Disentangling the History of Deep Ocean Disposal for DDT and Other Industrial Waste Off Southern California.

Ocean disposal of industrial waste from technical DDT [mainly 1,1'-(2,2,2-trichloroethane-1,1-diyl)bis(4-chlorobenzene), or 4,4'-DDT] manufacture occurred historically in the Southern California Bight. However, the paucity of historical records highlights uncertainties as to the mode, location, and timing of disposal or ongoing ecological effects of these wastes. This study combines sampling, chemical analysis, and numerical modeling of deep San Pedro Basin sediments revealing substantial DDT contamination that extends at least 25 km from the mainland. These findings narrate bulk DDT waste disposal to the offshore that peaked in the 1950s, prior to the onset of formal regulations; was agnostic to later-designated disposal sites; and has experienced sluggish transformation. Our findings further indicate an attenuating secondary source for the DDT daughter product, 1-chloro-4-[2,2-dichloro-1-(4-chlorophenyl)ethenyl]benzene (4,4'-DDE), which still deposits into deep San Pedro Basin sediments. While demonstrating the severity of DDT contamination to the region, these findings further define the burial potential of DDT wastes and inform the past, present, and future contamination potential that is needed to understand and predict ecological consequences. This work also points firmly to bulk, not containerized, disposal of DDT waste and to potential alternative contents of collocated waste.

Increasing Salt Marsh Elevation Using Sediment Augmentation: Critical Insights from Surface Sediments and Sediment Cores.

Sea-level rise is particularly concerning for tidal wetlands that reside within an area with steep topography or are constrained by human development and alteration of sedimentation. Sediment augmentation to increase wetland elevations has been considered as a potential strategy for such areas to prevent wetland loss over the coming decades. However, there is little information on the best approaches and whether adaptive management actions can mimic natural processes to build sea-level rise resilience. In addition, the lack of information on long-term marsh characteristics, processes, and variability can hamper development of effective augmentation strategies. Here, we assess a case study in a southern California marsh to determine the nature of the pre-existing sediments and variability of the site in relation to sediments applied during an augmentation experiment. Although sediment cores revealed natural variations in the grain size and organic content of sediments deposited at the site over the past 1500 years, the applied sediments were markedly coarser in grain size than prehistoric sediments at the site (100% maximum sand versus 76% maximum sand). The rate of the experimental sediment application (25.1 ± 1.09 cm in ~2 months) was also much more rapid than natural accretion rates measured for the site historically. In contrast, post-augmentation sediment accretion rates on the augmentation site have been markedly slower than pre-augmentation rates or current rates on a nearby control site. The mismatch between the characteristics of the applied sediment and thickness of application and the historic conditions are likely strong contributors to the slow initial recovery of vegetation. Sediment augmentation has been shown to be a useful strategy in some marshes, but this case study illustrates that vegetation recovery may be slow if applied sediments are not similar or at a thickness similar to historic conditions. However, testing adaptation strategies to build wetland elevations is important given the long-term risk of habitat loss with sea-level rise. Lessons learned in the case study could be applied elsewhere.

Concussion in Non-athletes: Assessment of Cognition and Symptomatology (CONTACTS) study protocol - an exploratory cohort study investigating the utility of sports concussion assessment tools and salivary microRNAs to diagnose concussion in NHS patients.

INTRODUCTION: Concussion is a complex pathophysiological process with a wide range of non-specific signs and symptoms. There are currently no objective diagnostic tests to identify concussion, and diagnosis relies solely on history and examination. Recent research has identified a unique panel of microRNAs (miRNAs) that distinguish between concussed and non-concussed rugby players. This study aims to assess the diagnostic utility of salivary miRNAs in concussion for a sample of UK National Health Service patients and whether well-established sports-related concussion (SRC) assessment tools may be translated into the emergency department (ED). METHODS AND ANALYSIS: Concussion in Non-athletes: Assessment of Cognition and Symptomatology is a single-centre, prospective, two-phase cohort study. The concussed cohort will consist of participants with maxillofacial trauma and concurrent concussion. The control cohort will consist of participants with isolated limb trauma and no evidence of concussion. Participants will be recruited in the ED and saliva samples will be taken to identify the presence of miRNAs. The SRC assessments being investigated include the Sports Concussion Assessment Test, Fifth Edition (SCAT5), the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the ImPACT Quick. Follow-up will be at 24-48 hours in-hospital and remotely via telephone and email at 14 days and 6 months. ETHICS AND DISSEMINATION: Ethical approval was granted in February 2021 by the West Midlands Coventry & Warwickshire Research Ethics Committee (ref 20/WM/0299). The investigators intend to submit their study findings for publication in peer-reviewed journals and to disseminate study findings via presentation at academic meetings. The results will also form part of a doctorate thesis, registered at the University of Birmingham.

Elite and Professional sports facial injuries management - a consensus report.

Whilst there have been great improvements in the management of elite and professional athletes with the formalisation of the clinical specialty of Sports and Exercise medicine, the management of facial injuries has perhaps lagged in this group. Professional athletic careers can be put in jeopardy due to unnecessarily long absences from training and competition after facial injuries. Professional and elite sports athletes can benefit from different approaches to the management of their facial injuries to reduce time away from competing but maximise their safety. On 6th December 2018, a consensus meeting of interested clinicians involved in the management of facial injuries of elite and professional athletes was held at the Royal Society of Medicine, London, UK to provide a contemporary review of the approaches to conservative, operative and recovery management of facial injuries. National experts with specialist experience of facial injuries presentation and athlete needs from a range of elite and professional sports led the day's programme and the discussions so that guidelines could be formulated. These are presented in this review paper.

Human disease/clinical medical sciences in dentistry: Current state and future development of undergraduate assessments in the UK and Ireland.

INTRODUCTION: The United Kingdom and Ireland teachers of Human Disease/Clinical Medical Science for Dentistry (HD/CMSD) group continue to work together and most recently collaborated to review current and future assessments. MATERIALS AND METHODS: The first part of the review of assessments in HD/CMSD took place at a face-to-face meeting with presentations from delegates on assessments in their home institutions. The second and larger part comprised an online survey where all eighteen schools in the UK and Ireland participated. RESULTS: All schools had some element of formative assessment, and the majority had a stand-alone summative assessment at the end of the HD/CMSD teaching block. Most schools had a written paper and practical elements to their assessments, most commonly a combination of a multiple-choice type question combined with an objective structured clinical examination (OSCE). There was a trend towards the use of single best answer (SBA) questions and a willingness amongst participants to share a question bank. All schools incorporated elements of HD/CMSD in their final examinations. DISCUSSION AND CONCLUSION: This collaboration promoted the sharing of developments in assessment for HD/CMSD and demonstrated a willingness to cooperate between institutions. Assessment in HD/CMSD in the UK and Ireland continues to be refined by those responsible for its content and delivery, and assessment methods are progressing following evidence-based best practice.

Investigation into repetitive concussion in sport (RECOS): study protocol of a prospective, exploratory, observational cohort study.

INTRODUCTION: Sport-related concussion management remains a diagnostic dilemma to clinicians in all strata of care, coaching staff and players alike. The lack of objective diagnostic and prognostic biomarkers and over-reliance on subjective clinical assessments carries a significant health risk of undiagnosed concussive episodes and early return to play before full recovery increasing the risk of sustaining additional concussion, and leading to long-term sequelae and/or unfavourable outcome. OBJECTIVE: To identify a set of parameters (neuroimaging with neurophysiological, biological and neuropsychological tests) that may support pitch-side and outpatient clinical decision-making in order to objectively diagnose concussion, determine the severity of injury, guide a safe return to play and identify the potential predictors of the long-term sequelae of concussion. METHODS AND ANALYSIS: An exploratory, observational, prospective, cohort study recruiting between 2017 and 2020. The participants will have a baseline preseason screening (brain imaging, neuropsychological assessments, serum, urine and saliva sampling). If a screened player later suffers a concussion and/or multiple concussions then he/she will be assessed again with the same protocol within 72 hours, and their baseline data will be used as internal control as well as normative data. Inferential statistical analysis will be performed to determine correlations between biological, imaging techniques and neuropsychological assessments. ETHICS AND DISSEMINATION: This study was approved by the East of England-Essex Research Ethics Committee on 22 September 2017-REC 17/EE/0275; IRAS 216703. The results of this study will be presented at national and international conferences and submitted for publication in peer reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN16974791; Pre-results.

Catheter-based local analgesia for the fractured mandible in a patient with a history of hereditary angioedema.

Hereditary angioedema is a rare genetic condition causing episodes of angioedema-including life-threatening laryngeal oedema. Episodes can be unpredictable, or triggered by factors such as trauma, drugs or dental treatment. When faced with a patient with a fractured mandible, who has had a severe attack of angioedema when prescribed either ibuprofen or codeine based analgesia, this required an alternative approach to analgesia. Using a catheter and local anaesthesia, we were able to keep the patient comfortable, and pain free.

Study of Concussion in Rugby Union through MicroRNAs (SCRUM): a study protocol of a prospective, observational cohort study.

INTRODUCTION: The diagnosis of mild traumatic brain injury or sports-related concussion is a challenge for all clinicians, players, coaches and parents involved in contact sports. Currently, there is no validated objective biomarker available to assess the presence or severity of concussion in sport, and so it is necessary to rely on subjective measures like self-reporting of symptoms which depend on the cooperation of the athlete. There is a significant health risk associated with repetitive injury if the diagnosis is missed, and so there is great value in an objective biomarker to assist diagnostic and prognostic decisions. OBJECTIVE: To establish a panel of non-invasive MicroRNA biomarkers in urine and saliva for the rapid diagnosis of sports-related concussion and investigate the kinetics and clinical utility of these biomarkers in assisting diagnostic, prognostic and return-to-play decisions. METHODS AND ANALYSIS: Observational, prospective, multicentre cohort study recruiting between the 2017-2018 and 2018-2019 Rugby Union seasons. Professional rugby players in the two highest tiers of senior professional domestic rugby competition in England will be recruited prospectively to the study. During the season, three groups will be identified: athletes entering the World Rugby Head Injury Assessment (HIA) protocol, uninjured control athletes and control athletes with musculoskeletal injuries. Saliva and urine will be collected from these athletes at multiple timepoints, coinciding with key times in the HIA protocol and return-to-play process. ETHICS AND DISSEMINATION: Ethics approval has been obtained. The compiled and analysed results will be presented at national and international conferences concerning the care of patients with traumatic brain injury. Results will also be submitted for peer review and publication in the subject journals/literature.

Salivary MicroRNAs: Diagnostic Markers of Mild Traumatic Brain Injury in Contact-Sport.

Concussion is difficult to diagnose, particularly when symptoms are atypical or late in presenting. An accurate and timely initial assessment is crucial for clinical management. Cerebral spinal fluid (CSF) and blood markers of traumatic brain injury show promising results but their clinical applicability in concussion has significant limitations. In the study, we explored saliva as a new source of biomarkers of concussion. Saliva samples of concussed players were collected after 48-72 h from concussion and analyzed by high-throughput technologies. A discovery group of 10 concussed rugby professional and semiprofessional athletes and 10 non-concussed matched controls was used for the analysis of 92 inflammatory proteins by the Proseek-Multiplex-Inflammation technology. In addition, saliva samples of 6 concussed and 6 non-concussed athletes were used to screen 800 human microRNAs (miRNAs) by the Nanostring Technology. The results were then validated by RT-qPCR in an enlarged cohort (validation group) comprising 22 concussed athletes. Results showed, no significant variations of the 65 inflammatory proteins detected in saliva between groups but 5 microRNAs, miR-27b-3p (p = 0.016), let-7i-5p (p = 0.001), miR-142-3p (p = 0.008), miR-107 (p = 0.028), miR-135b-5p (p = 0.017) significantly upregulated in concussed athletes. Univariate ROC curve analysis showed that the differentially expressed miRNAs could be considered good classifiers of concussion. Further analyses showed significant correlation between these microRNAs and Reaction Time component of the ImPACT concussion assessment tool. In addition, biocomputation analysis predicted the involvement of these microRNAs in important biological processes that might be related to trauma, such as response to hypoxia, cell death, neurogenesis, axon repair and myelination. Ease of access and non-invasiveness of saliva samples make these biomarkers particularly suitable for concussion assessment.

The Reconstructive Trauma Surgery Interface Fellowship and its applicability to military and civilian trainees.

The Reconstructive Trauma Surgery Fellowship is a based at the Queen Elizabeth Hospital, Birmingham, and focuses on the multidisciplinary management of major trauma from presentation to discharge. It is unique to the UK in that it provides both management and leadership experience as well as operative surgical skills particularly in terms of reconstruction on complex trauma patients including those from the military. This paper describes the relevance of fellowships in modern surgical training, composition of the reconstructive trauma fellowship and the relevance for both civilian and military trainees.

Demographic features of patients with concomitant facial fractures and closed head injuries in Maricopa, Arizona.

OBJECTIVE: The aim of this study was to investigate the demographic profile of Native American patients with concomitant facial fractures and closed head injuries (CHIs) and to explore the validation of the craniofacial crumple zone. STUDY DESIGN: This was a retrospective, observational, case-control study of 2131 maxillofacial fractures from 2010 to 2014, of which 173 (8%) had concomitant CHIs. RESULTS: Of the study patients, 133 (77%) were males (mean age 40.6 years). Only 2.1% of the local population was Native American, but this group represented 24% of the patients with CHIs and sustained 4.6 times more (P value < .001) assault injuries and 2.6 times more concussion (P value < .001) compared with other groups. Other trauma comparisons were not significant. Of the 173 study patients, 86 (50%), had blood alcohol levels which exceeded 80 mg/100 mL compared with 93% of the Native Americans. CONCLUSIONS: Native American patients had a highly significant predisposition to violence and road traffic accidents resulting in maxillofacial fractures and CHIs. The high blood alcohol levels found in this group also reflected longstanding serious sociologic problems. This study provides a useful model to investigate the relative ethnic/racial role of comminuted paranasal structures for the protection of the brain (i.e., the crumple zone).

Case report: an atypical presentation of Eagle syndrome.

Elongation of the styloid process occurs in 4-7% of individuals. In the majority this elongation is asymptomatic. Presence of oropharyngeal pain and dysphagia with such elongation is known as Eagle syndrome. The aetiology of Eagle syndrome is believed to be a reactive osseus hyperplasia of the styloid process in response to pharyngeal trauma or surgical intervention, such as tonsillectomy. We present a case of a 72-year-old lady with a twelve month history of left sided oropharyngeal pain and worsening dysphagia, presenting with a long, slender, bony intraoral projection found to be an elongated styloid process. She previously underwent tonsillectomy and radiotherapy on the left side for a tonsillar carcinoma. Surgical reduction of the elongated styloid process via intraoral approach led to immediate post-operative pain relief and normal swallowing. We conclude that this atypical presentation of Eagle syndrome was caused by the patient's prior treatment for tonsillar carcinoma.

Does Extraction or Retention of the Wisdom Tooth at the Time of Surgery for Open Reduction and Internal Fixation of the Mandible Alter the Patient Outcome?

Whether to extract or retain wisdom teeth present in a fracture line is a controversial topic. This study reviewed the records of all patients who had mandibular wisdom teeth at the time of the injury, and had an open reduction and internal fixation procedure between January 2009 and January 2012. The cohort of patients who concomitantly had their wisdom tooth extracted at the time of fixation had a greater complication rate (24.3%) compared with patients who did not (14.9%). This suggests that if third molars in the line of a fracture have caries, are fractured, show signs of pericoronitis, are periodontally involved, or are interfering with the occlusion are extracted at the time of fixation, this will increase the incidence of complications.

Shallow Groundwater Conveyance of Geologically Derived Contaminants to Urban Creeks in Southern California.

In California alone, there are currently over 200 instances on the EPA's list of impaired water bodies with unknown sources of excessive salinity or trace contaminants. This investigation focuses on Orange County, CA, a region that has undergone extensive hydrological modification, relies heavily on imported water for municipal supply, and has come under regulatory scrutiny for elevated TDS, sulfate, Cd, Ni, and Se. A survey of shallow groundwater weeps and springs, discharging directly to urban creeks, reveals high concentrations of TDS, sulfate, Cd, Ni, Zn, Cu, and Se that are often far in excess of water quality standards. Isotopic (δ(34)S and δ(18)O) and geochemical evidence indicate that the source of sulfate and TDS is weathering of sulfide minerals in the Capistrano Formation marine mudstone and dissolution of secondary minerals formed during past periods of sulfide oxidation, rather than anthropogenic inputs. The relative availability of carbonate minerals along the flow path appears to control pH, which then influences trace metal mobility to surface waters. Stable isotopes of H2O indicate that despite widespread use of imported water, meteoric recharge dominates shallow groundwater inputs with municipal sources contributing only 13-29% of discharge. These findings highlight the importance of understanding the hydrogeological setting to properly apportion contaminant sources and conveyances.

Weight loss in orthognathic surgery: a clinical study.

OBJECTIVE: To analyse weight change, body composition change and Body Mass Index change in patients undergoing orthognathic surgery. DESIGN: A service evaluation was undertaken in orthognathic patients pre-operatively and at 4 weeks post-surgery. SETTING: Queen Elizabeth Hospital Birmingham outpatient department. SUBJECTS: Thirty-one patients scheduled for single- or two-jaw orthognathic surgery and rigid internal fixation. METHODS: Immediately pre-operatively and at 4 weeks post-surgery the following information was gathered: (1) patient height; (2) patient weight (kg); (3) Patient Body Mass Index; and (4) patient body fat percentage. RESULTS: In the 4-week post-operative period, the average weight loss was -4·96 kg (range: -9·6 to +3·0 kg), with a body fat reduction of -3·07% (range: -5·80% to +2·30%) and an average reduction in Body Mass Index of -1·63 (range: -3·4 to +0·8). There was no statistically significant difference in weight loss (P = 0·1562) or body fat composition change (P = 0·2391) between single- or two-jaw surgery. There was no statistically significant difference in weight loss (P = 0·4858) or body fat composition change (P = 0·5321) between male and female patients. CONCLUSIONS: Weight loss observed was similar to that reported in studies using inter-maxillary fixation. Closer psychological and dietetic support is needed for patients who have a low normal or underweight Body Mass Index. Better and more bespoke tailored Oral Nutritional Supplementation must be provided for all orthognathic surgery patients to potentially reduce this significant weight loss.

Revisiting the Boyne procedure.

BACKGROUND: The technique involving the free grafting of the mandibular condyle with a vertical ramus osteotomy was described by Philip Boyne in 1987 along with a series of 15 cases where a patient presented with a markedly displaced fracture dislocation of the mandibular condyle. METHOD: Twenty-one cases (25 condylar fractures) were treated with a modified Boyne technique. RESULTS: Results showed that we had a complication rate of 12% (8% resorption, 4% fracture of the plate). CONCLUSION: The Boyne procedure should be thought of as a mainstream treatment method for the displaced fractured mandibular condyle.

The Impact of Bacterial Strain on the Products of Dissimilatory Iron Reduction.

Three bacterial strains from the genus Shewanella were used to examine the influence of specific bacteria on the products of dissimilatory iron reduction. Strains CN32, MR-4 and W3-18-1 were incubated with HFO (hydrous ferric oxide) as the terminal electron acceptor and lactate as the organic carbon and energy source. Mineral products of iron reduction were analyzed using X-ray powder diffraction, electron microscopy, coulometry and susceptometry. Under identical nutrient loadings, iron reduction rates for strains CN32 and W3-18-1 were similar, and about twice as fast as MR-4. Qualitative and quantitative assessment of mineralized end products (secondary minerals) indicated that different products were formed during experiments with similar reduction rates but different strains (CN32 and W3-18-1), and similar products were formed during experiments with different iron reduction rates and different strains (CN32 and MR-4). The major product of iron reduction by strains CN32 and MR-4 was magnetite, while for W3-18-1 it was a mixture of magnetite and iron carbonate hydroxide hydrate (green rust), a precursor to fougerite. Another notable difference was that strains CN32 and MR-4 converted all of the starting ferric iron material into magnetite, while W3-18-1 did not convert most of the Fe(3+) into a recognizable crystalline material. Biofilm formation is more robust in W3-18-1 than in the other two strains used in this study. The differences in mineralization may be an indicator that EPS (or another cellular product from W3-18-1) may interfere with the crystallization of magnetite or facilitate formation of green rust. These results suggest that the relative abundance of mineral end products and the relative distribution of these products are strongly dependent on the bacterial species or strain catalyzing iron reduction.

Publish or perish? A survey of abstracts accepted for meetings of the British Association of Oral and Maxillofacial Surgeons, and subsequently published.

Publications are important for all surgeons, including those practising oral and maxillofacial surgery (OMFS). The results of relevant research are usually presented at the annual scientific meetings of the British Association of Oral and Maxillofacial Surgeons (BAOMS). The aim of this study was to find out how many abstracts that were accepted for presentation at the BAOMS go on to be published. Lists of abstracts accepted at BAOMS meetings 2002-2006 were obtained, and a thorough search was made for each article using the web-based search engine PubMed. Related publications were recorded. A total of 623 abstracts were accepted, of which only 147 (24%) resulted in peer-reviewed publication. Compared with clinical studies, scientific research was in the minority, but was more likely to appear in print and in journals with higher impact factors. Units with senior academic input had better records of publication. Currently only a small fraction of studies deemed worthy of presentation at the BAOMS become publications. This conversion from presentation to print is facilitated by strong academic support. Exposing trainees in OMFS training posts to basic research training might improve their ability to publish.

Resveratrol is pro-apoptotic and thyroid hormone is anti-apoptotic in glioma cells: both actions are integrin and ERK mediated.

The stilbene resveratrol (RV) initiates p53-dependent apoptosis via plasma membrane integrin alphaVbeta3 in human cancer cells. A thyroid hormone (L-thyroxine, T(4)) membrane receptor also exists on alphaVbeta3. Stilbene and T(4) signals are both transduced by extracellular-regulated kinases 1 and 2 (ERK1/2); however, T(4) promotes cell proliferation in cancer cells, whereas RV is pro-apoptotic. Thyroid hormone has been shown to interfere with RV-induced apoptosis. However, the mechanisms involved are not fully understood. In this study, we examined the mechanism whereby T(4) inhibits RV-induced apoptosis in glioma cells. RV activated conventional protein kinase C and ERK1/2 and caused nuclear localization of cyclooxygenase-2 (COX-2), consequent p53 phosphorylation and apoptosis. RV-induced ERK1/2 activation is involved in not only COX-2 expression but also nuclear COX-2 accumulation. NS-398, a COX-2 inhibitor, did not affect ERK1/2 activation, but reduced the nuclear abundance of COX-2 protein and the formation of complexes of nuclear COX-2 and activated ERK1/2 that are required for p53-dependent apoptosis in RV-treated cells. T(4) inhibited RV-induced nuclear COX-2 and cytosolic pro-apoptotic protein, BcLx-s, accumulation. Furthermore, T(4) inhibited RV-induced apoptosis by interfering with the interaction of nuclear COX-2 and ERK1/2. This effect of T(4) was prevented by tetraiodothyroacetic acid (tetrac), an inhibitor of the binding of thyroid hormone to its integrin receptor. Tetrac did not, in the absence of T(4), affect induction of apoptosis by RV. Thus, the receptor sites on alphaVbeta3 for RV and thyroid hormone are discrete and activate ERK1/2-dependent downstream effects on apoptosis that are distinctive.