Stories of a water-table: anomalous depressions, aquitard breaches and seasonal implications, Shelby County, Tennessee, USA.

An extensive water level survey of the water-table aquifer (i.e., shallow aquifer) within Shelby County, Tennessee, was conducted in the dry (fall 2020) and wet (spring 2021) seasons. Water-table surfaces were generated using cokriging to observe seasonal differences to identify anomalous water-table depressions, indicative of an underlying aquitard breach. Seasonal differences were attributed to non-coincident control and timing between the surveys and when optimum dry (fall) and wet (spring) conditions existed, as observed through comparisons with continuous historical water levels from 12 shallow monitoring wells. Additionally, data from fall 2020 were compared to previous studies in 2005 and 2015 to determine decadal changes in levels and shape of the water-table surface which were mostly attributed to changes in data control and potential climate variations. A prediction error map was generated from the 2020 dataset to identify areas of the county with high-prediction error (>7.0 m) to offer guidance on where future well control would be optimal.

Groundwater well optimization to minimize contaminant movement from a surficial shallow aquifer to a lower water supply aquifer using stochastic simulation-optimization modeling techniques: Strategy formulation.

The interaction between surficial shallow aquifers of poorer quality and semi-confined water-supply aquifers poses a potential risk for degradation of the water supply. Groundwater engineers and hydrogeologists use groundwater models to synthesize field data, conceptualize hydrological processes, and improve understanding of the groundwater system to support informed decision-making. Models for decision-making, called management models, aid in the efficient planning and sustainable management of groundwater systems. Management models search for the best or least-cost management strategy satisfying hydrologic and environmental regulations. In management models, a simulation model is linked or coupled with an optimization formulation. Widely used optimization formulations are linear, non-linear, quadratic, dynamic, and global search models. Management models are applied but are not limited to maximizing withdrawals, minimizing drawdown, pumping costs, and saltwater intrusion, and determining the best locations for production wells. This paper theoretically presents the development of groundwater wellfield management strategies and the corresponding modeling framework for each strategy's evaluation. Depending on the strategy, the modeling effort applies deterministic (simulation) and stochastic (simulation-optimization) techniques. The goals of the optimization strategies are to protect wells from potential contaminant sources, identify optimal future well installation sites, mitigate risks, and extend the life of wells that may face water contamination issues.•Several management strategies are formulated addressing well depth, seasonal pumping operation, and mapping no-drilling or red zones for new well installation.•Modeling methodologies are laid down that apply thousands of numerical simulations for each strategy to simulate and evaluate recurring patterns of contaminant movement.•The simulation model integrates MODFLOW and MODPATH to simulate 3D groundwater flow and advective contaminant movement, respectively and is transferred via FloPy to couple with the optimization/decision model using a custom Python script.

'Lonely in my head': The experiences of loneliness in individuals with brain injury.

PRIMARY OBJECTIVE: This paper reports on the personal experiences of loneliness for individuals living with brain injury. RESEARCH DESIGN: This is a qualitative research design, employing semi-structured interviews and subsequent contextualist thematic analysis. METHODS AND PROCEDURES: Eleven clients (two female and nine male, aged between 27 and 63 years) with brain injury participated in semi-structured interviews. Thematic analysis was employed in the interpretation of the data. MAIN OUTCOMES AND RESULTS: The interview data and subsequent analysis depicted three overarching themes in a healing process - 'Internal Loneliness', 'Healing the Cracks', and 'Visible with Cracks'. Participants described five factors which contribute to their feeling of loneliness: trauma, social isolation, concealment, rejection of part of self, and invisibility of their disability. The participants' accounts also detailed the necessity of a therapeutic intervention and relationship to deal with and address some of these issues. CONCLUSIONS: This study highlights that processing the trauma, developing dialectical thinking, self-compassion, and a degree of self-acceptance assist in the movement of participants towards allowing themselves to be 'Visible with Cracks'. This allowance of self to be fully seen appears to serve an important function for reconnection with self and others. These results may help to inform brain injury rehabilitative care, through developing their understanding of the internal loneliness factors that may be influencing an individual's social isolation or social withdrawal.

Low-level soluble chloride extraction in soil.

Three methods of extraction of low-level soluble chloride contents from vadose-zone soil were evaluated in this study. Three methods were employed on a silty sand soil using a 2:1 fluid:soil ratio: 1) Method A utilized three successive rinses with deionized water; 2) Method B applied three successive rinses of 0.0001 M and 0.001 M Na2SO4 solution; and 3) Method C passed deionized water through the soil with a pressurized filtration system three times. Method A had lower standard deviation and yielded more consistent soluble chloride contents per rinse than method C; Method B was ruled out because of concerns that the Na2SO4 reagent contained trace amounts of chloride. Method A was applied with a 1:1 fluid:soil ratio in duplicate to 50 samples from a 34-m thick vadose-zone borehole, yielding a mean difference in duplicates of 13.9% and percent total extracted soluble chloride of 62.4 ± 9.9%, 25.2 ± 7.4%, and 12.4 ± 6.6% in each of the three successive rinses.•Three successive rinses of soil with deionized water achieved consistent extraction results.•Multiple rinses are necessary to extract soluble chloride if chloride contents are low.•This method is amenable to analysis of soil in vadose-zone borehole samples.

Assessing water distribution and agricultural expansion in the Cele Oasis, China.

Oases support 90% of the province's inhabitants and produce more than 95% of the social wealth in Xinjiang Province of China. Oases' dependency on water availability from mountainous regions plays a critical factor in the sustainability of agricultural practices and oasis expansion. In this study, we have chosen the Cele Oasis located in the south rim of the Taklimakan Desert, typical of oases in the region, as a case study to examine water availability. With over 97% of Cele's economy tied to agriculture, unfettered expansion of the oasis into the desert has raised concern on water availability. A spatial and temporal analysis of water availability is performed using newly available data to determine whether agricultural production within the Cele Oasis has overexploited available water resources or if feasible expansion of agricultural production is feasible beyond its current boundary. Transferability of the methodology for assessing water availability spatially and temporally will be beneficial to other oases in the arid region that face similar concerns.

Attempted suicide leading to acquired brain injury: a scoping review.

Objective: Conduct a scoping review of literature surrounding acquired brain injury (ABI) sustained secondary to a suicide attempt to establish the current body of research on injury outcomes and rehabilitative needs for this population.Methods: A systematic search of the literature was conducted. Searches were conducted using terms relating to this injury etiology and search results with original or secondary data on individuals with an ABI were included for review.Results: Thirty-two articles were reviewed. Limited data characterizing this population exists in the literature. Findings indicate that this population have generally poorer injury outcomes compared with ABI sustained through other means. Rehabilitative needs are rarely addressed, but limited commentary suggests that extensive pre-morbid conditions, severity of injuries and psychosocial support needs of this population present implications for rehabilitative supports.Conclusion: There is a relative dearth of research examining ABI sustained secondary to a suicide attempt. Collated findings suggest these individuals are rarely recognized in the literature as a distinct ABI population with rehabilitative needs specific to this etiology. Future research should aim to address the gaps identified in the literature, including characterizing the population, establishing pre-morbid conditions and developing tailored rehabilitative support to address complex needs.

Emergency surgery in octogenarians: Outcomes and factors affecting mortality in the general hospital setting.

AIM: The Western world has an expanding older population, who are living longer with increasing numbers of comorbidities. In addition, expectations of patients and relatives are increasing. As a general hospital operating in a rural setting, our University Hospital Kerry, Tralee, Ireland, deals with a significant number of emergency presentations to the acute surgical service. The aim of the present study was to examine outcomes for patients in the extremes of age who present requiring emergency surgical procedures. METHODS: A retrospective review of theater and admission logs was carried out to identify all emergency surgeries from January 2008 to December 2015. All patients aged >80 years at the time of surgery were identified. Details of surgery were recorded, in addition to biochemical and hematological data, use of intensive care unit, length of stay and mortality. RESULTS: In total, 128 octogenarians underwent an emergency surgery. The average patient age was 84.3 years (range 80-94 years). The commonest procedures were laparotomy (65%, n = 84), repair of strangulated/incarcerated hernia (18%, n = 23) and laparoscopic procedures (16%, n = 21). The 30-day all-cause mortality was 22.6%. On multivariate analysis, American Society of Anesthesia status and intensive care unit utilization predicted mortality (P = 0.04 and 0.05, respectively). A total of 82 patients required intensive care unit admission, with an average length of stay of 4.8 days, using 484 bed days in total. CONCLUSIONS: Emergency surgery in octogenarians is a significant part of the workload of general surgeons. Poor baseline status is associated with an increased risk of mortality. Emergency surgery in older adults only utilizes a fraction of available intensive care unit resources. Geriatr Gerontol Int 2018; 18: 1211-1214.

Changes in aspects of social functioning depend upon prior changes in neurodisability in people with acquired brain injury undergoing post-acute neurorehabilitation.

Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the current study was to examine differences in the sequence of attainments for people with acquired brain injury (ABI) undergoing longer term post-acute neurorehabilitation. Participants with ABI who were referred to comprehensive home and community-based neurorehabilitation were assessed at induction to service, at 6 months and again at 1.5 years while still in service on the Mayo-Portland Adaptability Index (MPAI-4), Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and World Health Organisation Quality of Life measure. At 6 months post-induction to service, significant differences were evident in MPAI abilities, adjustment, and total neurodisability; and in anxiety and depression. By contrast, there was no significant effect at 6 months on more socially oriented features of experience namely quality of life (QoL), Community Integration and Participation. Eighteen month follow-up showed continuation of the significant positive effects with the addition of QoL-related to physical health, Psychological health, Social aspects of QoL and Participation at this later time point. Regression analyses demonstrated that change in QoL and Participation were dependent upon prior changes in aspects of neurodisability. Age, severity or type of brain injury did not significantly affect outcome. Results suggest that different constructs may respond to neurorehabilitation at different time points in a dose effect manner, and that change in social aspects of experience may be dependent upon the specific nature of prior neurorehabilitation attainments.

A qualitative exploration of how individuals reconstruct their sense of self following acquired brain injury in comparison with spinal cord injury.

PRIMARY OBJECTIVE: The present study aimed to investigate the specific ways in which individuals reconstruct their sense of self following injury to the nervous system, by comparing individuals with acquired brain injury (ABI) and individuals with spinal cord injury (SCI), two groups that have experienced a sudden-onset injury with life-changing repercussions. RESEARCH DESIGN: Phenomenological qualitative research. METHODS AND PROCEDURES: Nine individuals with ABI and 10 individuals with SCI took part in an interview exploring the ways in which individuals reconstruct their sense of self following injury. Data were analysed using interpretative thematic analysis. MAIN OUTCOMES AND RESULTS: Findings showed similar themes identified within the interview data of the ABI and SCI groups. Both groups developed positive and negative self-narratives. Individuals employed strategies that facilitated the reconstruction of positive self-narratives. In addition, individuals described their sense of self as simultaneously continuous and changing. DISCUSSION: Findings are discussed in relation to proposed models of self-reconstruction post-injury to the nervous system.

Cognitive behavioural therapy for depression and anxiety in adults with acquired brain injury: what works for whom?

This paper reviews treatment outcome studies on cognitive behavioural therapy (CBT) for depression and anxiety following acquired brain injury (ABI), including traumatic brain injury (TBI), cerebral vascular accident (CVA), anoxia and neurosurgery. Studies are included for review when the published paper included an anxiety disorder or depression as the treatment focus, or as part of outcome measurement. Relaxed criteria were used to select studies including relevant single-cases, case series and single group studies along with studies that employed control groups. Twenty-four studies were identified. Twelve papers were of a single-case design (with or without replication). Two papers used uncontrolled single groups and ten studies used a control group. There were a total of 507 people in the various treatment and control groups, which ranged in size from 6 to 67 persons. All participants in the study had an ABI. Our review indicates CBT often shows a within-group pre- to post-treatment statistical difference for depression and anxiety problems, or a statistical difference between CBT-treated and non-treated groups. For studies that targeted the treatment of depression with CBT, effect-sizes ranged from 0 to 2.39 with an average effect-size of 1.15 for depression (large effect). For studies that targeted the treatment of anxiety with CBT, effect-sizes ranged from 0 to 3.47 with an average effect-size of 1.04 for anxiety (large effect). However, it was not possible to submit all twenty-four studies identified to effect-size analysis. Additionally, it is clear that CBT is not a panacea, as studies frequently indicate only partial reduction in anxiety and depression symptoms. This review suggests that if CBT is aimed at, for example, anger management or coping, it can be effective for anger or coping, but will not generalise to have an effect on anxiety or depression. CBT interventions that target anxiety and depression specifically appear to generate better therapeutic effects on anxiety and depression. Gaps in the literature are highlighted with suggestions for future research.

Family planning and inflammatory bowel disease: the patient and the practitioner.

BACKGROUND: Patients with inflammatory bowel disease (IBD) are commonly in their child-bearing years. Maintainance medication, as recommended by international guidelines, is an emotive topic and an anxiety source. This study measures the awareness of patients and primary practitioners of the issues involved. METHODS: A prospective questionnaire was sent to female patients (18-50 years) with an IBD diagnosis in Kerry General Hospital, Ireland, who were identified from radiology and pathology databases. A seperate questionnaire was sent to General Practitioners (GPs) in the region. RESULTS: About 31 female patients (42%) and 49 GPs (43%) returned completed questionnaires. About 29% had Crohn's disease and 71% ulcerative colitis. A total of 42% of patients would allow having IBD or its treatment to influence decisions about family planning. Most patients were on maintainance medications. Despite this, 68% had not discussed family planning with a doctor. One-third believed all medications should be stopped during pregnancy and 68% reported significant anxiety about future pregnancies. A total of 68% GPs report regular contact with IBD patients, but consultations with pregnant IBD patients are less frequent. About 41% of GPs have not opportunistically raised family planning with this patient group and 67% would refer to a tertiary specialist for advice. About 2% of GP's had need to research the topic in the last 12 months. CONCLUSIONS: There is a significant patient knowledge deficit about pregnancy and IBD resulting in unwarranted fears and anxiety. Further evidence based education for GP's with increased gastroenterologist/IBD nurse specialist support should maximize exploitation of health promotion opportunities to electively address this issue.

Gastric cancer-related information on the Internet: incomplete, poorly accessible, and overly commercial.

BACKGROUND: Patients increasingly use the Internet for gastric cancer information. However, the quality of the information is questionable. We evaluated the accuracy, completeness, accessibility, reliability, and readability of gastric cancer websites. METHODS: The Internet was searched for the terms "gastric cancer" or "stomach cancer" using general search engines. Websites were evaluated for completeness (CS) and accuracy (AS) using predefined quality appraisal instruments (QAIs), reliability using an integrity score (IS), readability using the Flesch-Kincaid (FK) grade level, and accessibility using automated accessibility appraisal tools. Site sponsor and the presence of quality labels were noted. RESULTS: Fifty-one websites were evaluated. The mean CS was 100.3 (SD ±44.9), AS was 107.22 (SD ±47.9), IS was 15.3 (SD ±3.7), and the mean readability grade level was 10.4 (SD ±2.5). Only 5 websites had the minimum mandatory basic accessibility. Commercial sites and sites with quality labels had significantly more accessibility violations. CONCLUSIONS: Internet gastric cancer information is overtly commercial, generally incomplete, and poorly accessible.

Critical role for transient receptor potential channel TRPM4 in myogenic constriction of cerebral arteries.

Local control of cerebral blood flow is regulated in part through myogenic constriction of resistance arteries. Although this response requires Ca2+ influx via voltage-dependent Ca2+ channels secondary to smooth muscle cell depolarization, the mechanisms responsible for alteration of vascular smooth muscle (VSM) cell membrane potential are not fully understood. A previous study from our laboratory demonstrated a critical role for a member of the transient receptor potential (TRP) superfamily of ion channels, TRPC6, in this response. Several other of the approximately 22 identified TRP proteins are also present in cerebral arteries, but their functions have not been elucidated. Two of these channels, TRPM4 and TRPM5, exhibit biophysical properties that are consistent with a role for control of membrane potential of excitable cells. We hypothesized that TRPM4/TRPM5-dependent currents contribute to myogenic vasoconstriction of cerebral arteries. Cation channels with unitary conductance, ion selectivity and Ca2+-dependence similar to those of cloned TRPM4 and TRPM5 were present in freshly isolated VSM cells. We found that TRPM4 mRNA was detected in both whole cerebral arteries and in isolated VSM cells whereas TRPM5 message was absent from cerebral artery myocytes. We also found that pressure-induced smooth muscle cell depolarization was attenuated in isolated cerebral arteries treated with TRPM4 antisense oligodeoxynucleotides to downregulate channel subunit expression. In agreement with these data, myogenic vasoconstriction of intact cerebral arteries administered TRPM4 antisense was attenuated compared with controls, whereas KCl-induced constriction did not differ between groups. We concluded that activation of TRPM4-dependent currents contributed to myogenic vasoconstriction of cerebral arteries.