Method Development for Enteric Virus Recovery from Primary Sludge.

Enteric viruses, such as poliovirus, are a leading cause of gastroenteritis, which causes 2-3 million deaths annually. Environmental surveillance of wastewater supplements clinical surveillance for monitoring enteric virus circulation. However, while many environmental surveillance methods require liquid samples, some at-risk locations utilize pit latrines with waste characterized by high solids content. This study's objective was to develop and evaluate enteric virus concentration protocols for high solids content samples. Two existing protocols were modified and tested using poliovirus type 1 (PV1) seeded into primary sludge. Method 1 (M1) utilized acid adsorption, followed by 2 or 3 elutions (glycine/sodium chloride and/or threonine/sodium chloride), and skimmed milk flocculation. Method 2 (M2) began with centrifugation. The liquid fraction was filtered through a ViroCap filter and eluted (beef extract/glycine). The solid fraction was eluted (beef extract/disodium hydrogen phosphate/citric acid) and concentrated by skimmed milk flocculation. Recovery was enumerated by plaque assay. M1 yielded higher PV1 recovery than M2, though this result was not statistically significant (26.1% and 15.9%, respectively). M1 was further optimized, resulting in significantly greater PV1 recovery when compared to the original protocol (p < 0.05). This method can be used to improve understanding of enteric virus presence in communities without liquid waste streams.

Inactivation of Coronaviruses and Phage Phi6 from Irradiation across UVC Wavelengths.

Ultraviolet (UV) devices emitting UVC irradiation (200-280 nm) have proven to be effective for virus disinfection, especially on surfaces and in air, due to their rapid effectiveness and limited to no material corrosion. Numerous studies of UV-induced inactivation focused on nonenveloped viruses. Little is known about UVC action on enveloped viruses across UVC wavelengths. In this study, we determined inactivation efficiencies of two coronaviruses (ssRNA) and an enveloped dsRNA bacteriophage surrogate in buffered aqueous solution (pH 7.4) using five commonly available UVC devices that uniquely emit light at different wavelengths spanning 222 nm emitting krypton chloride (KrCl*) excimers to 282 nm emitting UVC LEDs. Our results show that enveloped viruses can be effectively inactivated using UVC devices, among which the KrCl* excimer had the best disinfection performance (i.e., highest inactivation rate) for all three enveloped viruses. The coronaviruses exhibited similar sensitivities to UV irradiation across the UVC range, whereas the bacteriophage surrogate was much more resistant and exhibited significantly higher sensitivity to the Far UVC (<230 nm) irradiation. This study provides necessary information and guidance for using UVC devices for enveloped virus disinfection, which may help control virus transmission in public spaces during the ongoing COVID-19 pandemic and beyond.

Understanding patient choices regarding breast reconstruction after mastectomy for breast cancer.

PURPOSE: In Australia, about 40% of patients undergo mastectomy to treat breast cancer, with negative impacts on body image, sexual function and quality of life. Whilst breast reconstruction is associated with increased patient self-esteem and a greater sense of wholeness and well-being, the national reconstruction rate is low at 18%. This study aimed to compare demographics, treatment factors and information provision about breast reconstruction in women who had and did not have breast reconstruction following mastectomy treatment and identify goals and concerns underpinning women's reconstruction decisions. METHODS: Female patients who had a mastectomy to treat breast cancer between 2010 and 2014 in a culturally and linguistically diverse (CALD) and socially disadvantaged region participated in a cross-sectional study, completing a questionnaire in their language of choice (English, Vietnamese, Chinese or Arabic). RESULTS: Completed surveys were returned by 168 women (42% response rate; 77% English-speaking), of whom only 19.0% (n = 32) reported having had breast reconstruction. Reconstruction rates were significantly lower in women who reported speaking a language other than English at home versus only English (37.5% vs 62.5%, p = 0.03). However, all women expressed a desire for more information about breast reconstruction and more support to make their decision about breast reconstruction. CONCLUSIONS: Patients identified a need for greater information provision on breast reconstruction, highlighting an urgent need for resources specifically about breast reconstruction, particularly for non-English-speaking patients. Greater provision of information prior to mastectomy is critical to underpin breast cancer patients' decisions about breast reconstruction, especially for non-English speaking patients.

Spectral and phase-amplitude coupling signatures in human deep brain oscillations during propofol-induced anaesthesia.

BACKGROUND: Both the cerebral cortex and subcortical structures play important roles in consciousness. Some evidence points to general anaesthesia-induced unconsciousness being associated with distinct patterns of superficial cortical electrophysiological oscillations, but how general anaesthetics influence deep brain neural oscillations and interactions between oscillations in humans is poorly understood. METHODS: Local field potentials were recorded in discrete deep brain regions, including anterior cingulate cortex, sensory thalamus, and periaqueductal grey, in humans with implanted deep brain electrodes during induction of unconsciousness with propofol. Power-frequency spectra, phase-amplitude coupling, coherence, and directed functional connectivity analysis were used to characterise local field potentials in the awake and unconscious states. RESULTS: An increase in alpha (7-13 Hz) power and decrease in gamma (30-90 Hz) power were observed in both deep cortical (ACC, anterior cingulate cortex) and subcortical (sensory thalamus, periaqueductal grey) areas during propofol-induced unconsciousness. Robust alpha-low gamma (30-60 Hz) phase-amplitude coupling induced by general anaesthesia was observed in the anterior cingulate cortex but not in other regions studied. Moreover, alpha oscillations during unconsciousness were highly coherent within the anterior cingulate cortex, and this rhythm exhibited a bidirectional information flow between left and right anterior cingulate cortex but stronger left-to-right flow. CONCLUSION: Propofol increases alpha oscillations and attenuates gamma oscillations in both cortical and subcortical areas. The alpha-gamma phase-amplitude coupling and the functional connectivity of alpha oscillations in the anterior cingulate cortex could be specific markers for loss of consciousness.

Improvement of the Bag-Mediated Filtration System for Sampling Wastewater and Wastewater-Impacted Waters.

Environmental surveillance of poliovirus (PV) plays an important role in the global program for eradication of wild PV. The bag-mediated filtration system (BMFS) was first developed in 2014 and enhances PV surveillance when compared to the two-phase grab method currently recommended by the World Health Organization (WHO). In this study, the BMFS design was improved and tested for its usability in wastewater and wastewater-impacted surface waters in Nairobi, Kenya. Modifications made to the BMFS included the size, color, and shape of the collection bags, the filter housing used, and the device used to elute the samples from the filters. The modified BMFS concentrated 3-10 L down to 10 mL, which resulted in an effective volume assayed (900-3000 mL) that was 6-20 times greater than the effective volume assayed for samples processed by the WHO algorithm (150 mL). The system developed allows for sampling and in-field virus concentration, followed by transportation of the filter for further analysis with simpler logistics than the current methods. This may ultimately reduce the likelihood of false-negative samples by increasing the effective volume assayed compared to samples processed by the WHO algorithm, making the BMFS a valuable sampling system for wastewater and wastewater-impacted surface waters.

Anaesthesia in the prone position.

Prone positioning of patients during anaesthesia is required to provide operative access for a wide variety of surgical procedures. It is associated with predictable changes in physiology but also with a number of complications, and safe use of the prone position requires an understanding of both issues. We have reviewed the development of the prone position and its variants and the physiological changes which occur on prone positioning. The complications associated with this position and the published techniques for various practical procedures in this position will be discussed. The aim of this review is to identify the risks associated with prone positioning and how these risks may be anticipated and minimized.

Angina bullosa haemorrhagica presenting as acute upper airway obstruction.

We report a case of acute upper airway obstruction caused by a rapidly expanding blood-filled bulla in the oropharynx (angina bullosa haemorrhagica), requiring tracheal intubation. The larynx could not be visualized by either awake fibreoptic laryngoscopy or direct laryngoscopy under anaesthesia. Surgical tracheostomy was therefore performed under general anaesthesia.

Recent trends in tracheal intubation: a retrospective analysis of 97904 cases.

We conducted a review of routine anaesthetic audit data collected between April 1995 and December 2001 at Northampton General Hospital. A total of 97 904 anaesthetics were given. The average monthly rate of tracheal intubation fell during the study period from approximately 450 per month to approximately 280 per month. This was largely at the expense of tracheal tubes used during normal working hours, which fell by 40% (from approximately 390 per month to approximately 230 per month). Use outside normal working hours did not change. Of those cases managed in normal working hours with a tracheal tube, the decline in use over time was most obvious in patients of ASA physical status 1-2, and whose surgery was classified as elective or scheduled. The proportion of cases classified as ASA 3-5 or whose surgery was urgent or emergency increased (from 15.5% to 22.3%, and from 7.5% to 15.5%, respectively.) There was considerable variation across surgical specialities, with the greatest decline in tracheal intubation in head and neck surgery. These changes in practice have implications for the teaching of airway management skills.

Transposition of the great vessels: a series of three cases with a review of the literature.

Improvements in surgical techniques have led to increased survival in transposition of the great vessels. We present three women who required anaesthetic management for labour analgesia, instrumental delivery and evacuation of retained products; the literature is reviewed with regard to anaesthetic techniques and maternal outcome, and recommendations made for the management of this increasingly common condition.

Pharmacological characterisation of neurokinin receptors mediating anion secretion in rat descending colon mucosa.

Substance P (SP), neurokinin A (NKA), neurokinin B (NKB), [Sar9, Met (O2)11]-SP (SMSP), senktide, [beta Ala8]-NKA(4-10) and neuropeptide gamma (NP gamma) all stimulate secretory responses in rat descending colon mucosa under voltage clamp conditions. Secretory responses (measured as short circuit current under voltage clamp conditions) were transient and those evoked by SP, SMSP, NKA and senktide were significantly reduced by pretreating tissues with the chloride channel blocker, diphenylamine carboxylate (DPC). Concentration-response curves showed varying degrees of sensitivity to tetrodotoxin (TTX). Senktide-induced secretion was virtually abolished by TTX, while NP gamma and [beta Ala8]-NKA(4-10) were not significantly altered. Rightward shifts of concentration-response curves were observed for SMSP, NKA and SP in TTX treated preparations compared with controls. NKA response curves in the presence of TTX were further inhibited by MEN10,207 and CP-96,345. GR71251, GR82334 and CP-96,345 all inhibited SMSP secretory responses with pA2 values of 5.8, 6.5 and 6.9 respectively. In conclusion three types of neurokinin receptor exist in preparations of rat colon mucosa and their relative location within neuronal and epithelial surfaces are discussed.