Postoperative Outcomes and One-Year Mortality of Patients on Chronic Anticoagulation Medications Undergoing Infrainguinal Bypass.

BACKGROUND: Patients requiring open infrainguinal bypass (IIB) frequently are taking chronic anticoagulation (AC) medications. Taking these medications in the preoperative setting may affect the outcomes of surgery. This study aims to evaluate postoperative outcomes and 1-year mortality of patients taking chronic AC medications that undergo IIB. METHODS: Using data obtained from the Vascular Quality Initiative from January 2011 to October 2021, patients on warfarin or any direct oral anticoagulants (DOAC) within 30 days of IIB were compared with patients not taking chronic AC medications. The primary outcomes were in-hospital, 30-day, and 1-year mortality. The secondary outcomes included total procedure time, need for perioperative packed red blood cell transfusion, prolonged length of hospital stay, postoperative myocardial infarction or stroke, and graft patency at discharge. A subgroup analysis was performed comparing patients taking warfarin with those taking DOACs. Univariate analyses and multivariate logistic regression, Kaplan Meier survival, and Cox regression analyses were used to analyze the data for postoperative and 1-year outcomes, respectively. RESULTS: A total of 55,076 patients underwent IIB during the study period, and 11,547 (20.97%) were on chronic AC prior to surgery. The 2 cohorts differed significantly in almost every demographic and clinical characteristic. Multivariate analyses adjusting for 45 potential confounders revealed that there was no significant difference in in-hospital, 30-day, and 1-year mortality. The total procedure time for the chronic AC cohort was on average 11.46 ± 2.16 min longer (P ≤ 0.001) and there was a greater risk of prolonged length of stay in the hospital (adjusted odds ratio [aOR]: 1.19, 95% confidence interval [CI]: 1.13-1.26, P < 0.001). These patients also returned to the operating room (OR) at a greater rate (aOR: 1.12, 95% CI: 1.05-1.19; P = 0.016) and demonstrated a significantly lower rate of graft patency at discharge (aOR: 0.73, 95% CI: 0.62-0.86, P = 0.001). On subgroup analysis, multivariate analysis demonstrated lower 30-day mortality for the DOAC group in comparison to the warfarin group (aOR: 0.74, 95% CI: 0.57-0.94, P = 0.015), but no significant differences in in-hospital and 1-year mortality. CONCLUSIONS: Patients taking AC medications within 30 days prior to IIBs may require more perioperative red blood cell transfusions, longer hospitalizations, and return to the OR at a greater rate. They are also at an increased risk for loss of graft patency at discharge. However, these patients are not at increased risk of in-hospital, 30-day, or 1-year mortality. IIB can, therefore, be performed safely in patients taking chronic AC medications.

Using Surrogate Parameters to Enhance Monitoring of Community Wastewater Management System Performance for Sustainable Operations.

Community wastewater management systems (CWMS) are small-scale wastewater treatment systems typically in regional and rural areas with less sophisticated treatment processes and often managed by local governments or communities. Research and industrial applications have demonstrated that online UV-Vis sensors have great potential for improving wastewater monitoring and treatment processes. Existing studies on the development of surrogate parameters with models from spectral data for wastewater were largely limited to lab-based. In contrast, industrial applications of these sensors have primarily targeted large wastewater treatment plants (WWTPs), leaving a gap in research for small-scale WWTPs. This paper demonstrates the suitability of using a field-based online UV-Vis sensor combined with advanced data analytics for CWMSs as an early warning for process upset to support sustainable operations. An industry case study is provided to demonstrate the development of surrogate monitoring parameters for total suspended solids (TSSs) and chemical oxygen demand (COD) using the UV-Vis spectral data from an online UV-Vis sensor. Absorbances at a wavelength of 625 nm (UV625) and absorbances at a wavelength of 265 nm (UV265) were identified as surrogate parameters to measure TSSs and COD, respectively. This study contributes to the improvement of WWTP performance with a continuous monitoring system by developing a process monitoring framework and optimization strategy.

Outcomes of elective peripheral endovascular interventions for peripheral arterial disease performed in hospital outpatient departments, ambulatory surgical centers and office-based labs.

BACKGROUND: A recent shift in the location where peripheral endovascular interventions (PVI) are performed has occurred, from traditional settings such as hospital outpatient departments (HOPD), to ambulatory surgical centers (ASC) and outpatient-based laboratories (OBL). Different settings may influence the safety and efficacy of the PVI, as well as how it is done. This study aims to compare the postprocedural outcomes and intraprocedural details between the three settings. METHODS: The Vascular Quality Initiative database was queried for all elective infrainguinal PVIs for occlusive peripheral arterial disease between January 2016 and December 2021. The primary outcomes were rates of postprocedural hospital admissions, postprocedural medical complications, and access site complications. Secondary outcomes included technical success and intraprocedural details, such as types and number of devices used, amount of contrast, and fluoroscopy time. The χ2 test, analysis of variance, and multivariate logistic regression were used to analyze the outcomes. RESULTS: A total of 66,101 PVI cases (HOPD, 57,062 [83.33%]; ASC, 4591 [6.95%]; OBL, 4448 [6.73%]) were included in the study. There were 445 cases requiring hospital admission (HOPD, 398 [0.70%]; ASC, 26 [0.57%]; OBL, 21 [0.47%]; P = .126). There were no significant differences in cardiac, pulmonary, or renal complications. Access site complications occurred in less than 1.7% of all cases and were significantly higher in OBLs when compared with ASCs (adjusted odds ratio [aOR], 3.70; 95% confidence interval [CI], 1.70-8.03; P = .001) and significantly lower in ASCs in comparison to HOPDs (aOR, 0.27; 95% CI, 0.18-0.41; P < .001). Technical success occurred in at least 92% of all cases, regardless of setting. There was a 16-fold increase in the use of atherectomy devices in an OBL vs HOPD setting (aOR, 16.79; 95% CI, 11.77-23.95; P < .001) and a five-fold increase in the use of atherectomy devices in an ASC vs HOPD setting (aOR, 5.37; 95% CI, 2.47-11.65; P < .001). There was a five-fold decrease in the use of special balloons in an OBL vs HOPD setting (aOR, 0.20; 95% CI, 0.10-0.39; P < .001) and a four-fold decrease when comparing ASCs with HOPDs (aOR, 0.25; 95% CI, 0.12-0.51; P < .001). CONCLUSIONS: Elective PVIs performed in any outpatient setting proved to be safe and technically successful. However, there are significant differences in the way PVIs are performed in each setting, such as the greater use of atherectomy devices in OBLs and greater use of special balloons in HOPDs. Long-term studies are needed to evaluate the durability and reintervention outcomes and understand factors associated with practice pattern variability across these different settings.

Evaluating postoperative outcomes in patients with hostile neck anatomy undergoing transcarotid artery revascularization versus transfemoral carotid artery stenting.

BACKGROUND: Carotid endarterectomy is relatively contraindicated in patients with a hostile neck anatomy who were historically revascularized with transfemoral carotid artery stenting (TFCAS). As transcarotid artery revascularization (TCAR) has progressively replaced TFCAS, evidence pertaining to hostile neck anatomy and TCAR is necessary to establish its safety and feasibility in this subgroup of patients. Therefore, we analyzed the impact of a hostile neck anatomy on outcomes in patients undergoing TCAR and further compared them with those undergoing TFCAS to establish recommendations for standard of care. METHODS: All patients undergoing TCAR and TFCAS from November 2016 to June 2021 in the Vascular Quality Initiative database were included. Patients were characterized into two groups based on the neck anatomy. Hostile neck anatomy was defined as a history of neck radiation or prior neck surgery including prior carotid endarterectomy or radical neck dissection. Primary outcomes included technical failure, access site complications (hematoma, stenosis, infection, pseudoaneurysm and arteriovenous fistula), and stroke or death. Secondary outcomes included stroke, transient ischemic attack (TIA), myocardial infarction (MI), death, and a composite end point of stroke or TIA. Patients with nonatherosclerotic or multiple lesions were excluded from the analysis. Primary analysis was performed with all patients undergoing TCAR and outcomes between patients with hostile and nonhostile neck anatomy were compared. Further analysis included a comparison of patients with a hostile neck anatomy undergoing TCAR and TFCAS. Univariable and multivariable logistic regression was used to assess impact of hostile neck anatomy on postoperative outcomes. Results were adjusted for relevant potential confounders including age, gender, race, degree of stenosis, symptomatic status, comorbidities, preoperative medications, anesthesia type, and protamine use. RESULTS: Among the 19,859 patients who underwent TCAR during the study period, 3636 (18.3%) had a hostile neck anatomy. On univariate analysis, both groups had comparable outcomes except for higher rates of stroke or death in patients with hostile neck anatomy. After adjusting for potential confounders, there were no differences in technical failure (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 0.59-2.21; P = .699), stroke (aOR, 0.86; 95% CI, 0.58-1.28; P = .464), death (aOR, 0.82; 95% CI, 0.39-1.71; P = .598), and MI (aOR, 1.18; 95% CI, 0.71-1.97; P = .518). However, patients with hostile neck were at a 30% increased risk of access site complications (aOR, 1.30; 95% CI, 1.0-1.6; P = .023). Further adjusted analysis comparing the outcomes in TFCAS and TCAR among patients with hostile neck anatomy showed an almost four-fold increase in risk of death (aOR, 3.77; 95% CI, 1.49-9.53; P = .005) and technical failure (aOR, 3.69; 95% CI, 1.82-7.47; P < .001) among patients undergoing treatment with TFCAS. CONCLUSIONS: Patients with a hostile neck anatomy undergoing TCAR experienced an increased risk of access site complications; however, the risk for technical failure and postoperative stroke/death, stroke, TIA, MI, or death was similar among both groups. TFCAS was associated with significant increase in the risk of death and technical failure compared with TCAR in this group of patients. These results confirm that TCAR should be the preferred minimally invasive revascularization procedure for patients with hostile neck anatomy.

Hemodynamic instability predicts in-hospital and 1-year mortality after transcarotid artery revascularization and transfemoral carotid stenting.

OBJECTIVE: Blood pressure fluctuations are a common hemodynamic alteration following carotid artery stenting either with transfemoral (TFCAS) or transcarotid (TCAR) approach and are thought to be related to alteration in baroreceptor function due to angioplasty and stent expansion. These fluctuations are particularly worrisome in the high-risk patient population referred for CAS. This study aims to evaluate the outcomes of patients who required the administration of intravenous blood pressure medication (IVBPmed) for hypotension or hypertension after CAS. METHODS: All patients undergoing carotid revascularization in the Vascular Quality Initiative (VQI) database between 2016 and 2021 were included. We compared outcomes of patients who required postoperative IVBPmed to treat hyper- or hypotension with normotensive patients. In-hospital outcomes were compared using multivariable logistic regression. One-year outcomes were assessed using Kaplan-Meier survival and multivariable Cox proportional hazard regression analyses. RESULTS: We identified 38,510 patients undergoing CAS (57.7% TCAR and 42.3% TFCAS), of which, 30% received IVBPmed for treatment of either postoperative hypertension (12.6%) or hypotension (16.4%). In multivariable analysis, postoperative hypotension was associated with a higher risk of stroke, death, or myocardial infarction (MI) (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.6-3.6; P < .001), stroke or death (OR, 2.9; 95% CI, 2.4-3.5; P < .001), stroke (OR, 2.6; 95% CI, 2.1-3.2; P < .001), death (OR, 3.5; 95% CI, 2.6-4.8; P < .001), MI (OR, 4.7; 95% CI, 3.3-6.7; P < .001), and bleeding (OR, 1.96; 95% CI, 1.4-2.7; P < .001) compared with normotensive patients. Postoperative hypertension was associated with a higher risk of stroke, death, or MI (OR, 3.6; 95% CI, 3-4.4; P < .001), stroke or death (OR, 3.3; 95% CI, 2.7-4.1; P < .001), stroke (OR, 3.7; 95% CI, 3-4.7; P < .001), death (OR, 2.7; 95% CI, 1.9-3.9; P < .001), MI (OR, 5.7; 95% CI, 3.9-8.3; P < .001), and bleeding (OR, 1.9; 95% CI, 1.4-2.7; P < .001) compared with normotensive patients. CONCLUSIONS: Postoperative hypertension or hypotension requiring IVBPmed after CAS is associated with an increased risk of in-hospital stroke, death, MI, and bleeding. Postoperative hypertension is associated with worse survival at 1 year. This study indicates that the need for IVBPmed after CAS is not benign; therefore, these patients necessitate aggressive perioperative medical management and safe techniques to avoid hypo and hypertension. Close follow-up and continue medical management are needed to maximize these patients' survival.

Negative emodiversity is associated with emotional eating in adolescents: An examination of emotion dynamics in daily life.

INTRODUCTION: Emotional eating is a mental health concern, common in adolescents, that develops as a result of their tendency to use high-energy food to regulate their fluctuating emotions. Due to their highly fluctuating emotional life, adolescents tend to have unique within-person profiles of emotional experiences that change across moments and days, often lost in global assessments of emotions. Hence, it is imperative to examine individual differences in dynamics of emotions, as experienced in daily life, in relation to emotional eating in adolescents. METHODS: In an Ecological Momentary Assessment study, we examined individual differences in three within-person dynamic characteristics (baseline levels, intraindividual variability, and emodiversity) of emotions in 158 dominantly Hispanic adolescents in the United States, aged 14-17 years old, predicting trait-level emotional eating. RESULTS: Results indicated that higher negative emodiversity, baselines, and variability in stress were predictive of emotional eating in adolescents. When all considered together, negative emodiversity (i.e., variety of the types of negative emotions experienced in one's daily life) remained the only significant predictor of emotional eating. CONCLUSIONS: This study affirms the importance of diversity in emotional experiences in relation to emotional eating, particularly in daily contexts of adolescents' lives. Additionally, the study emphasizes the importance of distinguishing between diversity (i.e., variety in types) in positive versus negative emotional experiences with regard to emotional eating. By taking into account the ecological validity of adolescents' daily lives and individual differences in dynamical changes in emotions, we are taking a step forward by shedding light on how the dynamics of negative emotions-in terms of within-person baselines, variability, and diversity-might be related to general levels of emotional eating in adolescents.

Development of a Knowledge Graph for Automatic Job Hazard Analysis: The Schema.

In the current practice, an essential element of safety management systems, Job Hazard Analysis (JHA), is performed manually, relying on the safety personnel's experiential knowledge and observations. This research was conducted to create a new ontology that comprehensively represents the JHA knowledge domain, including the implicit knowledge. Specifically, 115 actual JHA documents and interviews with 18 JHA domain experts were analyzed and used as the source of knowledge for creating a new JHA knowledge base, namely the Job Hazard Analysis Knowledge Graph (JHAKG). To ensure the quality of the developed ontology, a systematic approach to ontology development called METHONTOLOGY was used in this process. The case study performed for validation purposes demonstrates that a JHAKG can operate as a knowledge base that answers queries regarding hazards, external factors, level of risks, and appropriate control measures to mitigate risks. As the JHAKG is a database of knowledge representing a large number of actual JHA cases previously developed and also implicit knowledge that has not been formalized in any explicit forms yet, the quality of JHA documents produced from queries to the database is expectedly higher than the ones produced by an individual safety manager in terms of completeness and comprehensiveness.

Noonan syndrome and pregnancy outcomes.

BACKGROUND: Noonan syndrome is a genetic disorder with high prevalence of congenital heart defects, such as pulmonary stenosis, atrial septal defect and hypertrophic cardiomyopathy. Scarce data exists regarding the safety of pregnancy in patients with Noonan syndrome, particularly in the context of maternal cardiac disease. STUDY DESIGN: We performed a retrospective chart review of patients at Yale-New Haven Hospital from 2012 to 2020 with diagnoses of Noonan syndrome and pregnancy. We analysed medical records for pregnancy details and cardiac health, including echocardiograms to quantify maternal cardiac dysfunction through measurements of pulmonary valve peak gradient, structural heart defects and interventricular septal thickness. RESULTS: We identified five women with Noonan syndrome (10 pregnancies). Three of five patients had pulmonary valve stenosis at the time of pregnancy, two of which had undergone cardiac procedures. 50% of pregnancies (5/10) resulted in pre-term birth. 80% (8/10) of all deliveries were converted to caesarean section after a trial of labour. One pregnancy resulted in intra-uterine fetal demise while nine pregnancies resulted in the birth of a living infant. 60% (6/10) of livebirths required care in the neonatal intensive care unit. One infant passed away at 5 weeks of age. CONCLUSIONS: The majority of mothers had pre-existing, though mild, heart disease. We found high rates of prematurity, conversion to caesarean section, and elevated level of care. No maternal complications resulted in long-term morbidity. Our study suggests that women with Noonan syndrome and low-risk cardiac lesions can become pregnant and deliver a healthy infant with counselling and risk evaluation.

Applications of Online UV-Vis Spectrophotometer for Drinking Water Quality Monitoring and Process Control: A Review.

Water quality monitoring is an essential component of water quality management for water utilities for managing the drinking water supply. Online UV-Vis spectrophotometers are becoming popular choices for online water quality monitoring and process control, as they are reagent free, do not require sample pre-treatments and can provide continuous measurements. The advantages of the online UV-Vis sensors are that they can capture events and allow quicker responses to water quality changes compared to conventional water quality monitoring. This review summarizes the applications of online UV-Vis spectrophotometers for drinking water quality management in the last two decades. Water quality measurements can be performed directly using the built-in generic algorithms of the online UV-Vis instruments, including absorbance at 254 nm (UV254), colour, dissolved organic carbon (DOC), total organic carbon (TOC), turbidity and nitrate. To enhance the usability of this technique by providing a higher level of operations intelligence, the UV-Vis spectra combined with chemometrics approach offers simplicity, flexibility and applicability. The use of anomaly detection and an early warning was also discussed for drinking water quality monitoring at the source or in the distribution system. As most of the online UV-Vis instruments studies in the drinking water field were conducted at the laboratory- and pilot-scale, future work is needed for industrial-scale evaluation with ab appropriate validation methodology. Issues and potential solutions associated with online instruments for water quality monitoring have been provided. Current technique development outcomes indicate that future research and development work is needed for the integration of early warnings and real-time water treatment process control systems using the online UV-Vis spectrophotometers as part of the water quality management system.

Innominate Artery Ligation: A History From Mott to Matas.

Innominate artery ligation emerged in the 19th century as an early operation for right subclavian aneurysm. Clinical outcomes were often dire, but undeterred surgeons believed that ligation represented an opportunity that outweighed the risks of nonoperative aneurysm management. Valentine Mott of New York performed the procedure in 1818; his patient died 26 days later. Variations on Mott's approach were undertaken 13 more times from 1822 to 1861 by surgeons in the United States and abroad, all of which proved fatal. Andrew Woods Smyth of New Orleans was the first to successfully control a subclavian artery aneurysm with innominate ligation in 1864. The Charity Hospital house surgeon used a series of ligations on the innominate, common carotid, vertebral, and internal mammary arteries to prevent collateral and recurrent blood flow to the aneurysmal sac. These physiologically-oriented operations kept Smyth's patient alive and functional for ten years. New Orleans became an internationally-recognized hub for advancements in aneurysm surgery. One of Smyth's students, Rudolph Matas, went on to revolutionize vascular surgery. Along his path to becoming the Father of modern vascular surgery, Matas documented his own performance of Smyth's operation at Charity 4 times over the course of his career. Although later supplanted by primary vascular anastomosis and grafting, the first successful innominate ligation was a collaborative effort between New York and New Orleans that served as a foundation for the development of modern aneurysm repair.

Development of an Optical Method to Monitor Nitrification in Drinking Water.

Nitrification is a common issue observed in chloraminated drinking water distribution systems, resulting in the undesirable loss of monochloramine (NH2Cl) residual. The decay of monochloramine releases ammonia (NH3), which is converted to nitrite (NO2-) and nitrate (NO3-) through a biological oxidation process. During the course of monochloramine decay and the production of nitrite and nitrate, the spectral fingerprint is observed to change within the wavelength region sensitive to these species. In addition, chloraminated drinking water will contain natural organic matter (NOM), which also has a spectral fingerprint. To assess the nitrification status, the combined nitrate and nitrite absorbance fingerprint was isolated from the total spectra. A novel method is proposed here to isolate their spectra and estimate their combined concentration. The spectral fingerprint of pure monochloramine solution at different concentrations indicated that the absorbance difference between two concentrations at a specific wavelength can be related to other wavelengths by a linear function. It is assumed that the absorbance reduction in drinking water spectra due to monochloramine decay will follow a similar pattern as in ultrapure water. Based on this criteria, combined nitrate and nitrite spectra were isolated from the total spectrum. A machine learning model was developed using the support vector regression (SVR) algorithm to relate the spectral features of pure nitrate and nitrite with their concentrations. The model was used to predict the combined nitrate and nitrite concentration for a number of test samples. Out of these samples, the nitrified sample showed an increasing trend of combined nitrate and nitrite productions. The predicted values were matched with the observed concentrations, and the level of precision by the method was ± 0.01 mg-N L-1. This method can be implemented in chloraminated distribution systems to monitor and manage nitrification.

Quantifying the annual incidence and underestimation of seasonal influenza: A modelling approach.

BACKGROUND: Seasonal influenza poses a significant public health and economic burden, associated with the outcome of infection and resulting complications. The true burden of the disease is difficult to capture due to the wide range of presentation, from asymptomatic cases to non-respiratory complications such as cardiovascular events, and its seasonal variability. An understanding of the magnitude of the true annual incidence of influenza is important to support prevention and control policy development and to evaluate the impact of preventative measures such as vaccination. METHODS: We use a dynamic disease transmission model, laboratory-confirmed influenza surveillance data, and randomized-controlled trial (RCT) data to quantify the underestimation factor, expansion factor, and symptomatic influenza illnesses in the US and Canada during the 2011-2012 and 2012-2013 influenza seasons. RESULTS: Based on 2 case definitions, we estimate between 0.42-3.2% and 0.33-1.2% of symptomatic influenza illnesses were laboratory-confirmed in Canada during the 2011-2012 and 2012-2013 seasons, respectively. In the US, we estimate between 0.08-0.61% and 0.07-0.33% of symptomatic influenza illnesses were laboratory-confirmed in the 2011-2012 and 2012-2013 seasons, respectively. We estimated the symptomatic influenza illnesses in Canada to be 0.32-2.4 million in 2011-2012 and 1.8-8.2 million in 2012-2013. In the US, we estimate the number of symptomatic influenza illnesses to be 4.4-34 million in 2011-2012 and 23-102 million in 2012-2013. CONCLUSIONS: We illustrate that monitoring a representative group within a population may aid in effectively modelling the transmission of infectious diseases such as influenza. In particular, the utilization of RCTs in models may enhance the accuracy of epidemiological parameter estimation.

Upper limb dimensions in adults presenting for elective surgery - implications for blood pressure measurement.

BACKGROUND: Arm conicity is associated with non-invasive blood pressure (NIBP) measurement error and may be avoided by using finger cuffs. Predicting arm conicity may help decisions regarding NIBP measurement techniques. METHODS: We obtained upper limb measurements of adults presenting to the Pre-Anesthetic Clinic to determine: the suitability of arm and finger cuff sizes; the best anthropometric predictor of arm conicity based on the right arm slant angle; the incidence of a right arm slant angle < 83 degrees. Right mid-arm circumference (MAC) was compared to recommended cuff sizes and finger circumference compared to available cuffs. Slant angle was calculated from the measurements obtained. Linear regression was used to determine the better predictor of right arm slant angle. Correlation coefficients were calculated and R2 values compared. RESULTS: Four hundred fifty-four patients participated and 453 had cone-shaped arms. One participant (0.2, 95% CI 0.0-1.2) had a MAC outside the recommended cuff range. Twenty-five participants (5.5, 95% CI 3.6-8.0) had a middle finger circumference greater than the largest ClearSight™ cuff. Body mass index (BMI), weight and right MAC all had low to moderate correlation with right arm slant angle (r = - 0.49, - 0.39, - 0.48, all p < 0.001) and regression revealed R2 values of 0.24, 0.15 and 0.23. Six participants (1.3, 95% CI 0.5-2.9) had a slant angle < 83 degrees. CONCLUSION: Current NIBP equipment caters for most patients, based on the traditional measure of MAC. The utility of finger cuffs is limited by cuff size. BMI and right MAC showed the most promise in predicting arm conicity.

Spectrophotometric Online Detection of Drinking Water Disinfectant: A Machine Learning Approach.

The spectra fingerprint of drinking water from a water treatment plant (WTP) is characterised by a number of light-absorbing substances, including organic, nitrate, disinfectant, and particle or turbidity. Detection of disinfectant (monochloramine) can be better achieved by separating its spectra from the combined spectra. In this paper, two major focuses are (i) the separation of monochloramine spectra from the combined spectra and (ii) assessment of the application of the machine learning algorithm in real-time detection of monochloramine. The support vector regression (SVR) model was developed using multi-wavelength ultraviolet-visible (UV-Vis) absorbance spectra and online amperometric monochloramine residual measurement data. The performance of the SVR model was evaluated by using four different kernel functions. Results show that (i) particles or turbidity in water have a significant effect on UV-Vis spectral measurement and improved modelling accuracy is achieved by using particle compensated spectra; (ii) modelling performance is further improved by compensating the spectra for natural organic matter (NOM) and nitrate (NO3) and (iii) the choice of kernel functions greatly affected the SVR performance, especially the radial basis function (RBF) appears to be the highest performing kernel function. The outcomes of this research suggest that disinfectant residual (monochloramine) can be measured in real time using the SVR algorithm with a precision level of ± 0.1 mg L-1.

Utilization of drinking water treatment sludge in concrete paving blocks: Microstructural analysis, durability and leaching properties.

The management of abundant drinking water treatment sludge (DWTS) in landfill remains an important issue. The reuse of DWTS as construction material could contribute to the development of greener concrete product and to mitigating the detrimental environment effect from excessive production of DWTS. This paper investigates the potential of using DWTS as sand replacement in Concrete Paving Blocks (CPB). Five CPB mixtures were designed and the replacement ratios of sand by DWTS were 0%, 5%, 10%, 15%, and 20%, by weight. Properties of CPB such as compressive strength, water absorption, abrasion resistance, sulfate attack and metal leachability were determined. The results indicated that above 10% of DWTS, the replacement was detrimental to such properties of the CPB. Microstructure analysis proved the addition of DWTS could result in ettringite formation and the interfacial transition zone (ITZ) between the cement matrix and DWTS was more porous than that of sand. In addition, the metal leachability test of CPB demonstrated that the addition of high-copper DWTS into CPB was safe.

The Toll pathway underlies host sexual dimorphism in resistance to both Gram-negative and Gram-positive bacteria in mated Drosophila.

BACKGROUND: Host sexual dimorphism is being increasingly recognized to generate strong differences in the outcome of infectious disease, but the mechanisms underlying immunological differences between males and females remain poorly characterized. Here, we used Drosophila melanogaster to assess and dissect sexual dimorphism in the innate response to systemic bacterial infection. RESULTS: We demonstrated sexual dimorphism in susceptibility to infection by a broad spectrum of Gram-positive and Gram-negative bacteria. We found that both virgin and mated females are more susceptible than mated males to most, but not all, infections. We investigated in more detail the lower resistance of females to infection with Providencia rettgeri, a Gram-negative bacterium that naturally infects D. melanogaster. We found that females have a higher number of phagocytes than males and that ablation of hemocytes does not eliminate the dimorphism in resistance to P. rettgeri, so the observed dimorphism does not stem from differences in the cellular response. The Imd pathway is critical for the production of antimicrobial peptides in response to Gram-negative bacteria, but mutants for Imd signaling continued to exhibit dimorphism even though both sexes showed strongly reduced resistance. Instead, we found that the Toll pathway is responsible for the dimorphism in resistance. The Toll pathway is dimorphic in genome-wide constitutive gene expression and in induced response to infection. Toll signaling is dimorphic in both constitutive signaling and in induced activation in response to P. rettgeri infection. The dimorphism in pathway activation can be specifically attributed to Persephone-mediated immune stimulation, by which the Toll pathway is triggered in response to pathogen-derived virulence factors. We additionally found that, in absence of Toll signaling, males become more susceptible than females to the Gram-positive Enterococcus faecalis. This reversal in susceptibility between male and female Toll pathway mutants compared to wildtype hosts highlights the key role of the Toll pathway in D. melanogaster sexual dimorphism in resistance to infection. CONCLUSION: Altogether, our data demonstrate that Toll pathway activity differs between male and female D. melanogaster in response to bacterial infection, thus identifying innate immune signaling as a determinant of sexual immune dimorphism.

Drugs of Abuse and Novel Psychoactive Substances at Outdoor Music Festivals in Colorado.

BACKGROUND: Drugs of abuse (DOA) are widely used in the United States and are ubiquitous at outdoor music festivals. Attendees at music festivals are at high-risk for novel psychoactive substance (NPS) use, which is becoming more prevalent worldwide. No U.S. studies have employed an qualitative approach to investigate the etiologies of both traditional DOA and NPS use amongst music festival attendees. OBJECTIVES: The objective of this study was to improve understanding of the knowledge, attitudes, beliefs, and practices of festival attendees using NPS and DOA. METHODS: We conducted semi-structured interviews of 171 attendees during the Sonic Bloom and Arise music festivals in Colorado in 2015 and 2016. Discrete variables were summarized with descriptive statistics. The anonymous, multi-domain interview documented the knowledge, attitudes beliefs, and practices underlying DOA use, which were analyzed with qualitative methods. RESULTS: We enrolled 171 participants that endorsed DOA use at the festivals. Most were experienced DOA users, who perceived minimal risks associated with DOA and NPS use. Nearly all unanimously reported normalization of DOA at music festivals. Participants popularly cited empathogenic, entactogenic, and entheogenic effects of DOA as their primary motivations for use. NPS use was endorsed by 39.8% (n = 68) of respondents, all of whom identified as being experienced DOA users. CONCLUSIONS: This population of novel psychoactive substance users is primarily composed of experienced drug users that endorsed use because of low cost, minimal perceived risk, accessibility, and normalization of drug use at music festivals.

Removing ammonium from water and wastewater using cost-effective adsorbents: A review.

Ammonium is an important nutrient in primary production; however, high ammonium loads can cause eutrophication of natural waterways, contributing to undesirable changes in water quality and ecosystem structure. While ammonium pollution comes from diffuse agricultural sources, making control difficult, industrial or municipal point sources such as wastewater treatment plants also contribute significantly to overall ammonium pollution. These latter sources can be targeted more readily to control ammonium release into water systems. To assist policy makers and researchers in understanding the diversity of treatment options and the best option for their circumstance, this paper produces a comprehensive review of existing treatment options for ammonium removal with a particular focus on those technologies which offer the highest rates of removal and cost-effectiveness. Ion exchange and adsorption material methods are simple to apply, cost-effective, environmentally friendly technologies which are quite efficient at removing ammonium from treated water. The review presents a list of adsorbents from the literature, their adsorption capacities and other parameters needed for ammonium removal. Further, the preparation of adsorbents with high ammonium removal capacities and new adsorbents is discussed in the context of their relative cost, removal efficiencies, and limitations. Efficient, cost-effective, and environmental friendly adsorbents for the removal of ammonium on a large scale for commercial or water treatment plants are provided. In addition, future perspectives on removing ammonium using adsorbents are presented.

Does Hospital Transfer Impact Outcomes After Colorectal Surgery?

BACKGROUND: With increasing public reporting of outcomes and bundled payments, hospitals and providers are scrutinized for morbidity and mortality. The impact of patient transfer before colorectal surgery has not been well characterized in a risk-adjusted fashion. OBJECTIVE: We hypothesized that hospital-to-hospital transfer would independently predict morbidity and mortality beyond traditional predictor variables. DESIGN: We constructed a retrospective cohort of 158,446 patients who underwent colorectal surgery using the 2009-2013 American College of Surgeons National Surgical Quality Improvement Program database. SETTINGS: The study was conducted at a tertiary care hospital. PATIENTS: All of the patients who underwent colorectal surgery during the study period were included. Patients were excluded for unknown transfer status or transfer from a chronic care facility. MAIN OUTCOME MEASURES: Baseline characteristics were compared by transfer status. Multivariate logistic regression was used to evaluate the impact of transfer on major complications and mortality. RESULTS: A total of 7259 operations (4.6%) were performed after transfer. Transferred patients had higher rates of complications (p < 0.0001) with significant differences in unplanned endotracheal reintubation, bleeding, organ-space surgical site infection, wound dehiscence, postoperative sepsis, cardiac arrest requiring cardiopulmonary resuscitation, deep venous thrombosis, and myocardial infarction. Transferred patients also had longer hospital stays (9 vs 6 days; p < 0.0001) and a higher risk of death (13.2% vs 2.6%; p < 0.0001). On multivariate analysis, transferred patients had higher mortality rates despite risk adjustment (OR = 1.13 (95% CI, 1.02-1.25); p = 0.019) and were also more likely to have serious complications (OR = 1.12 (95% CI, 1.06-1.19); p < 0.001). LIMITATIONS: We were unable to analyze outcomes beyond 30 days, and we did not have information on preoperative evaluation or the reason for patient transfer. CONCLUSIONS: Hospital-to-hospital transfer independently contributed to patient morbidity and mortality in patients undergoing colorectal surgery. The impact of hospital transfer must be considered when evaluating surgeon and hospital performance, because the increased risk of serious complications or death is not fully accounted for by traditional methods.

The effect of comorbidities on overall mortality in Stevens- Johnson Syndrome: an analysis of the Nationwide Inpatient Sample.

BACKGROUND: Stevens Johnson Syndrome (SJS) is a life threatening skin condition with an overall mortality rate of 5%. Although the causes and pathology of the disease have been well studied, the factors that significantly contribute to mortality remain unclear. OBJECTIVE: To determine relevant risk factors that increase the likelihood of inpatient mortality after diagnosis of SJS. METHODS: A retrospective cohort study of the 2010-2011 Healthcare Costs and Utilization Project (HCUP) Nationwide InpatientSample (NIS) database was conducted. This study included 1,811 patients who encountered inpatient hospital stays with a discharge diagnosis of SJS. RESULTS: The primary outcome of our study was inhospital mortality. We analyzed the prevalence and associated inpatient mortality of underlying critical illness in patients with SJS. Three age ranges of patients in this study showed significantly increased rates of inpatient mortality by odds-ratio with a 95% CI: 70-79 years (10.91% mortality, OR=4.57, p=0.001),80-89 years (10.67% mortality, OR=4.48, p=0.001), and 90+ years (9.30% mortality, OR=4.22, p=0.028). Two comorbid conditions showed significant association with increased inpatient mortality in SJS by odds-ratio with a 95% CI: cirrhosis (14.58% mortality, OR=2.79,p=0.028) and metastatic disease (10.62% mortality,OR=1.87, p=0.031). INTERPRETATION: Age (70+ years), cirrhosis, and metastatic disease were identified as significantly associated with inpatient mortality after diagnosis with SJS. These findings enhance current understanding of the pathology of this disease, as well as help improve clinical management of high-risk patients to reduce inpatient mortality.