (6) ECS2 in combination with advanced wastewater treatment, and (7) combinations of ECS3-6. The SHCC approach was chosen to facilitate transparency, to allow compensating for data gaps and to decrease the level of uncertainty in the results. The selected PHSs: cadmium (Cd), hexachlorobenzene (HCB), nonylphenol (NP) and pentabromodiphenyl ether (PBDE) differ in their uses and environmental fate and therefore accumulate in surface waters to differing extents in response to the application of alternative ECS. To achieve the required reduction in PHS levels in urban waters the full implementation of existing EU regulation is prioritised and feasible combinations of managerial and technological options (source control and treatment) can be highly relevant for mitigating releases.

Tympanic membrane perforation in adults. How to manage, when to refer.

Tympanic membrane perforation is a common and potentially serious condition. One of the most important aspects of primary care for perforations is deciding which patients need to be seen by an otolaryngologist and how urgently they need to be referred. There are several indications for surgical repair, but most cases can be managed with conservative care and require no referral.

Early post-laser stapedotomy hearing thresholds.

OBJECTIVE: Auditory testing is not routinely performed within 4-6 weeks after stapedotomy, because hearing acuity is thought to be transiently depressed. In rare circumstances, postsurgical auditory and vestibular complaints may lead one to test hearing soon after stapedotomy. The early postoperative effects of carbon dioxide (CO2) and potassium titanyl phosphate (KTP) lasers, which now are routinely used to perform stapedotomies, have not been reported. The purpose of this report is to present normative data for auditory thresholds measured within 2 weeks of laser stapedotomy. STUDY DESIGN: The study design was a prospective, unblinded study. SETTING: The study was conducted at three academic medical centers. PATIENTS: Thirty-six subjects undergoing 38 stapedotomies for otosclerosis by 5 surgeons participated. MAIN OUTCOME MEASURES: Behavioral audiometry was performed using standard techniques beginning before surgery and continuing through > 1 year after surgery. RESULTS: The CO2 laser was used in 26 stapedotomies and the KTP laser was used in 12. Nine cases were revision procedures. Bone conduction pure-tone averages and speech discrimination scores did not worsen during the early postoperative period. Bone conduction at 250 and 4,000 Hz dropped slightly within the first 2 weeks (-4.3 and -6.7 dB) but recovered thereafter. Bone conduction at 1,000 Hz actually improved within the first week after surgery (+6.2 dB, p = 0.021). Significant improvements in air conduction thresholds (and air-bone gap) were seen at the second week and late audiometry. The results for CO2 and KTP laser-treated groups were not significantly different. CONCLUSIONS: Cochlear function is not significantly depressed in the early postoperative period after laser (CO2 or KTP) stapedotomy.

A comparison of the biocompatibility of three absorbable hemostatic agents in the rat middle ear.

Absorbable gelatin sponge (Gelfoam) has been used for many years in middle ear surgery. Although the sponge is generally well tolerated, fibrosis occasionally forms in the mesotympanum; some studies indicated that the absorbable gelatin sponge may be responsible. Many of these studies lack statistical analysis. We prospectively studied three absorbable hemostatic agents in the middle ear of adult male Sprague-Dawley rats to determine which promotes fibrosis to the greatest degree: absorbable gelatin sponge (Gelfoam), absorbable gelatin sheet (Gelfilm), or absorbable collagen sheet (Instat). The materials were implanted in the middle ear through a post-auricular approach and the temporal bones were serially harvested at different time intervals so we could examine histologic changes. The nonimplanted ear served as surgical control. Examination of the specimens at 6, 8, and 10 weeks by light microscopy revealed that although absorbable gelatin film and collagen-absorbable hemostat are well tolerated in this animal model, absorbable gelatin sponge promoted the presence of fibrosis to a significantly greater degree, (p = 0.0344). We conclude that absorbable gelatin sponge promotes fibrosis more frequently than do collagen-absorbable hemostat and absorbable gelatin film in this animal model.

Mechanical versus CO2 laser occlusion of the posterior semicircular canal in humans.

The purpose of this study was to compare the effectiveness of mechanical and laser-assisted posterior semicircular canal occlusion (PCO) for the treatment of intractable benign paroxysmal positional vertigo (BPPV). Twelve consecutive patients with intractable BPPV underwent PCO by three surgeons, six with mechanical PCO and six with CO2 laser-assisted PCO. PCO eliminated positional vertigo in all patients treated with the laser and five of six patients treated without the laser. Dysequilibrium was present in all patients immediately postoperatively. This resolved in all patients treated with the CO2 laser but in only two of six patients treated without the laser (p = 0.03). Patients were hospitalized for dysequilibrium for an average of 5.2 and 2.8 days for the mechanical and laser-assisted groups, respectively. Preoperative and postoperative hearing was not significantly different between the groups. No clinically significant postoperative hearing loss was encountered in either group. These results suggest that PCO is an effective treatment for intractable BPPV. The incidence of dysequilibrium that persists following PCO may be reduced by using the CO2 laser to seal the membranous canal prior to occluding the bony canal.

Temporal bone encephalocele and cerebrospinal fluid leaks.

Nineteen cases of temporal bone brain herniation and cerebrospinal fluid (CSF) leaks in 17 adult patients since 1987 are reviewed. Of these 19 cases, 11 were spontaneous CSF leaks, 6 were related to chronic otitis media, and 2 were posttraumatic. Among the 10 women and 7 men, the average age was 51.2 years, with average follow-up time of 2 years, 7 months. Two cases were repaired by a middle fossa craniotomy approach, 1 case by a transmastoid approach, and 16 by a combined transmastoid and middle fossa approach. Ten cases utilized the preferred technique of fascia-bone-fascia to repair the defects. The diagnosis was made on clinical grounds in 18 of the 19 cases, with ancillary diagnostic test providing little useful information. There were no postoperative surgery-related complications, and definitive repair was accomplished in one stage in all cases.

Otosclerosis update.

The use of lasers for primary and revision stapes surgery has many applications and potential advantages over mechanical techniques. It should be emphasized, however, that the laser is simply a tool, albeit a sophisticated one, and not a substitute for knowledge, experience, judgment, or ability. A laser will not "make" a good stapes surgeon, any more than a scalpel "makes" a good surgeon. There are limitations as well as benefits to lasers. Excellent results for stapes surgery were obtained for years prior to the advent of lasers, which is testimony to the skill and understanding of nonlaser stapes surgeons.

Cytoreductive surgery for ovarian cancer with the Cavitron Ultrasonic Surgical Aspirator and the development of disseminated intravascular coagulation.

OBJECTIVE: To explore the association between the use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer and the intraoperative development of disseminated intravascular coagulation (DIC). METHODS: A retrospective chart review was performed of all patients undergoing surgery for ovarian cancer from September 1991 to February 1993. Data were extracted to correlate clinical and hematologic evidence of DIC with and without intraoperative use of the Cavitron Ultrasonic Surgical Aspirator. Statistical analyses were done by chi 2 and analysis of variance. RESULTS: Fifty-one patients underwent surgery for ovarian cancer; 33 had stage IIIB, IIIC, IV, or recurrent disease and could be evaluated for this study. Nineteen patients were treated with the surgical aspirator, five of whom developed an intraoperative coagulopathy, as compared to none of 14 patients treated with conventional cytoreduction (P < .04, chi 2). The duration of use of the surgical aspirator correlated with the risk of coagulopathy (P < .001, analysis of variance). CONCLUSION: These data suggest a potential risk of developing DIC after extended use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer.

Selective embolization of glomus jugulare tumors.

Four patients with grade C or D(1) glomus jugulare tumors who underwent preoperative highly selective embolization followed by infratemporal fossa removal of their tumors were compared to three patients undergoing surgery alone with respect to intraoperative blood loss, operative time, cranial nerve palsy, length of hospitalization, and perioperative complications. Embolized patients demonstrated a marked reduction in blood loss (650 vs 1375 cc) compared with the nonembolized group. Operative time was shortened (by 51 minutes). Facial nerve function did not appear related to embolization but was directly related to intraoperative nerve manipulation. Hospital stay, perioperative complications, and lower cranial nerve palsies were not related to embolization.

Ototoxicity and ototopical medications: a survey of otolaryngologists.

In an attempt to define the clinical parameters and relevance of ototopical medications, including their usefulness in permanent inner ear damage, a questionnaire survey was sent to 7463 otolaryngologists within the United States, of which 2235 responded. The four main categories were demographic data, patterns of practice, factors influencing use of ototopicals, and opinions/impressions of ototopicals under various circumstances. The vast majority of respondents use ototopical preparations in the presence of a draining perforation (84.1%), in the presence of drainage through a ventilation tube (93.7%), and in the presence of an open, draining tympanomastoid cavity (92.8%). A significant number of clinicians use ototopicals with intraoperative packing (75.3%) and postoperative prophylaxis against infection (57.9%). Eighty percent of respondents indicate that the risks for ototoxicity of otitis media is as great as, or greater than, the risks for ototoxicity of an ototopical preparation. Seventy-five percent of respondents stated that ototopicals are safe in a fresh postoperative ear. Some respondents (3.4%) reported that they had witnessed irreversible inner ear damage unquestionably related to ototopicals.

Facial nerve outcome in acoustic neuroma surgery.

Patients consider facial paralysis the most concerning sequelae following acoustic tumor resection. Surgical and anesthetic refinements have lowered operative mortality to allow the surgeon to focus on preserving facial nerve function. Tumor size, microsurgical technique, and intraoperative monitoring are the most important factors that define the risk of postoperative facial paralysis. A protocol for uniform surgical reporting is proposed.

Condylar neck fractures of the mandible.

Despite the effectiveness and many advantages of closed reduction of condylar neck fractures, open reduction techniques offer the advantage of anatomic repositioning of the fracture, which may reduce resultant deformities, malocclusion, and temporomandibular joint derangements in patients with complex subcondylar fractures. This objective is best achieved with rigid plate and screw fixation to obtain the stability required for immediate function. This article presents guidelines for the experienced surgeons who wish to address this controversial problem.

Adult respiratory distress syndrome secondary to ethylene glycol ingestion.

Presented is a case of ethylene glycol poisoning in a 24-year-old man who subsequently developed adult respiratory distress syndrome. The noncardiogenic nature of the patient's pulmonary edema was documented with hemodynamic monitoring, and a successful outcome was achieved with hemodialysis, ethanol, and intermittent mechanical ventilation with positive end-expiratory pressure.