North Shore Research Articles

A Canadian First Nations radon assessment and COVID-19 restrictions: A difficult pairing

Radon is a known carcinogen and a by-product of degrading naturally occurring radioactive elements. The North Shore Micmac District Council (NSMDC) board of directors, in Eastern New Brunswick, Canada, were aware of this issue and saw a need for increased radon testing and awareness in their communities. The initial plan was to administer a testing blitz across communities to gauge the current levels of radon exposure in both residential and band-owned structures. This, with Elder consultation and a participant health survey, would create a data set used to guide future strategies effectively and better direct resources to mitigate the leading cause of lung cancer in non-smokers. These plans were put in place prior to the COVID-19 pandemic that began in March 2020. The subsequent provincial levels of restriction could not have been predicted. The ever-changing pandemic-related restrictions, and public health’s focus on a new deadly pathogen, led to difficulties managing and following through on many health and wellness projects. These circumstances led to a unique situation that delayed results, prolonged exposure to a known carcinogen, and may have consequences in the long term. Few procedures, treatments, or medications do not have side effects, and even warranted pandemic-related measures affect other aspects of health.

Lake Superior's summer cooling of shorelines and adjacent inland forests: Implications for refugia of boreal forests and disjunct arctic-alpine plants.

Climate refugia can serve as remnant habitat for cold-adapted species and delay forest transitions. The world's largest freshwater lake by surface area, Lake Superior, serves as a model system for understanding cooling-mediated refugia effects, as its cool summer water temperatures have maintained disjunct populations of arctic-alpine plants on its shoreline since deglaciation. It is known to affect local inland climates by providing a summer cooling effect; however, the inland temperature gradient and spatial patterns of cooling have not been well quantified. Here, we describe the extent, degree, and patterns of temperature buffering and examine drivers of buffering and disjunct plant occurrence for Lake Superior's north shore over a 3-year period at distances of 10, 100 m, 1, 10, and 100 km inland. We analyzed temperature data by year, month, summer maximum (July), and growing degree days (GDD0) for each site. Average summertime cooling at shore sites (10 m) was ~5°C cooler than reference sites (100 km inland), with a maximum difference of -19.2°C. The magnitude of cooling varied geographically, with sites further west and southeast showing little to no cooling effect, while the exposed north-central shore showed the highest degree of buffering (5.8°C cooler) and had a shorter growing season than reference sites. Finally, north-central shorelines had fewer days above 16°C, a threshold above which disjunct plants are unlikely to grow. These sites also showed the highest proportion of disjunct arctic-alpine species, reflecting the highest buffering from inland sites. On north-central shores, sites up to 10 km inland had less than 10 days per year warmer than 20°C, a threshold identified for boreal forest transition. An understanding of the extent of lake-mediated cooling on adjacent forests can better inform the risk to disjunct species, inland forests, and vegetation transition models on Lake Superior's north shore.

Co-seismic Ground Deformation Monitoring on Brebes-Segment of Baribis-Kendeng Fault Zone Based on Sentinel-1 Data

Co-seismic deformation is a sudden change in the earth’s surface in a fault zone. Therefore, with modern satellite imagery, it is possible to investigate. Synthetic Aperture Radar (SAR) data from Mission Sentinel-1 is one example of satellite imagery that can be used to identify deformation. We employ the interferometry method by utilizing the Interferometric synthetic aperture radar Scientific Computing Environment (ISCE) and another InSAR software to monitor the co-seismic ground deformation in the form of line-of-sight (LOS) displacement. This research focused on the Brebes Segment of the Baribis-Kendeng Fault Zone and applied the interferometry method for the March 22, 2015, Balapulang earthquake (M4.7) and December 11, 2020, Brebes earthquake (M4.2). The earthquake event choice is based on the shallow depth of the hypocenter, which represents the earthquake originating from the fault in the crustal, not the megathrust subduction. The results show that despite the earthquake occurring under the thick quaternary sediment of the north shore of Java Island, the deformation caused by the co-seismic is still emerging to the surface. The LOS displacement was detected within the range of 6 cm from the ascending and descending track of the satellite sensors. Furthermore, this result may provide new information on the Baribis-Kendeng Fault zone, specifically the Brebes Segment.

Genome-wide DNA methylation pattern in whole blood of patients with Hashimoto thyroiditis.

Hashimoto thyroiditis (HT), a prevalent autoimmune disorder, is not yet thoroughly understood, especially when it comes to the influence of epigenetics in its pathogenesis. The primary goal of this research was to probe the DNAm profile across the genome in the whole blood derived from patients suffering from HT. Using the Illumina 850K BeadChip, we conducted a genome-wide DNAm assessment on 10 matched pairs of HT sufferers and healthy individuals. Genes with differential methylation (DMGs) were identified and underwent functional annotation via the databases of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes. The transcriptional significance of potential epigenetic biomarker genes was corroborated through qRT-PCR. The DNAm profiling across the genome indicated an overall reduction in methylation in HT subjects in comparison with their healthy counterparts. We detected 283 DMPs (adjusted P < 0.05 and |Δβ| > 0.1), among which 152 exhibited hypomethylation and 131 demonstrated hypermethylation. Further analysis exposed a noteworthy concentration of hypermethylated DMPs in the 3´UTR, North Shore, and CpG islands, while there was a significant decrease in the Open Sea (all P < 0.001). The 283 DMPs were broadly distributed from chromosome 1 to 22, with chromosome 6 harboring the most DMPs (n = 51) and chromosome 12 carrying the most DMGs (n = 15). The SLFN12 gene, which presented with extreme hypomethylation in its promoter DMPs among HT patients, was identified as the epigenetic marker gene. Consequently, the SLFN12 mRNA expression was markedly upregulated in HT, displaying a negative relationship with its methylation levels. The area under curve (AUC) value for the SLFN12 gene among HT patients was 0.85 (sensitivity: 0.7, specificity: 0.7), a significant difference compared with healthy controls. The methylation levels of all DMPs in SLFN12 gene were negatively correlated with TSH and one CpG site (cg24470734) was positively assocciated with FT4. This investigation presents an initial comprehensive DNAm blueprint for individuals with HT, which permits clear differentiation between HT subjects and normal controls through an epigenetic lens. The SLFN12 gene plays a pivotal role in the onset of HT, suggesting that the methylation status of this gene could serve as a potential epigenetic indicator for HT.

Highlighting the impacts of ciguatera poisoning on fishers and fish consumers in Hawaiʻi to inform future management strategies

Ciguatera poisoning (CP) occurs as a result of consuming seafood that has bioaccumulated toxins produced by dinoflagellates (primarily Gambierdiscus) in tropical, coastal ecosystems. The impacts of CP can be long-lasting for affected individuals and communities, especially in places like the Hawaiian Islands, where fish provide sustenance and have important financial and cultural value. This study used anonymous online surveys (n = 106) and targeted interviews (n = 20) to address data gaps on the prevalence, distribution, and impacts of CP among fishers and fish consumers in Hawaiʻi. Survey results indicated that few individuals (22%) reported their CP cases to the Department of Health, despite the fact that most impacted respondents (67%) experienced symptoms lasting more than a week and some (10%) were affected for more than a year. Certain locations (e.g., north shore of Kauaʻi) and species (e.g., uku - Aprion virescens and knifejaw - Oplegnathus punctatus) emerged as being highly problematic, though they have received little research, monitoring, or management attention historically. Interview data revealed common interests and themes among affected individuals, including a desire for more data on the environmental drivers, factors affecting individual CP response variability, and increased education and awareness, particularly for vulnerable populations. This study offers essential information for managers crafting policy and outreach materials to mitigate the risk of CP in Hawaiʻi and provides baseline information that can be used to inform future studies in Hawaiʻi and throughout the region.

PATH-48. KI-67 INDEX AS A PREDICTIVE MARKER OF MENINGIOMA CLINICO-PATHOLOGIC COURSE AND RECURRENCE FOLLOWING SURGICAL RESECTION: A RETROSPECTIVE STUDY

Abstract BACKGROUND/OBJECTIVE Meningiomas are the most common primary intracranial tumor in adults. Although usually benign, they have a variable clinical course. Ki-67, a nuclear protein involved in cell cycle regulation, has been widely studied as a marker of cellular proliferation in various cancers. However, the prognostic significance of Ki-67 in meningiomas remains controversial. Here, we investigate the Ki-67 index, as a predictive marker of meningioma recurrence following surgical resection and compare it to established prognostic markers such as WHO grade and degree of resection. METHODS The medical records of 451 consecutive patients with previously untreated cranial meningiomas who underwent resections from January 2011 to January 2021 at North Shore University Hospital (NSUH) were reviewed. Collected data included WHO grade, Ki-67 proliferative index, degree of resection, and meningioma recurrence. RESULTS There were 290 patients with grade I, 154 with grade II, and 7 with grade III meningiomas. The average post-resection follow-up period was 4 years, and 82 tumors (18%) recurred. Recurrence occurred significantly more frequently in tumors with a Ki67 index of 5 or more (31%) compared to those with a Ki67 index less than 5 (10.4%). Likewise, higher WHO grades were associated with a higher rates of recurrence, with rates of 11.3%, 27.9%, and 71.4% for grades 1, 2, and 3, respectively. Higher WHO grades also correlated with higher Ki67 scores (2.59, 10.01, and 20.71) for grades 1, 2, and 3, respectively. Additionally, a multivariate logistic regression model identified ki67, WHO grade and degree of resection as independent predictive variables for meningioma recurrence. CONCLUSION Our 10-year retrospective study suggests that the Ki67 index is a promising predictive marker for recurrence of intracranial meningioma following surgical resection. Our findings add to a growing body of data which supports inclusion of ki67 index in the WHO grading criteria.

Distribution of Aquatic Macrophytes in the Littoral of Lake Bohinj (Slovenia)

In alpine Lake Bohinj, which is an LTER site and a part of the national park, the occurrence and depth distribution of submerged and emerged aquatic macrophytes were analyzed. Nine submerged and one emergent macrophyte taxa were found in the lake: Myriophyllum spicatum, Chara virgata, Chara aspera, Potamogeton lucens, Potamogeton alpinus, Potamogeton crispus, Potamogeton perfoliatus, Potamogeton pusillus, Ranunculus circinatus with the synonym Batrachium foeniculaceum and the emergent species Phragmites australis. The depth of the vegetation zones was measured using a depth meter and their coordinates were recorded using a GNSS antenna with RTK receiver. These data were used along with a DEM of lake depths to accurately map the potential zone of macrophyte growth, which was based on the depths of macrophyte distribution. The potential zone of macrophyte growth consisted of 28 different transects and covered 240.14 ha of the lake. The macrophytes covered 5.55 ha. The most common and abundant species was M. spicatum. A significant difference in macrophyte cover was found between the south and north shores of the lake, with the south shore having more patches with a larger total area. A clear difference in macrophyte cover was also noted between the main inflow and outflow of the lake. The presence of macrophytes and their diversity varied in different parts of the lake due to differences in slope, depth and type of substrates.

Methods and insights on enabling geovisualisation for coastal communities of the North Shore of Vancouver

Contemporary sea level rise (SLR) research seldom considers enabling effective geovisualisation for the communities. This lack of knowledge transfer impedes raising awareness on climate change and its impacts. The goal of this study is to produce an online SLR map accessible to the public that allows them to interact with evolving high-resolution geospatial data and techniques. The study area was the North Shore of Vancouver, British Columbia, Canada. While typically coarser resolution (10 m+/pixel) Digital Elevation Models have been used by previous studies, we explored an open access airborne 1 m LiDAR which has a higher resolution and vertical accuracy and can penetrate tree cover at a higher degree than most satellite imagery. A bathtub method model with hydrologic connectivity was used to delineate the inundation zones for various SLR scenarios which allows for a not overly complex model and process using standard tools such as ArcGIS and QGIS with similar levels of accuracy as more complex models, especially with the high-resolution data. Deep learning and 3D visualizations were used to create past, present, and modelled future Land Use/Land Cover and 3D flyovers. Analysis of the possible impacts of 1, 2, 3, and 4 m SLR over the unique coastline, terrain, and land use was detailed. The generated interactive online map helps local communities visualize and understand the future of their coastlines. We have provided a detailed methodology and the methods and results are easily reproducible for other regions. Such initiatives can help popularize community-focused geovisualisation to raise awareness about SLR.

Dike risk evaluation incorporating the contribution of coastal wetlands: A case study on Chongming Island, China

Due to the increasing risk of coastal disasters and climate change, the traditional gray sea dikes may become unsustainable. Coastal wetlands provide natural protection for shoreline areas and have wave attenuation capacities as green dikes. In this study, we developed a new assessment approach to evaluate comprehensive dike risk for coastal gray-green defense systems, based on the dike characters and the wave attenuation capacity of coastal wetlands for the Chongming Island. The risk assessment system consists of nine indicators of dike constructure standards, dike-top height, land subsidence, wetland vegetation width, wave attenuation capacity of vegetation, mean high water level, storm frequency, rain intensity, and annual rainfall, to determine the dike risk index (RI). The information of dike and meteorological conditions were obtained by carrying out a field survey and referring to construction bulletins and domestic statistical yearbooks. The wave attenuation effect of wetland vegetation was characterized by plant morphology and seasonality. The results indicated that, without the coastal wetland indicators, the RI values of most parts of the dike ring of the island were high. The high-risk regions were mainly located in the south and north shores, consisting of several old dikes that did not meet the constructure standard. The risk level was higher in summer and autumn than in winter and spring, due to seasonal variations (typhoon or storm frequency and intensity). When the coastal wetland indicators were included, the presence of coastal wetland vegetation reduced the dike RI values by an average of 13.6% around the Chongming Island. During the flourishing periods of the vegetation, a high rate of wave attenuation reduced the RI levels considerably. We provide a reliable framework to carry out large-scale and high-resolution dike risk assessment to be applied for wetland vegetation restoration, green dike construction, and risk management in coastal areas.

Abundance and distribution of non-indigenous Calyptraeidae gastropods along north and central Atlantic shores of Portugal

Two non-indigenous species of slipper limpets (Gastropoda: Calyptraeidae) have been recorded in NW Europe: Crepidula fornicata and Crepipatella dilatata. Although the former is widespread distributed in European Atlantic, records on Portuguese coasts are scarce. Regarding C. dilatata, it has been only reported in the southern Galician Rías (NW Spain). In this study, C. dilatata is reported for first time on Portugal and the distribution of these two species were studied in the North and Centre of Portugal. Moreover, abundance, distribution and structure of C. dilatata populations were compared between two intertidal habitats. Abundance and structure of C. dilatata populations showed no significant differences between habitats, suggesting that the species is well established in both. Regarding size-frequencies, bigger individuals were more frequent in soft bottoms. The recent development of oyster aquaculture in Portugal and the variety of substrates in which these NIS have been found could facilitate future introductions in nearby locations.

Dynamics of dissolved organic phosphorus in the nearshore of eastern Lake Erie

Abstract The east basin of Lake Erie continues to suffer from blooms of filamentous green algae (primarily Cladophora). Potential management action through reduced phosphorus loadings have and continue to focus on the dissolved inorganic phosphorus pool but other potentially bioavailable phosphorus pools are not always considered. In this study, we describe the dissolved organic phosphorus pool in eastern Lake Erie, with an extensive sampling of four transects along the north shore of the eastern basin from May to September 2019. The dissolved organic phosphorus pool was characterized and quantified using sequential enzymatic hydrolysis to provide information on the enzymatically hydrolysable phosphorus fraction and component monoester P, diester P and a phytase hydrolysable component. These dissolved organic phosphorus fractions were compared to the soluble reactive phosphorus and total dissolved phosphorus pools. Results from this study revealed that a significant fraction (up to 63%) of the dissolved organic phosphorus pool is potentially bioavailable via enzymatic hydrolysis. Vertical differences in soluble reactive phosphorus, total dissolved phosphorus, and phosphate diester pools were also observed when comparing water column with near lake-bed samples, suggesting that the new benthic ecosystem since dreissenid colonization may be a greater source of dissolved inorganic phosphorus to the east basin than prior to colonization.

Calibrating the Wisconsin in the eastern Great Lakes of North America using optically stimulated luminescence (OSL) dating of the Quaternary sediments at Sand Hill Park, north shore of Lake Erie, Ontario

AbstractThe eastern Great Lakes Late Quaternary timescale is based on older thermoluminescence dates and on uncalibrated radiocarbon dates from extensive sections along the north shores of Lakes Erie and Ontario. New optically stimulated luminescence dates from Late Quaternary delta sediments from the north shores of Lake Erie at Sand Hills Park give consistent ages of 23.5 to 20.5 ka. This is 4 to 7 ka older than previously assigned based on lithologic correlation with 16.5 ka calibrated radiocarbon dated sediments 5 km to the west at Vanderven. On the existing eastern Great Lakes stratigraphy, it puts deposition of these Sand Hills Park sediments in the Erie interstadial and not in the fluctuating postglacial glacial retreat of the Mackinaw phase to which the Vanderven sediments belong. The Sand Hills delta and underlying diamicts must have been overridden by the Porty Bruce advance at 18 ka. IntCal20 calibration of existing radiocarbon ages suggests that the physical stratigraphic relations of the various Wisconsin units are accurate and that the existing timescale is simply too young.

Assessing changes in urban vegetation using Normalised Difference Vegetation Index (NDVI) for epidemiological studies

Urban vegetation is an important component of healthy, livable cities and has been linked to several benefits, including improved human health outcomes, natural system regulation, and habitat provision. Understanding and documenting changes to urban vegetation is essential for planning for sustainable cities. This study focuses on identifying where and when urban vegetation changed in Metro Vancouver between 2005 and 2019 using the dynamic change approach to aid longitudinal epidemiological studies in determining accurate exposure estimates. Vegetation change was detected for three time periods: 2005–2009, 2010–2014, and 2015–2019 using normalised difference vegetation index (NDVI) thresholds. A cluster analysis of vegetation change was then conducted to identify areas of change. The results show that Metro Vancouver has gained vegetation over this 15-year time period, particularly along the eastern part of the metropolitan area and along the Fraser River. Vegetation loss occurred mostly in areas under high housing demand, such as along the northern parts of the study area (e.g., the North Shore). The method demonstrated in this study provides a simple, cost-effective way of assessing vegetation change, which is an important step for understanding the relationships between urban development and vegetation and potentially related changes in human health.

Geophysical surveys and satellite imaging for the evaluation of near‐surface terrain dynamic – A case study on Grand Portage, MN, USA

AbstractFlooding, erosion and increases in the water level in Lake Superior have contributed to changes in the stem location and width of the Grand Portage Creek. Those events threaten parts of the Grand Portage National Monument, a historically significant site on the North Shore of Lake Superior, Minnesota. We performed geophysical surveys to investigate these dynamic effects. We studied the near‐surface geological deposits, the mechanisms associated with creek stem dynamics and sediment transport, as well as deposition along the lakeshore in Grand Portage Bay. We deployed ground‐penetrating radar (GPR), sub‐bottom profiler, side scan sonar, Geoprobe coring and Van Veen grab samplers and evaluated time‐lapse satellite images to assess the interaction of the Grand Portage Creek with the Grand Portage Bay. The onshore GPR surveys next to the national monument, the creek and the shoreline showed the presence of a complex deposition with eroded ground surfaces and sediment layers across the creek valley. Results from the offshore geophysical campaigns and the interpretations of satellite images also document a heterogeneous deposition sequence environment with fine‐grained sediment deposits present south and southwest of the creek mouth. In addition, we documented an exposed boulder bed towards the east of the creek mouth that was exposed by the current and wave‐driven erosion process in the Grand Portage Bay. Time‐lapse satellite images and hydraulic current velocity simulations validate these observations and provide insight into how anthropogenic activities and natural events interact and might contribute to the long‐term stability of a site of historical and cultural importance.

Globe trauma associated with falls at Australian tertiary centres.

Falls frequently cause globe and adnexal trauma, particularly in the elderly. The morbidity decreases confidence, independence and quality of life. We aimed to improve the understanding of fall-related globe and adnexal trauma and the involvement of ophthalmology at two tertiary trauma centres. A retrospective medical record review was conducted at Royal North Shore Hospital and Royal Prince Alfred Hospital of patients admitted with fall-related globe and/or adnexal trauma between January 2015 and December 2019. International Classification of Disease Tenth Revision codes were used to identify patients for inclusion. Medical records were reviewed to extract data on demographics, trauma, ocular examination and referrals to ophthalmology. From January 2015 to December 2019, 346 patients, 186 were female (54%) and median age 76 years (interquartile range 24 years), were admitted to Royal North Shore Hospital and Royal Prince Alfred Hospital with fall-related globe and/or adnexal trauma. One hundred and twenty-five (36%) suffered globe trauma with 48 (14%) classified as severe. Patients over 65 years old had at least three risk factors contributing to falls. Alcohol and illicit substances were involved in 20% of falls and occurred predominantly in younger populations. There were significantly more patients with globe trauma if orbital/mid-facial fractures were present (55% vs 36%, P < 0.001). Fall-related globe and adnexal trauma were more common in the elderly. Alcohol and illicit substances have a role in falls in younger populations. Thorough ocular assessment is required especially in mid-facial/orbital trauma to exclude globe trauma. Further, research is required to determine the effect of fall prevention strategies in preventing globe trauma.

Burn related globe and adnexal trauma at trauma centres

IntroductionPrompt management of burn-related globe trauma can prevent long term complications. Delays in diagnosis may occur when globe trauma is associated with life-threatening injuries. We aimed to improve the understanding of the epidemiology, acute assessment and management of burns-related globe and adnexal trauma admitted to two trauma centres in Sydney, Australia. MethodAdmitted patients with burns-related globe and/or adnexal trauma were retrospectively reviewed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) between January 2015 and December 2019. The International Classification of Disease, Tenth Revision codes was used to search and identify patients. Medical records were reviewed to extract data on demographics, injuries, ocular examination and ophthalmology involvement. ResultsOver the 5-years, 101 patients with globe and/or adnexal burns-related trauma were admitted to RNSH or RPAH. Median age was 37years. Most patients were male (76%) and were injured while at home or work (74%). Patients with chemical exposure were more likely to have globe trauma (100% vs 72%, p < 0.001) and severe globe trauma (54% vs 32%, p = 0.028). On initial review by emergency staff, 14 patients were not referred to ophthalmology, of these there were 2 patients where the diagnosis was delayed. ConclusionGlobe trauma is common in patients with chemical exposure. Thorough ocular assessment within the acute setting is vital to diagnose globe trauma. We investigated hospitals with specialised burn staff, further research is required to understand the management of globe trauma in hospitals without such resources. SynopsisChemicals in household-products can cause severe globe trauma. Globe trauma can occur alongside large burns leading to delay in its diagnosis and management. Ophthalmology can assist in the early diagnosis and management of globe trauma.

Estimation of breaking wave region based on coupled wave and storm surge simulations of historical typhoons: A case study of Hangzhou Bay

Breaking waves pose a serious threat to offshore structures. Estimating the breaking wave region is hence important for structural design and construction. This paper developed a numerical approach for estimating the breaking wave region based on the coupled wave and storm surge simulations of typhoons. The SWAN + ADCIRC coupling model was employed to hindcast the wave height, wave period, and storm surge under historical typhoons. The values of two breaking prediction variables at different mean return periods (MRPs) were calculated by probability models. The breaking wave region can then be estimated by either a univariate or bivariate probability model of the breaking prediction variables. The developed approach was illustrated using Hangzhou Bay as a case study. Hindcast simulations of 40 typhoons in the past 25 years were conducted. The effects of breaking criteria, probability model, and breaking threshold on the breaking wave region were investigated and discussed as a function of MRP. The main findings include that 1) the waves on the north shore of Hangzhou Bay break more easily; 2) the distribution and area of the estimated breaking wave region depend on the selection of breaking criteria and thresholds; and 3) neglecting the correlation between variables results in an underestimation of breaking wave hazards. This study provides engineers with an efficient tool to estimate the breaking wave hazards for projects located in tropical cyclone-prone sea areas.

Globe and adnexal trauma at Australian trauma centres

IntroductionIn multisystem trauma, the assessment and management of globe and adnexal trauma is often complex. Ophthalmology input may assist managing such patients. To understand the role of ophthalmology in tertiary trauma centres we report on the management of globe and adnexal trauma at two tertiary trauma centres in Sydney, Australia. MethodA retrospective case series was completed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) on patients admitted between January 2015 and December 2019. International Classification of Disease, Tenth Revision codes, diagnostic and procedural coding data were used to identify patients admitted with globe and/or adnexal trauma. Data extracted from medical records included demographics, mechanism of injury, ocular examination and specialist ophthalmic referral. ResultsOver 5-years, 773 patients, average age of 53.2years and 62% male, were admitted to RNSH and RPAH with globe and/or adnexal trauma. Most patients (83%) first presented to RNSH or RPAH. The most common mechanism of injury was falls (45%) followed by burns (13%). Two-hundred and thirty-five patients had multisystem trauma, of these patients, 121 (51%) suffered globe trauma with 49 (21%) classified as severe. Three patients were not diagnosed initially due to delayed ophthalmology referral. ConclusionFalls followed by burns were common causes of globe and adnexal trauma in Sydney, Australia. The presence of orbital/mid-facial injury may indicate a patient has globe trauma. In multisystem trauma, globe trauma may be diagnosed late or not identified. Ophthalmology review has an important role in diagnosing and managing globe trauma in multisystem trauma.

The new ‘surface storage’ concept versus the old ‘sponge effect’ concept: application to the analysis of the spatio-temporal variability of the annual daily maximum flow characteristics in southern Quebec (Canada)

AbstractThis study confronts the new concept of ‘surface storage’ with the old concept of ‘sponge effect’ to explain the spatio-temporal variability of the annual daily maximum flows measured in 17 watersheds of southern Quebec during the period 1930–2019. The new concept takes into account the hydrological impacts of wetlands and other topographic components of the landscape (lakes, depressions, ditches, etc.) while that of the sponge effect only takes into account the hydrological impacts of wetlands. With regard to spatial variability, the area of wetlands and other water bodies is the variable best correlated negatively with the magnitude but positively with the duration of flows. As for the temporal variability, the application of the long-term trend tests revealed a significant increase in the magnitude and, to a lesser extent, the duration of the flows occurring in the watersheds of the north shore characterized by a greater area of wetlands and other water bodies (&amp;gt;5%). This increase is explained by the fact that the storage capacity of these land types, which remains unchanged over time, does not make it possible to store the surplus runoff water brought by the increase in rainfall during the snowmelt season.

Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis

BackgroundThoracic epidural analgesia is commonly used for upper gastrointestinal surgery. Intrathecal morphine is an appealing opioid-sparing non-epidural analgesic option, especially for laparoscopic gastrointestinal surgery.MethodsFollowing ethics committee approval, we extracted data from the electronic medical records of patients at Royal North Shore Hospital (Sydney, Australia) that had upper gastrointestinal surgery between November 2015 and October 2020. Postoperative morphine consumption and pain scores were modelled with a Bayesian mixed effect model.ResultsA total of 427 patients were identified who underwent open (n = 300), laparoscopic (n = 120) or laparoscopic converted to open (n = 7) upper gastrointestinal surgery. The majority of patients undergoing open surgery received a neuraxial technique (thoracic epidural [58%, n = 174]; intrathecal morphine [21%, n = 63]) compared to a minority in laparoscopic approaches (thoracic epidural [3%, n = 4]; intrathecal morphine [12%, n = 14]). Intrathecal morphine was superior over non-neuraxial analgesia in terms of lower median oral morphine equivalent consumption and higher probability of adequate pain control; however, this effect was not sustained beyond postoperative day 2. Thoracic epidural analgesia was superior to both intrathecal and non-neuraxial analgesia options for both primary outcomes, but at the expense of higher rates of postoperative hypotension (60%, n = 113) and substantial technique failure rates (32%).ConclusionsWe found that thoracic epidural analgesia was superior to intrathecal morphine, and intrathecal morphine was superior to non-neuraxial analgesia, in terms of reduced postoperative morphine requirements and the probability of adequate pain control in patients who underwent upper gastrointestinal surgery. However, the benefits of thoracic epidural analgesia and intrathecal morphine were not sustained across all time periods regarding control of pain. The study is limited by its retrospective design, heterogenous group of upper gastrointestinal surgeries and confounding by indication.