Flood resilience, amenity and biodiversity benefits of an historic urban pond.

The main pond within the historic Royal Botanic Garden Edinburgh is an important component of urban blue-green infrastructure. This paper reports on flood resilience provided by the pond (simulated using the CityCAT hydrodynamic model), its water residence times (obtained using the Shetran hydrological model), and the ecology and biodiversity (vascular plants, bryophytes, aquatic invertebrates, phyto- and zooplankton, birds) of the pond and the adjacent area. The results show that the pond improves the flood resilience with at least a 27% reduction in the peak discharge during a 1 h, one in 100-year event. The area represents a biodiversity hot spot with a range of native taxa occurring among introduced plant species. The plankton community is dominated by diatoms, reflecting elevated levels of turbulence and a relatively short residence time, with an average value of 10 days. Analysis of macroinvertebrate community indicates a potential for water quality improvement. The results are discussed in relation to multiple societal benefits related to flood resilience, recreation, education, water quality, amenity and biodiversity value. The conclusions may prove particularly valuable for introducing practical measures in the water catchment, preventing waterlogging of the soil and ensuring an uninterrupted supply of public services. This article is part of the theme issue 'Urban flood resilience'.

The best management of SuDS treatment trains: a holistic approach.

The use of Sustainable Drainage Systems (SuDS) or Best Management Practice (BMP) is becoming increasingly common. However, rather than adopting the preferred "treatment train" implementation, many developments opt for end of pipe control ponds. This paper discusses the use of SuDS in series to form treatment trains and compares their potential performance and effectiveness with end of pipe solutions. Land-use, site and catchment characteristics have been used alongside up-to-date guidance, Infoworks CS and MUSIC to determine whole-life-costs, land-take, water quality and water quantity for different SuDS combinations. The results presented show that the use of a treatment train allows approaches differing from the traditional use of single SuDS, either source or "end of pipe", to be proposed to treat and attenuate runoff. The outcome is a more flexible solution where the footprint allocated to SuDS, costs and water quality can be managed differently to satisfy more efficiently the holistically stakeholders' objectives.

Including public perception data in the evaluation of the consequences of sewerage derived urban flooding.

This text reports research which was undertaken to assess the failure consequences associated with sewerage systems. In an effort to move away from considering only flood volume, depth or extent, the text will focus on how a survey of public opinion was used to inform the development of a consequence scoring methodology. The failure consequences considered range from internal flooding of properties, to road closure, environmental damage and odour problems. The text reports the extent to which experience of flooding influences perceptions of failure consequence and sewerage system management. It is also outlined how this data was used, along with other data sources, to construct an objective scoring process that can be used to evaluate failure consequence and readily prioritise sewerage maintenance.

A 25-Year-Old Man with Exudative Retinal Detachments and Infiltrates without Hematological or Neurological Findings Found to Have Relapsed Precursor T-Cell Acute Lymphoblastic Leukemia.

BACKGROUND: Precursor T-cell acute lymphoblastic leukemia (pre-T-ALL) may cause ocular pathologies such as cotton-wool spots, retinal hemorrhage, and less commonly, retinal detachment or leukemic infiltration of the retina itself. However, these findings are typically accompanied by the pathognomonic hematological signs of acute leukemia. CASE PRESENTATION: In this case report and review of the literature, we describe a particularly unusual case of a 25-year-old man who presented to our hospital with bilateral exudative retinal detachments associated with posterior pole thickening without any hematological or neurological findings. The patient, who had a history of previously treated pre-T-ALL in complete remission, was found to have leukemia cell infiltration on retinal biopsy. CONCLUSION: Our case underscores the fact that the ophthalmologist may be the first provider to detect the relapse of previously treated leukemia, and that ophthalmic evaluation is critical for detecting malignant ocular infiltrates.

A prospective questionnaire study in 100 healthy sleepers: non-bothersome forms of recognizable sleep disorders are still present.

STUDY OBJECTIVES: Despite several polysomnographic normative studies and multiple surveys of sleep disorders in the general population, few data have been collected on healthy sleepers. We aimed to survey the characteristics of healthy sleep. METHODS: We prospectively investigated the sleep history of 100 subjects of a representative population sample who reported undisturbed sleep and in whom relevant sleep disorders were ruled out by a two-step screening procedure. Approximately four subjects had to be contacted for identifying 1 eligible subject who participated. RESULTS: The median reported time in bed was from 23:00 (21:30-02:00) to 07:00 (05:30-11:00). The total sleep duration was 7.3 h (5-10 h), varying from 7.5 h in the age group ≤ 30 years to 7 h in subjects aged 40-60 years and to 8 h in subjects > 60 years (p = 0.002). The median sleep efficiency was high (93.3%, range: 55.6% to 100%). Fifty-one subjects reported occasional snoring. Forty-five subjects reported sporadic non-bothersome sleep-related movement disorders (25 sleep-related leg cramps, 22 lifetime bruxism, 5 restless legs syndrome), and 36 had a history of sporadic non-bothersome parasomnias (27 nightmares, 12 sleepwalking, 1 sleep paralysis). CONCLUSION: In this population of healthy sleepers, snoring is the most common finding. Moreover, non-bothersome forms of recognizable sleep-related movement disorders and parasomnias are surprisingly common. These findings may suggest that diagnostic criteria of sleep disorders should not only be based on the presence of symptoms but also account for a minimum frequency or discomfort.

Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up.

BACKGROUND: The anterior bundle of the ulnar collateral ligament (UCL) is the primary anatomical structure providing elbow stability in overhead sports, particularly baseball. Injury to the UCL in overhead athletes often leads to symptomatic valgus instability that requires surgical treatment. HYPOTHESIS: Ulnar collateral ligament reconstruction with a free tendon graft, known as Tommy John surgery, will allow return to the same competitive level of sports participation in the majority of athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Ulnar collateral reconstruction (1266) or repair (15) was performed in 1281 patients over a 19-year period (1988-2006) using a modification of the Jobe technique. Data were collected prospectively and patients were surveyed retrospectively with a telephone questionnaire to determine outcomes and return to performance at a minimum of 2 years after surgery. RESULTS: Nine hundred forty-two patients were available for a minimum 2-year follow-up (average, 38.4 months; range, 24-130 months). Seven hundred forty-three patients (79%) were contacted for follow-up evaluation and/or completed a questionnaire at an average of 37 months postoperatively. Six hundred seventeen patients (83%) returned to the previous level of competition or higher, including 610 (83%) after reconstruction. The average time from surgery to the initiation of throwing was 4.4 months (range, 2.8-12 months) and the average time to full competition was 11.6 months (range, 3-72 months) after reconstruction. Complications occurred in 148 patients (20%), including 16% considered minor and 4% considered major. CONCLUSION: Ulnar collateral ligament reconstruction with subcutaneous ulnar nerve transposition was found to be effective in correcting valgus elbow instability in the overhead athlete and allowed most athletes (83%) to return to previous or higher level of competition in less than 1 year.

Reconstruction of noncontained proximal tibial defects with divergent screws and cement.

Postoperative fracture is a well described complication following curettage and cementation of aggressive benign bone tumors. We asked whether: (1) the addition of diverging screws that engage the opposite cortex increase the strength and rigidity of the construct in the proximal tibia compared with (a) cement alone and (b) would cement with intramedullary Steinmann pins; and (2) the modes of failure be different for those constructs. The average load to failure for tibias reconstructed with cement augmented with diverging screws (6321 +/- 681 N) was higher than for tibias reconstructed with cement alone (2343 +/- 222 N). The average load to failure for tibias reconstructed with cement augmented with diverging screws (6885 +/- 445 N) was higher than for tibias reconstructed with cement and intramedullary Steinmann pins (5218 +/- 941 N). Furthermore, constructs with cement augmented with diverging screws were less likely to fail by an intraarticular fracture than other types of constructs. Our data support the use of diverging screws that engage the opposite cortex to augment the strength of the construct when using acrylic cement to fill noncontained defects after curettage of the proximal tibia. This more stable, stronger construct might allow earlier mobilization and rehabilitation after curettage, with a decreased risk of fracture.