Collection systems in coastal cities are often below the groundwater table, leading to groundwater infiltration (GWI) through defects such as cracks and poor lateral connections. ...Climate-change-induced sea level rise (SLR) will raise groundwater levels, increasing the head and thus the inflow. A method has been developed to predict GWI when groundwater levels change using calibration with sewershed flow monitoring data. The calibration results in a parameter that characterizes the porosity of the collection system. A case study is presented for a coastal city with reliable flow monitoring data for eight days that resulted in a large range of effective defect sizes (minimum 0.0044 to maximum 0.338 radians), however, the range of predicted future GWI in currently submerged pipes varied by only 12% from the mean. The mean effective defect predicts 70 to 200% increases in GWI due to SLR of 0.3 to 0.9 m (1 to 3 ft), respectively, for currently submerged pipes. Predicted additional GWI for pipes that will become submerged due to SLR will increase GWI to values that approach or exceed the current average dry weather flow. This methodology can be used for planning of infrastructure improvements to enhance resiliency in coastal communities.
Groundwater elevations in coastal cities will be affected by climate-change-induced sea level rise (SLR) and wastewater collection systems will experience increased groundwater infiltration (GWI) due ...to greater submergence of sewer pipes. Commercial sewer hydraulics models consider GWI to be a constant quantity estimated via a low-flow monitoring campaign and are incapable of predicting future flows due to changes in GW elevations. A global sensitivity analyses conducted for a two-dimensional GWI pipe flow model found the most important input parameters are groundwater head and surrounding soil hydraulic conductivity. Two case studies were conducted considering a range of pipe defect severity to estimate increases in GWI associated with predictions of future SLR. The findings are that SLR will begin to have noticeable impacts in terms of increased average dry weather flow (ADWF) as soon as 2030 (3–10%) and will increase dramatically in the future (10–29% by 2050, and 50% or more by 2100). Daily and seasonal tide ranges affect the normal diurnal flow variations by between 3% and 10%. The estimation methodology and case studies described here illustrate the coming future importance of SLR effects on GWI in coastal collection systems that should be included in facilities planning and design.
On-site Sewage Disposal Systems (OSDS) are globally common, and in Hawai'i they present a risk of contamination to drinking water sources and nearshore waters. State legislation has commanded that ...all cesspools are to be banned by 2050, thus requiring tens of thousands of systems to be converted in the coming decades. This project followed a participatory structured decision-making (SDM) approach to collaboratively design cost-effective and equitable solutions for thousands of cesspools in the high elevation areas of north Maui, Hawai'i. Participatory workshops with a diverse group of stakeholders set ten objectives and brainstormed 33 alternatives, for which the technical team then modeled groundwater nutrients, costs, and equity. All alternatives posed trade-offs, though composting toilets performed best across most objectives, albeit with high maintenance burden. Discounting innovative toilets, the multi-objective analysis suggests that the state should invest in cluster sewering of high-density communities, followed by incentivizing septic tank solutions in properties with the highest effluent flow first, then expanding across the area. The total project cost (installation and operation/maintenance) would be $183–258 million, depending upon the sewer-septic combination. An efficiency frontier reveals sub-par combinations, including aerobic treatment units and passive absorption systems, which cost much more and deliver lower mass flux reduction than more cost-effective alternatives. This study contributes a novel case of rural sanitation to the literature in which decision support tools are used to facilitate evidence-based, collaborative decision-making for sanitation planning. The state could use a similar participatory SDM process when approaching other communities to discuss their cesspool upgrade strategies. Broadening the use of decision analytic techniques can have wider ecological, economic, and social benefits for the state and contexts beyond Hawai'i, as SDM provides a transparent and rigorous, evidence-based decision-theoretic framework to explore multiple values and strategies to address difficult resource management problems.
•Cesspools responsible for 33% of groundwater nitrogen; are the only manageable source.•Site conditions limit technical options for cesspool upgrades, whose costs and benefits vary.•Trade-offs between objectives complicate decisions on cesspool upgrade strategies.•Structured decision-making reveals creative alternatives to meet stakeholder objectives.•Converting all cesspools in area would cost $183–258 million over the next 60 years.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Coastal sanitary sewer networks are increasingly at risk of groundwater infiltration (GWI) into pipes due to sea level rise (SLR). As sea level increases, so does the groundwater table, causing ...sanitary sewer pipes to become submerged. If structural defects or deterioration, such as cracks, are present, submerged pipes will be subject to GWI. Therefore, there is a strong need for GWI projections as SLR persists. While previous methods relied on specialized modeling expertise or general infiltration parameters, this thesis describes a user-friendly procedure based on a two-dimensional (2D) GWI model with explicit parameters that better visualize circumstances of the network. These parameters include hydraulic head, which is proportional to SLR, and pipe defect size, which is used to prioritize pipes for improvement. Using flow monitoring data, the 2D GWI model was calibrated for the network in three-meter-pipe intervals. Data analysis and calibration were performed using Microsoft Excel and U.S. Environmental Protection Agency’s Sanitary Sewer Overflow Analysis and Planning Toolbox. Pipes that are currently submerged and pipes that will be eventually submerged were investigated individually. Firstly, for pipes that are currently under the groundwater table and subject to GWI, the flow meter measurement provides a sum of GWI in the upstream pipes. To determine the flow in each of the three-meter pipe segments, two methods of calibration were explored. Following calibration, future GWI was projected by increasing hydraulic head depending on the level of SLR. Secondly, different methods of GWI projections were tested for pipes that will be eventually submerged due to future SLR. These methods included a severity matrix of varying defect sizes and lengths of pipes with defects, a mathematical relationship based on previous calibration results, and an effective defect size that is representative of the porosity of a given sewer area. In conclusion, a flow chart is presented with GWI projection methods that are recommended based on availability of flow monitoring data or system knowledge.
Accidental suffocation and strangulation in bed is a leading cause of preventable infant death. Bed sharing, teen motherhood, and Hispanic ethnicity have been associated with infant sleep suffocation ...death. Fifty-five Hispanic teen mothers were surveyed regarding acculturation/demographic characteristics and their infants' sleep behaviors. Most participants had 2 foreign-born parents from Latin America. Participants with 2 US-born parents were less likely to bed share than their less-acculturated peers. Many participants reported not always placing their infant in a supine sleep position. There is a significant need to reach out to Hispanic teen mothers, particularly from newer immigrant families, with culturally and linguistically appropriate multigenerational clinical messaging on the risks of infant bed sharing and nonsupine sleep positioning.
In January 2017, CDC identified a cluster of Salmonella enterica serotype Newport infections with isolates sharing an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern, JJPX01.0010 ...(pattern 10), through PulseNet, the national molecular subtyping network for foodborne disease surveillance. This report summarizes the investigation by CDC, state and local health and agriculture departments, and the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS) and discusses the possible role of dairy cows as a reservoir for strains of Salmonella that persistently cause human illness. This investigation combined epidemiologic and whole genome sequencing (WGS) data to link the outbreak to contaminated ground beef; dairy cows were hypothesized to be the ultimate source of Salmonella contamination.
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BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
How was the evolution of our unique biological life history related to distinctive human developments in cognition and culture? We suggest that the extended human childhood and adolescence allows a ...balance between exploration and exploitation, between wider and narrower hypothesis search, and between innovation and imitation in cultural learning. In particular, different developmental periods may be associated with different learning strategies. This relation between biology and culture was probably coevolutionary and bidirectional: life-history changes allowed changes in learning, which in turn both allowed and rewarded extended life histories. In two studies, we test how easily people learn an unusual physical or social causal relation from a pattern of evidence. We track the development of this ability from early childhood through adolescence and adulthood. In the physical domain, preschoolers, counterintuitively, perform better than school-aged children, who in turn perform better than adolescents and adults. As they grow older learners are less flexible: they are less likely to adopt an initially unfamiliar hypothesis that is consistent with new evidence. Instead, learners prefer a familiar hypothesis that is less consistent with the evidence. In the social domain, both preschoolers and adolescents are actually the most flexible learners, adopting an unusual hypothesis more easily than either 6-y-olds or adults. There may be important developmental transitions in flexibility at the entry into middle childhood and in adolescence, which differ across domains.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Background
Thyroid carcinoma, which is rare in pediatric patients (age 0–18 years) but more common in adolescent and young adult (AYA) patients (age 15–39 years), carries the potential for morbidity ...and mortality.
Methods
Hybrid‐capture‐based comprehensive genomic profiling (CGP) was performed prospectively on 512 consecutively submitted thyroid carcinomas, including 58 from pediatric and AYA (PAYA) patients, to identify genomic alterations (GAs), including base substitutions, insertions/deletions, copy number alterations, and rearrangements. This PAYA data series includes 41 patients with papillary thyroid carcinoma (PTC), 3 with anaplastic thyroid carcinoma (ATC), and 14 with medullary thyroid carcinoma (MTC).
Results
GAs were detected in 93% (54/58) of PAYA cases, with a mean of 1.4 GAs per case. In addition to BRAF V600E mutations, detected in 46% (19/41) of PAYA PTC cases and in 1 of 3 AYA ATC cases, oncogenic fusions involving RET, NTRK1, NTRK3, and ALK were detected in 37% (15/41) of PAYA PTC and 33% (1/3) of AYA ATC cases. Ninety‐three percent (13/14) of MTC patients harbored RET alterations, including 3 novel insertions/deletions in exons 6 and 11. Two of these MTC patients with novel alterations in RET experienced clinical benefit from vandetanib treatment.
Conclusion
CGP identified diverse clinically relevant GAs in PAYA patients with thyroid carcinoma, including 83% (34/41) of PTC cases harboring activating kinase mutations or activating kinase rearrangements. These genomic observations and index cases exhibiting clinical benefit from targeted therapy suggest that young patients with advanced thyroid carcinoma can benefit from CGP and rationally matched targeted therapy.
Implications for Practice
The detection of diverse clinically relevant genomic alterations in the majority of pediatric, adolescent, and young adult patients with thyroid carcinoma in this study suggests that comprehensive genomic profiling may be beneficial for young patients with papillary, anaplastic, or medullary thyroid carcinoma, particularly for advanced or refractory cases for which clinical trials involving molecularly targeted therapies may be appropriate.
Comprehensive genomic profiling (CGP) identified diverse clinically relevant genomic alterations in pediatric, adolescent, and young adult patients with thyroid carcinoma, including 83% (34/41) of papillary thyroid carcinoma cases harboring activating kinase mutations or activating kinase rearrangements. These genomic observations and index cases exhibiting clinical benefit from targeted therapy suggest that young patients with advanced thyroid carcinoma can benefit from CGP and rationally matched targeted therapy.
Reliable bonding of high-performance membranes onto polymeric supporting structures is critical for capitalizing their potentials within practical filtration applications. The successful bonding ...typically requires infiltration of the membrane pores by a thermoplastic polymer, driven by capillary pressure and/or external pressure. In this work, we systematically examine the capillary infiltration of a polypropylene (PP) within polyethersulfone (PES) membranes with a highly asymmetric pore structure, a nominal pore size of 20 nm, and varying degrees of hydrophilicity. Most significantly, the infiltration kinetics was strongly influenced by the asymmetric pore structure in two aspects: (1) the time to achieve full infiltration from the large-pore side was approximately 4 times shorter than that from the tight-pore side; (2) When bonding from the tight-pore side, the infiltration depth, L(t) showed L (t) ∼ t1.6, instead of characteristic L (t) ∼ t0.5. The accelerated infiltration rate over time was successfully modelled with the Cai model using depth-dependent pore size that captures the asymmetric pore structure. Furthermore, chemical modification reduced initial infiltration rate only, which is attributed to the reduction in surface porosity. No significant difference in infiltration kinetics at the later stage was observed. Mechanical integrity tests of the bonded samples display complex debonding behaviors including complete peeling, incomplete peeling, and complete membrane failure. The peel force corresponding to membrane failure appeared larger than the other two debonding modes, all of which showed insignificant dependence on the membrane chemistry or infiltration depth. Post-mortem analysis of the completely peeled sample showed PP nanofibers were pulled out of the PES membranes during debonding, emphasizing relatively weak mechanical interlocking due to the low surface porosity.
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•Capillary infiltration kinetics of PP within highly asymmetric PES membranes were determined.•The infiltration kinetics shows strong dependency on the asymmetric pore structure.•The infiltration kinetics is modelled by the Cai model with pore-size gradient.•The bonded PP/PES membrane display complete peeling, incomplete peeling and membrane fracture behaviors.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Otolaryngologic problems are common in primary care but are underrepresented in undergraduate medical education (UME). A significant portion of the total structured teaching received by physicians in ...primary care specialties is spent in UME, but teaching of otolaryngology in UME is limited and not standardized across Canadian medical schools. This study assessed the content and structure of otolaryngology UME at Canadian undergraduate medical programs and postgraduate primary care programs and surveyed community otolaryngologists to identify important clinical topics for inclusion in an otolaryngology curriculum.
A survey was created based on previously validated and published curriculum needs assessment instruments for medical education. Surveys were distributed to (1) undergraduate directors of otolaryngology, (2) postgraduate program directors of family and emergency medicine at English-language medical schools, and (3) community otolaryngologists in Canada.
There is large variation in the quantity of otolaryngology teaching in UME. Knowledge of otolaryngology is formally evaluated at half of the responding programs, although skills in otolaryngology are rarely tested. Clerkship rotations are not uniformly offered, and the length of these placements is limited. Opportunities in postgraduate training for formal education in otolaryngology are rare. Several important topics that are not uniformly taught include sudden sensorineural hearing loss, sleep apnea, and nasal trauma. Important skills that are not uniformly taught include treatment of benign paroxysmal positional vertigo and epistaxis.
There is limited time for teaching otolaryngology in UME; therefore, it is essential to emphasize teaching key topics and skills, which are highlighted in the results of this study.
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