Application of various molecular markers for investigating petrogenic inputs in coastal systems strongly impacted by anthropogenic stressors

In this study, multiple molecular markers [polycyclic aromatic hydrocarbons (PAHs), linear and branched alkanes, unresolved complex mixture (UCM), hopanes, and steranes] were applied to explore petroleum-related inputs in complex coastal systems influenced by various human-induced pressures. To investigate anthropogenic impacts related to petrogenic emissions, we analysed surface sediments from coastal areas of southern Baltic, including harbour/shipyard channels, offshore dumping sites, shipping routes, and major sinks for particulate matter discharged by large rivers. This study indicates a large spatial variability in the contamination degree of examined sites by petroleum-derived chemicals. Hopanes and steranes along with UCM appeared to have the highest potential to identify petroleum sources in studied locations, whereas investigations based on alkanes and PAHs seemed to be considerably affected by inputs of modern biogenic and combustion-derived materials, respectively. However, the combined use of all these markers provides deeper insight into the complexity of sedimentary organic matter in human-impacted environments.

Minimal invasive aortic arch repair with suture-mediated closure system

Port implantation can be associated with an array of serious vascular complications, typically involving the subclavian artery. We report a case in which implantation of a port resulted in iatrogenic perforation of the aortic arch at the level of the left subclavian artery, which was sealed off using a percutaneous vascular closure device.

Long-term effects of air pollutants on respiratory and cardiovascular mortality in a port city along the Adriatic sea

BACKGROUND

Shipping and port-related air pollution has a significant health impact on a global scale. The present study aimed to assess the mortality burden attributable to long-term exposure to ambient particulate matter (PM2.5, PM10) and nitrogen dioxide (NO2) in the city of Ancona (Italy), with one of the leading national commercial harbours.

METHODS

Exposure to air pollutants was derived by dispersion models. The relationship between the long-term exposure of air pollution exposure and cause-specific mortality was evaluated by Poisson regression models, after adjustment for gender, age and socioeconomic status. Results are expressed as percent change of risk (and relative 95% confidence intervals) per 5 unit increases in the exposures. The health impact on the annual number of premature cause-specific deaths was also assessed.

RESULTS

PM2.5 and NO2 annual concentrations were higher in the area close to the harbour than in the rest of the city. Positive associations between each pollutant and most of the mortality outcomes were observed, with estimates of up to 7.6% (95%CI 0.1, 15.6%) for 10 µg/m3 increase in NO2 and cardiovascular mortality and 15.3% (95%CI-1.1, 37.2%) for 10 µg/m3 increase PM2.5 and lung cancer. In the subpopulation living close to the harbour, there were excess risks of up to 13.5%, 24.1% and 37.9% for natural, cardiovascular and respiratory mortality. The number of annual premature deaths due to the excess of PM2.5 and NO2 exposure (having as a reference the 2021 World Health Organization Air Quality Guidelines) was 82 and 25, respectively.

CONCLUSIONS

Our study confirms the long-term health effects of PM and NO2 on mortality and reveals a higher mortality burden in areas close to shipping and port-related emissions. Estimating the source-specific health burdens is key to achieve a deeper understanding of the role of different emission sources, as well as to support effective and targeted mitigation strategies.

Port-site hernias in patients undergoing laparoscopic and/or robotic surgery: Can they be prevented?

As laparoscopic surgery advances into robotic surgery, there still remains the occurrence of port-site hernias. This can have severe consequences for the patient, including needing further surgery such as bowel resection. This has an impact on both patient and the National Health Service as the stay in hospital is prolonged, increasing the demand on staff and creating more expense to the National Health Service. This literature review explores the prevalence of port-site hernias and discovers the recommendations in preventive measures. Findings include the benefit of using non-bladed trocars and further studies need to be conducted into the association between smaller or larger ports and port-site hernias.

Spatiotemporal variations of NO2 and its driving factors in the coastal ports of China

Nitrogen Dioxide (NO₂) is one of the major air pollutants in coastal ports of China. Understanding the spatiotemporal varying effects of driving factors of NO₂ is vital for the implementation of differentiated air pollution control measures for different port areas. Based on the Ozone Monitoring Instrument (OMI) satellite data, we adopted a Geographically and Temporally Weighted Regression (GTWR) model to explore the influences of meteorological and socioeconomic factors on the NO₂ Vertical Column Concentrations (VCDs) in coastal ports of China from 2015 to 2021. The results indicate that NO₂ VCD in most ports has decreased since 2016 and the ports with serious NO₂ pollution are mainly distributed in northern China. The associations between NO₂ VCD levels and their drivers exhibit obvious spatiotemporal heterogeneity. Higher wind speed and relative humidity are more helpful to alleviate NO₂ pollution in ports of the Bohai Rim and the Pearl River Delta. Cargo throughput has more closely associated with NO₂ pollution in Beibu Gulf in recent years, yet there is no significant association found for Shanghai ports. The positive relationship between transportation emissions and NO₂ VCD is more significant in southern ports. This work provides some implications for the formulation of targeted emission reduction policies for different ports along the Chinese coast.

Humor, transparency, and the management of distrust among business rivals: a case study of berthing meetings at the Port of Tema in Ghana

This article builds on rich empirical data following our unexpected discovery of a local practice to circumvent a stressful and counterproductive work environment due to distrust at the Port of Tema in Ghana. Using theoretical work on networks, trust, and humor, as well as extensive ethnographic fieldwork, we found that the humorous atmosphere at the regularly held physical berthing meetings fosters a sense of community, which enables competing professions, private companies, and public institutions to manage their mutual distrust. In an environment where trust among competitors is unrealistic, we argue that the objective of the performance of humor and transparency at the physical berthing meetings is the management of distrust rather than the creation of trust. The meetings have, gradually, grown to serve as a pragmatic local stakeholder adaptation to the challenges posed by universally perceived politicized, opaque, and corrupt business practices at the Port of Tema and beyond. In conclusion, we posit that our empirical findings allow us to identify the potential of and gaps in theories about trust and humor in understanding the dynamics of coping strategies among competitors in business settings that are characterized by unethical practices.

Change and stasis of distinct sediment microbiomes across Port Everglades Inlet (PEI) and the adjacent coral reefs

Deep water ports are human built coastal structures that by definition welcome ship traffic and disturbance. Evidence is accumulating that enhanced port activities such as dredging or deepening have negatively affected nearby natural habitats. Port Everglades Inlet (PEI) is a large active South Florida cargo port for over two million people and lies adjacent to coral reefs, dwindling mangroves, and recreational beaches. In this study, the microbial communities of PEI and adjacent reef sediments were characterized to serve as indicators for change due to dredging and assess anthropogenic influence on these sensitive ecosystems by sequencing the V4 region of 16S rRNA ahead of a large-scale port deepening event. For the first time, this study established baseline bacterial community characterizations and their patterns of diversity prior to and after a maintenance dredging event. PEI samples were collected for two consecutive years 2020 (Phase I, before maintenance dredging) and 2021 (Phase II, after maintenance dredging) from PEI sediments and adjacent coral reef sediments. In spite of their proximity and tidal connections through the PEI, reef and PEI sediment microbial communities were distinct. Changes in microbial diversity within the intracoastal waterway (ICW), a route for community exchange or transfers, were the greatest after maintenance dredging occurred. Microbial diversity in reef sediments also changed after dredging, indicating potential influence from resuspended sediments due to an associated increase in trace metals and decrease in cyanobacterial diversity. Sediments were identified as a possible source of human and coral pathogens, although dredging did not affect the relative abundances of these indicator microorganisms. This study highlighted the utility and relative ease of applying current molecular ecology methods to address macroscale questions with environmental management ramifications.

The forgotten ones of ports: The filter feeders at the heart of siltation processes

Siltation is a major concern in dynamic and complex ecosystems, such as ports. The mud must be regularly dredged to avoid disturbing the navigation channels. Sediments are carried by the waters entering the port and are partially trapped by harbour structures. Numerous studies have been conducted on the physical factors influencing siltation in port areas, whereas, few have focused on the role of biotic factors in mud formation. However, research in other contexts has shown that organisms that are abundant in pontoons, such as bivalves and tunicates, play an important role in this siltation process. All of these organisms belong to the filter feeder group. The sediments sucked in by the filter feeders are excreted in the form of faeces or mucus-bound pseudo-faeces. These waste materials, called bioproducts, settle efficiently and are involved in the composition of the mud. This study aimed to highlight the role of filter feeders in the siltation process in port areas and to determine the factors that influence the production of bioproducts by filter feeders. To investigate the role of filter feeders in the siltation processes, an experimental analysis was conducted in the largest marina in Europe (La Rochelle, France). It is divided into four basins with distinct filter feeder communities and environmental conditions, allowing for a detailed study of the environmental factors that influence the production of bioproducts. This analysis consisted of recovering and studying the bioproducts generated by the filter feeders using sediment traps fixed under pontoons. To explore the evolution of this biological production, 16 campaigns were conducted from January to March 2020 and May to July 2020. The total amount of dry matter produced was constant between seasons at approximately 130 g/m²/d; marina-wide, this amount represents a total daily production of 3.2 tons. However, the production amount varies spatially and temporally in relation to marine hydrodynamics and the organisms involved. Bioproduction was taxon-dependent: areas abundant in oysters and mussels were the areas with the most pronounced bioproduction, whereas there was no significant relationship between bioproduction and the presence of tunicates or scallops. If we consider bioproduction on a seasonal scale, we can see that the campaigns with the greatest production correspond to the periods when the sediment supply was the highest, i.e. when the tidal range was the highest. The quality of the bioproducts (organic matter content) differed between seasons, which can be explained by both environmental and metabolic changes. Understanding the role of filter feeders in siltation processes appears to be essential in port environments that need to be regularly dredged to ensure safe navigation.

Health impact assessments of shipping and port-sourced air pollution on a global scale: A scoping literature review

BACKGROUND

Globalisation has led to international trade expand rapidly. Seaborne transport moves 80% of traded goods across the globe, producing around 3% of greenhouse gases and other hazardous pollutants, such as PM, NO_x and SO_x, known to be harmful to health.

METHODS

A scoping literature review was conducted reviewing peer-reviewed studies on health impact assessments (HIA) of global shipping and port-sourced air pollution. For review inclusion, studies had to (1) use a HIA methodology; (2) quantify the air pollution concentration attributable to at least one shipping or port activity scenario; (3) assess at least one health outcome (i.e. epidemiological measure or monetization); (4) quantify the attributable health burden of the respective scenario.

RESULTS

Thirty-two studies were included, studying predominantly European Sea shipping/ port-sourced emissions with health impacts for global or respective European populations. Also, Global, Asian, North American and Australian Sea shipping/ port-sourced emissions were studied, with attributable health impacts for global or respective populations. The health outcome predominantly studied was mortality (all-cause, cause-specific, loss in life expectancy, years of life lost (YLLs)), but also morbidity (disease cases, hospital admissions, years lived with disability (YLDs)), disability-adjusted life-years (DALYs), restricted activity days and work loss days. The highest air pollution concentrations were identified along major shipping routes and ports, and the strongest health impacts occurred among respective riparian populations. Globally, ∼265,000 premature deaths were projected for 2020 (∼0.5% of global mortality) attributable to global shipping-sourced emissions. Emission control scenarios studied were predominantly sulphur fuel content caps and NO_x emission reduction scenarios, consisting of technological interventions, cleaner fuels or fuel switches, and were assessed as effective in reducing shipping-sourced emissions, and hence, health burdens.

CONCLUSIONS

Our review positions maritime transport an important source of air pollution and health risk factor, which needs more research and policy attention and rigorous emission control efforts, as shipping-sourced emissions are projected to increase with increases in global trade and shipping volumes.

Monitoring Air Pollution in Greek Urban Areas During the Lockdowns, as a Response Measure of SARS-CoV-2 (COVID-19)

On March 11, 2020, the World Health Organization declared COVID-19 (SARS-CoV-2) a pandemic. Countries all over the world imposed restriction measures, in an attempt to limit the expansion of the pandemic. Provided that human activities in large urban areas affect air quality, we studied the concentrations of gaseous pollutants ΝΟ, ΝΟ₂, O₃, C₆H₆, and particulate matter PM₁₀ in the air, through gas pollution measuring stations in the center of Athens (Greek capital), the center of Piraeus (Greece's largest port), Athens International Airport (most international and domestic flights within Greece). We monitored and compared the concentrations of ΝΟ, ΝΟ₂, O₃, C₆H₆, and ΡΜ₁₀, of 2020 to those of the previous years and found that the primary air pollutants, ΝΟ, ΝΟ₂, and C₆H₆, recorded decreased compared to those of the past years. The O₃, which is produced secondarily at the ground of the earth being inversely dependent on NO/NO₂, had in most cases increased. The particulate matter PM₁₀, although reduced by the cessation of human activities, was inextricably linked to natural conditions, such as wind velocity and direction transporting African desert dust masses through storms, during which at certain periods was showing increased in concentrations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11270-022-06024-7.

Assessing core capacities for addressing public health emergencies of international concern at designated points of entry in cameroon during the COVID-19 Pandemic

BACKGROUND

Points of Entry (POEs) are at the frontline for prevention, detection and response to international spread of diseases. The objective of this assessment was to ascertain the current level of existing International Health Regulations (IHR) core capacities of designated airports, ports and ground crossings in Cameroon and identify critical gaps for capacity building for prevention, early warning and response to public health threats including COVID-19.

METHODS

Data were collected from April to May 2020 in 5 designated POEs: Yaounde Nsimalen International Airport (YIA), Douala international Airport (DIA), Douala Autonomous Port (DAP), Garoua-Boulai ground crossing, Kye-Ossi ground crossing which were all selected for their high volume of passenger and goods traffic. The World Health Organization (WHO) assessment tool for core capacity requirements at designated airports, ports and ground crossings was used to collect data on three technical capacities: (i) communication and coordination, (ii) Capacities at all times and (iii) capacities to respond to Public Health Emergencies of International Concern (PHEIC).

RESULTS

All the investigated POEs scored below 50% of capacities in place. YIA recorded the highest percentage for all groups of capacities, coordination and communication and for core capacity at all times with a percentage of 42%, 58% and 32% respectively. For core capacity to respond to PHEIC, all the POEs recorded below 50%. The DAP and all ground crossings lacked trained personnel for inspection of conveyances. Only DIA had a public health emergency plan. There is no isolation/quarantine and transport capacity at the POEs.

CONCLUSION

All POEs assessed did not meet IHR standards and need significant improvement to fulfill the IHR requirements. Unstructured communication channels between stakeholders make the implementation of IHR challenging. A coordination mechanism, with clear functions and structure, is necessary for well-coordinated response efforts to health emergencies at POEs. This assessment will serve as a baseline to inform planning and IHR implementation at designated POEs in Cameroon.

Self-reported prevalence of asthma symptoms in adults living in a port city

Air pollution is a worldwide health problem, and exposure to the pollution can cause damage to the human body, especially to the respiratory and cardiovascular systems. Asthma is the third most common chronic disease in Brazil, presenting high prevalence in some areas. The aim of this study was to evaluate the self-report the prevalence of asthma symptoms in Santos city, Brazil, and its associated factors in the adult population (between 18 and 59 years old). A cross-sectional study was applied in two different areas of the city. The participants of this study were selected by zip code estimated on a random sample. The ECHRS and a demographic questionnaire were used to collect data. Associations between categorical variables were tested using Pearson's chi-square test or Fisher's exact test. Single and multiple logistic regression models were applied to evaluate the risk factors for asthma. Georeferencing was implemented to distribute the cases. The highest prevalence of asthma was found in Ponta da Praia neighborhood (16.4%; p=0.019), as well as waking up with a coughing crisis in the last 12 months (26.4%; p <0.001). The risk factors for asthma were the following: living next Santos Port area (OR: 2.90; 95%CI 1.13-7.44); and the presence of O₃ (OR = 2.63; 95%CI 0.86-7.96). This pioneering study demonstrated that living near the port area increases the chances of adults having self-reported asthma symptoms.

Complications associated with totally implantable access ports in children less than 1 year of age

BACKGROUND

Long term central venous access is necessary for the treatment of several conditions affecting young children. Totally implantable access ports (ports) offer the advantage of containing no external components, thus simplifying their care and maintenance. However, there is no consensus on the safety of port placement in infants (birth to 1-year of age). The aim of this study was to describe complications associated with port placement in infants, including which specific factors may be associated with risk for developing complications among these patients, and thereby assess the safety of port placement in this young population.

METHODS

A two-institution, retrospective cohort study identified patients under 1-year old who underwent port placement. Intraoperative, early postoperative (within 30 days), and late postoperative (greater than 30 days) complications were recorded. Multivariate logistic regression models were employed to assess factors associated with port-related complications.

RESULTS

Among 121 patients who received a port, 36 (30%) experienced a complication with a median time to complication of 299.5 days [IQR 67.5-440.75]. Of those, 26 required unplanned port removal. Only 3 patients (2.5%) experienced an intraoperative complication, and 3 patients (2.5%) experienced a complication within 30 days of port placement. A diagnosis of cancer was found to be protective against early catheter malfunction (OR=0.31, p = 0.03). A non-statistically significant trend associated with increased complications for large caliber devices (>6.0Fr) and weight <7-kg (OR 2.20, p = 0.06 and OR=2.26, p = 0.11 respectively) was observed.

CONCLUSIONS

Port placement appears to be safe for most infants with low or acceptable rates of intra- or post-operative complications. Smaller patient size (< 7 kg) and larger-sized catheters (> 6.0Fr) may be associated with an increased risk for complications among this population.

LEVEL OF EVIDENCE

III.

A CT scan-based formula for predicting central venous catheter length in pediatric patients

PURPOSE

Placement of a central venous catheter (CVC) is the most commonly performed pediatric procedure. This study aims to develop simple formulas to calculate intravascular length of CVCs prior to insertion to minimize reliance on fluoroscopic and radiographic imaging, which may not be uniformly available.

METHODS

We performed a single-institution, retrospective review of 115 pediatric patients who received both CVC placement and computed tomography (CT) imaging of the chest within 3 months of the procedure. Using measurements from the CT imaging, formulas calculating the length of the intravascular component of the CVC based on height and insertion laterality were developed and compared to previously published formulas. These formulas were then trialed prospectively to validate reliability and application.

RESULTS

Formulas were developed for right-sided and left subclavian insertion. The right-side formula accurately predicted CVC length in 52.6% of patients, compared to 47.4% by the Andropoulos formula. The left subclavian formula accurately estimated 62.5%, compared to 34.5% by the Stroud formula.

CONCLUSIONS

The optimal intravascular length of central venous catheters may be determined by simple formulas based on patient height and insertion site.

LEVEL OF EVIDENCE

III.

Distribution patterns and transportation behavior of alkylphenol polyethoxylate degradation metabolites among river, port area, and coastal water bodies of Kaohsiung City, Taiwan

In this study, we conducted a comprehensive study of the distribution, transportation behavior and potential ecological risk of alkylphenol polyethoxylates (APnEOs) in the aquatic environments of Kaohsiung City, Taiwan because little information is available regarding the fate of APnEOs in the water bodies of a total environment. At Love River, APnEOs concentrations were much higher at upstream of interception stations L15 (27.33 ± 1.22 μg/L) and L16 (6.31 ± 0.14 μg/L) than at downstream of interception stations L1-L14 (0.69-2.54 μg/L). Additionally, the average ethoxy (EO) chain lengths of APnEOs at L15 and L16 were longer than at L1-L14. These observations were attributed to the sluice between L14 and L15 that intercepts and accumulates untreated sewage from upstream areas and to the infrastructure of the sewage system that prevents domestic sewage from flowing downstream in the river and to the Kaohsiung Port Area. At Kaohsiung Port Area, APnEO concentrations ranging from 0.63 to 6.50 μg/L were measured. The concentration range and average EO chain length of these APnEOs were similar to those of the downstream stretch of the river, which was attributed to the mixing efficiency of the Kaohsiung Port Area and Love River through tidal exchange. At Cijin Coastal Area, APnEO concentrations ranged from 0.14 to 18.77 μg/L. Notably, the APnEO concentration of surface waters was much higher than that of bottom waters. This observation was attributed to the sewage discharged from the ocean outfall buoying up to the surface instead of mixing with surrounding bottom waters. In potential ecological risk, 19 of 39 sampling points exceeded toxic equivalency of 1 μg/L, and approximately 48.7% of the sampling points would exceed the threshold. The result provides insight into the environmental implications of APnEOs contamination in aquatic environments and useful information for environmental policy and ecological risk assessments.

Resilience of U.S. Rail Intermodal Freight during the Covid-19 Pandemic

The rapid onset of the COVID-19 pandemic in March 2020 marked a challenging time for the US and its freight industry. Manufacturing slowed, consumer purchasing patterns changed, and for many, shopping moved online. The freight industry suffered a sharp decline in shipments, followed by a surprisingly quick rebound. The industry had to adapt quickly to meet fast-changing demand and supply patterns upended by global supply chain disruptions. This paper uses U.S. intermodal activity data, supported by in-depth interviews with leaders of railroads, intermodal carriers, equipment manufacturers, car leasing companies, shippers, and e-commerce players to characterize and assess how the rail industry met the challenge of this demand whiplash and other performance impediments. What emerges is a rich picture of the multi-actor intermodal supply chain, the impacts of COVID-19 on it, the performance of the logistics system in general, and railroads in particular during the pandemic. Industry interviews revealed that a handful of choke points, many of which were outside the rail industry, complicated supply chain responses to COVID-19. The paper shows how the rail industry was an essential component of pandemic resilience, demonstrating a high level of adaptability to meet consumer and business demands. Through the use of depth interviews it reveals the complexity of the intermodal supply chain, and it accurately foretells the subsequent disruptions that continued to plague that supply chain long after the initial impacts of the pandemic.

Size segregated ionic species collected in a harbour area

Water-soluble ions were analysed in size segregated aerosol samples collected in the port of Alicante (Southeastern Spain) during summer and winter using a multistage cascade impactor. Seasonal variations in the size distributions of the analysed components and the influence of bulk materials handling (loading/unloading and stockpiling) at the docks were investigated. The size distributions of SO₄^2-, NH₄⁺ and K⁺ were characterized by prominent peaks in the condensation and droplet modes, both in summer and winter, while those of Ca²⁺, Na⁺, Mg²⁺ and Cl^- had a main peak centred at ∼4 μm. Although oxalate size distributions were similar during both seasons, the fraction of coarse-mode oxalate increased in summer most likely as a result of volatilization and repartition processes or reactions of oxalic acid with coarse alkaline particles. Nitrate size distributions were dominated by a coarse mode; however, during winter, modal peaks in the submicron size range were also observed due to favourable conditions for the formation of fine-mode NH₄NO₃. Harbour activities had a significant impact only on the concentrations of calcium, particularly in the coarse fraction, during both summer and winter.

Intrathecal catheter and port placement for nusinersen infusion in children with spinal muscular atrophy and spinal fusion

BACKGROUND

Spinal administration of medications is challenging in patients with complete posterior spinal fusion. We describe percutaneous image-guided intrathecal port placement for administration of the antisense oligonucleotide nusinersen for children and young adults with spinal muscular atrophy.

OBJECTIVE

To describe and present our initial experience with a new technique for administering nusinersen in patients with spinal muscular atrophy and posterior spinal fusion.

MATERIALS AND METHODS

We reviewed medical records of 13 patients who received intrathecal ports using DynaCT, biplane fluoroscopy and iGuide from April 2018 through June 2019, and we describe the clinical course over 1 year.

RESULTS

Image-guided catheter and port implantation was successful in all cases. Two ports were subsequently removed, one for persistent cerebrospinal fluid leak and one for superficial infection. The other 11 have functioned successfully for a minimum of 23 months.

CONCLUSION

We report our experience with image-guided intrathecal port placement in children with complete posterior spine fusion. The implanted port permits dosing in an outpatient setting and avoids the need for multiple future radiologic procedures, and it reduces discomfort, procedural costs and potential risks and sequelae of multiple anesthetics and radiation exposures. Further studies are needed to define the relative risks and benefits of intrathecal ports compared to other approaches such as repeated transforaminal lumbar punctures.

Food safety knowledge, attitudes, and practices of food handlers at kitchen premises in the Port 'X' area, North Jakarta, Indonesia 2018

Improper food handling can be a major cause of food contamination. To prevent food contamination, the food handler should have good knowledge, display a positive attitude, and practice proper food handling practices. This study aimed to evaluate the food safety and personal hygiene knowledge, attitudes, and practices of food handlers at kitchen premises in the Port ‘X’ area in North Jakarta, Indonesia. This study uses a cross-sectional design. The research was conducted in April 2018 and May 2018. Data were collected from 72 food handlers from kitchens located in the Port ‘X’ area in North Jakarta. Data collection was performed through interviews and observations, using questionnaires and checklists as research instruments. The results show a significant correlation between the level of knowledge about food safety and the attitude of food handlers (p=0.01), and attitude scores were significantly higher among food handlers who reported attending a previous food safety training course (p=0.002) with (r=0.302) it means a weak uphill (positive) linear relationship attitude scores and training that food handlers attended. This study found a significant relationship between the knowledge and attitude of food handlers, but there was no significant relationship between knowledge or attitude and food handling practices. Thus, it is recommended that training activities for food handlers be held regularly, as the food safety knowledge obtained from training or courses can translate into the improvement of attitudes and food handling practices.

SARS-CoV-2 Containment (March-June 2020).]

During the state of alert declared in the national territory in March 2020 due to the health crisis caused by SARS-CoV-2, the free movement of the population was restricted in order to prevent the spread of the virus. In the Balearic Islands, access by air and sea was limited and, in addition, health controls were established at the entry points of the islands aimed to detect people with COVID-19. The health check is understood as a Public Health surveillance procedure through which all persons authorised to travel at that time were tested. This procedure, together with the security measures to prevent the spread of the virus, had never before been implemented in the Balearic Islands and required the collaboration of various organizations in order to organise and execute it. This paper shares the experience and analysis of the health control measures implemented in these circumstances. To do so, it describes the procedure carried out, the devices that were developed, the main results and the assessment of the project as a whole. Finally, the positive aspects and possible improvements are considered. The most of people screened upon arrival in Balearics Islands did not register or show clinical symptoms of COVID-19.

A mass casualty incident of infectious diseases at the port of Hamburg: an analysis of organizational structures and emergency concepts

Background

The project “ARMIHN” (Adaptive Resiliency Management in Port) focuses on strengthening the capability to act in a mass casualty incident (MCI) due to an outbreak of infectious diseases (MCI-ID). In addition to the current threat from the COVID-19 pandemic and associated outbreaks on cruise ships, previous MCI-ID were especially caused by pathogens such as Influenza virus or Norovirus. The first step was, to get an overview of processes and resources using the example of the Port of Hamburg, and to show the associated interaction of involved parties. This will serve as a basis for developing an operational strategy and offers the opportunity to optimize current work processes.

Methods

A selective literature research using specified key words was performed and existing MCI concepts were received from local authorities. Identified structures and processes were analyzed in a multiple step process and also brought together through discussions in workshops with involved organizations and other experts. Additionally, the distances between the nearest rescue stations and selected hospitals from the Port of Hamburg were analyzed.

Results

The current available concepts are proven, but an adaptation to an MCI-ID shows opportunities for a further cross-organizational development. The organizational structure of an MCI-ID in the Port of Hamburg was described, including a large number of involved organizations (n = 18). There are 17 involved fire and rescue stations and the port can be reached from these locations within 6 to 35 min. Based on their specialist expertise, 14 of the 31 listed clinics were selected.

Conclusion

The purpose of the study was to provide an analysis of the current situation and show how involved parties would cope an MCI. A description of processes and resources at the Port of Hamburg will be used when designing a management plan for responding to an MCI-ID.

White Matter Governed Superior Frontal Sulcus Surgical Paradigm: A Radioanatomic Microsurgical Study-Part II

BACKGROUND

Kocher's point (KP) and its variations have provided standard access to the frontal horn (FH) for over a century. Anatomic understanding of white matter tracts (WMTs) has evolved, now positioning us to better inform the optimal FH trajectory.

OBJECTIVE

To (1) undertake a literature review analyzing entry points (EPs) to the FH; (2) introduce a purpose-built WMT-founded superior frontal sulcus parafascicular (SFSP)-EP also referred to as the Kassam-Monroy entry point (KM-EP); and (3) compare KM-EP with KP and variants with respect to WMTs.

METHODS

(1) Literature review (PubMed database, 1892-2018): (a) stratification based on the corridor: i. ventricular catheter; ii. through-channel endoscopic; or iii. portal; (b) substratification based on intent: i. preoperatively planned or ii. intraoperative (postdural opening) for urgent ventricular drainage. (2) Anatomic comparisons of KM-EP, KP, and variants via (a) cadaveric dissections and (b) magnetic resonance-diffusion tensor imaging computational 3D modeling.

RESULTS

A total of 31 studies met inclusion criteria: (a) 9 utilized KP coordinate (1 cm anterior to the coronal suture (y-axis) and 3 cm lateral of the midline (x-axis) approximated by the midpupillary line) and 22 EPs represented variations. All 31 traversed critical subcortical WMTs, specifically the frontal aslant tract, superior longitudinal fasciculus II, and inferior fronto-occipital fasciculus, whereas KM-EP (x = 2.3, y = 3.5) spares these WMTs.

CONCLUSION

KP (x = 3, y = 1) conceived over a century ago, prior to awareness of WMTs, as well as its variants, anatomically place critical WMTs at risk. The KM-EP (x = 2.3, y = 3.5) is purpose built and founded on WMTs, representing anatomically safe access to the FH. Correlative clinical safety, which will be directly proportional to the size of the corridor, is yet to be established in prospective studies.

Assessing training needs in infectious disease management at major ports, airports and ground-crossings in Europe

BACKGROUND

The implementation of core capacities as stated in the International Health Regulations (IHR) is far from complete, and, as the COVID-19 pandemic shows, the spreading of infectious diseases through points of entry (POEs) is a serious problem. To guide training and exercises, we performed a training needs assessment on infectious disease management among professionals at European POE.

METHODS

We disseminated a digital questionnaire to representatives of designated airports, ports, and ground-crossings in Europe. Topics were derived from the IHR core capacities for POEs. Based on the importance (4-point Likert scale) and training needs (4-point Likert scale), we identified the topics with the highest priority for training. These results were put in further perspective using prior experience (training < 3 year, exercise < 5 years, events < 5 years). Also, preferences for training methodologies were assessed.

RESULTS

Fifty questionnaires were included in the analyses, representing 50 POEs from 19 European countries. Importance is high for 26/30 topics, although scores widely vary among respondents. Topics with a high training need (16/30) are amongst others the handling of ill travelers; using and composing the public health emergency contingency plan, and public health measures. Respondents from ports and airports attribute equal importance to most topics, but respondents from ports showed higher training needs on 75% of the topics. POEs are unevenly and generally little experienced. The most preferred training methods were presentations. Simulation is the preferred methodology for training the handling of ill or exposed travelers.

CONCLUSIONS

The European workforce at designated ports, airports and ground-crossings has a different level of experience and perceives varying importance of the topics assessed in our study. We identified the topics on which training is required. We call for European collaboration between POEs to agree upon the importance of infectious disease management, and to jointly build a trained and prepared workforce that is ready to face the next crisis.

[Air and maritime transport during the COVID-19 pandemic in Germany: challenges for the public health service]

COVID-19 has been challenging our society since January 2020. Due to global travel, the new coronavirus has rapidly spread worldwide. This article aims to provide an overview of the challenges in implementing measures in the air and maritime transport sector from the perspective of the German Public Health Service (Öffentlicher Gesundheitsdienst, ÖGD). Significant events and measures for air and maritime transport between January and August 2020 were selected. Lessons learned are discussed.During the COVID-19 pandemic, the ÖGD has been operating in a field of tension between the dynamics of scientific knowledge, political decision-making, social acceptance and consent.There are specific challenges at points of entry such as airports and seaports. These include staff shortages and the need to implement measures with a high organisational effort at very short notice such as health authority passenger checks carried out on aircraft, the establishment of test centres at points of entry and control of compliance with quarantine measures. Aggravating the situation, passenger lists, which are necessary for effective contact tracing, are often not available or incomplete. There is also a lack of digital tools for contact tracing but also, for example, the exchange of personal data within the ÖGD. Further difficulties in outbreak management arise from the cramped conditions on board ships and from the potential psychological stress on crew members and passengers, which have not yet been sufficiently considered.In view of all these challenges, it is paramount to strengthen the German Public Health Service in general and at points of entry and to intensify the exchange between the national, federal state and local levels.

Quantification of the impact of port activities on PM10 levels at the port-city boundary of a mediterranean city

The main objective of this work was to quantify the impact of handling of bulk materials on PM₁₀ levels measured at the port-city border of Alicante (Spain), located on the western Mediterranean coast. To achieve that goal, 355 PM₁₀ samples were collected at the perimeter of the harbor of Alicante from March 2017 to February 2018. A 181 sample subgroup was chemically characterized in order to perform a source apportionment study with the EPA PMF 5.0 model. Eight factors were identified, two of them directly related to the handling of bulk materials (Limestone + gypsum and Clinker), accounting jointly for 35% of the average PM₁₀ concentration. A Road traffic factor was the second highest contributor to PM₁₀ levels (17%) while the Shipping emissions factor accounted for only 6% of the average PM₁₀ mass. Other factors such as Biomass burning+ secondary nitrate and Aged sea salt represented a joint contribution of 25% of the PM₁₀ mass. Results indicate that emission abatement strategies should primarily focus on the reduction of fugitive emissions caused by the handling of bulk materials at the docks. Moreover, scenarios including reductions of more than 50% in bulk handling sources and 10% in other anthropogenic sources would help to reduce anthropogenic exceedances of the daily PM₁₀ limit (50 μg·m^-3) and to approach to WHO daily PM₁₀ standard (20 μg m^-3).

Impact of COVID-19 on environmental noise emitted from the port

Identification of noise sources and their ranking is a crucial part of any noise abatement program. This is a particularly difficult task when a complex source, such as a seaport, is considered. COVID-19 epidemic has had a significant impact on environmental noise related to road, rail, air and ship traffic and provided a unique opportunity to observe immediate noise reduction. In order to identify the noise sources, whose reduction was most effective in reducing noise from the port area, this study compared and quantified noise emissions between the historical and epidemic periods. Environmental noise measurements from three noise monitoring stations at the port boundary were analysed. In addition, noise emissions from ship, road, rail and industry as well as meteorological data in the historical pre - COVID-19 (January 2018-February 2020) and COVID-19 (April 2020) period were analysed in detail. The characteristics of the noise sources mentioned, geographical data and noise measurements were used to develop and validate a noise model of the port area, which was used to calculate noise contour maps. Our results show that the reduction in noise levels observed at all monitoring stations coincides with the reduced shipping traffic. The A weighted equivalent sound pressure levels in the day, evening and night periods were reduced by 2.2 dB to 5.7 dB compared to the long-term averages, and the area of the 55 dB day-evening-night noise contour was reduced by 23%. Compared to the historical period, the number of people exposed to noise levels above 55 dB(A) in the day-evening-night period due to shipping and industrial activities was reduced by 20% in the COVID-19 period. Such results show that environmental noise generated by moored ships is a problem for port cities that should be regulated internationally. In addition, this paper provides precise guidance on noise emission characteristics, ship categorisation and the post-processing of long-term measurement data, taking into account wind conditions and undesired sound events, which can be applied to future research at other locations near shipping ports and used to prepare strategies for noise reduction in ports.

Endovascular Repositioning of a Central Venous Port Malposition in the Internal Thoracic Vein

Malpositioning of a central venous port in the internal thoracic vein can be difficult to check based on single-plane (PA) chest radiographs only, and can be managed by interventional radiology. Teaching Point: Central venous port malposition in the internal thoracic vein must be detected on postero-anterior chest radiograph and can be repositioned via endovascular procedure.

A systematic evaluation of polycyclic aromatic hydrocarbons in South Atlantic subtropical mangrove wetlands under a coastal zone development scenario

Mangrove forests worldwide are threatened environments considered vulnerable to chronic contamination by hydrophobic contaminants such as polycyclic aromatic hydrocarbons (PAHs). These ecosystems have a key role in the dynamics of biogenic and anthropogenic carbon storage and provide proper conditions for accumulation. One of most important subtropical mangrove swamps in the South Atlantic is located in the Paranaguá Estuarine System (PES), the largest bay of South Brazil surrounded by well-preserved Atlantic rainforests; however, the PES is under imminent risks of damage, e.g., due to incidental oil spills during port operations. In this scenario, PAHs were assessed for the first time in the mangrove sediments of the PES. The concentrations of 16 priority PAHs (EPA) (<DL - 234.3 ng g^-1, 36 samples) were higher than those observed in previous studies for bottom sediments and had a similar order of magnitude as those for other human-impacted mangroves but were lower than those of other heavily impacted mangroves. A moderate level of anthropic contamination was observed, and the main probable sources of PAHs were navigation and domestic effluents. Bulk parameters (TOC/TN ratio and δ¹³C) showed the estuarine land-sea gradient and helped define the preferential sites of PAH deposition due to its correlation with TOC and fine sediments. Marine hydrodynamics and/or dilution processes had a major influence on PAH distribution, resulting in higher concentrations in the inner/sheltered areas of the estuary and lower values in the outer zone of the estuary with higher hydrodynamic energy. The environmental features and anthropogenic forcing of the PES added to the relative absence of a detailed evaluation of the levels of and environmental risks posed by PAHs in other subtropical mangrove ecosystems located in the Southern Hemisphere, reinforcing the importance of the current study.

Combined Decompressive Hemicraniectomy and Port-Based Minimally Invasive Parafascicular Surgery for the Treatment of Subcortical Intracerebral Hemorrhage: Case Series, Technical Note, and Review of Literature

BACKGROUND

Intracerebral hemorrhage (ICH) is a neurosurgical emergency. Combined decompressive hemicraniectomy (DHC) and minimally invasive parafascicular surgery (MIPS) may provide a practical method of managing subcortical ICH.

OBJECTIVE

1) To present a case series of combined DHC-MIPS for the treatment of subcortical-based ICH; 2) to describe technical nuances of DHC-MIPS; and 3) to provide a literature overview of MIPS for ICH.

METHODS

The following inclusion criteria were used: 1) Glasgow Coma Scale (GCS) score <3-4; 2) admission within 6 hours of onset; 3) increased intracranial pressure caused by hemorrhage; 4) patient unresponsive to medical management; 5) hemorrhage >30 cm³; 6) subcortical location; and 7) midline shift (mm). Before DHC, sulcal cannulation used the following coordinates: intersection of tragus-frontal bone and midpoint of midpupillary line and midline; coronal suture: 3-4 cm posterior to this point).

RESULTS

Three patients were selected: a 62-year old woman, a 45-year old woman, and a 36-year-old man. GCS and ICH scores on admission were 7 and 3, 3 and 4, and 3 and 4, respectively. ICH was located in left basal ganglia in patients 1 and 3 and right basal ganglia in patient 2, all with intraventricular extension. ICH volume was 81.7, 68.2, and 42.3 cm³, respectively. The postoperative GCS score was 11, 10, and 6, respectively. There were no intraoperative complications or mortalities. Evacuation was within 15 minutes in all patients. The modified Rankin Scale score was 3, 4, and 5, respectively, with semi-independence in case 1.

CONCLUSIONS

Combined DHC-MIPS, with the use of craniometric points, can provide a unique and simple surgical option for the management of subcortical ICH.

Non-indigenous species in Mediterranean ports: A knowledge baseline

Port areas have been considered bioinvasion hotspots due to the concentration of several invasion vectors. However, the actual distribution of non-indigenous species (NIS) in Mediterranean ports is still poorly understood. Here we conducted a literature review with the aim to provide a knowledge baseline about NIS distribution in Mediterranean ports. NIS distribution in Mediterranean ports showed a high degree of heterogeneity in terms of studies across the whole basin, with a limited knowledge on both specific taxa and geographical areas, as well as a generally low proportion of investigated ports. The low rate of specific studies designed to monitor these particular environments may represent the main source of knowledge gaps. Mediterranean ports host NIS from all regions of the world, playing a key role in marine bioglobalization. Our synthesis represents the first baseline addressing the presence of NIS in Mediterranean ports, which may be useful to define plans of NIS management and strategies focusing on a network of recognised focal hotspots.

Enterocutaneous fistula from migration of hepatic artery infusion catheter

We present an 84-year-old man with erosion of the chemotherapy port on his chest wall. He had a history of colorectal cancer with liver metastases more than 20 years ago, when he underwent right hemicolectomy and liver resection. A hepatic artery infusion catheter was placed for targeted administration of chemotherapy for the liver metastases. Imaging showed the catheter had migrated into the small bowel lumen. We considered the best approach for removing the migrated catheter - either remove the catheter and accept the likelihood of a low-volume enterocutaneous fistula that may self-resolve, or explore the enterocutaneous tract with a view to small bowel resection. We discuss the advantages and disadvantages here.

Variables affecting the plankton network in Mediterranean ports

Attention on port waters is increasing since these economically important infrastructures are embedded in the coastal environment and their management needs to be considered in the monitoring programmes of coastal ecosystems. To implement the sustainable development (blue growth) of port areas, a general knowledge on the ongoing processes in their waters needs to be obtained, considering both abiotic and biotic variables. The present study aimed at inspecting the relationships among plankton components to provide insights into the ecology of ports. Seasonal samplings were carried out in three Mediterranean touristic ports where bacterio-, phyto- and zoo-plankton were simultaneously assessed at a large spatial scale and compared with respect to environmental variables and anthropogenic inputs. Factor analysis revealed the effects of load of inland waters, seasonality, water turbulence and hydrocarbon pollution on the planktonic components and zooplankton variability in port sectors characterized by different depths and uses.

Port Site Hernias Following Laparoscopic Ventral Hernia Repair

BACKGROUND

Port site hernias (PSH) are underreported following laparoscopic ventral hernia repair (LVHR). Most occur at the site of laterally placed 10-12-mm ports used to introduce large pieces of mesh. One alternative is to place the large port through the ventral hernia defect; however, there is potential for increased risk of surgical site infection (SSI). This study evaluates the outcomes when introducing mesh through a 10-12-mm port placed through the hernia defect.

METHODS

This was a retrospective case series of patients who underwent LVHR in three prospective trials from 2014-2017 at one institution. All patients had mesh introduced through a 10-12-mm port placed through the ventral hernia defect. The primary outcome was SSI. Secondary outcomes were hernia occurrences including recurrences and PSH.

RESULTS

A total of 315 eligible patients underwent LVHR with a median (range) follow-up of 21 (11-41) months. Many patients were obese (66.9%), recently quit tobacco use (8.8%), or had diabetes (18.9%). Most patients had an incisional hernia (61.2%), and 19.2% were recurrent. Hernias were on average 4.8 ± 3.8 cm in width. Two patients (0.6%) had an SSI. Fourteen patients had a hernia occurrence-13 (4.4%) had a recurrent hernia, and one patient (0.3%) had a PSH.

CONCLUSION

During LVHR, introduction of mesh through a 10-12-mm port placed through the hernia defect is associated with a low risk of SSI and low risk of hernia occurrence. While further studies are needed to confirm these results, mesh can be safely introduced through a port through the defect.

Implantable venous access devices in children with severe hemophilia: a tertiary pediatric institutional experience

BACKGROUND

Clotting factor replacement forms the pillar of treatment for children with hemophilia. Most children can be treated using peripheral venipuncture, but very young children and children with poor venous access might require a central venous catheter. Short-term and long-term complications of implantable venous access device placement (also known as port placement) can result in important morbidity and mortality in children with hemophilia.

OBJECTIVE

The purpose of this study is to describe our experience with port placement in children and adolescents with severe hemophilia (<1% of the Factors VIII or IX).

MATERIALS AND METHODS

We performed a retrospective review over a 10-year period to identify port placement in pediatric patients with severe hemophilia. We reviewed demographic and procedural information, access frequency, mechanical complications, and central-line-associated bloodstream infections (CLABSI). Eighteen males were included, with median age at insertion of 3.9 years (0.7-22.7 years). Fifteen of the 18 patients had hemophilia Type A and 3/18 had Type B. Thirteen had high neutralizing inhibitor titers.

RESULTS

Technical success in port placement was achieved in 26/27 (96.3%) patients, with 1 port failure caused by venous occlusion from prior catheter placement. Port catheter size ranged from 5 French (Fr) to 7.5 Fr. All were single-lumen and placed via right (76.9%) or left (23.1%) internal jugular vein; 59.3% were placed during general anesthesia, and all had factor replacement prophylaxis. A peripherally inserted central catheter (PICC) was placed concurrently in 69.2% of the cases; per hospital policy, the port was only accessed 15 days post-placement to reduce the risk of site hematoma. Two patients were lost to follow-up. The total catheter days was 15,893. Ports were removed in 14/24 cases, most commonly because of CLABSI (7/24; 29.2%) and transition to peripheral infusion (3/24; 12.5%). Bleeding was the most common complication in the first 30 days after placement. There were nine CLABSI events (0.57 per 1,000 catheter days), all in patients with high neutralizing inhibitor titers. A higher frequency of port access (more or equal to daily vs. less than daily) correlated with higher infection rates (P=0.02). Median time from port insertion to first infection was 348 days (range 167-1,055 days). There were four fibrin-sheath-related catheter occlusions (0.25 per 1,000 catheter days): three catheters were salvaged with intra-catheter tissue plasminogen activator (tPA) instillation resulting in a salvage of an additional 1,214 catheter days, and one catheter was removed after tPA failure (0.06 per 1,000 catheter days).

CONCLUSION

Port maintenance in boys with severe hemophilia is challenging given the need for long-term frequent device access that is associated with catheter-related infections. The rate of bleeding or infection did not differ in patients whether the device was accessed immediately or 15 days post placement. With appropriate pre- and post-procedural factor replacement, immediate and early term severe complications are not common.

Minimally Invasive Parafascicular Surgical Approach for the Management of a Pediatric Third Ventricular Ependymoma: Case Report and Review of Literature

BACKGROUND

Minimally invasive parafascicular surgery (MIPS) has evolved into a safe alternative to access deep-seated subcortical and intraventricular pathologies. We present a case of a port-mediated resection of a pediatric third ventricular tumor.

CASE DESCRIPTION

The patient is a 7-year-old boy who presented with worsening headache, nausea, vomiting, dizziness, unsteady gait, photophobia, and blind spots with positional changes. Magnetic resonance imaging (MRI) scan revealed a large isointense mass, with areas of hyperintensities suggestive of intratumoral hemorrhage, centered in the posterior segment of the third ventricle with extension into the aqueduct of Sylvius. The superior frontal sulcus was used as an access corridor for the port to the frontal horn of the lateral ventricle en route to the third ventricle. Intraoperative visualization was aided with a 3-dimensional exoscopic system. After cannulation, the tumor was seen within the foramen of Monro and tethered to the thalamostriate vein. The tumor was removed completely, with the exception of small residual attached to the thalamostriate vein, which was left intentionally. A flexible endoscope was placed through the port to verify the absence of residual along the superior wall of the third ventricle. Intraoperative MRI scan confirmed presence of residual, along with normal postoperative changes, including pneumocephalus. Postoperative MRI scan revealed cortical recovery along the sulcal path and resolution of ventriculomegaly.

CONCLUSIONS

The patient improved from baseline, with no remaining visual deficits, headaches, or balance issues. Pathology reported a World Health Organization grade II tanycytic ependymoma. To our knowledge, few cases have reported the utilization of port-based MIPS in pediatric patients.

Occurrence and risk assessment of benzothiazole, benzotriazole and benzenesulfonamide derivatives in airborne particulate matter from an industrial area in Spain

In this study we monitored benzothiazole (BTHs), benzotriazole (BTRs) and benzenesulfonamide (BSAs) derivatives in airborne particulate matter from four sampling sites near the port of Tarragona (Spain) over a one-year period. To do so, we developed a method based on ultrasound-assisted solvent extraction (USAE) followed by gas chromatography-mass spectrometry (GC-MS). We also studied concentrations of NO₂ and airborne particulate matter (PM_2.5 and PM_coarse) for a year. Our results showed NO₂ and PM_2.5 concentrations below the maximum average values established by the Europen Directive 2008/50/EC in the zone under study. Moreover, NO₂ values are directly proportional to changes in weather conditions and traffic emissions, while PM_coarse and PM_2.5 concentrations do not follow a clear trend as these may be generated from multiple sources (loading and unloading activities and traffic emissions). Regarding BTHs, BTRs and BSAs concentrations in particulate matter, the compounds found at the highest concentrations were 1-H-benzothiazole, 2-methylbenzothiazole, 2-chlorobenzothiazole, 1-H-benzotriazole, 4-methyl-1-H-benzotriazole, 2-(methylthio)-benzothiazole, 5-methyl-1-H-benzotriazole and bromobenzenesulfonamide with average concentrations ranging from 0.19 to 1.54 ng m^-3 in PM_coarse and from 0.09 to 0.61 ng m^-3 in PM_2.5. The remaining compounds were below the method quantification limits (MQLs) or were undetected in the samples analysed. Health risk values associated with the inhalation of the studied compounds were between 1.80 × 10^-3 and 1.27 × 10^-2 in the worst-exposure scenario.

Assessment of the Antithrombogenicity of a Poly-2-Methoxyethylacrylate-Coated Central Venous Port-Catheter System

PURPOSE

The purpose of this study was to evaluate the antithrombogenic effects of poly-2-methoxyethylacrylate (PMEA) coating applied to the internal surfaces of the port-catheter system to prevent thrombotic occlusion.

MATERIALS AND METHODS

PMEA coating was applied to the inner surfaces of the entire system, including the chamber, catheter, and connecting stem. PMEA-coated and uncoated port-catheter systems were each filled with fresh human blood for 1 or 3 h and then flushed with saline. Volumes of residual thrombi in the system and protein in the catheter were then compared.

RESULTS

Saline flushing of the PMEA-coated port-catheter system expelled all visually recognizable thrombi, leaving no unremovable adhesions. In contrast, the uncoated port showed thrombi adherent to the inner surfaces and incomplete expulsion with flushing. Mean (± standard deviation) residual thrombus mass was significantly lower in PMEA-coated port-catheter systems (20.5 ± 6.2 mg) than in uncoated systems (230.3 ± 92.5 mg; p < 0.01). Mean residual protein was likewise significantly lower in PMEA-coated systems (20.5 ± 6.2 mg) than in uncoated systems (230.3 ± 92.5 mg; p < 0.01).

CONCLUSIONS

PMEA coating on a central venous port-catheter system decreased accumulation and facilitated flushing of thrombi from the system by flushing, as compared with the uncoated system. PMEA-coated central venous port-catheter systems appear relatively antithrombotic compared to uncoated systems.

Assessing the Efficacy of a Sediment Remediation Program Using Benthic and Pelagic Copepod Bioassays

Tributyltin is an organotin chemical that has been commonly used in ship antifouling paints. Despite the global total prohibition of tributyltin-based paint in 2008, tributyltin continues to be found at toxic levels in areas of high maritime traffic such as ports and harbors. A remediation program was conducted at a New Zealand port to reduce tributyltin and copper concentrations to acceptable values. The present study assessed the efficacy of the program using a combination of chemical analyses and copepod bioassays. Sediment and water samples were collected at 3 locations along a spatial gradient within the port, and concentrations of various organotin compounds and trace metal levels were measured pre- and postremediation. The toxicity of sediment and elutriate samples was estimated by benthic and pelagic copepod bioassays. Although acute toxicity in sediment samples was reduced following remediation, reproductive success was still affected for the benthic copepod. This approach combining chemical analysis and bioassays is promising for assessing the efficacy of remediation processes at contaminated marine sites. Environ Toxicol Chem 2020;39:492-499. © 2019 SETAC.

Three Years of High Time-resolution Air Pollution Monitoring in the Complex Multi-source Harbor of New York and New Jersey

In densely developed port areas with numerous emissions sources, relating measured air quality changes to emissions is challenging given the geographic density of sources without unique pollutant composition signatures. To better understand air quality during increasing emission controls at the Port of New York and New Jersey ("Port"), an air monitoring station was sited to minimize collinearity of sources along ordinal directions. The study area includes an international airport, interstate highway, port terminals and shipping lanes, and industrial sources, as well as typical urban emissions of a megacity. Because air flow travel time from sources to the monitor were usually much less than one hour, minute-by-minute, high-precision data were collected for three years (2013-2015) for sulfur dioxide (SO₂), carbon monoxide (CO), oxides of nitrogen (NO, NO₂), black carbon (BC), fine particulate matter (PM_2.5), and meteorology (wind speed, wind direction, temperature, humidity). From summer 2014 to spring 2015, hourly metals data were also collected. A high degree of temporal variability was observed for pollutants associated with direct emissions, with highest hourly average coefficient of variation observed for NO (2.65), SO₂ (1.45) and BC (1.21). Nonparametric trajectory analysis (NTA) was utilized to separate the source areas influencing the monitoring data and observe how they changed over time, with over 1.6 million trajectories computed in total. Comparing the last 5 quarters of the study to the first 5 quarters, concentrations at the monitoring site associated with three port-related geographic areas decreased by 34-41%, 11-17%, and 28-41% for SO₂, NO_x, and BC, respectively. Over the same period, indicators of shipping and cargo activity at the port remained relatively constant; therefore, a shift in emission factors is likely the cause of the change. This study demonstrates the value of high-time resolution, accurate monitoring data along with careful siting to understand source area influences.

Oceanographic characteristics of the Adriatic Sea - Support to secondary HAOP spread through natural dispersal

Vessels, specifically ballast water and hull fouling, are a major vector for the introduction of non-indigenous species (NIS) in European seas. The Mediterranean is one of the world's marine regions where their invasion is heaviest. The shallow Adriatic basin is a highly sensitive area that is already experiencing its consequences. The secondary spread of NIS over a wider area through natural dispersion is a complex process that depends on a wide range of oceanographic factors. This work analysed the dataset of the BALMAS project, in whose framework twelve ports in the Adriatic Sea were subjected to a Port Baseline Survey (PBS), to estimate the natural spread of NIS organisms from their port of arrival to the wider Adriatic basin. Its findings indicate that the prevailing water circulation patterns facilitate the natural dispersal of harmful aquatic organisms and pathogens (HAOP).

Preparedness and management of global public health threats at points of entry in Ireland and the EU in the context of a potential Brexit

Health security in the European Union (EU) aims to protect citizens from serious threats to health such as biological agents and infectious disease outbreaks- whether natural, intentional or accidental. Threats may include established infections, emerging diseases or chemical and radiological agents. Co-ordinated international efforts attempt to minimize risks and mitigate the spread of infectious disease across borders.

We review the current situation (March 2019) with respect to detection and management of serious human health threats across Irish borders- and what may change for Ireland if/when the United Kingdom (UK) withdraws from the EU (Brexit).

Specifically, this paper reviews international legislation covering health threats, and its national transposition; and EU legislation and processes, especially the relevant European Decision No. 1082/2013/EU of the European Parliament and of the Council on serious cross border threats to health with repeal of Decision No 2119/98/EC. We enumerate European surveillance systems and agencies which relate to port health security; we consider consortia and academic arrangements within the EU framework and established collaboration with the World Health Organization. We describe current Health Services Executive port health structures in Ireland which address preparedness and management of human health threats at points of entry. We appraise risks which Brexit could bring, reviewing literature on shared concerns about these risks, and we evaluate post-Brexit challenges for the EU, and potential opportunities to remain within current structures in shared health threat preparedness and response.

It is imperative that the UK, Ireland and the EU work together to mitigate these risks using some agreed joint coordination mechanisms for a robust, harmonised approach to global public health threats at points of entry.

Butyltins in sediments from the Southern Baltic coastal zone: Is it still a matter of concern, 10 years after implementation of the total ban?

The study was done to assess butyltin contamination in sediments of the Southern Baltic coastal zone, ten years after implementation of the total ban on harmful organotin use in antifouling paints. Sediment samples were collected from two seaports of international significance: the Port of Gdańsk and the Port of Gdynia, as well as from the Szczecin Lagoon which plays a significant role as a shipping route connecting the Port of Szczecin with the Port of Świnoujście. Total concentrations of butyltins in the sediment samples ranged between 5.7 and 3321 ng Sn g^-1 d.w. Eighty percent of the samples were found as highly and grossly contaminated with tributyltin. The results were compared with those recorded ten years ago. Despite the improvement, the butyltin contamination still gives rise to concern in the study area. According to the HELCOM recommendation, all samples exceeded the Good Environmental Status boundary for tributyltin in sediments.

Complications of central venous port systems: a pictorial review

Central venous port devices are indicated for patients, who need long-term intravenous therapy. Oncologic patients may require intermittent administration of chemotherapy, parenteral nutrition, infusions, or blood transfusions. A venous port system is composed of a port chamber attached to a central catheter, which is implanted into the central venous system. The subcutaneous location of the catheter chamber improves the patients’ quality of life and the infection rate is lower than in non-totally implantable central venous devices. However, proper implantation, use, and care of a port system are important to prevent short- and long-term complications. Most common early complications (< 30 days) include venous malpositioning of catheter and perforation with arterial injury, pneumothorax, hemothorax, thoracic duct injury, or even cardiac tamponade. Delayed complications include infection, catheter thrombosis, vessel thrombosis and stenosis, catheter fracture with extravasation, or fracture with migration or embolization of catheter material. Radiologic imaging has become highly relevant in intra-procedural assessment and postoperative follow-up, for detection of possible complications and to plan intervention, e.g., in case of catheter migration. This pictorial review presents the normal imaging appearance of central venous port systems and demonstrates imaging features of short- and long-term complications.

Ultrasound guidance improves safety and efficiency of central line placements

BACKGROUND

Use of ultrasound-guidance for central venous access in adults is the standard of care. There is, however, less clarity in the role of routine ultrasound use in obtaining venous access in children. We sought to evaluate safety and efficiency of the placement of central lines utilizing an ultrasound-guided approach compared to the traditional, landmark approach in pediatric patients.

STUDY DESIGN

A single-institution retrospective chart review, using CPT codes, was performed for all tunneled central venous catheters in children between 2005 and 2017 by the same pediatric surgery group. During the study period, a practice change occurred from exclusively landmark-based line placement to ultrasound-guided line placement. Groups were divided into three phases: a traditional/landmark era (Phase 1), transitional period (Phase 2), and the ultrasound era (Phase 3). The primary outcomes analyzed were postoperative chest tube insertions and operative time.

RESULTS

A total of 2010 tunneled central lines were included for analysis: Phase 1 (N = 930), Phase 2 (N = 313) and Phase 3 (N = 767). Venous access for chemotherapy was the most common indication (29%). Phase 1 had a chest tube placement rate of 9.7/1000 procedures, while Phase 2 had a rate of 6.4/1000 procedures, and Phase 3 had no chest tube insertions (p = 0.009). Phase 1 had longer OR times compared to Phase 2 (57 vs. 49, p = 0.0026) and Phase 3 (57 vs. 46 min, p < 0.001).

CONCLUSIONS

This study represents the largest analysis of ultrasound-guided access for children. A complete practice transition to the ultrasound-guided approach was feasible within a two-year period. The ultrasound-guided approach had a shorter operative time and less chest tube insertions than the traditional, landmark technique in children. Level III evidence.

Risk Factors of Infection and Role of Antibiotic Prophylaxis in Totally Implantable Venous Access Port Placement: Propensity Score Matching. Cardiovasc Intervent Radiol. 2019;42:1302-1310. [PMID: 31187229 DOI: 10.1007/s00270-019-02255-0]

BACKGROUND

To evaluate risk factors of infection and effectiveness of preprocedural single-dose intravenous prophylactic antibiotic (PABX) during totally implantable venous access port (TIVAP) placement in preventing procedure-related infections.

METHODS

This was a retrospective single-institution multicenter study evaluating short-term (30-day) infection outcomes after TIVAP placement. Correlation between infection rates and clinical factors, including hematologic versus non-hematologic malignancy, inpatient versus outpatient status, single versus double lumen and PABX, was investigated using univariate and multivariable analysis in the overall study population as well as the propensity-score-matched cohort.

RESULTS

Overall, 5967 patients underwent TIVAP placement from 2005 to 2016, of which 3978 (67%) patients received PABX. On propensity score matching, 1952 patients with PABX were matched to the same number of patients without PABX. TIVAP was removed due to infection concern in 48 patients in unmatched and 30 patients in matched population. There was no difference in the rate of infection between those who received PABX and those who did not in both unmatched and matched population (p = 0.5387 and 0.9999). Although infection rate was significantly higher in patients who had TIVAP placement in inpatient setting (p < 0.0001), who received a double-lumen TIVAP (p < 0.0001), or who had hematologic malignancy (p = 0.0004) on univariate analysis, inpatient status was the sole factor associated with higher rate of TIVAP infection on multivariable analysis of both overall (odds ratio 2.31, p < 0.0001) and matched populations (odds ratio 4.36, p = 0.0004).

CONCLUSION

Placement of TIVAP in inpatient setting increases the risk of TIVAP infection. PABX before TIVAP placement does not prevent short-term procedure-related infections.

Colour profile analysis of Port wines by various instrumental and visual methods

BACKGROUND

Wine colour is an important quality parameter, being the first sensorial attribute evaluated during wine tasting. The perception of wine colour can be different depending on many factors, including the depth of the sample under observation. The main objectives of the present study were to measure the colour of Port wines using CIE L*, a*, b* parameters at different depths with various instrumental techniques (spectrophotometry and colorimetry), and to compare the obtained results with the sensory (visual) perception of colour samples.

RESULTS

Representative profiles of lightness (L*), hue (H*) and chroma (C*) at different depths were obtained using Port wine samples from various categories and ages. In general, relatively good correlations between the colorimetric and spectrophotometric methods were obtained for the L* and H* parameters. The results of the sensory tests also showed good correlations between the visually assessed hue scores and the colorimetric measurements of the H* parameter, particularly at the lower depths tested (up to 4.0 mm).

CONCLUSIONS

Overall, the results indicate that the colorimetric method can be used for estimating wine colour parameters, providing useful information about the colour profile of wines at different depths. © 2019 Society of Chemical Industry.

Port-a-cath and ventriculoatrial shunt at the same atrium: technical note

Hydrocephalus is a rare complication of brain involving acute lymphoblastic leukemia (ALL). The standard treatment is ventriculoperitoneal (VP) shunting, while ventriculoatrial (VA) shunting is the second option in a case of VP shunt failure in young children. But the presence of port catheter at the right atrium restricts and makes a VA shunt difficult to place in the same atrium. We presented a 4-year-old boy who had the diagnoses of ALL and underwent chemotherapy through a port-a-cath. He also had hydrocephalus due to the brain invasion of the ALL. He firstly underwent VP shunting for the treatment of hydrocephalus, but it failed due to an intraabdominal cyst. Then, he underwent VA shunting through the left internal jugular vein. This is the first case in the literature showing both catheters in the right atrium.

Risk management abilities in multimodal maritime supply chains: Visibility and control perspectives

Supply chain complexity and disintegration lead to increased uncertainty from a stakeholders' perspective, which is emerging as one of the major challenges of risk management. The ability to identify risks has weakened, as the responsibility of supply chain risk management is handed over to outside service providers. Regardless, the risks, their visibility and their impact depend on the position of the companies in the supply chain. The actors in the chain must therefore collaborate to create effective risk management conditions. This challenging situation is especially pronounced in multimodal maritime supply chains, where the risks and actor focality are high. This paper contributes to current risk management literature by providing a holistic and systemic view of risk visibility and control in maritime supply chains. The study employs broad-based, qualitative interview data collected from actors operating in southern Finland and the Gulf of Finland as well as an expert-panel assessment of the related risk management abilities. The results show a high level of variance in the level of risk identification and visibility between the actors in question. This further suggests that collaboration in supply chain risk management is essential, as an awareness of the risks and their control mechanisms do not necessarily reside in the same company.