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Pathogenic viruses represent one of the greatest threats to human well-being. As evidenced by the COVID-19 global pandemic, however, halting the spread of highly contagious diseases is notoriously difficult. Successful control strategies therefore have to rely on effective surveillance. Here, we describe how monitoring wastewater from urban areas can be used to detect the arrival and subsequent decline of pathogens, such as SARS-CoV-2. As the amount of virus shed in faeces and urine varies largely from person to person, it is very difficult to quantitatively determine the number of people who are infected in the population. More research on the surveillance of viruses in wastewater using accurate and validated methods, as well as subsequent risk analysis and modelling is paramount in understanding the dynamics of viral outbreaks., Graphical abstract Image 1

Acceptance and Commitment Therapy (ACT) targets six core processes of change including acceptance/experiential avoidance/, mindfulness/lack of contact with the present moment, committed action/inaction, cognitive defusion/fusion, self-as-context/self-as-content, and values clarification/values problems (Hayes, Strosahl, & Wilson, 1999). Previous researchers suggested that targeting experiential avoidance, cognitive fusion, and valued living may assist with posttraumatic stress disorder (PTSD) treatment (Donahue, Khan, Huggins, & Marrow, 2017; Walser & Hayes, 2006), yet few researchers have investigated these ACT core processes in a PTSD treatment-seeking sample. Therefore, we sought to investigate the relationship between these three ACT core processes, quality of life, PTSD symptom severity, and depression symptoms. Results indicated that experiential avoidance was most strongly related to PTSD symptom severity and depression, though it was not related to quality of life. In contrast, valued living was not significantly related to PTSD symptom severity or depression and was related only to quality of life. Overall, experiential avoidance and valued living appear to be especially relevant ACT processes in a sample of people reporting elevated levels of PTSD symptoms.

Waterborne enteric viruses are an emerging cause of disease outbreaks and represent a major threat to global public health. Enteric viruses may originate from human wastewater and can undergo rapid transport through aquatic environments with minimal decay. Surveillance and source apportionment of enteric viruses in environmental waters is therefore essential for accurate risk management. However, individual monitoring of the >100 enteric viral strains that have been identified as aquatic contaminants is unfeasible. Instead, viral indicators are often used for quantitative assessments of wastewater contamination, viral decay and transport in water. An ideal indicator for tracking wastewater contamination should be (i) easy to detect and quantify, (ii) source-specific, (iii) resistant to wastewater treatment processes, and (iv) persistent in the aquatic environment, with similar behaviour to viral pathogens. Here, we conducted a comprehensive review of 127 peer-reviewed publications, to critically evaluate the effectiveness of several viral indicators of wastewater pollution, including common enteric viruses (mastadenoviruses, polyomaviruses, and Aichi viruses), the pepper mild mottle virus (PMMoV), and gut-associated bacteriophages (Type II/III FRNA phages and phages infecting human Bacteroides species, including crAssphage). Our analysis suggests that overall, human mastadenoviruses have the greatest potential to indicate contamination by domestic wastewater due to their easy detection, culturability, and high prevalence in wastewater and in the polluted environment. Aichi virus, crAssphage and PMMoV are also widely detected in wastewater and in the environment, and may be used as molecular markers for human-derived contamination. We conclude that viral indicators are suitable for the long-term monitoring of viral contamination in freshwater and marine environments and that these should be implemented within monitoring programmes to provide a holistic assessment of microbiological water quality and wastewater-based epidemiology, improve current risk management strategies and protect global human health., Graphical abstract Image 1, Highlights • Human mastadenoviruses are robust indicators for human-associated pollution in water. • Bacteroides-associated phages and crAssphage are promising indicators. • Multiple indicators should be used to assess wastewater treatment efficiency. • Survival and abundance of indicator viruses should be further assessed.

SARS-CoV-2 and the resulting COVID-19 pandemic represents one of the greatest recent threats to human health, wellbeing and economic growth. Wastewater-based epidemiology (WBE) of human viruses can be a useful tool for population-scale monitoring of SARS-CoV-2 prevalence and epidemiology to help prevent further spread of the disease, particularly within urban centres. Here we present a longitudinal analysis (March-July, 2020) of SARS-CoV-2 RNA prevalence in sewage across six major urban centres in the UK (total population equivalent 3 million) by q(RT-)PCR and viral genome sequencing. Our results demonstrate that levels of SARS-CoV-2 RNA generally correlated with the abundance of clinical cases recorded within the community in large urban centres, with a marked decline in SARS-CoV-2 RNA abundance following the implementation of lockdown measures. The strength of this association was weaker in areas with lower confirmed COVID-19 case numbers. Further sequencing analysis of SARS-CoV-2 from wastewater suggested that multiple genetically distinct clusters were co-circulating in the local populations covered by our sample sites, and that the genetic variants observed in wastewater reflected similar SNPs observed in contemporaneous samples from cases tested in clinical diagnostic laboratories. We demonstrate how WBE can be used for both community-level detection and tracking of SARS-CoV-2 and other virus’ prevalence, and can inform public health policy decisions. Although, greater understanding of the factors that affect SARS-CoV-2 RNA concentration in wastewater are needed for the full integration of WBE data into outbreak surveillance. In conclusion, our results lend support to the use of routine WBE for monitoring of SARS-CoV-2 and other human pathogenic viruses circulating in the population and assessment of the effectiveness of disease control measures., Graphical abstract Image, graphical abstract

Problems sourcing spat from naturally occurring seed beds for relay has been the main underlying limiting factor in mussel aquaculture over recent years. Attempts to address this issue require a better understanding of mussel larval patterns during the initial planktonic phase prior to settlement. A crucial step in progressing the detection and prediction of larval travel is the accurate identification of mussel larvae within environmental samples in conjunction with hydrodynamic patterns. This requires unambiguous, high throughput methods for the discrimination between larvae of morphologically-similar bivalve species. Presently methodologies require direct microscopic observation with accuracy based on taxonomic skills, techniques which are impractical for large-scale larval movement studies. Species-specific polymerase chain-reaction (PCR) presents a powerful alternative method for species detection. In addition, the technique allows for the collection of quantitative real-time PCR data which can be used for inter sample comparisons of relative larval abundance. In this study Blue mussel Mytilus edulis D-stage larvae were used to compare and optimise DNA extraction methods and to examine the quantitative potential of species-specific qPCR targeting the polyphenolic adhesive protein involved in byssal thread production. Molecular data were used to create a predictive model which could be employed to determine larval numbers from real-time data. Assays were then used to estimate M. edulis abundance in vertical–tow plankton samples collected from a trial aquaculture site off the North Wales coast. This method offers a more effective means of temporal and spatial larval pattern analysis which will improve the tracking and predictive capabilities of seed supply hydrodynamic models used for dispersal and population connectivity predictions.

The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102–105 gc/ml) and feces (ca. 102–107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105–1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector., Graphical abstract Unlabelled Image, Highlights • SARS-CoV-2 RNA can be readily detected in feces and occasionally urine. • Severe GI dysfunction only occurs in a small number of cases (11 ± 2%). • Likelihood of SARS-CoV-2 being transmitted via feces appears very low. • Likelihood of infection from sewage-contaminated water or food is extremely low.

Bivalve shellfish have the capacity to accumulate norovirus (NoV) from waters contaminated with human sewage. Consequently, shellfish represent a major vector for NoV entry into the human food chain, leading to gastrointestinal illness. Identification of areas suitable for the safe cultivation of shellfish requires an understanding of NoV behaviour upon discharge of municipal-derived sewage into coastal waters. This study exploited the potential of edible mussels ( Mytilus edulis ) to accumulate NoV and employed the ISO method for quantification of NoV within mussel digestive tissues. To evaluate the spatial spread of NoV from an offshore sewage discharge pipe, mesh cages of mussels were suspended from moorings deployed in a 9 km 2 grid array around the outfall. Caged mussels were retrieved after 30 days and NoV (GI and GII), total coliforms and E. coli enumerated. The experimentally-derived levels of NoV GI and GII in mussels were similar with total NoV levels ranging from 7 × 10 1 to 1.6 × 10 4 genome copies g −1 shellfish digestive gland (ΣGI + GII). NoV spread from the outfall showed a distinct plume which matched very closely to predictions from the tidally-driven effluent dispersal model MIKE21. A contrasting spatial pattern was observed for coliforms (range 1.7 × 10 2 to 2.1 × 10 4 CFU 100 g −1 shellfish tissue) and E. coli (range 0–1.2 × 10 3 CFU 100 g −1 shellfish tissue). These data demonstrate that hydrodynamic models may help inform effective exclusion zones for bivalve harvesting, whilst coliform/ E. coli concentrations do not accurately reflect viral dispersal in marine waters and contamination of shellfish by sewage-derived viral pathogens.

Acute Oak Decline is a syndrome within the Oak Decline complex in Britain. Profuse stem bleeding and larval galleries of the native buprestid, Agrilus biguttatus characterize the disease. A systematic study comparing healthy with diseased trees was undertaken. This work reports the result of isolations from healthy trees, diseased and non-symptomatic tissue within AOD affected trees, at five sites in England. Bacteria and fungi were identified using the DNA gyrase B gene, or ITS 1 sequencing. A significantly higher proportion of diseased tissues (82%) yielded more bacteria than either healthy (18%) or non-symptomatic tissue in diseased trees (33%). Overall bacterial community compositions varied at each site, but significant similarities were evident in diseased tissues at all sites. Enterobacteriaceae dominated in diseased trees whereas Pseudomonadaceae dominated healthy trees. Significant associations between diseased tissues and certain bacterial species occurred, implying that the cause of tissue necrosis was not due to random microbiota. Brenneria goodwinii and Gibbsiella quercinecans were key species consistently isolated from diseased tissue; Rahnella victoriana and an un-named Pseudomonas taxon were also frequently isolated from both healthy and diseased trees. Most fungi isolated were from the outer bark and had no significant association with tree health status. It was concluded that there was a shift in the cultivatable bacterial microbiome of diseased trees, with Enterobacteriaceae strongly represented in symptomatic but not healthy tissues. No single species dominated the isolations from diseased tissues and the tissue degradation in AOD is therefore likely to have a polymicrobial cause.

We describe the comprehensive 3-dimensional analysis of facial changes after Le Fort I osteotomy and introduce a new tool for anthropometric analysis of the face. We studied the cone-beam computed tomograms of 33 patients taken one month before and 6-12 months after Le Fort I maxillary advancement with or without posterior vertical impaction. Use of a generic facial mesh for dense correspondence analysis of changes in the soft tissue showed a mean (SD) anteroposterior advancement of the maxilla of 5.9 (1.7) mm, and mean (SD) minimal anterior and posterior vertical maxillary impaction of 0.1 (1.7) mm and 0.6 (1.45) mm, respectively. It also showed distinctive forward and marked lateral expansion around the upper lip and nose, and pronounced upward movement of the alar curvature and columella. The nose was widened and the nostrils advanced. There was minimal forward change at the base of the nose (subnasale and alar base) but a noticeable upward movement at the nasal tip. Changes at the cheeks were minimal. Analysis showed widening of the midface and upper lip which, to our knowledge, has not been reported before. The nostrils were compressed and widened, and the lower lip shortened. Changes at the chin and lower lip were secondary to the limited maxillary impaction.

The Fibrobacteres phylum contains two described species, Fibrobacter succinogenes and Fibrobacter intestinalis, both of which are prolific degraders of cellulosic plant biomass in the herbivore gut. However, recent 16S rRNA gene sequencing studies have identified novel Fibrobacteres in landfill sites, freshwater lakes and the termite hindgut, suggesting that members of the Fibrobacteres occupy a broader ecological range than previously appreciated. In this study, the ecology and diversity of Fibrobacteres was evaluated in 64 samples from contrasting environments where cellulose degradation occurred. Fibrobacters were detected in 23 of the 64 samples using Fibrobacter genus-specific 16S rRNA gene PCR, which provided their first targeted detection in marine and estuarine sediments, cryoconite from Arctic glaciers, as well as a broader range of environmental samples. To determine the phylogenetic diversity of the Fibrobacteres phylum, Fibrobacter-specific 16S rRNA gene clone libraries derived from 17 samples were sequenced (384 clones) and compared with all available Fibrobacteres sequences in the Ribosomal Database Project repository. Phylogenetic analysis revealed 63 lineages of Fibrobacteres (95% OTUs), with many representing as yet unclassified species. Of these, 24 OTUs were exclusively comprised of fibrobacters derived from environmental (non-gut) samples, 17 were exclusive to the mammalian gut, 15 to the termite hindgut, and 7 comprised both environmental and mammalian strains, thus establishing Fibrobacter spp. as indigenous members of microbial communities beyond the gut ecosystem. The data highlighted significant taxonomic and ecological diversity within the Fibrobacteres, a phylum circumscribed by potent cellulolytic activity, suggesting considerable functional importance in the conversion of lignocellulosic biomass in the biosphere.

Objective To evaluate the safety and efficacy of Intrastromal Corneal Ring Segments (ICRS) for the correction of myopia. Design Nonrandomized, comparative trial. Participants Patients enrolled in the United States Food and Drug Administration phase II and phase III clinical trials of the ICRS had best spectacle-corrected visual acuity (BSCVA) of 20/20 or better, myopia of −1.00 to −3.50 diopters (D), and a cylindrical correction of 1.00 D or less as measured by manifest refraction. Intervention Surgical correction of myopia with an ICRS. Main outcome measures Efficacy was assessed by predictability of refractive outcome (deviation from predicted cycloplegic refraction spherical equivalent), stability of refractive effect, and postoperative uncorrected visual acuity. Safety was assessed by adverse events, maintenance or loss of preoperative BSCVA, and induced manifest refraction cylinder. Results Four hundred fifty-two patients were enrolled at 11 investigational sites in both studies. Of the 454 surgical attempts, 449 received an ICRS in one eye (0.25, 0.30, and 0.35 mm in 148, 151, and 150 eyes, respectively). First surgeries were attempted in 452 patients. An ICRS was successfully implanted in 447 initial eyes, and 5 surgeries were discontinued. Of the five discontinued surgeries, three patients subsequently exited from the study, and two patients went on to have the ICRS implanted in the second eye, bringing the total number of successful implants to 449 patient eyes. Month 24 postoperative follow-up was completed on 358 patients (80%). At month 24, 328 of 354 eyes (93%) were within ±1.00 D of predicted refractive outcome. Refraction changed by 1 D or less in 97% of eyes (421/435) between 3 and 6 months after implantation and in 99% (343/348) between months 18 and 24. Before surgery, 87% of eyes (390/448) saw worse than 20/40 uncorrected; 24 months after surgery, 55% of eyes (196/358) saw 20/16 or better, 76% (271/358) saw 20/20 or better, and 97% (346/358) saw 20/40 or better. Although two eyes (2/358; 0.5%) lost two or more lines of BSCVA at 24 months; visual acuity in both was 20/20 or better. Intraoperative complications included anterior corneal surface perforation (three eyes) and anterior chamber perforations (two eyes, one during an attempted exchange procedure); all healed spontaneously without suturing and without loss of BSCVA. The ICRS was repositioned in five eyes to increase correction. Postoperative complications in one eye each were infectious keratitis, shallow segment placement, and loss of two lines of BSCVA at two or more consecutive examinations (subsequently regained). Conclusions The ICRS safely, predictably, and effectively reduced or eliminated myopia of −1.00 to −3.50 D. The refractive effect was stable over time.

m m m t ( t a t P m u BACKGROUND The 9/11 World Trade Center terrorist attack increased our sensitivity to potential future terrorist attacks. There are more than 100,000 abandoned radioactive sources in the world, approximately 1,000 of which are strong enough to cause harm [1]. The International Atomic Energy Agency reported that in the past decade, there have been about 300 incidents of attempted radioactive material smuggling worldwide [1], suggesting that potential terrorists will likely plan future radiologic attacks such as “dirty bombs.” Furthermore, several large-scale radiation accidents, such as the Chernobyl and Japanese nuclear power plant disasters, have had powerful immediate and long-term effects on the environment and detrimental yet uncertain long-term consequences to human health. The recent earthquake and tsunami in March 2011, and the resultant radiation leakage from the Fukushima Daiichi nuclear power plant, resulted in human cost as well as billions of dollars in the evacuation effort and abandonment of the devastated local farm industry. These current events serve as a continual reminder to the medical community of possibilities that would require a coordinated, sophisticated response. Members of the radiology community, including radiologists, nuclear medicine physicians, and technologists, have training and ongoing experience with the routine handling of radioactive materials, use of survey instruments, the appropriate containment and

A formal knowledge-elicitation methodology that incorporates psychological scaling techniques to produce empirically derived knowledge representations is discussed. The methodology has been successfully applied in several domains and overcomes many of the difficulties of traditional knowledge-elicitation techniques. Research issues pertaining to the use of scaling techniques as knowledge-elicitation tools are outlined and a particular issue, the elicitation of levels of abstraction in knowledge representations, is discussed in detail. Results from a study on the elicitation of knowledge about levels of abstraction for a set of Unix commands from experienced Unix users indicated that the representations obtained using this methodology can be used to obtain more abstract (i.e. categorical) representations of that knowledge.

This article discusses general features of school phobia and specific clinical and familial traits and characteristics. Included are overviews of theoretical explanations, types of school phobia, suggested methods of treatment, and their efficacy.

Menus are an increasingly popular style of user-system interface. Although many aspects of menu design can affect user performance (e.g. item names and selection methods), the organization of items in menus is a particularly salient aspect of their design. Unfortunately, empirical studies of menu layout have yet to resolve the basic question of how menus should be organized to produce optimal performance. Furthermore, a disturbingly common finding has been that any initial effects of menu layout disappear with practice. Thus it is tempting to conclude that menu organization is not important or that it only affects performance during learning. In this paper we present some reasons to doubt this conclusion. In particular, we have found persistent effects of layout with multiple-item selection tasks, in contrast with studies employing a single-item selection paradigm. The results of a controlled study comparing various menu designs (fast-food keyboards) show that the types of tasks to be performed by users must be considered in organizing items in menus and that there may be sustained effects of menu organization with some tasks. In addition, the results of this study support the use of a formal methodology based on user knowledge for menu design. By comparing the performance of subjects using menus designed using our methodology with the performance of subjects using “personalized” menus, we were able to demonstrate the general superiority of our method for designing menus, and for tailoring menus to meet task requirements as well.

A computerized radiotracer technique for the detection of loss of retinal vascular integrity secondary to diabetes is presented. Radionuclide retinal scintigraphy with Technetium-99m DTPA was performed on 40 insulindependent diabetics and 10 nondiabetics. A ratio of eye to brain activity was used to eliminate errors associated with absolute counting. Ratios were found to be significantly higher in diabetics, especially those with active neovascularization. This technique may prove useful in the assessment and staging of eyes prone to retinopathy.