Explore the sludge stabilization process in sludge drying bed by modeling study from mesocosm experiments.

Sludge drying bed (SDB) treatment is a valuable alternative to conventional sludge treatment methods. However, changes in sludge hydrotexture during dewatering present a barrier for direct modeling of the SDB process. This study proposes a modeling strategy to simulate the sludge stabilization process in SDB treatment by separating sludge dewatering and sludge solids stabilization into independent processes. Two cell decay theories widely used by activated sludge models (ASM), death-regeneration concept and endogenous respiration theory, are compared to describe the biokinetic processes of sludge digestion. Both cell decay theories are found to adequately describe effluent total COD, NH4-N, NO3-N, and sludge layer composition, but have pronounced differences in describing effluent COD compositions. Results show that natural aeration does not maintain adequate aerobic/anoxic sludge digestion within the sludge layer to fully nitrify NH4-N released by cell decay. Results also indicate that the kinetics of sludge digestion are adaptable over time, indicating the need to adopt lumped values for biokinetic simulations. While lowered sludge dewatering rates (outflow) can increase biodegradable COD for cell metabolism, increased sludge loading rates (inflow) lead to higher effluent COD and NH4-N concentrations. Contrary to conventional judgement, this study demonstrates the merit of sludge layer formation to reduce leaching loss of biodegradable COD. Overall, the proposed modeling strategy is proven capable of simulating deposited sludge digestion processes in an SDB.

Classification of the Acoustics of Loose Gravel.

Road condition evaluation is a critical part of gravel road maintenance. One of the assessed parameters is the amount of loose gravel, as this determines the driving quality and safety. Loose gravel can cause tires to slip and the driver to lose control. An expert assesses the road conditions subjectively by looking at images and notes. This method is labor-intensive and subject to error in judgment; therefore, its reliability is questionable. Road management agencies look for automated and objective measurement systems. In this study, acoustic data on gravel hitting the bottom of a car was used. The connection between the acoustics and the condition of loose gravel on gravel roads was assessed. Traditional supervised learning algorithms and convolution neural network (CNN) were applied, and their performances are compared for the classification of loose gravel acoustics. The advantage of using a pre-trained CNN is that it selects relevant features for training. In addition, pre-trained networks offer the advantage of not requiring days of training or colossal training data. In supervised learning, the accuracy of the ensemble bagged tree algorithm for gravel and non-gravel sound classification was found to be 97.5%, whereas, in the case of deep learning, pre-trained network GoogLeNet accuracy was 97.91% for classifying spectrogram images of the gravel sounds.

Risk Factors and Survival Analysis of Spinal Cord Stimulator Explantation.

OBJECTIVE: The treatment failure rate for spinal cord stimulators (SCS) remains unacceptably high, with reports of removal in up to 30% of patients. The purpose of this study is to perform survival and multivariate regression analyses of patients who have undergone SCS explantation in order to identify patient characteristics that may predict treatment failure. MATERIALS AND METHODS: We identified 253 patients who underwent SCS placement using current procedural terminology codes in a private health insurance data base spanning 2003-2016. Patient demographics, opioid use, surgical indications, as well as comorbidities were noted. At least 6 months of continuous claims data before and after implantation were required for inclusion. Patients who underwent explantation were defined as those who underwent removal without replacement within 90 days and had at least 90 days of continuous insurance eligibility following removal. Those who underwent removal for infectious reasons were identified with corresponding diagnosis codes. RESULTS: Of the 252 patients who met the inclusion criteria, 17 (6.7%) underwent SCS explantation. Median follow-up time was 2.0 years. Of those who had their system explanted, six patients (2.8%) had their systems removed for infection and 11 (4.3%) for noninfectious reasons. Bivariate analysis revealed that younger age and tobacco use were associated with an increased likelihood of explantation. The Cox proportional hazards analysis demonstrated that younger age, tobacco use, and the presence of "other" mental health disorders were predictive of explantation. CONCLUSIONS: In a cohort of SCS patients from multiple institutions, this study demonstrates that explantation for noninfectious reasons is more likely in younger patients, tobacco users, and those with certain psychiatric conditions. With an estimated 10% of patients opting to have their devices removed within 5 years of implantation, refining the ability of clinicians to predict who will see benefit from SCS treatment remains necessary.

Predictors of Reduced Opioid Use With Spinal Cord Stimulation in Patients With Chronic Opioid Use.

OBJECTIVES: Spinal cord stimulation (SCS) has gained traction as an alternative to chronic opioid therapy in light of the opioid crisis. Prior reports vary widely in their estimates of its effect on opioid consumption. We therefore aimed to address the following questions: 1) Does chronic opioid use change after SCS? 2) Which patient characteristics predict reduced opioid consumption after SCS? MATERIALS AND METHODS: Claims from a private health insurance company were used to identify patients with SCS implantation from 2003 to 2014. We required 12 months of continuous data before and after surgery (i.e., a minimum total observation period of two years), and at least two opioid prescription fills in the six months before surgery. Daily morphine equivalent dose (MED) was calculated from prescription medication claims. Diagnosis codes identified common comorbidities. RESULTS: Hundred forty-five patients met inclusion criteria. MED of 65 was the most statistically meaningful preoperative dose threshold. Approximately half of patients decreased opioid use >20% after SCS implantation. Logistic regression analysis revealed age (p = 0.0362), gender (p = 0.0076), and preoperative daily MED < 65 (p = 0.0322) as predictors of meaningful reduction, which was defined as a 20% reduction in MED. CONCLUSIONS: With only half of chronic opioid users demonstrating meaningful opioid reduction after SCS implantation, we demonstrate that current SCS technology does not reliably help a larger number of patients reduce opioid usage. Women, older age, and preoperative MED < 65 are predictive of meaningful opioid reduction but only one of these is modifiable. As not all patients saw benefit from their therapies, there is still much room for improvement in the treatment of refractory chronic pain that is associated with failed back surgery syndrome and chronic regional pain syndrome.

Infectious Diseases Specialty Intervention Is Associated With Better Outcomes Among Privately Insured Individuals Receiving Outpatient Parenteral Antimicrobial Therapy.

BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) can be managed by specialists in infectious diseases (ID) or by other physicians. Better management of OPAT can reduce the likelihood of readmission or emergency department (ED) use. The relative success of ID specialists and other physicians in managing OPAT has received little study. METHODS: We analyzed a national database of insurance claims for privately insured individuals under age 65, locating inpatient acute-care stays in 2013 and 2014 that were followed by OPAT. Through propensity scoring, patients who received outpatient ID intervention (ID-led OPAT) were matched 1-to-1 with those who did not (Other OPAT). We estimated regression models of hospital and ED admissions and of total healthcare payments over the first 30 days after discharge. RESULTS: The final analytic sample of 8200 observations was well balanced on clinical and demographic characteristics. Soft-tissue infection and osteomyelitis were the most common infections in the index event, each affecting more than 40% of individuals. Relative to those with Other OPAT, people with ID-led OPAT had lower odds of an ED admission (odds ratio [OR] 0.449, 95% confidence interval [CI] 0.311-0.645) or hospitalization (OR 0.661, 95% CI 0.557-0.791) over 30 days, and they accumulated $1488 less in total healthcare payments (95% CI -2 688.56--266.58). CONCLUSIONS: Among privately insured individuals below age 65, ID consultations during OPAT are associated with large and significant reductions in the rates of ED admission and hospital admission in the 30 days after index events, as well as lower total healthcare spending.

Verification of a Method for Measuring Parkinson's Disease Related Temporal Irregularity in Spiral Drawings.

Parkinson's disease (PD) is a progressive movement disorder caused by the death of dopamine-producing cells in the midbrain. There is a need for frequent symptom assessment, since the treatment needs to be individualized as the disease progresses. The aim of this paper was to verify and further investigate the clinimetric properties of an entropy-based method for measuring PD-related upper limb temporal irregularities during spiral drawing tasks. More specifically, properties of a temporal irregularity score (TIS) for patients at different stages of PD, and medication time points were investigated. Nineteen PD patients and 22 healthy controls performed repeated spiral drawing tasks on a smartphone. Patients performed the tests before a single levodopa dose and at specific time intervals after the dose was given. Three movement disorder specialists rated videos of the patients based on the unified PD rating scale (UPDRS) and the Dyskinesia scale. Differences in mean TIS between the groups of patients and healthy subjects were assessed. Test-retest reliability of the TIS was measured. The ability of TIS to detect changes from baseline (before medication) to later time points was investigated. Correlations between TIS and clinical rating scores were assessed. The mean TIS was significantly different between healthy subjects and patients in advanced groups (p-value = 0.02). Test-retest reliability of TIS was good with Intra-class Correlation Coefficient of 0.81. When assessing changes in relation to treatment, TIS contained some information to capture changes from Off to On and wearing off effects. However, the correlations between TIS and clinical scores (UPDRS and Dyskinesia) were weak. TIS was able to differentiate spiral drawings drawn by patients in an advanced stage from those drawn by healthy subjects, and TIS had good test-retest reliability. TIS was somewhat responsive to single-dose levodopa treatment. Since TIS is an upper limb high-frequency-based measure, it cannot be detected during clinical assessment.

A pathway to earlier discharge following TAVI: Assessment of safety and resource utilization.

INTRODUCTION: There is considerable variability within the population of patients treated with transcatheter aortic valve implantation (TAVI), the procedural approach and time to discharge. In Belfast, from the commencement of our program, our approach has been to perform TAVI by the least invasive approach, where feasible, utilizing a percutaneous transfemoral route and local anesthetic. By analyzing our Belfast TAVI database we identified factors that predicted shorter admission times without impacting adversely on patient safety. Following this, we developed an early discharge pathway. The aim of this current study was to perform a prospective analysis of outcomes in our unit since implementation of this pathway assessing discharge time, mortality, serious adverse events, readmission, and resource implications for patients according to time to discharge. METHODS: Consecutive patients who underwent TAVI and were successfully discharged from 2013 to 2014 over a 14 month period were included, and analyzed according to time to discharge. Baseline and procedural characteristics, mortality, serious adverse events, readmission, and cost were assessed. RESULTS: In total 120 patients were included, 26 (21.7%) were discharged the same/next day, 39 (32.5%) early (>1-4 days), and 55 (45.8%) discharged in the late group. There was no significant difference in baseline or preprocedural characteristics. The incidence of complications was low, and there was no difference in 30-day mortality (P = 0.167) or readmission rates between groups (P = 0.952). Resource analysis revealed the late discharge group cost £3,091.6 more per patient per TAVI than same/next day discharge group. CONCLUSION: Same/next day discharge can be performed safely in appropriately selected patients. Although this will be achieved in a minority of patients (21.7% in this study using an early discharge pathway) it has potential for resource and cost savings. © 2015 Wiley Periodicals, Inc.

Sellar Reconstruction With a Bioabsorbable Plate After Endoscopic Transsphenoidal Pituitary Adenoma Resection: Safe and Efficacious.

OBJECTIVE: To report outcomes of a large cohort of patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for resection of a pituitary adenoma with subsequent Resorb-X plate (RXP) sellar reconstruction. METHODS: A retrospective review of 620 EETS operations performed at a single academic center between 2005 and 2020 was conducted. RESULTS: A total of 215 EETS operations of 208 patients were identified between 2012 and 2020 who underwent reconstruction with the RXP after EETS for pituitary tumor resection with a final pathologic diagnosis of pituitary adenoma. Analysis of pooled data revealed a mean preoperative tumor volume of 6.8 cm3 (range: 0.038-51.03 cm3). Postoperative cerebrospinal fluid leak occurred in 2 patients (0.93%). Postoperative meningitis occurred in 1 patient (0.47%). There were no cases of RXP extrusion. CONCLUSIONS: The rate of postoperative CSF leak and meningitis after use of the RXP for sellar reconstruction compares favorably to other methods, including use of autologous grafts and flaps. Use of RXP during EETS is a safe and efficacious method of sellar reconstruction and may obviate the need for autologous tissue reconstruction after pituitary adenoma resection.

Epigenetic reprogramming shapes the cellular landscape of schwannoma.

Mechanisms specifying cancer cell states and response to therapy are incompletely understood. Here we show epigenetic reprogramming shapes the cellular landscape of schwannomas, the most common tumors of the peripheral nervous system. We find schwannomas are comprised of 2 molecular groups that are distinguished by activation of neural crest or nerve injury pathways that specify tumor cell states and the architecture of the tumor immune microenvironment. Moreover, we find radiotherapy is sufficient for interconversion of neural crest schwannomas to immune-enriched schwannomas through epigenetic and metabolic reprogramming. To define mechanisms underlying schwannoma groups, we develop a technique for simultaneous interrogation of chromatin accessibility and gene expression coupled with genetic and therapeutic perturbations in single-nuclei. Our results elucidate a framework for understanding epigenetic drivers of tumor evolution and establish a paradigm of epigenetic and metabolic reprograming of cancer cells that shapes the immune microenvironment in response to radiotherapy.

Impact of a real-time controlled wastewater subsurface drip disposal system on the selected chemical properties of a vertisol.

The operation of onsite septic effluent disposal without considering seasonal moisture changes in drain field conditions can be a major cause of the failure of conventional septic systems. This study addressed this issue from a soil hydraulic perspective by using real-time drain field soil moisture levels to limit septic effluent disposal in a vertisol via subsurface drip irrigation. A prototype system was field-tested in a Houston clay soil and results describe the subsequent impact on selected soil chemical properties. After one year of hydraulic dosing with a synthetic wastewater, soil total carbon and nitrogen concentrations increased, but no increase in soil total phosphorus concentration was observed. Soil NO3-N leaching potential was noted, but soil NH4-N concentrations decreased, which could be ascribed to NH4-N nitrification, fixation within clay sheets and NH3 volatilization. Soil K+, Mg2+ and Na+ concentrations increased in soil layers above the drip lines, but decreased in soil layers below drip lines. Soil electrical conductivity accordingly increased in soil layers above drip lines, but the range was significantly lower than the threshold for soil salinity. Although the moisture-controlled effluent disposal strategy successfully avoided hydraulic dosing during unfavourable wet drain field conditions and prevented accumulation of soil salts in the soil profile beneath the drip lines, soil salts tended to accumulate in top soil layers. These adverse effects warrant system corrections before large-scale implementation of subsurface drip irrigation of effluent in similar vertisols.

Reduction of sporadic and neurofibromatosis type 2-associated vestibular schwannoma growth in vitro and in vivo after treatment with the c-Jun N-terminal kinase inhibitor AS602801.

OBJECTIVE: Vestibular schwannomas (VSs) are benign nerve sheath tumors that result from mutation in the tumor suppressor gene NF2, with functional loss of the protein merlin. The authors have previously shown that c-Jun N-terminal kinase (JNK) is constitutively active in human VS cells and plays a central role in their survival by suppressing accumulation of mitochondrial superoxides, implicating JNK inhibitors as a potential systemic treatment for VS. Thus, the authors hypothesized that the adenosine 5'-triphosphate-competitive JNK inhibitor AS602801 would demonstrate antitumor activity in multiple VS models. METHODS: Treatment with AS602801 was tested in primary human VS cultures, human VS xenografts, and a genetic mouse model of schwannoma (Postn-Cre;Nf2flox/flox). Primary human VS cell cultures were established from freshly obtained surgical tumor specimens; treatment group media was enriched with AS602801. VS xenograft tumors were established in male athymic nude mice from freshly collected human tumor. Four weeks postimplantation, a pretreatment MRI scan was obtained, followed by 65 days of AS602801 (n = 18) or vehicle control (n = 19) treatment. Posttreatment MRI scans were used to measure final tumor volume. Tumors were then harvested. Finally, Postn-Cre;Nf2flox/flox mice were treated with AS602801 (n = 10) or a vehicle (n = 13) for 65 days. Posttreatment auditory brainstem responses were obtained. Dorsal root ganglia from Postn-Cre;Nf2flox/flox mice were then harvested. In all models, schwannoma identity was confirmed with anti-S100 staining, cell proliferation was measured with the EdU assay, and cell death was measured with terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining. All protocols were approved by the local institutional review board and Institutional Animal Care and Use Committees. RESULTS: Treatment with AS602801 decreased cell proliferation and increased apoptosis in primary human VS cultures. The systemic administration of AS602801 in mice with human VS xenografts reduced tumor volume and cell proliferation. Last, the AS602801-treated Postn-Cre;Nf2flox/flox mice demonstrated decreased cell proliferation in glial cells in the dorsal root ganglia. However, AS602801 did not significantly delay hearing loss in Postn-Cre;Nf2flox/flox mice up to 3 months posttreatment. CONCLUSIONS: The data suggest that JNK inhibition with AS602801 suppresses growth of sporadic and neurofibromatosis type 2-associated VSs. As such, AS602801 is a potential systemic therapy for VS and warrants further investigation.

Endoscopic Reconstruction of the Anterior Skull Base Following Tumor Resection: Application of a Novel Bioabsorbable Plate.

OBJECTIVE: Endoscopic repair of skull base defects is required following resection of intracranial pathology via the endoscopic endonasal approach (EEA). Many closure techniques have been described, but choosing between techniques remains controversial. We report outcomes of 560 EEA procedures of skull base reconstruction performed on 508 patients over a 15-year-period. Halfway through this period, we adopted the use of a rigid, bioabsorbable extrasellar plate for reconstruction, enabling a comparison between this technique and those used previously. METHODS: All patients undergoing EEA from 2005 to 2019 at our institution were retrospectively reviewed. Demographic information, surgical pathology, tumor dimensions and radiographic features, reconstructive technique, and patient-related outcomes were collected and analyzed with univariate and multivariate statistical modeling. RESULTS: Five-hundred sixty procedures were performed on 508 patients. The series complication rate was 8.2%. Overall, cerebrospinal fluid (CSF) leak rate was 5.0% but varied significantly across closure techniques (p < 0.001). Critically, the CSF leak rate in the 272 cases prior to our 2013 adoption of the Resorb-X Plate (RXP) was 8.5%, whereas leak rate in the subsequent 288 cases was 1.7%. RXP was protective against CSF leak (p = 0.001), whereas gross total resection (GTR) correlated with increased leak rate (p = 0.001). Patient BMI was significantly associated with risk of leak (p = 0.047). Other variables did not impact leak risk. CONCLUSION: Reconstructive technique, extent of resection, and patient BMI significantly contributed to CSF leak rate. GTR was associated with increased leak risk while the RXP was protective. The bioabsorbable RXP is an effective option for rigid skull base repair with comparatively few complications. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1092-1098, 2023.

Surgical outcomes and risk factors for recurrence of myxopapillary ependymoma: a single-center experience.

OBJECTIVE: Myxopapillary ependymomas (MPEs) are low-grade, well-circumscribed tumors that often involve the conus medullaris, cauda equina, or filum terminale. They account for up to 5% of all tumors of the spine and 13% of spinal ependymomas, with a peak incidence between 30 and 50 years of age. Because of the rarity of MPEs, their clinical course and optimal management strategy are not well defined, and long-term outcomes remain difficult to predict. The objective of this study was to review long-term clinical outcomes of spinal MPEs and identify factors that may predict tumor resectability and recurrence. METHODS: Pathologically confirmed cases of MPE at the authors' institution were identified and medical records were reviewed. Demographics, clinical presentation, imaging characteristics, surgical technique, follow-up, and outcome data were noted. Two groups of patients-those who underwent gross-total resection (GTR) and those who underwent subtotal resection (STR)-were compared using the Mann-Whitney U-test for continuous and ordinal variables and the Fisher exact test for categorical variables. Differences were considered statistically significant at p ≤ 0.05. RESULTS: Twenty-eight patients were identified, with a median age of 43 years at the index surgery. The median postoperative follow-up duration was 107 months (range 5-372 months). All patients presented with pain. Other common presenting symptoms were weakness (25.0%), sphincter disturbance (21.4%), and numbness (14.3%). GTR was achieved in 19 patients (68%) and STR in 9 (32%). Preoperative weakness and involvement of the sacral spinal canal were more common in the STR group. Tumors were larger and spanned more spinal levels in the STR group compared with the GTR cohort. Postoperative modified McCormick Scale grades were significantly higher in the STR cohort compared with the GTR group (p = 0.00175). Seven of the 9 STR patients (77.8%) underwent reoperation for recurrence at a median of 32 months from the index operation, while no patients required reoperation after GTR, for an overall reoperation rate of 25%. CONCLUSIONS: Findings of this study emphasize the importance of tumor size and location-particularly involvement of the sacral canal-in determining resectability. Reoperation for recurrence was necessary in 78% of patients with subtotally resected tumors; none of the patients who underwent GTR required reoperation. Most patients had stable neurological status postoperatively.

Validation of a home environment test battery for supporting assessments in advanced Parkinson's disease.

Test sequences in a test battery for Parkinson's disease patients, consisting of self-assessments and motor tests, were carried out repeatedly in a telemedicine setting, during week-long test periods and results were summarized in an 'overall score'. 35 patients in stable and fluctuating conditions (15 age- and gender-matched pairs) used the test battery for 1 week, and were then assessed with UPDRS and PDQ-39. This procedure was repeated 1 week later, without treatment changes. Reliability was assessed by intraclass correlation coefficients and Cronbach's alpha. Convergent validity was assessed by Spearman rank correlations and known-groups' validity, by the Mann-Whitney test. According to anonymous usability questionnaires, the patients could easily complete the tasks. Median compliance (93%) and test-retest reliability (0.88) were good. The correlations between overall score and total UPDRS (-0.64) and PDQ-39 (-0.72) were adequate. Median overall score was 18% better in the stable compared to the fluctuating group (p = 0.0014).

The hemodynamic and respiratory effects of cuirass ventilation in healthy volunteers: Part 1.

OBJECTIVE: Negative-pressure ventilation (NPV) by external cuirass (RTX; Deminax Medical Instruments Limited, London, UK) in intubated patients after cardiac surgery improves hemodynamics measured by pulmonary artery catheter (PAC)-based methods, with an increased cardiac output (CO) and stroke volume (SV), without changing the heart rate (HR). The less-invasive pressure recording analytical method (PRAM) (Mostcare; Vytech Health srl, Padova, Italy) allows radial artery-based monitoring of the CO, SV, SV variation, and cardiac cycle efficiency (CCE). The authors investigated the hypothesis that NPV improves PRAM-based hemodynamics and arterial blood gas analysis in spontaneously breathing subjects. DESIGN: A clinical investigation. SETTING: A teaching hospital. PARTICIPANTS: Ten healthy volunteers. INTERVENTIONS: Subjects underwent 5 consecutive experimental ventilation modalities lasting 5 minutes: (1) baseline (no cuirass ventilation), (2) mode 1: cuirass ventilation with a continuous negative pressure of -20 cmH(2)O, (3) first rest period (no cuirass ventilation), (4) mode 2: cuirass ventilation in control mode of 12 breaths/min at -20 cmH(2)O, and (5) second rest period. MEASUREMENTS AND MAIN RESULTS: PRAM parameters were analyzed throughout the final minute of each experimental modality, which concluded with arterial blood gas sampling. Both NPV modes significantly reduced HR without changing CO or systemic vascular resistance. Mode 1 significantly increased CCE and decreased SVV. PO(2) decreased in both rest modes compared with baseline. This was prevented by NPV. In 5 smokers, PO(2) significantly increased in the control mode compared with first rest period. The control mode NPV improved oxygenation with a reduced PCO(2) and reciprocally increased pH. CONCLUSIONS: Five minutes of NPV improves hemodynamics and oxygenation in healthy subjects.

The hemodynamic and respiratory effects of continuous negative and control-mode cuirass ventilation in recently extubated cardiac surgery patients: Part 2.

OBJECTIVE: Negative-pressure ventilation (NPV) by external cuirass (RTX; Deminax Medical Instruments Limited, London, UK) in intubated patients after cardiac surgery improves hemodynamics measured by pulmonary artery catheter (PAC)-based methods with increased cardiac output (CO) and stroke volume (SV) without changing the heart rate (HR). The less-invasive pressure recording analytical method (PRAM) (MostCare; Vytech Health srl, Padova, Italy) allows radial artery monitoring of CO, SV, SV variation, and cardiac cycle efficiency (CCE). The authors investigated the hypothesis that NPV improves PRAM-based hemodynamics and arterial blood gas analysis in extubated cardiac surgery patients. DESIGN: A clinical investigation. SETTING: A teaching hospital. PARTICIPANTS: Twenty recently extubated cardiac surgery patients. INTERVENTIONS: Five consecutive experimental ventilation modalities lasted 5 minutes: (1) baseline (no cuirass ventilation), (2) mode 1 (cuirass ventilation with a continuous negative pressure of -20 cmH(2)O), (3) rest 1 (no cuirass ventilation), (4) mode 2 (cuirass ventilation in the control mode of 12 breaths/min at -20 cmH(2)O, and (5) rest 2. MEASUREMENTS AND MAIN RESULTS: PRAM parameters were analyzed throughout the final minute of each experimental modality, concluding with arterial blood gas sampling. NPV was well tolerated. HR was unchanged. Mode 2 SV was higher than baseline and rest 2. Mode 2 CO was higher than rest 2. Rest 2 systolic blood pressure was lower than rest 1 and mode 2. Increased CCE with NPV was not significant (p = 0.0696). Oxygenation and PCO(2) were unchanged although mode 2 pH increased. CONCLUSIONS: Extubated sedated cardiac surgery patients comfortably tolerated NPV with unchanged HR. SV and pH increased.

Spinal Meningioma in Adults: Imaging Characteristics, Surgical Outcomes, and Risk Factors for Recurrence.

OBJECTIVE: Although spinal meningiomas (SMs) are associated with overall long tumor-free survival, SMs can recur. This study analyzed factors associated with complications, misdiagnosis, and recurrence of SMs. METHODS: We reviewed patient demographics; radiographic characteristics of patients with SMs, including level, location within the canal, and size; surgical resection; pathology; and recurrence. RESULTS: The study included 64 women and 10 men (74 SMs). Of patients, 64 showed no recurrence after surgery with a median (range) follow-up of 17 (1-99) months. Recurrence was identified in 10 patients (13.5%) during a median (range) follow-up of 66 (25-230) months. There was no significant difference in sex between the recurrence and no recurrence cohorts. Patients in the recurrence cohort were significantly younger (median [range] age 58 [35-70] years) than patients in the no recurrence cohort (median [range] age 69 [18-93] years; P = 0.0091). There was significant predilection for foraminal locations in the recurrence cohort (P < 0.001) compared with the no recurrence cohort. SM was correctly identified on preoperative magnetic resonance imaging or computed tomography myelography in 62 of 64 tumors (96.9%) in the no recurrence cohort, but in only 6 of 10 tumors (60%) in the recurrence cohort (P < 0.001). CONCLUSIONS: In 74 patients with SMs, a preponderance of female patients and a predilection of tumors for the thoracic spine were shown. Recurrence was significantly more common in younger than older patients. Risk factors for recurrence included larger tumors, foraminal location, and en plaque lesions. Patients who developed recurrence were significantly more likely to have been misdiagnosed on preoperative imaging with nerve sheath tumors or lymphoma.

Hydraulic management of a soil moisture controlled SDI wastewater dispersal system in an Alabama Black Belt soil.

Rural areas represent approximately 95% of the 14000 km(2) Alabama Black Belt, an area of widespread Vertisols dominated by clayey, smectitic, shrink-swell soils. These soils are unsuitable for conventional onsite wastewater treatment systems (OWTS) which are nevertheless widely used in this region. In order to provide an alternative wastewater dosing system, an experimental field moisture controlled subsurface drip irrigation (SDI) system was designed and installed as a field trial. The experimental system that integrates a seasonal cropping system was evaluated for two years on a 500-m(2) Houston clay site in west central Alabama from August 2006 to June 2008. The SDI system was designed to start hydraulic dosing only when field moisture was below field capacity. Hydraulic dosing rates fluctuated as expected with higher dosing rates during warm seasons with near zero or zero dosing rates during cold seasons. Lower hydraulic dosing in winter creates the need for at least a two-month waste storage structure which is an insurmountable challenge for rural homeowners. An estimated 30% of dosed water percolated below 45-cm depth during the first summer which included a 30-year historic drought. This massive volume of percolation was presumably the result of preferential flow stimulated by dry weather clay soil cracking. Although water percolation is necessary for OWTS, this massive water percolation loss indicated that this experimental system is not able to effective control soil moisture within its monitoring zone as designed. Overall findings of this study indicated that soil moisture controlled SDI wastewater dosing is not suitable as a standalone system in these Vertisols. However, the experimental soil moisture control system functioned as designed, demonstrating that soil moisture controlled SDI wastewater dosing may find application as a supplement to other wastewater disposal methods that can function during cold seasons.

Numerical assessment of a soil moisture controlled wastewater SDI disposal system in Alabama Black Belt Prairie.

To promote the environmental sustainability of rural sanitation, a soil moisture controlled wastewater subsurface drip irrigation (SDI) dispersal system was field tested in the Black Belt Prairie of Alabama, USA. The soil moisture control strategy was designed to regulate wastewater disposal timing according to drain field conditions to prevent hydraulic overloading and corresponding environmental hazard. CW2D/HYDRUS simulation modeling was utilized to explore difficult-to-measure aspects of system performance. While the control system successfully adapted hydraulic loading rate to changing drain field conditions, saturated field conditions during the dormant season presented practical application challenges. The paired field experiment and simulation model demonstrate that soil biofilm growth was stimulated in the vicinity of drip emitters. Although biofilm growth is critical in maintaining adequate COD and NH4+-N removal efficiencies, the efficient removal of biodegradable COD itself by soil biofilm limits denitrification of formed NO3--N . Furthermore, stimulated soil biofilm growth can create soil clogging around drip emitters, which was discerned in the field experiment along with salt accumulation, both of which were verified by simulation. Comparable modeling of system performance in sand and clay media demonstrate that the placement of soil moisture sensors within the drain field can have pronounced impacts on system hydraulic performance, depending on the soil permeability. Overall, the soil moisture control strategy tested is shown as a viable supplemental technology to promote the environmental sustainability of rural sanitation systems.