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This article describes a simple and reproducible arthroscopic technique for passing sutures in the shoulder glenoid labrum in the lateral decubitus position for orthopaedic surgeons. Communicating and teaching surgeons how to perform certain maneuvers with precision can be challenging at times. This technique will simplify and more efficiently communicate the advanced arthroscopic motor skill of passing sutures in the shoulder. It will facilitate skill acquisition while teaching surgeons in training how to perform the procedure.

The polycyclic musks, AHTN and HHCB are fragrance ingredients widely used in consumer products. A monitoring campaign was conducted and collected grab effluent and sludge samples at 40 wastewater treatment plants (WWTP) across the United States to understand their occurrence and statistical distribution in these matrices. AHTN concentration in effluent ranged from <0.05 μg/L (LOQ) to 0.44 μg/L with a mean and standard deviation of 0.18 ± 0.11 μg/L. HHCB concentrations in effluent ranged from 0.45 to 4.79 μg/L with a mean of 1.86 ± 1.01 μg/L. AHTN concentrations in sludge ranged from 0.65 to 15.0mg/kg dw (dry weight) with a mean and standard deviation being 3.69 ± 2.57 mg/kg dw, while HHCB sludge concentrations were between 4.1 and 91 mg/kg with a mean of 34.0 ± 23.1mg/kg dw. Measured concentrations of AHTN and HHCB were significantly correlated with each other in both effluent and sludge. The concentrations of HHCB in both effluent and sludge were approximately an order of magnitude higher than those for AHTN, consistent with 2011 usage levels. The highest measured effluent concentrations for both AHTN and HHCB were below their respective freshwater PNECs (predicted no effect concentrations), indicating a negligible risk to biological communities below WWTPs, even in the absence of upstream dilution. Moreover, the large number of effluents and sludges sampled provides a statistical distribution of loadings that can be used to develop more extensive probabilistic exposure assessments for WWTP mixing zones and sludge amended soils., (Copyright © 2014 Elsevier B.V. All rights reserved.)

The objective of this work was to conduct an environmental risk assessment for the consumer use of the polycyclic musk, HHCB (CAS No. 1222-05-5) in the U.S. focusing on mixing zones downstream from municipal wastewater treatment plants (WWTPs) and sludge amended soils. A probabilistic exposure approach was utilized combining statistical distributions of effluent and sludge concentrations for the U.S. WWTPs with distributions of mixing zone dilution factors and sludge loading rates to soil to estimate HHCB concentrations in surface waters and sediments below WWTPs and sludge amended soils. These concentrations were then compared to various toxicity values. Measured concentrations of HHCB in effluent and sludge from a monitoring program of 40 WWTPs across the U.S. formed the basis for estimating environmental loadings. Based upon a Monte Carlo analysis, the probability of HHCB concentrations being below the PNEC (predicted no effect concentration) for pelagic freshwater organisms was greater than or equal to 99.87% under both mean and low flow regimes. Similarly, the probability of HHCB concentrations being less than the PNEC for freshwater sediment organisms was greater than or equal to 99.98%. Concentrations of HHCB in sludge amended soils were estimated for single and repeated annual sludge applications with tilling of the sludge into the soil, surface application without tilling and a combination reflecting current practice. The probability of soil HHCB concentrations being below the PNEC for soil organisms after repeated sludge applications was 94.35% with current sludge practice. Probabilistic estimates of HHCB exposures in surface waters, sediments and sludge amended soils are consistent with the published values for the U.S. In addition, the results of these analyses indicate that HHCB entering the environment in WWTP effluent and sludge poses negligible risk to aquatic and terrestrial organisms in nearly all exposure scenarios., (Copyright © 2014 Elsevier B.V. All rights reserved.)