Sustainability performance of bioretention systems with various designs

Bioretention systems for urban drainage are one type of blue-green infrastructure that have gained more attention in recent decades. There are numerous design options for these systems, including various construction components, filter material mixtures, and plants. However, the research focus on the impacts of these many design options has mainly been technical, i.e., how different bioretention designs affect runoff pollution treatment and hydraulic control. Knowledge of the effects of various design elements on other sustainability criteria, such as economic, social, and environmental aspects, needs to be developed. This research aimed to evaluate and compare various design elements and bioretention types to gain a better understanding of the relative sustainability of various bioretention systems. This was accomplished by identifying relevant criteria and sub-criteria, covering social, economic, and technical-environmental indicators, in a multicriteria analysis. To evaluate the sustainability performance of various bioretention designs, 12 sub-criteria were allotted -100 to 100 points in a scoring process. The main finding was that while design features had a major impact on bioretention performance, no single design configuration excelled in all criteria. High scores in the social criteria were correlated with the use of trees and smaller volumes of pumice in the filter material mixture. In the economic criteria, extensive use of concrete and a complex mixture of filter material increased the costs. The system with a water-saturated zone and a variety of plant species outperformed the other systems in the technical-environmental criteria. The results can be utilized as a reference to assess design configurations that best satisfy specific needs for each unique bioretention implementation.

The characteristics and in-sewer transport potential of solids derived from domestic food waste disposers

This study aims to assess the transportability of food waste disposer particles within a sewer system. A series of laboratory studies has examined the physical characteristics of solid particles derived from domestic food waste disposers. Particle size distributions and maximum settling velocity characteristics were measured for 18 common food types, and stored in a publicly accessible database. Particle size distributions are shown to fit well with a 2-parameter Gamma distribution. Settling velocity is generally higher for larger particles, except when particle density and sphericity change. For most food types, particle specific gravity was close to unity. Egg shell particles had a significantly higher specific gravity. This information, combined with the particle size data have been used to show that there is a very low likelihood of food waste particle deposition in sewers during normal operational flows, other than temporary transient deposits of egg shell particles.

Multi-Voiced Music Bypasses Attentional Limitations in the Brain

Attentional limits make it difficult to comprehend concurrent speech streams. However, multiple musical streams are processed comparatively easily. Coherence may be a key difference between music and stimuli like speech, which does not rely on the integration of multiple streams for comprehension. The musical organization between melodies in a composition may provide a cognitive scaffold to overcome attentional limitations when perceiving multiple lines of music concurrently. We investigated how listeners attend to multi–voiced music, examining biological indices associated with processing structured versus unstructured music. We predicted that musical structure provides coherence across distinct musical lines, allowing listeners to attend to simultaneous melodies, and that a lack of organization causes simultaneous melodies to be heard as separate streams. Musician participants attended to melodies in a Coherent music condition featuring flute duets and a Jumbled condition where those duets were manipulated to eliminate coherence between the parts. Auditory–evoked cortical potentials were collected to a tone probe. Analysis focused on the N100 response which is primarily generated within the auditory cortex and is larger for attended versus ignored stimuli. Results suggest that participants did not attend to one line over the other when listening to Coherent music, instead perceptually integrating the streams. Yet, for the Jumbled music, effects indicate that participants attended to one line while ignoring the other, abandoning their integration. Our findings lend support for the theory that musical organization aids attention when perceiving multi–voiced music.

Managing flooding: from a problem to an opportunity

The paper argues that the concept and practice of sustainability have proved too difficult to achieve within traditional water management, and there is a lack of political will to move towards truly sustainable water services. Instead, compromised concepts, including resistance, resilience, ecosystem services, natural capital and adaptation are defining approaches; each of which may contribute partially to sustainability. Pressures due to the changing climate, ecological degradation, human demands, urbanization and deteriorating assets are challenging sustainability and compelling changes to water management. Water is now seen less as a problem to be managed than as an opportunity, as wherever situated, water brings many opportunities to contribute to anthropogenic needs. New ideas are helping to frame the way in which water management is being approached: (i) waste is no longer waste, but a potential resource within a circular economy; (ii) the interconnectedness of infrastructure systems and services and circularity of the water cycle mean there is a need to integrate approaches; (iii) nature-based systems should be preferenced for water infrastructure. These issues and ideas are considered here, together with examples of schemes showing that managing flooding can lead to wider benefits, and potential longer-term sustainability. This article is part of the theme issue 'Urban flood resilience'.

Speech-in-noise perception is linked to rhythm production skills in adult percussionists and non-musicians

Speech rhythms guide perception, especially in noise. We recently revealed that percussionists outperform non-musicians in speech-in-noise perception, with better speech-in-noise perception associated with better rhythm discrimination across a range of rhythmic expertise. Here, we consider rhythm production skills, specifically drumming to a beat (metronome or music) and to sequences (metrical or jittered patterns), as well as speech-in-noise perception in adult percussionists and non-musicians. Given the absence of a regular beat in speech, we hypothesise that processing of sequences is more important for speech-in-noise perception than the ability to entrain to a regular beat. Consistent with our hypotheses, we find that the sequence-based drumming measures predict speech-in-noise perception, above and beyond hearing thresholds and IQ, whereas the beat-based measures do not. Outcomes suggest temporal patterns may help disambiguate speech under degraded listening conditions, extending theoretical considerations about speech rhythm to the everyday challenge of listening in noise.

Got Rhythm? Better Inhibitory Control Is Linked with More Consistent Drumming and Enhanced Neural Tracking of the Musical Beat in Adult Percussionists and Nonpercussionists

Musical rhythm engages motor and reward circuitry that is important for cognitive control, and there is evidence for enhanced inhibitory control in musicians. We recently revealed an inhibitory control advantage in percussionists compared with vocalists, highlighting the potential importance of rhythmic expertise in mediating this advantage. Previous research has shown that better inhibitory control is associated with less variable performance in simple sensorimotor synchronization tasks; however, this relationship has not been examined through the lens of rhythmic expertise. We hypothesize that the development of rhythm skills strengthens inhibitory control in two ways: by fine-tuning motor networks through the precise coordination of movements "in time" and by activating reward-based mechanisms, such as predictive processing and conflict monitoring, which are involved in tracking temporal structure in music. Here, we assess adult percussionists and nonpercussionists on inhibitory control, selective attention, basic drumming skills (self-paced, paced, and continuation drumming), and cortical evoked responses to an auditory stimulus presented on versus off the beat of music. Consistent with our hypotheses, we find that better inhibitory control is correlated with more consistent drumming and enhanced neural tracking of the musical beat. Drumming variability and the neural index of beat alignment each contribute unique predictive power to a regression model, explaining 57% of variance in inhibitory control. These outcomes present the first evidence that enhanced inhibitory control in musicians may be mediated by rhythmic expertise and provide a foundation for future research investigating the potential for rhythm-based training to strengthen cognitive function.

Thai Rate-Varied Vowel Length Perception and the Impact of Musical Experience

Musical experience has been demonstrated to play a significant role in the perception of non-native speech contrasts. The present study examined whether or not musical experience facilitated the normalization of speaking rate in the perception of non-native phonemic vowel length contrasts. Native English musicians and non-musicians (as well as native Thai control listeners) completed identification and AX (same-different) discrimination tasks with Thai vowels contrasting in phonemic length at three speaking rates. Results revealed facilitative effects of musical experience in the perception of Thai vowel length categories. Specifically, the English musicians patterned similarly to the native Thai listeners, demonstrating higher accuracy at identifying and discriminating between-category vowel length distinctions than at discriminating within-category durational differences due to speaking rate variations. The English musicians also outperformed non-musicians at between-category vowel length discriminations across speaking rates, indicating musicians' superiority in perceiving categorical phonemic length differences. These results suggest that musicians' attunement to rhythmic and temporal information in music transferred to facilitating their ability to normalize contextual quantitative variations (due to speaking rate) and perceive non-native temporal phonemic contrasts.

Assessing receptivity for change in urban stormwater management and contexts for action

Individual and organisational receptivity for change towards the use of sustainable stormwater management systems has been previously examined, but the significance of the different contexts for achieving this has been largely unexplored. This paper examines the significance of contexts associated to the actions to bring this about by proposing and evaluating an emerging framework based on two related receptivity theories: the individual or organisational approach and the contextual approach. Results from a Swedish national questionnaire with professionals in stormwater management have been used, together with a limited number of interviews to develop and understand the validity of the framework. The analysis has indicated that the respondents were professionally prepared for change (action) but not practically prepared due to inadequate supportive contexts. In response, a number of potential contexts associated to the necessary actions were identified. The framework was found to provide new insights into the influence of receptive contexts for a change in water management practice. These insights can be used by policy makers and others to better support the realization of professional openness for change and thus accelerate the process of change to sustainable stormwater practice.

Art and science: how musical training shapes the brain

What makes a musician? In this review, we discuss innate and experience-dependent factors that mold the musician brain in addition to presenting new data in children that indicate that some neural enhancements in musicians unfold with continued training over development. We begin by addressing effects of training on musical expertise, presenting neural, perceptual, and cognitive evidence to support the claim that musicians are shaped by their musical training regimes. For example, many musician-advantages in the neural encoding of sound, auditory perception, and auditory-cognitive skills correlate with their extent of musical training, are not observed in young children just initiating musical training, and differ based on the type of training pursued. Even amidst innate characteristics that contribute to the biological building blocks that make up the musician, musicians demonstrate further training-related enhancements through extensive education and practice. We conclude by reviewing evidence from neurobiological and epigenetic approaches to frame biological markers of musicianship in the context of interactions between genetic and experience-related factors.

Monitoring rainwater and seaweed reveals the presence of (131)I in southwest and central British Columbia, Canada following the Fukushima nuclear accident in Japan

Detailed analysis of (131)I levels in rainwater and in three species of seaweed (Fucus distichus Linnaeus, Macrocystis pyrifera, and Pyropia fallax) collected in southwest British Columbia and Bella Bella, B.C., Canada was performed using gamma-ray spectroscopy following the Fukushima nuclear power plant accident on March 11, 2011. Maximum (131)I activity was found to be 5.8(7) Bq/L in rainwater collected at the campus of Simon Fraser University in Burnaby, B.C. nine days after the accident. Concomitantly, maximum observed activity in the brown seaweed F. distichus Linnaeus was observed to be 130(7) Bq/kg dry weight in samples collected in North Vancouver 11 days following the accident and 67(6) Bq/kg dry weight in samples collected from the Bamfield Marine Sciences Centre on Vancouver Island 17 days following the accident. The (131)I activity in seaweed samples collected in southwest B.C. following the Fukushima accident was an order of magnitude less than what was observed following Chernobyl. Iodine-131 activity in F. distichus Linnaeus remained detectable for 60 days following the accident and was detectable in each seaweed species collected. The Germanium Detector for Elemental Analysis and Radioactivity Studies (GEARS) was modeled using the Geant4 software package and developed as an analytical tool by the Nuclear Science group in the Simon Fraser University Department of Chemistry for the purpose of these measurements.

Stereotactic body radiotherapy for localized prostate cancer: disease control and quality of life at 6 years

Background

Stereotactic body radiotherapy (SBRT) may yield disease control for prostate cancer in a brief, hypofractionated treatment regimen without increasing treatment toxicity. Our report presents a 6-year update from 304 low- (n = 211), intermediate- (n = 81), and high-risk (n = 12) prostate cancer patients who received CyberKnife SBRT.

Methods

The median PSA at presentation was 5.8 ng/ml. Fifty-seven patients received neoadjuvant hormonal therapy for up to one year. The first 50 patients received a total dose of 35 Gy in 5 fractions of 7 Gy. The subsequent 254 patients received a total dose of 36.25 Gy in 5 fractions of 7.25 Gy. Toxicity was assessed with the Expanded Prostate Cancer Index Composite questionnaire and the Radiation Therapy Oncology Group urinary and rectal toxicity scale. Biochemical failure was assessed using the nadir + 2 definition.

Results

No patients experienced Grade III or IV acute complications. Fewer than 5% of patients experienced any acute Grade II urinary or rectal toxicities. Late urinary Grade II complications were observed in 4% of patients treated to 35 Gy and 9% of patients treated to 36.25 Gy. Five (2%) late Grade III urinary toxicities occurred in patients who were treated with 36.25 Gy. Late Grade II rectal complications were observed in 2% of patients treated to 35 Gy and 5% of patients treated to 36.25 Gy. Bowel and urinary quality of life (QOL) scores initially decreased, but later returned to baseline values. An overall decrease of 20% in the sexual QOL score was observed. QOL in each domain was not differentially affected by dose. For patients that were potent prior to treatment, 75% stated that they remained sexually potent. Actuarial 5-year biochemical recurrence-free survival was 97% for low-risk, 90.7% for intermediate-risk, and 74.1% for high-risk patients. PSA fell to a median of 0.12 ng/ml at 5 years; dose did not influence median PSA levels.

Conclusions

In this large series with long-term follow-up, we found excellent biochemical control rates and low and acceptable toxicity, outcomes consistent with those reported for from high dose rate brachytherapy (HDR BT). Provided that measures are taken to account for prostate motion, SBRT’s distinct advantages over HDR BT include its noninvasiveness and delivery to patients without anesthesia or hospitalization.

Developing the evidence base for mainstreaming adaptation of stormwater systems to climate change

In a context of high uncertainty about hydro-climatic variables, the development of updated methods for climate impact and adaptation assessment is as important, if not more important than the provision of improved climate change data. In this paper, we introduce a hybrid method to facilitate mainstreaming adaptation of stormwater systems to climate change: i.e., the Mainstreaming method. The Mainstreaming method starts with an analysis of adaptation tipping points (ATPs), which is effect-based. These are points of reference where the magnitude of climate change is such that acceptable technical, environmental, societal or economic standards may be compromised. It extends the ATP analysis to include aspects from a bottom-up approach. The extension concerns the analysis of adaptation opportunities in the stormwater system. The results from both analyses are then used in combination to identify and exploit Adaptation Mainstreaming Moments (AMMs). Use of this method will enhance the understanding of the adaptive potential of stormwater systems. We have applied the proposed hybrid method to the management of flood risk for an urban stormwater system in Dordrecht (the Netherlands). The main finding of this case study is that the application of the Mainstreaming method helps to increase the no-/low-regret character of adaptation for several reasons: it focuses the attention on the most urgent effects of climate change; it is expected to lead to potential cost reductions, since adaptation options can be integrated into infrastructure and building design at an early stage instead of being applied separately; it will lead to the development of area-specific responses, which could not have been developed on a higher scale level; it makes it possible to take account of local values and sensibilities, which contributes to increased public and political support for the adaptive strategies.

Stereotactic Body Radiation Therapy for Low- and Low-Intermediate-Risk Prostate Cancer: Is there a Dose Effect?

This study examines the efficacy and toxicity of two stereotactic body radiation therapy (SBRT) dose regimens for treatment of early prostate cancer. Forty-one patients treated with 35 Gy were matched with 41 patients treated with 36.25 Gy. Both patient groups received SBRT in five fractions over five consecutive days using the CyberKnife. Each group had 37 low-risk patients and 4 intermediate-risk patients. No statistically significant differences were present for age, prostate volume, PSA, Gleason score, stage, or risk between the groups. The dose was prescribed to the 83–87% isodose line to cover the prostate and a 5-mm margin all around, except 3 mm posteriorly. The overall median follow-up is 51 months (range, 45–58 months) with a median 54 and 48 months follow-up for the 35 and 36.25-Gy dose groups, respectively. One biochemical failure occurred in each group yielding a 97.5% freedom from biochemical failure. The PSA response has been favorable for all patients with a mean PSA of 0.1 ng/ml at 4-years. Overall toxicity has been mild with 5% late grade 2 rectal toxicity in both dose groups. Late grade 1 urinary toxicity was equivalent between groups; grade 2 urinary toxicity was 5% (2/41 patients) and 10% (4/41 patients) in the 35-Gy and 36.25-Gy dose groups (p = 0.6969), respectively. Overall, the highly favorable PSA response, limited biochemical failures, limited toxicity, and limited impact on quality of life in these low- to low-intermediate-risk patients are supportive of excellent long-term results for CyberKnife delivered SBRT.

Stereotactic body radiotherapy as boost for organ-confined prostate cancer

Stereotactic body radiotherapy (SBRT) boost following external beam radiation therapy (EBRT) for advanced localized prostate cancer may reduce toxicity while escalating the dose. We present preliminary biochemical control and urinary, rectal and sexual toxicities for 73 patients treated with SBRT as a boost to EBRT. Forty-one intermediate- and 32 high-risk localized prostate cancer patients received 45 Gy EBRT with SBRT boost. Twenty-eight patients (38.3%) received a total SBRT boost dose of 18 Gy (3 fractions of 6 Gy), 28 patients (38.3%) received 19.5 Gy (3 fractions of 6.5 Gy), and 17 patients (23.2%) received 21 Gy (3 fractions of 7 Gy). Toxicity was assessed using the Radiation Therapy Oncology Group urinary and rectal toxicity scale. Biochemical failure was assessed using the Phoenix definition. The median follow-up was 33 months (range, 22 - 43 months). Less than 7% Grade II and no higher grade acute toxicities occurred. To date, one Grade III and no Grade IV late toxicities occurred. For the 97% of patients with 24 months minimum follow-up, 71.8% achieved a PSA nadir threshold of 0.5 ng/mL. Three intermediate-risk and seven high-risk biochemical failures occurred; one high-risk patient died of his cancer. Three-year actuarial biochemical control rates were 89.5% and 77.7% for intermediate- and high-risk patients, respectively. SBRT boost for prostate cancer treatment is safe and feasible with minimal acute toxicity. At 33 months late toxicity and biochemical control are promising. Long-term durability of these findings remains to be established.

Experience-induced malleability in neural encoding of pitch, timbre, and timing

Speech and music are highly complex signals that have many shared acoustic features. Pitch, Timbre, and Timing can be used as overarching perceptual categories for describing these shared properties. The acoustic cues contributing to these percepts also have distinct subcortical representations which can be selectively enhanced or degraded in different populations. Musically trained subjects are found to have enhanced subcortical representations of pitch, timbre, and timing. The effects of musical experience on subcortical auditory processing are pervasive and extend beyond music to the domains of language and emotion. The sensory malleability of the neural encoding of pitch, timbre, and timing can be affected by lifelong experience and short-term training. This conceptual framework and supporting data can be applied to consider sensory learning of speech and music through a hearing aid or cochlear implant.

Toxicokinetic profile of swainsonine following exposure to locoweed(Oxytropis sericea)in naïve and previously-exposed sheep

AIM

To determine the toxicokinetic profiles of swainsonine (SW) in sheep previously (subacute) and not previously (acute) exposed to locoweed.

METHODS

Twenty-nine wethers were stratified by bodyweight (BW; 68.0 (SE 7.6) kg) and randomly assigned to one of six treatments. Treatments were: 0 (n=5), 0.4 (n=5), and 1.6 (n=5) mg SW/kg BW for Trial 1, and 0 (n=4), 0.2 (n=5), and 0.8 (n=5) mg SW/kg BW for Trial 2. Acute exposure in both trials included adaptation to blue grama (Bouteloua gracilis) hay for 14 days and no previous exposure to locoweed (i.e. SW), followed by administration of a single oral dose of SW prepared from an extract of locoweed, in the doses described above. Subacute exposure comprised ingestion of a blue grama and locoweed (428 microg SW/g locoweed) diet for 21 days in Trial 1 and 28 days in Trial 2, followed by removal from locoweed for 5 days, then an oral dose of SW, as above. Quantities of locoweed fed in the diet were adjusted to achieve the dose rates specified for each treatment. Blood samples were collected via jugular venepuncture twice daily for 3 days prior to initial exposure to SW and then every 7 days for the duration of the trials, to monitor serum alkaline phosphatase (Alk-P) and aspartate aminotransferase (AST) activities. For intensive sampling periods, SW was administered immediately following blood sampling at 0 h, and blood samples were collected at hourly intervals from 0-12 h, 3-h intervals from 15-24 h, 6-h intervals from 30-48 h, and 12-h intervals from 60-168 h. Concentrations of SW in serum and locoweed extract were determined using the alpha-mannosidase inhibition assay (detection limit=25 ng/ml). Rates of absorption and elimination of SW from serum were calculated for each animal, using exponential curve fits of the concentration of SW in serum concentration vs time plots.

RESULTS

In both trials, SW was detected in serum in all animals exposed to locoweed. Elevated (p<0.05) serum Alk-P and AST activities indicated that subclinical SW intoxication was induced during the subacute exposure phase. Calculated rates of elimination were faster (p<0.001) for the 1.6 vs 0.4 (Trial 1) and 0.8 vs 0.2 (Trial 2) mg SW/kg BW doses. Rates of elimination indicated that, in both trials, SW was removed from serum faster (p<0.06) following acute exposure than subacute exposure. Higher exposure rates to SW resulted in higher concentrations of SW in serum within a trial.

CONCLUSIONS

Multiple compartments were involved in the kinetics of SW, and dose and previous exposure altered the toxicokinetics of SW. CLININCAL RELEVANCE: Should the true elimination half-life prove to be as high or higher than the 95 h demonstrated for the treatment using 0.4 mg SW/kg BW in Trial 1, then withdrawal periods for clearing SW from sheep should be >40 days (assuming 10 half-lives to clear the compound).

Short, thin asbestos fibers contribute to the development of human malignant mesothelioma: pathological evidence

Based on animal studies, long and thin asbestos fibers (> or =8 microm in length and < or = 0.25 microm in width) have been postulated to be strongly carcinogenic inducing pleural malignant mesothelioma, while shorter, thicker fibers have been postulated to pose a lesser risk (Stanton hypothesis). The objective of this study is to test the validity of the Stanton hypothesis through direct pathologic analysis of human mesothelioma tissue. Digested bulk tissue samples, or ashed 25 microm thick sections, or both, were prepared from lung and mesothelial tissues taken from 168 cases of human malignant mesothelioma. In these tissues, 10,575 asbestos fibers (4820 in the lung and 5755 in mesothelial tissues (1259 in fibrotic serosa and 4496 in mesotheliomatous tissue)) were identified by high-resolution analytical electron microscopy. Dimensions of these asbestos fibers were measured in printed electron micrographs. Results were as follows: (1) long, thin asbestos fibers consistent with the Stanton hypothesis comprised only 2.3% of total fibers (247 / 10,575) in these tissues; (2) the majority (89.4%) of the fibers in the tissues examined were shorter than or equal to 5 microm in length (9454 of 10,575), and generally (92.7%) smaller than or equal to 0.25 microm in width (9808 of 10,575). (3) Among asbestos types detected in the lung and mesothelial tissues, chrysotile was the most common asbestos type to be categorized as short, thin asbestos fibers. (4) Compared with digestion technique of the bulk tissue, ashing technique of the tissue section was more effective to detect short, thin fibers. We conclude that contrary to the Stanton hypothesis, short, thin, asbestos fibers appear to contribute to the causation of human malignant mesothelioma. Such fibers were the predominant fiber type detected in lung and mesothelial tissues from human mesothelioma patients. These findings suggest that it is not prudent to take the position that short asbestos fibers convey little risk of disease.

Quantifying pepper maggot (Diptera: Tephritidae) oviposition and infestation over time

In 1998 and 1999, pepper maggot flies, Zonosemata electa (Say), were excluded from pepper plants with row covers for 0-6 wk after initial oviposition was detected. The proportion of oviposition attempts (scars) and larval infestation that occurred each week and the cumulative oviposition and infestation over time were determined. Due to environmental factors, initial oviposition was delayed, and the numbers of oviposition scars on fruit and flies caught on traps were lower in 1998 than in 1999. The proportions of scarred or infested fruit were low (< 8% of total) during the first 7 d after the pest was detected each year. Oviposition peaked 8-14 d after beginning in 1998, but not until 21-28 d after the initial scar was detected in 1999. Because systemic insecticides tend to provide control of adults and most hatching larvae, it may be possible to delay the initial insecticide application for up to a week after oviposition commences and still minimize fruit damage. There was no association with either year between the proportion of flies captured on traps and the proportion of oviposition scars on fruit the same week or 1 and 2 wk later.

Sewer solids-20 years of investigation

Knowledge about sewer solids has advanced rapidly in the last few decades due to academic research triggered by an emerging renewed interest from sewer operators. It is now known that sewer solids are implicated in: loss of conveyance; potential for acute and chronic pollution of watercourses and effects inside sewers such as generation of malodorous gases and fabric corrosion. Despite this advance in knowledge, there is much that still needs to be understood, particularly the details of some of the mechanisms of flow-solids interactions, such as deposition, consolidation, erosion, biochemical interactions and processes. The history of knowledge development is outlined and areas where there is a need for further elucidation are highlighted.

Investigating the effect of storm events on the particle size distribution in a combined sewer simulator

The changes in particle size of sewer sediment particles rapidly eroded from a previously deposited sediment bed are described, using a rotating annular flume as a laboratory scale sewer simulator. This is the first time that particle size distributions of eroded sewer sediments from a previously deposited sediment bed have been monitored in such a controlled experimental environment. Sediments from Loenen, The Netherlands and Dundee, UK were used to form deposits in the base of the annular flume (WL Delft Netherlands) with varying conditions for consolidation in order to investigate the effect of changing consolidation time, temperature and sediment type on the amount and size of particles eroded from a bed under conditions of increasing shear. The median size of the eroded particles did not change significantly with temperature, although the eroded suspended solids concentration was greater for the higher temperature under the same shear stresses, indicating a weaker bed deposit. An increase in consolidation time caused an increase in median size of eroded solids at higher bed shear stresses, and this was accompanied by higher suspended solids concentrations. As the shear stress increased, the solids eroded from the bed developed under a longer consolidation time (56 hours) tended towards a broad unimodal distribution, whilst the size distribution of solids eroded from beds developed under shorter consolidation times (18 or 42 hours) retained a bi- or tri-modal distribution. Using different types of sediment in the flume had a marked effect on the size of particles eroded.

Detailed observation and measurement of sewer sediment erosion under aerobic and anaerobic conditions

A greater understanding of the erosion behaviour of sewer sediments is necessary in order to reliably estimate the amount and nature of the sewer sediments released from deposits in sewers and transported either to waste water treatment plants or discharged into the environment. Research has indicated that microbial activity in sediment can influence the physical release of sediment from in-pipe deposits. This paper reports on a series of erosion tests in which sewer sediments from different sewer networks are kept under different environmental conditions and their resistance to erosion is examined. The erosion tests are carried out under aerobic and anaerobic conditions and two temperatures, one representing ambient sewer temperatures and a lower temperature that significantly suppresses bacterial activity.

Managing the pepper maggot (Diptera: Tephritidae) using perimeter trap cropping

A perimeter trap crop barrier of hot cherry peppers, border-row insecticide applications, and a combination of the two management strategies were evaluated to see if they could protect a centrally located main crop of bell peppers from oviposition and infestation by the pepper maggot, Zonosemata electa (Say). In large plots, the main cash crop of bell peppers was protected from the majority of the oviposition and infestation by all three barriers. The combination sprayed/trap crop barrier provided the best protection against both oviposition and infestation and resulted in over 98% pest-free fruit at harvest. Maggots infested only 1.7% of the main crop fruit when protected by a sprayed or unsprayed trap crop barrier, compared with 15.4% in control plots. The perimeter sprayed/trap crop strategy was employed in three commercial fields in 2000 and 2001. The combination barrier resulted in superior insect control and reduced insecticide use at all commercial locations, compared with the same farms' past history or to farms using conventional and integrated pest management (IPM) methods. Economic analysis showed that the technique is more cost effective and profitable than relying on whole-field insecticide applications to control the pepper maggot. Farmer users were surveyed and found the perimeter trap crop technique simple to use, with many hard-to-measure benefits associated with worker protection issues, marketing, personnel/management relations, pest control and the environment. Use of the perimeter trap crop technique as part of an IPM or organic program can help improve crop quality and overall farm profitability, while reducing pesticide use and the possibility of secondary pest outbreaks.

The nature and pollutant role of solids at the water-sediment interface in combined sewer networks

Solids at the water-sediment interface in combined sewers are known to be important for pollution potential during storm washout via CSOs. They have been investigated in several studies, but nonetheless, little is known about the origins, build-up, transport and nature of these solids. From a review of current knowledge it is apparent that whilst there is general agreement that these solids are largely organic and have high polluting potential, their modes of transport and definition are not generally agreed upon. It is possible that there may be several "types" of these solids, defined as either: "near bed solids" or "fluid sediments/dense undercurrents", possibly representing transport modes in flows with different ranges of ambient (dry weather) velocities and with differing sewerage layouts. Current knowledge is presented and new ideas for resolving the uncertainties regarding the nature, movement and effects of this material are outlined.

Herpes simplex virus type 1 infection: a sexually transmitted infection of adolescence?

OBJECTIVES

To examine the factors associated with antibodies to herpes simplex virus type 1 (HSV-1).

DESIGN

Cross sectional study with HSV-1 antibody testing performed by University of Washington western blot assay.

SETTING

Central London STD clinic (1990-1) and central London blood donation centre (1992).

PARTICIPANTS

Representative sample of 869 new and rebooked GUM clinic attenders and 1494 consecutive blood donors.

RESULTS

The prevalence of HSV-1 antibody among clinic attenders was 60.4% (95% CI 57.0 to 63.7) and among donors was 46.1% (95% CI 43.5 to 48.7). HSV-1 antibody was independently associated with increasing age in both populations (p<0.001). Among clinic attenders, HSV-1 was less common among heterosexual men than women and homosexual men (p<0.005), and was more common among black people (p=0.001) and those of lower socioeconomic status (p=0.05). Among blood donors, being single rather than married was independently associated with HSV-1 infection (p=0.03). Early age at first intercourse was strongly associated with presence of HSV-1 in both populations. The adjusted odds of HSV-1 among GUM clinic attenders was 0.37 (95% CI 0.21 to 0.65) for someone aged 20 at first intercourse compared with someone aged <or=15. Among blood donors, those aged 20 had an adjusted odds of 0.64 (95% CI 0.39 to 1.05) compared with someone aged 15. HSV-1 was not associated with increasing number of lifetime partners after adjustment for other factors.

CONCLUSIONS

Genital herpes due to HSV-1 antibody is increasing in the United Kingdom, particularly among young people. In this study we found that HSV-1 was strongly associated with early age of first sexual intercourse, which may reflect the sexual practices of people initiating sex in this age group.

Experience and extensions to the ASM2 family of models

The development of ASM2 has created a complex model for biological phosphorus removal. Most of the published work on calibrating this model has focused on the design of experiments to maximise information with which to calibrate the model, or the use of hourly data collected around and within an aeration tank. But many sewage works do not collect such data, nor have such instrumentation. The application of ASM2 with sparse data collected at a low frequency, and mostly only input-output, is considered in this paper, based on data collected at a Swedish sewage works. This paper shows that ASM2 can be calibrated with such measurements. This paper also looks at a modification to ASM2d to better handle heterotrophic usage of volatile fatty acids, and the use of this model to study the effects of large increases in in-sewer storage on sewage treatment works. Concern about the generation of large quantities of VFAs, and their effect on the sewage treatment processes, was unfounded.

Serologic evidence of herpes simplex virus 1 infection and oropharyngeal cancer risk

In vitro and animal models suggest that the herpes simplex virus 1 (HSV1) may contribute to the development of oropharyngeal squamous cell carcinoma (OSCC). To determine whether the risk of OSCC is related to infection with HSV1 in humans, we recruited 260 patients from 18 to 65 years old who were newly diagnosed with OSCC between 1990-1995 while residing in three western Washington State counties. For comparison, we recruited at random 445 controls frequency matched to cases on age and sex. Participants completed in-person interviews and provided serum samples that were tested for antibody response to HSV1. After adjusting for sex, cigarette smoking, alcohol consumption, age, and income, HSV1 antibody positivity was associated with a slightly increased risk of OSCC [adjusted odds ratio (OR), 1.3; 95% confidence interval (CI), 0.9-2.0]. The adjusted association between HSV1 antibody positivity and OSCC risk among those who were current cigarette smokers (OR, 4.2; CI, 2.4-7.1) was stronger than would be predicted based on the additive combination of smoking alone (OR, 2.3; CI, 1.2-4.2) and HSV1 seropositivity alone (OR, 1.0; CI, 0.6-1.7). There was suggestive evidence that the association between HSV1 infection and OSCC was similarly modified by evidence of HPV infection but no evidence of effect modification with alcohol consumption. This population-based study suggests that HSV1 may enhance the development of OSCC in individuals who are already at increased risk of the disease because of cigarette smoking or HPV infection.

Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women

CONTEXT

Herpes simplex virus type 2 (HSV-2) is one of the most common sexually transmitted infections in the United States. No prospective study has shown the ability of condoms to reduce transmission of HSV-2.

OBJECTIVE

To evaluate risk factors for HSV-2 acquisition and efficacy of condoms in prevention of HSV-2 transmission.

DESIGN

Analysis of data from a randomized, double-blind, placebo-controlled trial conducted December 13, 1993, to June 28, 1996, of an ineffective candidate HSV-2 vaccine with 18 months of follow-up.

SETTING

Eighteen clinical trial centers in the United States.

PARTICIPANTS

A total of 528 monogamous couples discordant for HSV-2 infection, including an HSV-2-susceptible population of 261 men and 267 women.

MAIN OUTCOME MEASURE

Acquisition of HSV-2 infection by susceptible partners, compared with those remaining free of HSV-2 with regard to demographic characteristics, sexual activity, and condom use.

RESULTS

Twenty-six women (9.7%) vs 5 men (1.9%) acquired HSV-2, for a rate per 10 000 sex acts (episodes of sexual intercourse) of 8.9 vs 1.5, respectively (P<.001). In multivariable analysis, younger age (adjusted hazard ratio [HR] per 5 years, 1.57; 95% confidence interval [CI], 1.22-2.04), seropositivity for HSV-1 and HSV-2 vs HSV-2 alone in the source partner (adjusted HR, 2.34; 95% CI, 1.14-4.82), and more frequent sexual activity (adjusted HR per additional sex act per week, 1.10; 95% CI, 1.01-1.19) were associated with higher risk of HSV-2 acquisition. Condom use during more than 25% of sex acts was associated with protection against HSV-2 acquisition for women (adjusted HR, 0.085; 95% CI, 0.01-0.67) but not for men (adjusted HR, 2.02; 95% CI, 0.32-12.50). Risk of HSV-2 transmission declined from 8.5 per 100 person-years in the initial 150-day interval to 0.9 per 100 person-years in the final 150-day interval (P =.002 for trend), concurrent with a decrease in sexual activity and proportion of sex acts occurring when the source partner had genital lesions.

CONCLUSIONS

Condom use offers significant protection against HSV-2 infection in susceptible women. Changes in sexual behavior, correlated with counseling about avoiding sex when a partner has lesions, were associated with reduction in HSV-2 acquisition over time. These data suggest that identification of discordant couples can reduce transmission of HSV-2, especially for heterosexual couples in which the male partner has HSV-2 infection.

Demographic rather than behavioral risk factors predict herpes simplex virus type 2 infection in sexually active adolescents

BACKGROUND

Despite the high prevalence of herpes simplex virus type 2 (HSV-2) infection in adults and data indicating that many HSV-2 infections are acquired in late adolescence, the demographic and sexual behavior correlates of HSV-2 infection in high risk adolescents have not been extensively studied.

METHODS

Using a cross-sectional design we evaluated serologic evidence of HSV-2 infection in 381 adolescents age 14 to 19 years at an urban sexually transmitted disease clinic and a community clinic. Study enrollment was offered to all patients participating in a project offering free hepatitis B vaccine. Participants were interviewed and blood was drawn for HSV Western blot.

RESULTS

Twelve percent [95% confidence interval (CI), 8.6 to 15.1] of 379 adolescents in this study had antibodies to HSV-2. Only 22% of HSV-2-seropositive youth reported a history of herpes. Seropositivity for HSV-2 was significantly associated with African-American race (odds ratio, 2.3; 95% CI 1.1 to 4.8) and female gender (odds ratio, 6.0; 95% CI 2.3 to 15.9); 25% of the African-American girls were HSV-2-seropositive. Self-reported condom use, number of sexual partners in the prior 2 months and history of a sexually transmitted disease did not predict HSV-2 antibody status.

CONCLUSIONS

HSV-2 infection among adolescents was prevalent, particularly among African-American girls, and correlated with demographic rather than behavioral variables. As in adults most HSV-2 infections were unrecognized. These data suggest that type-specific serologic testing for HSV-2 infection should be considered in sexually active adolescents. Prevention efforts should target children before initiation of sexual activity.

Biodistribution of radiolabeled [(3)H] CMT-3 in rats

CMT-3 is a NON-ANTIMICROBIAL tetracycline (TC), chemically modified to enhance its collagenase-inhibitory property. This property is therapeutically useful in treating diseases such as periodontitis, cancer and arthritis. CMT-3 was labeled with tritium [(3)H] at Carbon 7. Four adult male Sprague-Dawley rats (350--400 g body weight) were gavaged once with a mixture of cold CMT-3 and [(3)H] CMT-3 (750 microCi). An additional four rats were gavaged for 2 days with cold CMT-3(15 mg/Kg/day) and on the third day the rats were gavaged with a mixture of cold and [(2)H] CMT-3 (750 microCi); and all 8 rats were placed in the metabolic cages. Blood samples were collected from the tail at multiple intervals from 1--14 hr after [(3)H] CMT-3 administration. At 14 hr, the rats were anesthetized, euthanized and various tissues including visceral organs were removed and weighed. The contents of GI tracts were emptied and added to the fecal pellets and weighed. The urine samples were collected and volume measured. Each tissue or organ was minced finely with scissors and 100 mg of tissue was digested in 1 ml of Tissue-solv (Packard Lab), for 4 hrs at 37 degrees C and each sample was diluted up to 10 ml of distilled water. A 100 microl aliquot was taken and diluted with an equal volume of glacial acetic acid, 10 ml of Atom-lite was added and counted for radioactivity in a liquid scintillation spectrometer. This biodistribution study revealed that over 14 hrs, 54% and 3% of [(3)H] CMT-3 were excreted in the feces and urine, respectively. The serum [(3)H] CMT-3 count reached its maximum value at about 12 hours. The tissues retained the CMTs as follow: muscle (23%); skin (2.41%); bone (1.72%); and the brain retained 0.21% of the label. The radioactive CMT-3 in the visceral organs is as follows: GI tract - its contents (8.9%); heart (0.41%), testis (0.41%); lungs >(0.16%); spleen (0.08%); liver (0.03%); kidneys > (0.02%).

Chlamydia pneumoniae, herpes simplex virus type 1, and cytomegalovirus and incident myocardial infarction and coronary heart disease death in older adults : the Cardiovascular Health Study

BACKGROUND

Whether serological evidence of prior infection with Chlamydia pneumoniae, herpes simplex virus type 1 (HSV-1), and cytomegalovirus (CMV) is associated with myocardial infarction (MI) and coronary heart disease (CHD) death remains a source of controversy.

METHODS AND RESULTS

We conducted a nested case-control study among participants in the Cardiovascular Health Study, a cohort study of persons aged >/=65 years. Cases experienced an incident MI and CHD death (n=213). Control subjects were matched to cases by age, sex, clinic, year of enrollment, and month of blood draw (n=405). Serum was analyzed for IgG antibodies to C pneumoniae, HSV-1, and CMV. After adjustment for other risk factors, the risk of MI and CHD death was associated with the presence of IgG antibodies to HSV-1 (odds ratio [OR] 2.0, 95% CI 1.1 to 3.6) but was not associated with the presence of IgG antibodies to either C pneumoniae (OR 1.1, 95% CI 0.7 to 1.8) or CMV (OR 1.2, 95% CI 0.7 to 1.9). Although there was little association with low to moderate C pneumoniae antibody titers (</=1:512), high-titer (1:1024) C pneumoniae antibody was associated with an increased risk (OR 2.2, 95% CI 1.1 to 4.4).

CONCLUSIONS

Among older adults, the presence of IgG antibodies to HSV-1 was associated with a 2-fold increase in the risk of incident MI and CHD death. For C pneumoniae, only high-titer IgG antibodies were associated with an increased risk of MI and CHD death. The presence of IgG antibodies to CMV was not associated with risk among the elderly.

Reactivation of genital herpes simplex virus type 2 infection in asymptomatic seropositive persons

BACKGROUND

Most persons who have serologic evidence of infection with herpes simplex virus (HSV) type 2 (HSV-2) are asymptomatic. Historically, it has been assumed that these persons have less frequent viral reactivation than those with symptomatic infection.

METHODS

We conducted a prospective study to investigate genital shedding of HSV among 53 subjects who had antibodies to HSV-2 but who reported having no history of genital herpes, and we compared their patterns of viral shedding with those in a similar cohort of 90 subjects with symptomatic HSV-2 infection. Genital secretions of the subjects in both groups were sampled daily and cultured for HSV for a median of 94 days.

RESULTS

HSV was isolated from the genital mucosa in 38 of the 53 HSV-2-seropositive subjects (72 percent) who reported no history of genital herpes, and HSV DNA was detected by the polymerase-chain-reaction assay in cultures prepared from genital mucosal swabs in 6 additional subjects. The rate of subclinical shedding of HSV in the subjects with no reported history of genital herpes was similar to that in the subjects with such a history (3.0 percent vs. 2.7 percent). Of the 53 subjects who had no reported history of genital herpes, 33 (62 percent) subsequently reported having typical herpetic lesions; the duration of their recurrences in these subjects was shorter (median, three days vs. five days; P<0.001) and the frequency lower (median, 3.0 per year vs. 8.2 per year; P<0.001) than in the 90 subjects with previously diagnosed symptomatic infection. Only 1 of these 53 subjects had no clinical or virologic evidence of HSV infection.

CONCLUSIONS

Seropositivity for HSV-2 is associated with viral shedding in the genital tract, even in subjects with no reported history of genital herpes.

Examining the role of neoadjuvant androgen deprivation in patients undergoing prostate brachytherapy

PURPOSE

To assess the role of neoadjuvant androgen deprivation (NAAD) and transperineal interstitial permanent prostate brachytherapy (TIPPB) using a matched-pair analysis selected from a large cohort of patients undergoing TIPPB.

PATIENTS AND METHODS

Six hundred twelve consecutive patients with clinically confined prostate cancer were treated between June 1992, and January 1997, with permanent ultrasound-guided TIPPB with either palladium-103 or iodine-125 as monotherapy or combined with external radiation. Patients with prostate glands >/= 60 g underwent treatment with NAAD before TIPPB to reduce the prostate volume (n = 163). The median duration of NAAD was 3.4 months before TIPPB (range, 1 to 8 months). To assess the benefit of NAAD, a matched-pair analysis was performed. The American Society of Therapeutic Radiology and Oncology Consensus Group definition of prostate-specific antigen (PSA) relapse-free survival (RFS) was used with the added caveat of an absolute increase of >/= 1.0 ng/mL. Differences in pretreatment PSA, Gleason scores, and stage were analyzed by Kaplan-Meier curves and the log-rank test.

RESULTS

Two hundred sixty-three patients were matched, with a median follow-up duration of 46 months (range, 24 to 76 months). The actuarial 5-year PSA-RFS rate for all 263 patients is 86.5%. The 5-year PSA-RFS rate for patients treated with NAAD and TIPPB was 87.1% compared with 86.9% for those treated with TIPPB only (P =.935). Subgroup analysis by Gleason score groupings, pretreatment PSA, or stage of disease failed to identify any factors for which androgen ablation was beneficial.

CONCLUSION

We were unable to identify any improvement with the addition of NAAD to TIPPB in patients with localized prostate cancer in this retrospective matched-pair analysis. Furthermore, there was no subset for which the addition of NAAD was found to be beneficial. Clarification of the role and duration of NAAD in patients with early-stage prostate cancer will require prospective data.

Isotope selection for patients undergoing prostate brachytherapy

PURPOSE

Ultrasound-guided transperineal interstitial permanent prostate brachytherapy (TIPPB) is generally performed with either 103Pd or 125I. The use of 125I for low Gleason score tumors and 103Pd for higher Gleason scores has been suggested based on isotope dose rate and cell doubling time observed in in vitro studies. While many centers follow these isotope selection criteria, other centers have elected to use only a single isotope, regardless of Gleason score. No clinical data have been published comparing these isotopes. This study was undertaken to compare outcomes between 125I and 103Pd in a matched pair analysis for patients undergoing prostate brachytherapy.

METHODS AND MATERIALS

Six hundred forty-eight consecutively treated patients with clinically confined prostate cancer underwent TIPPB between June 1992 and February 1997. Five hundred thirty-two patients underwent TIPPB alone, whereas 116 received pelvic external beam irradiation and TIPPB. Ninety-three patients received androgen deprivation therapy prior to TIPPB. The prescribed doses for TIPPB were 160 Gy for 125I (pre-TG43) and 120 Gy for 103Pd. Patients treated with combination therapy received 41.4 or 45 Gy (1.8 Gy/fraction) external beam irradiation followed by a 3- to 5-week break and then received either a 120-Gy 125I or a 90-Gy 103Pd implant. Until November 1994, all patients underwent an 125I implant after which the isotope selection was based on either Gleason score (Gleason score 2-5:125I; Gleason 5-8:103Pd) or isotope availability. A matched pair analysis was performed to assess any difference between isotopes. Two hundred twenty-two patients were matched according to Gleason score, prostate-specific antigen (PSA), and stage. PSA relapse-free survival (PSA-RFS) was calculated based on the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Group definition of failure. Kaplan-Meier actuarial survival curves were compared to assess differences in pretreatment PSA and Gleason score.

RESULTS

Univariate analysis of the 648 patients identified Gleason score, pretreatment PSA value, and stage as significant factors to predict PSA-RFS, but failed to identify isotope selection as significant. To address the significance of isotope selection further, the matched pair groupings were performed. The minimum follow-up for all 222 matched patients is 24 months with a median follow-up of 42 months (24-82). The actuarial PSA-RFS at 5 years for all 222 patients is 86.5%. One hundred eleven of the 222 matched patients received a 103Pd implant with an 87.1% 5-year PSA-RFS. The remaining 111 patients underwent a 125I implant with an 85.9% 5-year PSA-RFS (p = n.s.). Analysis of Gleason score subgroups 2-4, 5-6, and 7-9 failed to show any significant difference in PSA-RFS comparing isotopes. Pretreatment PSA subgroups of < or = 10 or > 10 ng/ml also failed to show any significant difference in PSA-RFS survival comparing isotopes. Analysis of postimplant dosimetry using dose delivered to 90% of the prostate volume (D90) did not identify any difference between the isotope groups.

CONCLUSIONS

This matched pair analysis failed to demonstrate a difference for 125I and 103Pd in PSA-RFS for patients undergoing TIPPB. In addition, there were no observed advantages for either 125I or 103Pd in either the low or high Gleason score groups. This data indicates that the role of isotope selection for patients undergoing TIPPB requires further clarification.

Urinary morbidity following ultrasound-guided transperineal prostate seed implantation

PURPOSE

To assess the urinary morbidity experienced by patients undergoing ultrasound-guided, permanent transperineal seed implantation for adenocarcinoma of the prostate.

METHODS AND MATERIALS

Between September 1992 and September 1997, 693 consecutive patients presented with a diagnosis of clinically localized adenocarcinoma of the prostate, and were treated with ultrasound-guided transperineal interstitial permanent brachytherapy (TPIPB). Ninety-three patients are excluded from this review, having received neoadjuvant antiandrogen therapy. TPIPB was performed with 125I in 165 patients and with 103Pd in 435 patients. Patients treated with implant alone received 160 Gy with 125I (pre TG43) or 120 Gy with 103Pd. One hundred two patients received preimplant, pelvic external beam radiation (XRT) to a dose of either 41.4 or 45 Gy because of high-risk features including PSA > or = 10 and/or Gleason score > or = 7. Combined modality patients received 120 Gy and 90 Gy, respectively for 125I or 103Pd. All patients underwent postimplant cystoscopy and placement of an indwelling Foley catheter for 24-48 h. Follow-up was at 5 weeks after implant, every 3 months for the first 2 years, and then every 6 months for subsequent years. Patients completed AUA urinary symptom scoring questionnaires at initial consultation and at each follow-up visit. Urinary toxicity was classified by the RTOG toxicity scale with the following adaptations; grade 1 urinary toxicity was symptomatic nocturia or frequency requiring none or minimal medical intervention such as phenazopyridine; grade 2 urinary toxicity was early obstructive symptomatology requiring alpha-blocker therapy; and grade 3 toxicity was considered that requiring indwelling catheters or posttreatment transurethral resection of the prostate for symptom relief. Log-rank analysis and Chi-square testing was performed to assess AUA score, prostate size, isotope selection, and the addition of XRT as possible prognosticators of postimplant urinary toxicity. The prostate volume receiving 150% of the prescribed dose (V150) was studied in patients to assess its correlation with urinary toxicity.

RESULTS

Median follow-up was 37 months (range 6-68). Within the first 60 days, 37.3% of the patients reported grade 1 urinary toxicity, 41% had grade 2, and 2.2% had grade 3 urinary toxicity. By 6 months, 21.4% still reported grade 1 urinary toxicity, whereas 12.8% and 3% complained of grade 2 and 3 urinary difficulties, respectively. Patients with a preimplant AUA score < or = 7 had significantly less grade II toxicity at 60 days compared to those with an AUA score of >7 (32% vs. 59.2%, respectively, p = 0.001). Similarly, prostatic volumes < or = 35 cc had a significantly lower incidence of grade II urinary toxicity (p = 0.001). There was no difference in toxicity regarding the isotope used (p = 0.138 at 60 days, p = 0.45 at 6 months) or the addition of preimplant XRT (p = 0.069 at 60 days, p = 0.84 at 6 months). Twenty-eight patients (4.7%) underwent TURP after 3 isotope half-lives for protracted obstructive symptoms. Five of these men (17%) developed stress incontinence following TURP, but all patients experienced relief of their obstructive symptoms without morbidity at last follow-up. The percent of the prostate receiving 150% of the prescribed dose (V150) did not predict urinary toxicity.

CONCLUSIONS

TPIPB is well tolerated but associated with mild to moderate urinary morbidity. Pretreatment prostatic volume and AUA scoring were shown to significantly predict for grade 2 toxicity while the use of preimplant, pelvic XRT and isotope selection did not. Patients undergoing TURP for protracted symptoms following TPIPB did well with a 17% risk of developing stress incontinence. V150 did not help identify patients at risk for urinary morbidity. As transperineal prostate implantation is used more frequently the associated toxicities and the definition of possible pretreatment prognostic factors is necessary to