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Managing excess nutrients remains a major obstacle to improving ecosystem service benefits of urban waters. To inform more ecologically based landscape nutrient management, we compared watershed inputs, outputs, and retention for nitrogen (N) and phosphorus (P) in seven subwatersheds of the Mississippi River in St. Paul, Minnesota. Lawn fertilizer and pet waste dominated N and P inputs, respectively, underscoring the importance of household actions in influencing urban watershed nutrient budgets. Watersheds retained only 22% of net P inputs versus 80% of net N inputs (watershed area-weighted averages, where net inputs equal inputs minus biomass removal) despite relatively low P inputs. In contrast to many nonurban watersheds that exhibit high P retention, these urban watersheds have high street density that enhanced transport of P-rich materials from landscapes to stormwater. High P exports in storm drainage networks and yard waste resulted in net P losses in some watersheds. Comparisons of the N/P stoichiometry of net inputs versus storm drain exports implicated denitrification or leaching to groundwater as a likely fate for retained N. Thus, these urban watersheds exported high quantities of N and P, but via contrasting pathways: P was exported primarily via stormwater runoff, contributing to surface water degradation, whereas N losses additionally contribute to groundwater pollution. Consequently, N management and P management require different strategies, with N management focusing on reducing watershed inputs and P management also focusing on reducing P movement from vegetated landscapes to streets and storm drains.

Waterlogging and salinity can occur together in salinised landscapes and restrict crop production. Drainage can alleviate waterlogging and salinity, but previous research suggested the need for deep drains, which may not be acceptable to smallholder farmers. Consequently, for the first time to our knowledge, we tested the usefulness of shallow drains in sunflower cultivation for smallholder farmers in a salt-affected, waterlogged coastal clay soil in the Ganges Delta. Experimental treatments were as follows: undrained, open surface drains (SD; 0.1 m deep, 1.8 m apart), slotted-pipe subsoil drains (SSD; 0.5 m deep, 4.5 m apart) and SSD+SD. All plots were inundated (2–3 cm above the soil surface) for 24 h before opening drains, at vegetative emergence and then at the V8 stage of plants. Relative to the most-drained (SSD+SD) treatment, the SD and SSD treatments gave 15–29% less yield, while the undrained treatment depressed yield by 48%. Soil water content (SWC) at 0–60 cm depth early in the season was 6–21, 4–10 and 3–5% less in SSD+SD treatment than in the undrained, SD and SSD treatments, respectively, while from flowering to harvest, SWC in SSD+SD was 2–4, 4–8 and 4–10% higher than in the undrained, SD and SSD treatments, respectively. In addition, soil electrical conductivity EC 1:5 at 0–60 cm depth in SSD+SD treatment was 31–52, 16–38 and 11–32% lower than in the undrained, SD and SSD treatments, respectively. Across all treatments, the increases in yield due to drainage were associated with decreases in waterlogging (in the 0–30 cm layer) early in the growing season, increases in SWC late in the growing season and decreases in EC 1:5 throughout the cropping season. While the shallow surface drains alone increased the yield, additional shallow subsoil drains further increased crop yield on coastal saline soils.

Introduction External ventricular drains (EVDs) are crucial for treating neurocritically ill patients but are complicated by feared EVD-associated infections (EVDIs) in up to 35% of all inserted drains, contributing significantly to morbidity, mortality and account for a significant proportion of intensive care unit (ICU) antibiotic use. However, the lack of a universal definition for EVDIs leads to inconsistent diagnostic criteria across studies, with a concern of substantial overtreatment with broad-spectrum antibiotics. This study aimed to evaluate if current EVDI surveillance parameters can be optimized to better distinguish true from suspected EVDI. Methods We conducted a retrospective cohort study at the Karolinska University Hospital ICU, including all patients treated with EVDs between 2006 and 2023, excluding patients with primary central nervous system (CNS) infections. EVDI surveillance included biweekly sampling and cultures from cerebrospinal fluid (CSF). Patients were categorized as no infection (NI), suspected infection (SI), or verified infection (VI) based on culture results and treatment status. We employed classification and regression analyses to identify predictors of VI. Results Among 1,828 patients with EVDs, 29.8% were initiated on antibiotic treatment due to suspected infection and 4.1% were found to have culture confirmed infections. The main finding is that current accepted diagnostic parameters cannot distinguish aseptic inflammation from true EVDI. In multivariable logistic analysis the best models exhibited low accuracy, with a pseudo- R 2 of only 0.06. CSF lactate was the most important metric in a univariable setting, however with a cut-off of 8.9 mmol/L it showed low discrimintive ability and limited clinical utility. Conclusions In this study we evaluate current accepted EVDI surveillance methods in, to our knowledge, the largest cohort of paired samples to date. We find that current surveillance parameters cannot distinguish aseptic CNS inflammation from true EVDIs in an ICU setting. This contributes to a significant antibiotic overtreatment, with 25% of our entire cohort being unnecessarily initiated on broad-spectrum antibiotics, a number we expect can be generalized. We identify a large clinical problem with consequences on both a individual and population level, and recommend that future research focus on evaluating new techniques, such as fast bedside sequencing methods.

Purpose While well-designed drainage systems could improve crop growth and yield by mitigating waterlogging and salinity stresses, field evidence of the yield responses to changes in plant-water relations and ion concentrations in leaves is scarce. We investigated the changes in ion concentrations in leaves and plant-water relations of sunflower caused by drainage in waterlogged saline soil, and their relationships to growth and yield. Methods Over two growing seasons, we tested four drainage treatments: undrained, surface drains (SD; 0.1 m deep, 1.8 m apart), subsoil drains (SSD; 0.5 m deep, 4.5 m apart) and SSD + SD. All plots were inundated (2–3 cm depth; water salinity, EC w , 1.5–2.5 dS m –1 ) for 24 h at vegetative emergence and at the 8-leaf stage before opening drains. Results Relative to the most drained treatment (SSD + SD), the undrained treatment caused higher waterlogging at 0–30 cm depth, and decreased solute potential (Ψ s ) of soil at 7.5 cm to 52–374 kPa, leaf K + by 5–20%, stomatal conductance by 5–37% and leaf greenness by 12–25%, but increased leaf Na + by 25–70%, Na + /K + ratio by 38–100% and leaf water potential by 90–250 kPa throughout the cropping season; these changes were closely related to reduced growth and yield. Conclusions The improved yield from the combination of shallow surface and sub-surface drains was attributed to an alleviation of salinity-waterlogging stress early in the season and to increased soil water late in the season that increased Ψ s and decreased Na + /K + ratio in leaves.

BackgroundRetromuscular drains are commonly placed during retromuscular hernia repair (RHR) to decrease postoperative wound complications and help mesh in-growth. Drains are traditionally removed when output is low but the relationship between drain output at the time of removal and postoperative complications has yet to be delineated. This study aimed to investigate outcomes of RHR patients with drain removal at either high or low output volume.MethodsAn institutional review board-approved retrospective chart review evaluated adult patients undergoing open RHR with retromuscular drain placement between 2013 and 2022 at a single academic medical center. Patients were stratified into low output drainage (LOD, < 50 mL/day) or high output drainage (HOD, ≥ 50 mL/day) groups based on volume on the day of drain removal.ResultsWe identified 336 patients meeting inclusion criteria: 58% LOD (n = 195) and 42% HOD (n = 141). Demographics and risk factors pertaining to hernia complexity were similar between cohorts. Low-drain output at the time of removal was associated with a significantly longer drain duration (6.3 ± 4.5 vs. 4.4 ± 1.6 days, p < 0.001) and postoperative hospital stay (5.9 ± 3.6 vs. 4.8 ± 2.8 days, p < 0.001). With a 97% 30-day follow-up, incidence of surgical site occurrence (SSO) was not statistically different between groups (29.2% LOD, 26.2% HOD, p = 0.63). Surgical site infection and SSO requiring procedural intervention was also not statistically significant between cohort. At 1-year follow-up, hernia recurrence rates were the same between groups (4.2% LOD, 1.4% HOD, p = 0.25).ConclusionFollowing open ventral hernia repair with retromuscular mesh placement, the rate of postoperative wound complications was not statistically different based on volume of drain output day of removal. These results suggest that removing drains earlier despite higher output is safe and has no effect on short- or long-term hernia outcomes.

The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

The benefit of drains remains unclear and variable among thyroid surgeons. This study examines the utility and trend in drain use after thyroidectomy. This is a retrospective cross-sectional study utilizing a pooled sample of thyroidectomy patients from the 2016–2019 NSQIP. The impact of drain use on outcomes of interest (rate of postoperative neck hematoma (PNH)–primary outcome, and length-of-stay (LOS)–secondary outcome), as well as year-over-year and practice variations were evaluated using inverse-probability-weighted-regression adjustment and multivariable logistic regression analyses. Of 24,370 patients, 6673(27.4 ​%) received drains. The average LOS and PNH rates were 27.3 ​h and 1.87 %, respectively. Drain use increased year-over-year for concomitant neck dissections (OR ​= ​1.08,p ​= ​0.002). Year-over-year odds of drain use trended down across specialties (OR ​= ​0.96,p ​= ​0.005); however, ENT used drains more frequently than General Surgeons (RR ​= ​3.06, 95%CI ​= ​2.91–3.22). Drains were associated with longer LOS (mean-difference ​= ​9.6hrs, 95%CI 8.51–10.62) with no effect on PNH rates (RR ​= ​0.96,p ​< ​0.05). Drain use is decreasing, but practice variations across specialties persist. Post-thyroidectomy drain use was associated with longer LOS with no effect on PNHR. •Drain use after thyroidectomy is associated with increased post-operative length of stay.•Drain use after thyroidectomy had no significant effect on postoperative neck hematoma.•Drain use increased year-over-year for concomitant neck dissections.•Practice variation for drain after thyroid surgery use persist across surgical specialties.•There is a downtrend in year-over-year odds of drain use after thyroidectomy across specialties.

Sand drains are extensively utilized to fasten the consolidation rate, especially in soft clay deposits. However, due to the scarcity of sand, it should be substituted with some cost-effective material. In view of this, in the current investigation, along with sand, waste materials like rice husk ash, coir pith, fly ash, and quarry dust were used as drain materials. The consolidation test was performed using Kuttanad clay, filled in a mould of 15 cm diameter and 10 cm height, allowing single drainage. A triangular pattern of three drain system was used in the study. A parametric study on the effect of the spacing of the drain on consolidation characteristics was investigated by varying the spacing/diameter ratio (s/d ratio). It was observed that the consolidation rate is more for coir pith and quarry dust drains compared to rice husk ash and fly ash drain used in the study. The consolidation rate reduces with the increase in the spacing of the drain. For achieving a particular consolidation rate, the required drain spacing has to be known. Correlations were developed to predict the spacing between the drains for attaining a particular coefficient of consolidation.

The Korean Peninsula has 75% of land covered by the mountain and three sides of land are facing with the sea. The availability of land for the use of various structures are quite limited. The western and southern part of coastal areas are relatively shallow water depth and hence the west and south coastal lines in Korea have been expanded by means of land reclamation from the sea to construct social infrastructures such as residential area, industrial complex, seaport, airport and so on. The reclaimed land from the sea is mostly consisted of silty clay and soft clay. The depth of soft ground in the western coastal area is approximately from 5 m to 20 m while the southern part of coastal area is approximately from 20 m to 60 m. The efficient method of soft ground improvement was investigated through the pilot scale test at the Incheon International Airport site. The sand drains, packed drain, sand compaction pile, and prefabricated vertical drain were used for the ground improvement work. The settlement levels are ranged between 35 cm and 40 cm with the surcharged height of 12 m for 6 months period. The prefabricated vertical drain was finally selected with consideration of filling material availability and efficiency of installation. The obtaining a good quality of sand is quite difficult with dredging the soil along the coastal area because the massive of a good quality sand has been used for the building construction work in the process of concrete production and lack of available sand in the construction market. The PVDs (prefabricated vertical drains) method has been developed with utilizing the polymer core and cover jacket since 1980s in Korea. The maximum depth of PVDs has been successfully installed more than 50 -70 m with the help of bamboo mattress. The discharged capacity of pore water using PVDs can be accelerated the process of consolidation in soft clay ground with incorporated with the wing prefabricated horizontal drains (PHDs and WHDs) as well as preload or vacuum technology. The total length of PVDs’s installation from year 2013 to 2022 in Korea alone is approximately 470 million meters with an average length of 46.75 million meters per year. The field application of case histories for installation of PVDs or WHDs are focused on Incheon & Siheung areas in the western coastal area, Busan and Kwangyang-Yeochon areas in the southern part of coastal area.

Artificial neural networks are a tool for modeling of nonlinear systems in various engineering fields. These networks are effective tools for modeling the nonlinear systems. Each artificial neural network includes an input layer, an output layer between which there are one or some hidden layers. In each layer, there are one or several processing elements or neurons. The neurons of the input layer are independent variables of the understudy issue, and the neurons of the output layer are its dependent variables. Artificial neural system, through exerting weight on inputs and by suing an activation function attempts to achieve a desirable output. In this research, in order to calculate the drain spacing in an unsteady state in a region situated in the north east of Ahwaz, Iran with different soil properties and drain spacing, the artificial neural networks have been used. The neurons in the input layer were: Specific yield, hydraulic conductivity, depth of the impermeable layer, height of the water table in the middle of the interval between the drains in two-time steps. The neurons in output layer were drain spacing. The network designed in this research was included a hidden layer with four neurons. The distance of drains computed via this method had a good agreement with real values and had a high precision in compare with other methods.