Potential impact of the 2023 Lahaina wildfire on the marine environment: Modeling the transport of ash-laden benzo[a]pyrene and pentachlorophenol.

The Lahaina urban/wildland fire event is considered the deadliest wildfire in the past century of U.S. history. This fire resulted in over 2200 building structures destroyed or damaged, approximately 4000 automobiles were incinerated and between 450 and 878 ha of grassland burned in areas adjoining the town of Lahaina, Maui County, State of Hawaii, U.S.A. One of the most abundant contaminants of both wildland and urban fires is the incomplete combustion product, benzo[a]pyrene. Pentachlorophenol from burned and unburned utility poles/residential burn sites enter into navigable waters, thus posing a serious risk to the water quality of coastal waters. The Risk Quotient Plumes for benzo[a]pyrene and pentachlorophenol, mobilized from Lahaina into coastal waters were calculated based on a hydrodynamic analysis and an integrated ecological risk assessment. This plume was simulated using rainfall events in November 2022 as a proxy for the first major rainfall event expected in Lahaina in 2024. The models indicated that the estimated levels of benzo[a]pyrene and pentachlorophenol posed a risk to near shore habitants within 2 km of Lahaina. The levels of pentachlorophenol were more widespread than benzo[a]pyrene and were predicted to pose a hazard to marine life as far away as Molokini Shoal Marine Life Conservation District and 'Ahihi-Kina'u Natural Area Reserve. Fisheries species captured near these areas should be tested for consumption safety.

Outcomes and patient perspectives of a novel virtual spinal referral pathway in a non-specialist centre.

INTRODUCTION: In Irish orthopaedic centres without dedicated spinal services, the care of patients is facilitated through tertiary referral centres in Dublin, Cork & Galway. The outpatient waiting list for elective spinal opinion remains lengthy and challenging. Previous practice in University Hospital Waterford (UHW) necessitated an assessment with a local non-spinal orthopaedic specialist following a GP referral, incurring up to a 2-year wait prior to subspecialist spinal referral. These patients subsequently incurred a further wait for an appointment at the tertiary referral centre. A novel virtual spine clinic in collaboration with the Mater Misericordiae University Hospital (MMUH) was developed to fast-track this process. AIMS AND METHODS: A retrospective study was performed to audit efficiency by assessing time to initial consultation and time to virtual consultation, treatment outcomes, and patient satisfaction using an adapted patient-satisfaction questionnaire (PSQ-18) and a semi-structured interview. This study reflected the unique nature of patient experience in this pathway. RESULTS: The median time from referral to being seen in an in-person rapid access physiotherapist combined orthopaedic clinic was 185 days. The median time from initial consultation to virtual consultation was 36 days. The median time interval from virtual consultation to intervention was 110 days. Twenty percent of patients underwent surgery, 14% were further seen in the MMUH outpatients, 7% managed with the trial of physiotherapy, 7% required no follow-up, and 50% planned for radiologically guided spinal injections. DISCUSSION AND CONCLUSION: This novel pathway is efficient for orthopaedic units without a dedicated spinal service. This can easily be replicated across other orthopaedic centres with minimal cost implications.

Operative management of lateral third clavicle fractures: a comparison of internal fixation methods.

PURPOSE: Clavicle fractures in the lateral third are associated with more complications. Various methods of internal fixation exist; however, there is no consensus which should be employed. The purpose of this study was to evaluate the outcomes of these various methods in our regional trauma unit. METHODS: We performed a retrospective review of patients who underwent internal fixation of a lateral clavicle fracture in our unit between 1 August 2014 and 31 July 2019. Demographic and outcome data were extracted from electronic care records and imaging systems. RESULTS: In total, 44 patients were included, with the following demographics: mean age 26 years, 63.6% male, 65.9% high-energy injury, 68.2% Neer II fracture. The following operations were performed: hook plate fixation (HPF) = 10, locking plate fixation (LPF) = 16, coracoclavicular ligament reconstruction (CCLR) = 12, and LPF + CCLR = 6. Patients having LPF had a significantly larger post-operative coracoclavicular distance (7.6 mm vs 13.5 mm, p < 0.01), and trends towards a lesser decrease in CCD (9.9 mm vs 12.6 mm, p = 0.37) and incomplete ACJ reduction (50.0% vs 89.3%, p = 0.11). There was a significantly higher re-operation rate after HPF (100% vs 23.5%, p < 0.01). There were no differences in time to union or duration of follow-up. CONCLUSION: In our unit there is no clearly favoured method of internal fixation of lateral clavicle fractures. When LPF is used, there should be consideration of concomitant CCLR. The high rate of re-operation after HPF is concordant with previous research.

Rhinovirus bronchiolitis, maternal asthma, and the development of asthma and lung function impairments.

BACKGROUND: Children with a history of rhinovirus (RV) positive bronchiolitis have a high risk of developing subsequent asthma. Maternal asthma might also increase this risk. The aim of this study was to investigate the combined effects of hospitalization for RV positive bronchiolitis in infancy and a history of maternal asthma on the development of asthma at preschool age. METHODS: This is a prospective cohort study of 139 preschool-aged children, with a history of hospital admission for bronchiolitis in infancy, followed-up to ascertain asthma and asthma-like symptoms, skin prick allergy test positivity, and lung function measured pre- and post-bronchodilator using impulse oscillometry. RESULTS: Children with a past hospitalization for RV positive bronchiolitis (42.4% of all) and a history of maternal asthma (36.7% of all) had the greatest prevalence and risk ratio (RR) for doctor-diagnosed asthma (prevalence 81.8% and RR 2.10, 95% confidence interval [CI] 1.37-3.19, p = .001), use of inhaled corticosteroids (68.2% and RR 2.17, 95% CI 1.19-3.99, p = .001) and short-acting ß-agonists in the last 12 months (95.2% and RR 1.49, 95% CI 1.17-1.89, p = .001), as compared to those with RV negative bronchiolitis and no maternal asthma history. More children in this group had an abnormal airway resistance (33.3% and adjusted risk ratio [aRR] 3.11, 95% CI 1.03-9.47, p = .045) and reactance (27.8% and aRR 2.11, 95% CI 1.06-4.26, p = .035) at 5 Hz, as compared to those with RV negative bronchiolitis and no maternal asthma history. CONCLUSION: Hospitalization for RV positive bronchiolitis in early life combined with a history of maternal asthma identifies a subgroup of children with a high asthma burden while participants with only one of the two risk factors had intermediate risk for asthma.