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Objective: To develop a core outcome set (COS), an agreed minimum set of outcomes to measure and report in all studies evaluating the introduction and evaluation of novel surgical techniques.Summary Background Data: Agreement on the key outcomes to measure and report for safe and efficient surgical innovation is lacking, hindering transparency and risking patient harm.Methods: (I) Generation of a list of outcome domains from published innovation-specific literature, policy/regulatory body documents, and surgeon interviews; (II) Prioritization of identified outcome domains using an international, multi-stakeholder Delphi survey; (III) Consensus meeting to agree the final COS. Participants were international stakeholders, including patients/public, surgeons, device manufacturers, regulators, trialists, methodologists and journal editors.Results: 7,972 verbatim outcomes were identified, categorized into 32 domains, and formatted into survey items/questions. 410 international participants (220 professionals, 190 patients/public) completed at least one round 1 survey item, of which 153 (69.5%) professionals and 116 (61.1%) patients completed at least one round 2 item. 12 outcomes were scored ‘consensus in’ (‘very important’ by ≥70% of patients and professionals) and 20 ‘no consensus’. A consensus meeting, involving 19 professionals and 10 patient/public representatives, led to agreement on a final 8-domain COS. Six domains are specific to a surgical innovation context: modifications, unexpected disadvantages, device problems, technical procedure success, whether the overall desired effect was achieved, surgeons’/operators’ experience. Two domains relate to intended benefits and expected disadvantages.Conclusions: The COS is recommended for use in all studies prior to definitive RCT evaluation to promote safe, transparent, and efficient surgical innovation.

Background The governance for introducing innovative surgical procedures/devices differs from the research requirements needed for new drugs. New invasive procedures/devices may be offered to patients outside of research protocols with local organization oversight alone. Such institutional arrangements exist in many countries and written policies provide guidance for their use, but little is known about their scope or standards. Methods One hundred and fifty acute NHS trusts in England and seven health boards in Wales were systematically approached for information about their policies. A modified framework approach was used to analyse when policies considered new procedures/devices to be within local organization remit and/or requiring research ethics committee (REC) approval. Results Of 113 policies obtained, 109 and 34 described when local organization and REC approval was required, respectively. Procedures/devices being used for the first time in the organization (n = 69) or by a clinician (n = 67) were commonly within local remit, and only 36 stated that evidence was required. Others stated limited evidence as a rationale for needing REC approval (n = 13). External guidance categorizing procedures as ‘research only’ was the most common reason for gaining REC approval (n = 15). Procedures/devices with uncertain outcomes (n = 28), requiring additional training (n = 26), and not previously used (n = 6) were within the remit of policies, while others recommended REC application in these situations (n = 5, 2 and 7, respectively). Conclusion This study on NHS policies for surgical innovation shows variability in the introduction of procedures/devices in terms of local oversight and/or need for REC approval. Current NHS standards allow untested innovations to occur without the safety of research oversight and thus a standard approach is urgently needed.

Drinking water treatment plants (DWTPs) produce wastewaters with elevated concentrations of heavy metals, metalloids, ammonia, and other contaminants. These wastewaters require treatment via processes including wastewater stabilization ponds (WSPs). This study assessed the arsenic (As), iron (Fe), and ammonia (NH3) concentrations in a Saskatchewan DWTP WSP system of five sequential ponds. Drone imaging combined with flow and depth data was used to estimate retention times which increased from 7–9 to 8–10 days after the DWTP upgrade. Concentration trends showed Fe decreased from Pond 1 to 3 and increased in Ponds 3 and 5, while As decreased from Pond 1 to 5. Average effluent As concentrations of 10.6 µg/L were above the 5.0 µg/L guideline, while concentration guidelines for both Fe and NH3 were easily met post-upgrade in 2020. Several actions are recommended to ensure adequate WSP operation including dredging, aeration, and installing macrophytes capable of As uptake.

Summary Accurate and representative determination of greenhouse gases (GHG) from oil and gas (O&G) production facilities requires high-spatial-resolution data, which can be acquired by airborne imaging spectrometers. However, assessment of nonmethane hydrocarbon emissions, which are far less amenable to remote sensing, requires mobile surface in-situ measurements (e.g., a mobile air quality laboratory). Field in-situ measurements and airborne thermal infrared spectral imagery were acquired for three producing California oil fields (Poso Creek, Kern Front, and Kern River) located next to each other on 14 September 2018. In addition, a profile ascending a nearby mountain collected in-situ data for the Round Mountain oilfield. Plume methane to ethane ratios were consistent within different regions of the field and differed between these fields in a manner related to field geological structures. Data acquired by an airborne thermal infrared imaging spectrometer, Mako, in 2015 and 2018 showed most emissions were from distant plumes in the Kern Front and Poso Creek fields. The spatial distribution of detected plumes was strongly related to faults, particularly active faults, which are proposed to stress infrastructure, leading to higher fugitive emissions and/or emissions from natural migration pathways (seepage). Additionally, the spatial distribution of detected plumes suggested unmapped faults. Thus, high-sensitivity imaging spectroscopy can improve understanding of reservoir geological structures that impact hydrocarbon migration and field operations, highlighting the potential for a novel reservoir management tool.

Background Innovative surgical procedures and devices are often modified throughout their development and introduction into clinical practice. A systematic approach to reporting modifications may support shared learning and foster safe and transparent innovation. Definitions of ‘modifications’, and how they are conceptualized and classified so they can be reported and shared effectively, however, are lacking. This study aimed to explore and summarize existing definitions, perceptions, classifications and views on modification reporting to develop a conceptual framework for understanding and reporting modifications. Methods A scoping review was conducted in accordance with PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Targeted searches and two database searches were performed to identify relevant opinion pieces and review articles. Included were articles relating to modifications to surgical procedures/devices. Data regarding definitions, perceptions and classifications of modifications, and views on modification reporting were extracted verbatim. Thematic analysis was undertaken to identify themes, which informed development of the conceptual framework. Results Forty-nine articles were included. Eight articles included systems for classifying modifications, but no articles reported an explicit definition of modifications. Some 13 themes relating to perception of modifications were identified. The derived conceptual framework comprises three overarching components: baseline data about modifications, details about modifications and impact/consequences of modifications. Conclusion A conceptual framework for understanding and reporting modifications that occur during surgical innovation has been developed. This is a first necessary step to support consistent and transparent reporting of modifications, to facilitate shared learning and incremental innovation of surgical procedures/devices. Testing and operationalization is now needed to realize the value of this framework.

Additional file 2. Survey items using multiple choice or ranking. Percentage of participants selecting options.

Additional file 1. Survey items where consensus was not achieved.

ObjectiveTo review guidance, included in written local UK National Health Service (NHS) organisation policies, on information provision and consent for the introduction of new invasive procedures- including surgeries, and devices (IPs/Ds).DesignA qualitative documentary analysis of data on patient information provision and consent extracted from policies for the introduction of IP/Ds from NHS organisations in England and Wales.SettingNHS trusts in England and health boards in Wales, UK.ParticipantsBetween December 2017 and July 2018, 150 acute trusts in England and 7 health boards in Wales were approached for their policies for the introduction of new IP/Ds. In total, 123 policies were received, 11 did not fit the inclusion criteria and a further policy was included from a trust website resulting in 113 policies included for review.ResultsFrom the 113 policies, 22 did not include any statements on informed consent/information provision or lacked guidance on the information to be provided to patients and were hence excluded. Consequently, 91 written local NHS policies were included in the final dataset. Within the guidance obtained, variation existed on disclosure of the procedure’s novelty, potential risks, benefits, uncertainties, alternative treatments and surgeon’s experience. Few policies stated that clinicians should discuss the existing evidence associated with a procedure. Additionally, while the majority of policies referred to patients needing written information, this was often not mandated and few policies specified the information to be included.ConclusionsNearly a fifth of all the policies lacked guidance on information to be provided to patients. There was variability in the policy documents regarding what patients should be told about innovative procedures. Further research is needed to ascertain the information and level of detail appropriate for patients when considering innovative procedures. A core information set including patients’ and clinicians’ views is required to address variability around information provision/consent for innovative procedures.

The spread of SARS-CoV-2 has been studied at unprecedented levels worldwide. In jurisdictions where molecular analysis was performed on large scales, the emergence and competition of numerous SARS-CoV-2 lineages has been observed in near real-time. Lineage identification, traditionally performed from clinical samples, can also be determined by sampling wastewater from sewersheds serving populations of interest. Of particular interest are variants of concern (VOCs), SARS-CoV-2 lineages that are associated with increased transmissibility and/or severity. Here, we consider clinical and wastewater data sources to retrospectively assess the emergence and spread of different VOCs in Canada. We show that, overall, wastewater-based VOC identification provides similar in-sights to the surveillance based on clinical samples. Based on clinical data, we observed a synchrony in VOC introduction as well as similar emergence speeds across most Canadian provinces despite the large geographical size of the country and differences in provincial public health measures. In particular, it took approximately four months for VOC Alpha and Delta to contribute to half of the incidence, whereas VOC Omicron achieved the same contribution in less than one month. By quantifying the timing and rapidity of SARS-CoV-2 VOCs invasion in Canada, this study provides important benchmarks to support preparedness for future VOCs, and to some extent, for future pandemics caused by other pathogens.

We present an electrochemical advanced oxidation process (eAOP) reactor employing expanded graphite, potassium iodide (KI), and electrical current, which demonstrates an exceptionally high rate of ...

Recent findings that 2-anilo-5-[(4-methylpentan-2-yl)amino]cyclohexa-2,5-diene-1,4-dione (6PPD-quinone), the transformation product of a common tire rubber antioxidant, is acutely toxic in stormwat...

Molten salt solutions consisting of eutectic LiCl-KCl and concentrations of samarium chloride (0.5 to 3.0 wt%) at 500℃ were analyzed using both cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The CV technique gave the average diffusion coefficient for Sm3+ over the concentration range. Equipped with Sm3+ diffusion coefficient, the Randles-Sevcik equation predicted Sm3+ concentration values that agree with the given experimental values. From CV measurements; the anodic, cathodic, and half-peak potentials were identified and subsequently used as a parameter to acquire EIS spectra. A six-element Voigt model was used to model the EIS data in terms of resistance-time constant pairs. The lowest resistances were observed at the half-peak potential with the associated resistance-time constant pairs characterizing the reversible reaction between Sm3+ and Sm2+. By extrapolation, the Voigt model estimated the polarization resistance and established a polarization resistance-concentration relationship.

ObjectiveOutcome selection and reporting in studies of novel surgical procedures and devices lacks standardisation, hindering safe and effective evaluation. A core outcome set (COS) to measure and report in all studies of surgical innovation is needed. We explored outcomes in a specific sample of innovative surgical device case studies to identify outcome domains specifically relevant to innovation to inform the development of a COS.DesignA targeted review of 11 purposive selected case studies of innovative surgical devices.MethodsElectronic database searches in PubMed (July 2018) identified publications reporting the introduction and evaluation of each device. Outcomes were extracted and categorised into domains until no new domains were conceptualised. Outcomes specifically relevant to evaluating innovation were further scrutinised.Results112 relevant publications were identified, and 5926 outcomes extracted. Heterogeneity in study type, outcome selection and reporting was observed across surgical devices. Categorisation of outcomes was performed for 2689 (45.4%) outcomes into five broad outcome domains. Outcomes considered key to the evaluation of innovation (n=66; 2.5%) were further categorised as surgeon/operator experience (n=40; 1.5%), unanticipated events (n=15, 0.6%) and modifications (n=11; 0.4%).ConclusionOutcome domains unique to evaluating innovative surgical devices have been identified. Findings have been combined with multiple other data sources relevant to the evaluation of surgical innovation to inform the development of a COS to measure and report in all studies evaluating novel surgical procedures/devices.

Monitoring the communal incidence of COVID-19 is important for both government and residents of an area to make informed decisions. However, continuous reliance on one means of monitoring might not be accurate because of biases introduced by government policies or behaviours of residents. Wastewater surveillance was employed to monitor concentrations of SARS-CoV-2 RNA in raw influent wastewater from wastewater treatment plants serving three Canadian Prairie cities with different population sizes. Data obtained from wastewater are not directly influenced by government regulations or behaviours of individuals. The means of three weekly samples collected using 24 h composite auto-samplers were determined. Viral loads were determined by RT-qPCR, and whole-genome sequencing was used to charaterize variants of concern (VOC). The dominant VOCs in the three cities were the same but with different proportions of sub-lineages. Sub-lineages of Delta were AY.12, AY.25, AY.27 and AY.93 in 2021, while the major sub-lineage of Omicron was BA.1 in January 2022, and BA.2 subsequently became a trace-level sub-variant then the predominant VOC. When each VOC was first detected varied among cities; However, Saskatoon, with the largest population, was always the first to present new VOCs. Viral loads varied among cities, but there was no direct correlation with population size, possibly because of differences in flow regimes. Population is one of the factors that affects trends in onset and development of local outbreaks during the pandemic. This might be due to demography or the fact that larger populations had greater potential for inter- and intra-country migration. Hence, wastewater surveillance data from larger cities can typically be used to indicate what to expect in smaller communities.

Background Surgical innovation can lead to important improvements in patient outcomes. Currently, information and knowledge about novel procedures and devices are disseminated informally and in an unstandardized way (eg, through social media). This can lead to ineffective and inefficient knowledge sharing among surgeons, which can result in the harmful repetition of mistakes and delay in the uptake of promising innovation. Improvements are needed in the way that learning in surgical innovation is shared through the development of novel, real-time methods, informed by a contemporary and comprehensive investigation of existing methods. Objective The aim of this scoping review is to explore the application of existing digital methods for training/education and feedback to surgeons in the context of performing invasive surgical procedures. This work will (1) summarize existing methods for shared learning in surgery and how they are characterized and operationalized, (2) examine the impact of their application, and (3) explore their benefits and barriers to implementation. The findings of this scoping review will inform the development of novel, real-time methods to optimize shared learning in surgical innovation. Methods This study will adhere to the recommended guidelines for conducting scoping reviews. A total of 6 different searches will be conducted within multiple sources (2 electronic databases, journals, social media, gray literature, commercial websites, and snowball searches) to comprehensively identify relevant articles and data. Searches will be limited to articles published in the English language within the last 5 years. Wherever possible, a 2-stage study selection process will be followed whereby the eligibility of articles will be assessed through the title, abstract, and full-text screening independently by 2 reviewers. Inclusion criteria will be articles providing data on (1) fully qualified theater staff involved in performing invasive procedures, (2) one or more methods for shared learning (ie, digital means for training/education and feedback), and (3) qualitative or quantitative evaluations of this method. Data will be extracted (10% double data extraction by an independent reviewer) into a piloted proforma and analyzed using descriptive statistics, narrative summaries, and principles of thematic analysis. Results The study commenced in October 2021 and is planned to be completed in 2023. To date, systematic searches were applied to 2 electronic databases (MEDLINE and Web of Science) and returned a total of 10,093 records. The results of this scoping review will be published as open access in a peer-reviewed journal. Conclusions This scoping review of methods for shared learning in surgery is, to our knowledge, the most comprehensive and up-to-date investigation that maps current information on this topic. Ultimately, efficient and effective sharing of information and knowledge of novel procedures and devices has the potential to optimize the evaluation of early-phase surgical research and reduce harmful innovation. International Registered Report Identifier (IRRID) PRR1-10.2196/37544

BACKGROUND Surgical innovation can lead to important improvements in patient outcomes. Currently, information and knowledge about novel procedures and devices is disseminated informally and in an unstandardized way (e.g., through social media). This can lead to ineffective and inefficient sharing of learning amongst surgeons, which can result in harmful repetition of mistakes and delay in the uptake of promising innovation. Improvements are needed in the way that learning in surgical innovation is shared through development of novel, real-time, informed by contemporary and comprehensive investigation of existing methods. OBJECTIVE The aim of this scoping review is to explore the application of existing digital methods for training/education and feedback to surgeons in the context of performing invasive surgical procedures. This work will: (i) summarize existing methods for shared learning in surgery and how they are characterized and operationalized, (ii) examine the impact of their application, and (iii) explore their benefits and barriers to implementation. The findings of this scoping review will inform the development of novel, real-time methods to optimize shared learning in surgical innovation. METHODS This study will adhere to recommended guidance for conducting scoping reviews. A total of six different searches will be conducted within multiple sources (two electronic databases, journals, social media, grey literature, commercial websites, and snowball searches) to comprehensively identify relevant articles and data. Searches will be limited to articles published in English language within the last five years. Wherever possible, a two-stage study selection process will be followed whereby eligibility of articles will be assessed through title/abstract, and full-text screening independently by two reviewers. Inclusion criteria will be articles providing data on: (i) fully qualified theatre staff involved in performing invasive procedures, (ii) one or more methods for shared learning (i.e., digital means for training/education and feedback), and (iii) qualitative or quantitative evaluations of this method. Data will be extracted (10% double data extraction by an independent reviewer) into a piloted proforma and analyzed using descriptive statistics, narrative summaries and principles of thematic analysis. RESULTS The study commenced in October 2021 and is planned to be completed in 2022. To date, systematic searches were applied to two electronic databases (Medline, Web of Science) and returned a total of 6,994 records. The results of this scoping review will be published as open access in a peer-reviewed journal. CONCLUSIONS This scoping review of methods for shared learning in surgery is, to our knowledge, the most comprehensive and up-to-date investigation that maps the current information on this topic. Ultimately, efficient and effective sharing of information and knowledge of novel procedures and devices has the potential to optimize evaluation of early phase surgical research and reduce harmful innovation. CLINICALTRIAL n/a

Objective\ud \ud To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making.\ud \ud \ud \ud Patients and Methods\ud \ud Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores.\ud \ud \ud \ud Results\ud \ud Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P

IntroductionThe development of innovative invasive procedures and devices are essential to improving outcomes in healthcare. However, how these are introduced into practice has not been studied in detail. The Lotus study will follow a wide range of ‘case studies’ of new procedures and/or devices being introduced into NHS trusts to explore what information is communicated to patients, how procedures are modified over time and how outcomes are selected and reported.Methods and analysisThis qualitative study will use ethnographic approaches to investigate how new invasive procedures and/or devices are introduced. Consultations in which the innovation is discussed will be audio-recorded to understand information provision practice. To understand if and how procedures evolve, they will be video recorded and non-participant observations will be conducted. Post-operative interviews will be conducted with the innovating team and patients who are eligible for the intervention. Audio-recordings will be audio-recorded, transcribed verbatim and analysed thematically using constant comparison techniques. Video-recordings will be reviewed to deconstruct procedures into key components and document how the procedure evolves. Comparisons will be made between the different data sources.Ethics and disseminationThe study protocol has Health Research Authority (HRA) and Health and Care Research Wales approval (Ref 18/SW/0277). Results will be disseminated at appropriate conferences and will be published in peer-reviewed journals. The findings of this study will provide a better understanding of how innovative invasive procedures and/or devices are introduced into practice.

Background: Well-designed surgical registries are essential for high-quality patient centred evaluation of implantable devices and surgical procedures. The importance of registries was highlighted in the recent Cumberlege report that detailed important innovation failures such as the use of vaginal mesh. Many surgical registries exist, but it is currently unclear how different registries are funded, governed, designed, and how their databases are hosted and utilised. There is therefore a need to understand the variation and characteristics of existing surgical registries to identify limitations and make recommendations for improvement. This work aims to understand the characteristics and heterogeneity in the design, governance, and function of existing surgical registries in the United Kingdom (UK).Methods: Existing surgical registries will be identified using multiple data sources including surgical society websites; search engine review; a targeted search of the Medline and Embase databases and expert knowledge. The data identified were reviewed following the synthesis without meta-analysis (SWiM) methodology. This information will be gathered from sources in the public domain only to fully understand registry transparency for professionals and the public. Details of each registry including disease area/condition/device evaluated; types of outcomes collected; governance, consent, and oversight; linkage to other datasets and funding will be extracted using a standardised data extraction tool. Characteristics of identified registries will be summarised into a narrative review.Dissemination: Findings will be presented at national and international conferences and published in peer-reviewed journals. Results will be presented to key stakeholders including surgeons, methodologists, trialists, regulators, data managers and patients to provide an up-to-date description of the current state of surgical registries in the UK. This work will inform a consensus process to agree how the design of new and existing registries can be optimised to support high quality research to benefit patients and the NHS.Highlights: Well-designed surgical registries are essential for high-quality patient centred evaluation of implantable devices and surgical proceduresPresently there is limited understanding on how these registries are designed, governed, what data they collect and how this data is utilised for research.This review aims to map the landscape of surgical registries in the UK, and understand how they are optimised for research.

Background Stormwater is water resulting from precipitation events and snowmelt running off the urban landscape, collecting in storm sewers, and typically being released into receiving water bodies through outfalls with minimal to no treatment. Despite a growing body of evidence observing its deleterious pollution impacts, stormwater management and treatment in cold climates remains limited, partly due to a lack of quality and loading data and modeling parameters. This study examines the quality of stormwater discharging during the summer season in a cold-climate, semi-arid Canadian city (Saskatoon, Saskatchewan). Results Seven stormwater outfalls with mixed-land-use urban catchments > 100 km2 were sampled for four summer (June–August 2019) storm events and analyzed for a suite of quality parameters, including total suspended solids (TSS), chemical oxygen demand (COD), dissolved organic carbon (DOC), metals, and targeted polyaromatic hydrocarbons (PAHs). In addition, assessment of stormwater toxicity was done using the two toxicity assays Raphidocelis subcapitata (algae) and Vibrio fischeri (bacteria). Notable single-event, single-outfall contaminant pulses included of arsenic (420 µg/L), cadmium (16.4 µg/L), zinc (924 µg/L), fluorene (4.95 µg/L), benzo[a]pyrene (0.949 µg/L), pyrene (0.934 µg/L), phenanthrene (1.39 µg/L), and anthracene (1.40 µg/L). The IC50 in both R. subcapitata and V. fischeri was observed, if at all, above expected toxicity thresholds for individual contaminant species. Principal component analysis (PCA) showed no clear trends for individual sampling sites or sampling dates. In contrast, parameters were correlated with each other in groups including DOC, COD, TSS, and reduced algal toxicity; and total dissolved solids (TDS), sum of metals, and pH. Conclusions In general, stormwater characteristics were similar to those of previous studies, with a bulk of contamination carried by the first volume of runoff, influenced by a combination of rainfall depth, antecedent dry period, land use, and activity within the catchment. Roads, highways, and industrial areas contribute the bulk of estimated contaminant loadings. More intensive sampling strategies are necessary to contextualize stormwater data in the context of contaminant and runoff volume peaks.

Stormwater results from precipitation events and melting snow running off urban landscapes and typically being released into receiving water bodies with little to no treatment. Despite evidence of its deleterious impacts, snowmelt (SM) management and treatment are limited, partly due to a lack of quality and loading data. This study examines snowmelt quality during the spring for a cold-climate, semi-arid Canadian city (Saskatoon, Saskatchewan). Four snow storage facilities receiving urban snow plowed from roads in mixed-land-use urban catchments (228 km2) were sampled including snow piles (five events) and SM (twelve events) runoff in 2019 and 2020. Samples were analyzed for pH, EC, TDS, TSS, COD, DOC, metals, chloride, PAHs, and Raphidocelis subcapitata and Vibrio fischeri toxicity. Notable event-specific TSS spikes occurred on April 13th, 2019 (3,513 mg/L) and April 24th, 2019 (3,838 mg/L), and TDS, chloride, and manganese on March 26th, 2020 (15,000 mg/L, 5,800 mg/L, 574 mg/L), April 17th, 2020 (5,200 mg/L, 2,600 mg/L, 882 mg/L), and April 23rd, 2020 (5,110 mg/L, 2,900 mg/L, 919 mg/L), though chloride remained elevated through May 1st, 2020 samples (1,000 mg/L). Additionally, at two sites sampled April 13th, 2019 pulses of aluminum (401 mg/L) and PAHs (pyrene, phenanthrene, anthracene; 71 µg/L, 317 µg/L, 182 µg/L) were detected. The EC50 for R. subcapitata and V. fischeri was observed, if at all, above expected toxicity thresholds.

Background Video-assisted thoracoscopic surgery (VATS) approaches are increasingly used in lung cancer surgery, but little is known about their impact on patients’ health-related quality of life (HRQL). This prospective study measured recovery and HRQL in the year after VATS for non-small cell lung cancer (NSCLC) and explored the feasibility of HRQL data collection in patients undergoing VATS or open lung resection. Patients and Methods Consecutive patients referred for surgical assessment (VATS or open surgery) for proven/suspected NSCLC completed HRQL and fatigue assessments before and 1, 3, 6 and 12 months post-surgery. Mean HRQL scores were calculated for patients who underwent VATS (segmental, wedge or lobectomy resection). Paired t-tests compared mean HRQL between baseline and expected worst (1 month), early (3 months) and longer-term (12 months) recovery time points. Results A total of 92 patients received VATS, and 18 open surgery. Questionnaire response rates were high (pre-surgery 96–100%; follow-up 67–85%). Pre-surgery, VATS patients reported mostly high (good) functional health scores [(European Organisation for Research and Treatment of Cancer) EORTC function scores > 80] and low (mild) symptom scores (EORTC symptom scores Conclusions Lung resection has a considerable detrimental impact on patients’ HRQL that is not fully resolved 12 months post-surgery, despite a VATS approach. Graphic Abstract

Electrochemical and kinetic properties of samarium (Sm) in LiCl–KCl eutectic salt were investigated at various concentrations and temperatures. Cyclic voltammetry (CV) were performed to determine diffusion coefficient and the rate constant (k0). In addition, electrochemical impedance spectroscopy (EIS) was conducted for further understandings on the kinetic behaviors of Sm(III)/Sm(II) couple. The values of the diffusion coefficients were in the range of 3.54 × 10−6 to 9.58 × 10−5 cm2 s−1 and the values of k0 were estimated to be in the range of 0.63 × 10−2 to 1.11 × 10−2 cm s−1. The values of i0 for Sm(III)/Sm(II) were computed by obtaining the charge transfer resistance from the curve fitting analysis, ranging from 1.04 × 10−3 to 2.97 × 10−3 A cm−2.

Background RCTs in surgery are challenging owing to well established methodological issues. Well designed pilot and feasibility studies (PFS) may help overcome such issues to inform successful main trial design and conduct. This study aimed to analyse protocols of UK-funded studies to explore current use of PFS in surgery and identify areas for practice improvement. Methods PFS of surgical interventions funded by UK National Institute for Health Research programmes from 2005 to 2015 were identified, and original study protocols and associated publications sourced. Data extracted included study design characteristics, reasons for performing the work including perceived uncertainties around conducting a definitive main trial, and whether the studies had been published. Results Thirty-five surgical studies were identified, of which 29 were randomized, and over half (15 of 29) included additional methodological components (such as qualitative work examining recruitment, and participant surveys studying current interventions). Most studies focused on uncertainties around recruitment (32 of 35), with far fewer tackling uncertainties specific to surgery, such as intervention stability, implementation or delivery (10 of 35). Only half (19 of 35) had made their results available publicly, to date. Conclusion The full potential of pretrial work to inform and optimize definitive surgical studies is not being realized.

The application of biological sulfate reduction technologies have an excellent potential for removing arsenic from groundwater, acid mine drainage, and sediments, among other matrices. Under sulfate reducing conditions, arsenic can be removed from waters by precipitating as an orpiment-like phase (As2S3), a realgar-like phase (AsS) or an arsenopyrite-like phase (FeAsS). Alternatively, it can be removed by adsorption onto a biogenic mackinawite-like phase (FeS), greigite-like phase (Fe3S4) and pyrite-like phase (FeS2) in the presence of iron. There has been a recent interest for studies exploring sulfate reducing conditions for arsenic removal given its numerous advantages over other technologies; however, we found that these studies have not been independently reviewed with emphasis on process fundamentals and their relationship to the performance in applications for arsenic removal. This review paper presents a summary of 32 research studies on the treatment of arsenic using sulfate reducing bacteria (SRB). Overall, these studies have generally focused on treatment of groundwater (13 in total), acid mine drainage (8 in total), and various other matrices (11 in total) with the majority of experimental work typically being conducted in laboratory-based bioreactors including batch reactors and continuous flow reactors. This paper presents an assessment of these study applications in various fields; a background on arsenic tolerant SRBs; discussion on carbon sources used to promote growth and metabolism of SRBs; fundamentals of SRB metabolism; factors impacting bioremediation including arsenic concentrations, heavy metals, hydrogen sulfide, pH, and volatilization; and challenges that remain for successful arsenic bioremediation in the future.

Selenium (Se) has become an increasingly serious water contamination concern worldwide. It is an essential micronutrient for humans and animals, however, can be extremely toxic if taken in excess. Sorption can be an effective treatment for Se removal from a wide range of water matrices. However, despite the synthesis and application of numerous adsorbents for remediation of aqueous Se, there has been no comprehensive review of the sorption capacities of various natural and synthesized sorbents. Herein, literature from 2010 to 2021 considering Se remediation using 112 adsorbents has been critically reviewed and presented in several comprehensive tables including: clay minerals and waste materials (presented in Table 1); zero-valent iron, iron oxides, and binary iron-based adsorbents (Table 2); other metals-based adsorbents (Table 3); carbon-based adsorbents (Table 4); and other adsorbents (Table 5). Each of these tables, and their relevant sections, summarizes preparation/modification methods, sorption capacities of various Se adsorbents, and proposed model/mechanisms of adsorption. Furthermore, future perspectives have been provided to assist in filling noted research gaps for the development of efficient Se adsorbents for real-world applications. This review will help in preliminary screening of various sorbent media to set up Se treatment technologies for a variety of end-users worldwide.

ObjectivesCOVID-19 presents a risk of infection and transmission for operating theatre teams. Guidelines to protect patients and staff emerged and changed rapidly based on expert opinion and limited evidence. This paper presents the experiences and innovations developed by international surgical teams during the early stages of the pandemic to attempt to mitigate risk.DesignIn-depth, semistructured interviews were audio recorded, transcribed and analysed thematically using methods of constant comparison.Participants43 participants, including surgeons from a range of specialties (primarily general surgery, otolaryngology, neurosurgery, cardiothoracic and ophthalmology), anaesthetists and those in nursing roles.SettingThe UK, Italy, Spain, the USA, China and New Zealand between March and May 2020.ResultsSurgical teams sought to mitigate COVID-19 risks by modifying their current practice with an abundance of strategies and innovations. Communication and teamwork played an integral role in how teams adapted, although participants reflected on the challenges of having to improvise in real time. Uncertainties remained about optimal surgical practice and there were significant tensions where teams were forced to balance what was best for patients while contemplating their own safety.ConclusionsThe perceptions of risks during a pandemic such as COVID-19 can be complex and context dependent. Management of these risks in surgery must be driven by evidence‐based practice resulting from a pragmatic and novel approach to collation of global evidence. The context of surgery has changed dramatically, and surgical teams have developed a plethora of innovations. There is an urgent need for high-quality evidence to inform surgical practice that optimises the safety of both patients and healthcare professionals as the COVID-19 pandemic unfolds.

Greenhouse gas (GHG) emissions including carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) created via wastewater treatment processes are not easily modeled given the non-linearity and complexity of biological processes. These factors are also impacted by limited data availability making the development of artificial data generation algorithms, such as a generative adversarial network (GAN), useful for determination of GHG emission rate estimates (EREs). The main objective of this study was to develop a hybrid approach of using GAN and regression modelling to determine GHG EREs from a cold-region biological nutrient removal (BNR) municipal wastewater treatment plant (MWTP) in which the aerobic reactor has previously been established as the main GHG emission source. To our knowledge, this is the first application of GAN used for MWTP modelling purposes. The EREs were generated from laboratory-scale reactors used in conjunction with facility-monitored operating parameters to develop the GAN and regression models. Results showed that regression models provided reasonable EREs using parameters including hydraulic retention time (HRT), temperature, total organic carbon, and dissolved oxygen (DO) concentrations for CO2 EREs; HRT, temperature, DO and phosphate (PO43−) concentrations for CH4 EREs; and temperature, DO, and nitrogen (nitrite, nitrate, and ammonium) concentrations for N2O EREs. Additionally, the addition of 100 GAN-created virtual data points improved regression model metrics including increased correlation coefficient and index agreement values, and decreased root mean square error values. Clearly, virtual data augmentation using GAN is a valuable resource in supplementation of limited data for improved modelling outcomes. Genetic algorithm optimization was also used to determine operating parameter modifications resulting in potential for minimization (or maximization) of GHG emissions.

Anaerobic digestion processes create biogases that can be useful sources of energy. The development of data-driven models of anaerobic digestion processes via operating parameters can lead to increased biogas production rates, resulting in greater energy production, through process modification and optimization. This study assessed processed and unprocessed input operating parameter variables for the development of regression models with transparent structures (‘white-box’ models) to: (1) estimate biogas production rates from municipal wastewater treatment plant (MWTP) anaerobic digestors; (2) compare their performances to artificial neural network (ANN) and adaptive network-based fuzzy inference system (ANFIS) models with opaque structures (‘black-box’ models) using Monte Carlo Simulation for uncertainty analysis; and (3) integrate the models with a genetic algorithm (GA) to optimize operating parameters for maximization of MWTP biogas production rates. The input variables were anaerobic digestion operating parameters from a MWTP including volatile fatty acids, total/fixed/volatile solids, pH, and inflow rate, which were processed via correlation tests and principal component analysis. Overall, the results indicated that the processed data did not improve regression model performances. Additionally, the developed non-linear regression model with the unprocessed inputs had the best performance based on values including R = 0.81, RMSE = 0.95, and IA = 0.89. However, this model was less accurate, but interestingly had less uncertainty, as compared to ANN and ANFIS models which indicates the compromise between model accuracy and uncertainty. Thus, all three models were coupled with GA optimization with maximum biogas production rate estimates of 22.0, 23.1, and 28.6 m3/min for ANN, ANFIS, and non-linear regression models, respectively.

Remote sensing techniques offer significant potential for generating accurate thick oil slick maps critical for marine oil spill response. However, field validation and methodology assessment challenges remain. Here, we report on an approach to leveraging oil emissions from the Coal Oil Point (COP) natural marine hydrocarbon seepage offshore of southern California, where prolific oil seepage produces thick oil slicks stretching many kilometers. Specifically, we demonstrate and validate a remote sensing approach as part of the Seep Assessment Study (SAS). Thick oil is sufficient for effective mitigation strategies and is set at 0.15 mm. The brightness temperature of thick oil, TBO, is warmer than oil-free seawater, TBW, allowing segregation of oil from seawater. High spatial-resolution airborne thermal and visible slick imagery were acquired as part of the SAS; including along-slick “streamer” surveys and cross-slick calibration surveys. Several cross-slick survey-imaged short oil slick segments that were collected by a customized harbor oil skimmer; termed “collects”. The brightness temperature contrast, ΔTB (TBO − TBW), for oil pixels (based on a semi-supervised classification of oil pixels) and oil thickness, h, from collected oil for each collect provided the empirical calibration of ΔTB(h). The TB probability distributions provided TBO and TBW, whereas a spatial model of TBW provided ΔTB for the streamer analysis. Complicating TBW was the fact that streamers were located at current shears where two water masses intersect, leading to a TB discontinuity at the slick. This current shear arose from a persistent eddy down current of the COP that provides critical steering of oil slicks from the Coal Oil Point. The total floating thick oil in a streamer observed on 23 May and a streamer observed on 25 May 2016 was estimated at 311 (2.3 bbl) and 2671 kg (20 bbl) with mean linear floating oil 0.14 and 2.4 kg m−1 with uncertainties by Monte Carlo simulations of 25% and 7%, respectively. Based on typical currents, the average of these two streamers corresponds to 265 g s−1 (~200 bbl day−1) in a range of 60–340 bbl day−1, with significant short-term temporal variability that suggests slug flow for the seep oil emissions. Given that there are typically four or five streamers, these data are consistent with field emissions that are higher than the literature estimates.

We present an electrochemical advanced oxidation process (eAOP) reactor employing expanded graphite, potassium iodide (KI), and electrical current, which demonstrates an exceptionally high rate of inactivation of E. coli (6log reduction in viable cells) at low current density 0.12 mA/cm^2), with low contact time (5 minutes) and low concentration of KI (10 ppm). Operando X-ray fluorescence mapping is used to show the distribution of iodine species in the reactor, and operando X-ray absorption spectroscopy in the anodic chamber reveals iodine species with higher effective oxidation state than periodate. Operando electrochemical measurements confirm the conditions in the anodic chambers are favourable for the creation of highly oxidized iodine products. The killing efficiency of this new eAOP reactor far exceeds that expected from either traditional iodine-based electrochemical water treatment or advanced oxidation systems alone, a phenomenon that may be associated with the production of highly oxidized iodine species reported here.

Background: Protocols are an essential document for conducting randomised controlled trials (RCTs). However, the completeness of the information provided is often inadequate. To help improve the content of trial protocols, an international group of stakeholders published the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Initiative in 2013. Presently, there is increasing use of cohorts and routinely collected data (RCD) for RCTs because these data have the potential to improve efficiencies by facilitating recruitment, simplifying, and reducing the cost of data collection. Reporting guidelines have been shown to improve the quality of reporting, but there is currently no specific SPIRIT guidance on protocols for trials conducted using cohorts and RCD. This protocol outlines steps for developing SPIRIT-ROUTINE, which aims to address this gap by extending the SPIRIT guidance to protocols for trials conducted using cohorts and RCD. Methods: The development of the SPIRIT-ROUTINE extension comprises five stages. Stage 1 consists of a project launch and a meeting to finalise the membership of the steering group and scope of the extension. In Stage 2, a rapid review will be performed to identify possible modifications to the original SPIRIT 2013 checklist. Other key reporting guidelines will be reviewed to identify areas where additional items may be needed, such as the Consolidated Standards of Reporting Trials (CONSORT) extension for trials conducted using cohorts and RCD (CONSORT-ROUTINE). Stage 3 will involve an online Delphi exercise, consisting of two rounds and involving key international stakeholders to gather feedback on the preliminary checklist items. In Stage 4, a consensus meeting of the SPIRIT-ROUTINE steering group will finalise the items to include in the extension. Stage 5 will involve the publication preparation and dissemination of the final checklist. Conclusion: The SPIRIT-ROUTINE extension will contribute to improving design of trials using cohorts and RCD and transparency of reporting.

Background Little is known about the electronic collection and clinical feedback of patient-reported outcomes (ePROs) following surgical discharge. This systematic review summarized the evidence on the collection and uses of electronic systems to collect PROs after discharge from hospital after surgery. Method Systematic searches of MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central were undertaken from database inception to July 2019 using terms for ‘patient reported outcomes’, ‘electronic’, ‘surgery’ and ‘at home’. Primary research of all study designs was included if they used electronic systems to collect PRO data in adults after hospital discharge following surgery. Data were collected on the settings, patient groups and specialties, ePRO systems (including features and functions), PRO data collected, and integration with health records. Results Fourteen studies were included from 9474 records, including two RCTs and six orthopaedic surgery studies. Most studies (9 of 14) used commercial ePRO systems. Six reported types of electronic device were used: tablets or other portable devices (3 studies), smartphones (2), combination of smartphones, tablets, portable devices and computers (1). Systems had limited features and functions such as real-time clinical feedback (6 studies) and messaging service for patients with care teams (3). No study described ePRO system integration with electronic health records to support clinical feedback. Conclusion There is limited reporting of ePRO systems in the surgical literature, and ePRO systems lack integration with hospital clinical systems. Future research should describe the ePRO system and ePRO questionnaires used, and challenges encountered during the study, to support efficient upscaling of ePRO systems using tried and tested approaches., This systematic review examined the use of electronic systems to collect patient-reported outcomes (ePROs) post-discharge after surgery. Fourteen studies were included - most used commercial ePRO systems, few reported the types of electronic devices used, systems had limited features and functions and none described integration of the system with electronic health records. There is limited reporting of ePRO systems in surgical literature.

The production of oil from oil sands in northern Alberta has led to the generation of large volumes of oil sands process-affected water (OSPW) that was reported to be toxic to aquatic and other living organisms. The toxicity of OSPW has been attributed to the complex nature of OSPW matrix including the inorganic and organic compounds primarily naphthenic acids (NAs: CnH2n+ZOx). In the present study, granular activated carbon (GAC) adsorption was investigated for its potential use to treat raw and ozonated OSPW. The results indicated that NA species removal increased with carbon number (n) for a fixed Z number; however, the NA species removal decreased with Z number for a fixed carbon number. The maximum adsorption capacities obtained from Langmuir adsorption isotherm based on acid-extractable fraction (AEF) and NAs were 98.5 mg and 60.9 mg AEF/g GAC and 60 mg and 37 mg NA/g GAC for raw and ozonated OSPW, respectively. It was found that the Freundlich isotherm model best fits the AEF and NA equilibrium data (r2 ≥ 0.88). The adsorption kinetics showed that the pseudo-second order and intraparticle diffusion models were both appropriate in modeling the adsorption kinetics of AEF and NAs to GAC (r2 ≥ 0.97). Although pore diffusion was the rate limiting step, film diffusion was still significant for assessing the rate of diffusion of NAs. This study could be helpful to model, design and optimize the adsorption treatment technologies of OSPW and to assess the performance of other adsorbents.

Tropical montane landscapes harbor diverse flora and fauna, and many species there are ecological specialists with narrow elevational distributions, limited geographic ranges, and small global populations. Along elevational gradients, environmental conditions and community composition change dramatically over small spatial scales. As forests are disturbed and edges formed with modified habitat, natural communities could be affected differently across elevations by the many physical and biotic changes at edges. We asked whether forest edges produced altered patterns of avian species composition along a cloud forest - dry forest gradient on the Pacific slope of the Tilaran mountains in Monteverde, Costa Rica. A strong moisture gradient produces cloud forests near the ridgetops, with a concentration of species endemic to the Costa Rica – Panama highlands that are habitat specialists. We conducted 552 point counts across 110 locations from 1100 to 1800 m elevation, yielding 6586 detections of 115 species in 10 km2 of montane forest. We analyzed differences in species composition and single-species abundances between interior and near-edge forest habitats for species grouped by geographic range size. Species composition changed markedly from forest edge to interior in cloud forest habitats, but not in drier forests downslope. Endemic species, especially in cloud forest, were detected less frequently in mature forest near edges than in mature forest interior, and this difference was more pronounced than for cosmopolitan species. On tropical mountainsides, we can expect habitat-specialist endemic species to be more sensitive to further habitat modification. This sensitivity could limit the resilience of tropical bird communities.

This paper describes the sensor technology, measurement methodology and data analysis algorithms that are used to characterize gaseous emissions observed with a large-area coverage longwave-infrared (LWIR) hyperspectral imaging (HSI) sensor. In so doing the demonstrated capability is expanded well beyond the small number of gas species that have typically been reported and also sets these observations within a definitive, comprehensive framework that documents in detail the procedures used for detection, identification, and quantification of atmospheric trace gases using LWIR HSI systems, along with the methodology for determining their respective detection limits. Examples are provided for a 530 km 2 region of the Los Angeles Basin collected on July 22, 2014.

The Salton Trough lies in the transition between the San Andreas Fault and oblique spreading centers and transform faults in the Gulf of California. The Salton Sea Geothermal Field is the northernmost expression of those spreading centers. In ~ 2007 two ammonia-emitting fumarole fields that had been submerged beneath the Salton Sea were exposed for the first time in nearly 50 years. As the sea level continued to drop these fields have developed a number of boiling pools, mud pots, gryphons and a unique suite of ammonium sulfate minerals. These have been studied over time with long-wave infrared remote sensing coupled with ground truth surveys backed by laboratory analyses of the minerals. Many vents lie at the center of concentric rings of mineralization with systematic occurrence of different minerals from center to edge. Three semi-concentric zones (fumarole, transition and evaporite) have been defined with respect to ammonia-emitting vents and bubbling pools. The scale of these zones range from several meters, localized around individual vents, to that of the fumarole fields as a whole. The fumarole zone is closest to the vents and locally contains cavernous sulfur crystals and significant deposits of gypsum, mascagnite, boussingaultite and other ammonium sulfates. The transition zone comprises a dark brown surficial band of inconspicuous sodium nitrate underlain by anhydrite/bassanite that is thought to have formed by ammonia-oxidizing microbes interacting with the ammonium sulfates of the outer fumarole zone. The evaporite zone is the outermost and contains blodite, thenardite and glauberite, which are typical of the sulfates associated with the shoreline of the Salton Sea. Remote sensing has shown that the mineral zones have remained relatively stable from 2013 to 2017, with minor variations depending on rainfall, temperature and levels of agricultural runoff.

Biological phosphorous (P) and nitrogen (N) removal from municipal wastewater was studied using an innovative anoxic-aerobic-anaerobic side-stream treatment system. The impact of influent water quality including chemical oxygen demand (COD), ammonium and orthophosphate concentrations on the reactor performance was evaluated. The results showed the system was very effective at removing both COD (>88%) and NH4+-N (>96%) despite varying influent concentrations of COD, NH4+-N, and total PO43--P. In contrast, it was found that the removal of P was sensitive to influent NH4+-N and PO43--P concentrations. The maximum PO43--P removal of 79% was achieved with the lowest influent NH4+-N and PO43--P concentration. Quantitative PCR (qPCR) assays showed a high abundance and diversity of phosphate accumulating organisms (PAO), nitrifiers and denitrifiers. The MiSeq microbial community structure analysis showed that the Proteobacteria (especially β-Proteobacteria, and γ-Proteobacteria) were the dominant in all reactors. Further analysis of the bacteria indicated the presence of diverse PAO genera including Candidatus Accumulibacter phosphatis, Tetrasphaera, and Rhodocyclus, and the denitrifying PAO (DPAO) genus Dechloromonas. Interestingly, no glycogen accumulating organisms (GAOs) were detected in any of the reactors, suggesting the advantage of proposed process in term of PAO selection for enhanced P removal compared with conventional main-stream processes.

Purpose The insulin-like growth factor (IGF) system is modifiable by diet and lifestyle, and has been linked to prostate cancer development and progression. Methods We conducted a prospective cohort study of 621 men diagnosed with localized prostate cancer to investigate the associations of dietary and lifestyle changes with post-diagnosis circulating levels of IGF-I and IGFBP-3. We used analysis of covariance to estimate the associations, controlling for baseline IGF-I or IGFBP-3, respectively. Results Mean IGF-I levels were 6.5% (95% CI −12.8, −0.3%, p = 0.04) lower in men who decreased their protein intake after diagnosis compared to men who did not change. Men who changed their fruit and vegetable intake had lower IGF-I levels compared to non-changers [Decreased intake: −10.1%, 95% CI −18.4, −1.8%, p = 0.02; Increased intake: −12.0%, 95% CI −18.4, −1.8%, p = 0.002]. IGFBP-3 was 14.6% (95% CI −24.5, −4.8%, p = 0.004) lower in men who achieved a healthy body mass index after diagnosis. Men who became inactive had 9.5% higher average IGF-I levels (95% CI 0.1, 18.9%, p = 0.05). Conclusions Decreased protein intake and body mass index, and increased physical activity and fruit and vegetable intake, following a prostate cancer diagnosis were associated with reduced post-diagnosis serum IGF-I and IGFBP-3. Counterintuitively, reduced fruit and vegetable intake was also associated with reduced IGF-I, but with weak statistical support, possibly implicating chance. If confirmed in other studies, our findings may inform potential lifestyle interventions in prostate cancer. ProtecT was registered at International Standard Randomised Controlled Trial Registry, http://isrctn.org as ISRCTN20141297.