Aquatic nitrogen source elucidation using stable isotope analysis in the North Carolina Coastal Plain.

Eastern North Carolina has been subjected to widespread water quality degradation for decades, notably throughout the Cape Fear River Watershed, owing largely to the magnitude of concentrated animal feeding operations (CAFOs) in the region. Long-term nutrient monitoring data from numerous locations throughout southeastern North Carolina have shown significantly elevated organic nitrogen (Org-N) concentrations starting around the year 2000-a concerning development, as labile Org-N can stimulate algal blooms and subsequent bacterial production, thus enhancing eutrophication in freshwater systems. By measuring the stable isotope signatures (δC, δN) of particulate organic matter sampled from a range of southeastern North Carolina waters, the predominant sources to the observed Org-N loadings were elucidated.

Integrated Primary Care Mental Health Service: A Qualitative Exploration of an Integrated Approach to Supporting People with Significant Mental Health Problems in Primary Care.

Individuals with significant mental health problems (SMHP) have historically faced challenges accessing mental health care due to gaps between primary and secondary care services. The National Health Service (NHS) Long Term Plan aims to bridge this gap through the introduction of integrated primary care services that provide holistic, person-centred, multidisciplinary support for people with SMHP. This evaluation aimed to explore the experience of service users, carers and staff working within this new model of care.

Beyond early warning: towards greater granularity in the use of event-based surveillance for public health emergencies.

Background: The international health emergency caused by the emergence of the SARS-CoV-2 virus demonstrated the expanding usefulness of multi-country disease outbreak information gathered through event-based surveillance (EBS) as an extension beyond the main purposes of early warning, alert, and response (EWAR). In this article, previous events of multi-country outbreaks from 2010-2019 were reviewed for how EBS, within an expanded sphere of Epidemic Intelligence (EI), may help to enhance the understanding of outbreaks for a more timely and nuanced, multiple-point trigger approach to health emergencies.

Methods: The public, open-source database of ProMed reports were reviewed for the date of first notification on major outbreaks of infectious diseases and then compared for subsequent dates of any new, exceptional epidemiological findings (novel host, settings, transmission characteristics) as a determining factor for prolonged, multi-country events later acknowledged on the WHO disease outbreak news (DON) website, or by peer-reviewed journal publication if no related DON information became available.

Otolaryngologist surgical preferences for orbital decompression in thyroid eye disease: A North American survey.

Background: Orbital decompression is recommended for TED especially in the treatment of severe, refractory cases yet there are no clear guidelines regarding the optimal surgical approach. Previously conducted surveys assessed variations in the management of TED but only amongst ophthalmologists. Our study attempts to better characterize surgical and perioperative preferences amongst otolaryngologists in the management of TED.

Suture Button Fixation in Shoulder Instability Surgery to Achieve Bone Healing: A Critical Analysis Review.

» Suture button fixation has emerged as an effective surgical construct in arthroscopic and open Latarjet and anterior glenoid reconstruction with free autograft bone with high rates of bone block healing.» Biomechanical data suggest that screw and suture button mechanical fixation constructs provide similar load to failure and stability for the Latarjet procedure.» Preliminary bone healing models have identified that flexible fixation may exhibit a higher degree of bone callus maturation, whereas rigid fixation results in excessive callus hyperplasia» Mechanical tensioner use provides consistent tensioning of suture button constructs and improves bone-to-bone healing rates when used for anterior glenoid reconstruction surgery.