Systemic long-term impact of clinical pathways: UPMC experience with hysterectomy patients

Environment Systems and Decisions - Clinical pathways are defined as evidence-based, multidisciplinary care algorithms that outline essential steps in the management of patients. Pathway...     

The effect of macrophytes on retention times in a constructed wetland for wastewater treatment

Retention times of treated water in a constructed wetland (CW) with horizontal subsurface flow were determined both in the vegetative and non-vegetative periods of 2005. Tracer experiments were performed using fluorescein, an organic compound detectable at extremely low concentrations. Nominal and tracer retention times were determined and compared. Winter tracer retention time (TRT 194 h) and nominal retention time (nHRT 190 h) were nearly exactly equal, while summer TRT (335 h) was approximately twofold higher than nHRT (158 h). Residence time distribution function (RTD) was used to compare retention times obtained for the vegetative and non-vegetative periods. The obtained results document a significant influence of dense common reed vegetation on retention characteristics of the studied system. Common reed can convert a significant volume of water from liquid to gas via evapotranspiration (ET) and thus prolong water retention times in the system. This is very important both technically and ecologically. Longer retention times mean a longer time for microbiological decay of wastewater. Water converted from liquid to gas causes cooling of the microclimate, which is very important, especially in intensively cultivated areas with a lack of water.     

Controlled Exposures of Volunteers to Respirable Carbon and Sulf uric Acid Aerosols

Respirable carbon or fly ash particles are suspected to increase the respiratory toxicity of coexisting acidic air pollutants, by concentrating acid on their surfaces and so delivering it efficiently to the lower respiratory tract. To investigate this issue, we exposed 15 healthy and 15 asthmatic volunteers in a controlled- environment chamber (21°C, 50 percent relative humidity) to four test atmospheres: (i) clean air; (ii) 0.5-μm H2SO4 aerosol at =100 μg/m³, generated from water solution; (iii) 0,5-μm carbon aerosol at =250 μg/m³, generated from highly pure carbon black with specific surface area comparable to ambient pollution particles; and (iv) carbon as in (iii) plus =100 μg/m³ of ultrafine H2SO4 aerosol generated from fuming sulfuric acid. Electron microscopy showed that nearly all acid in (iv) became attached to carbon particle surfaces, and that most particles remained in the sub-μm size range. Exposures were performed double-blind, 1 week apart. They lasted 1 hr each, with alternate 10-min periods of heavy exercise (ventilation =50 L/min) and rest. Subjects gargled citrus juice before exposure to suppress airway ammonia. Lung function and symptoms were measured pre-exposure, after initial exercise, and at endexposure. Bronchial reactivity to methacholine was measured after exposure. Statistical analyses tested for effects of H₂SO₄ or carbon, separate or interactive, on health measures. Group data showed no more than small equivocal effects of any exposure on any health measure. One individual's responses were consistent with a clinically significant excess airway constriction from H₂SO₄ plus carbon, and 2-3 others showed slight excess responses to the combined pollutants, but all these observations might have reflected chance variations. We conclude that coexisting carbon aerosol did not increase respiratory irritancy of H₂SO₄, in most healthy and asthmatic subjects exposed for 1 hr under simulated "worst-case" ambient conditions.     

An Inexpensive Dual-Chamber Particle Monitor: Laboratory Characterization

Abstract

In developing countries, high levels of particle pollution from the use of coal and biomass fuels for household cooking and heating are a major cause of ill health and premature mortality. The cost and complexity of existing monitoring equipment, combined with the need to sample many locations, make routine quantification of household particle pollution levels difficult. Recent advances in technology, however, have enabled the development of a small, portable, data-logging particle monitor modified from commercial smoke alarm technology that can meet the needs of surveys in the developing world at reasonable cost. Laboratory comparisons of a prototype particle monitor developed at the University of California at Berkeley (UCB) with gravi-metric filters, a tapered element oscillating microbalance, and a TSI DustTrak to quantify the UCB particle monitor response as a function of both concentration and particle size and to examine sensor response in relation to changes in temperature, relative humidity, and elevation are presented here. UCB particle monitors showed good linearity in response to different concentrations of laboratory-generated oleic acid aerosols with a coarse (mass median diameter, 2.1 µm) and fine (mass median diameter, 0.27–0.42 µm) size distributions (average r² = 0.997 ± 0.005). The photoelectric and ionization chamber showed a wide range of responses based on particle size and, thus, require calibration with the aerosol of interest. The ionization chamber was five times more sensitive to fine rather than coarse particles, whereas the photoelectric chamber was five times more sensitive to coarse than fine. The ratio of the response between the two sensors has the potential for mass calibration of individual data points based on estimated parameters of the size distribution. The results demonstrate the significant potential of this monitor, which will facilitate the evaluation of interventions (improved fuels, stoves, and ventilation) on indoor air pollution levels and research on the impacts of indoor particle levels on health in developing countries.     

Biodegradation of microcystins and nodularin in freshwaters

Microcystin-LR (MC-LR) was readily biodegraded on addition to six different water samples irrespective of their previous exposure to microcystins. Subsequent studies with water from three of these water bodies confirmed the degradation of MC-LR and also demonstrated the biodegradation of MC-LF, nodularin and mixture of microcystins and nodularin. Rates of degradation of MC-LR, MC-LF and NOD in individual water samples ranged from a half-life of 4 to 18d. Analysis by HPLC-PDA-ESI+ and MALDI MS/MS revealed novel intermediate degradation products of MC-LF and nodularin which included demethylation, hydrolysis, decarboxylation and condensation of the parent compound(s). Our study suggests a possible diversity of micro-organisms and/or pathways which has not been previously observed.     

Unprecedented bleaching-induced mortality in Porites spp. at Rangiroa Atoll, French Polynesia

In April-May 1998, mass coral bleaching was observed in the lagoon of Rangiroa Atoll, Tuamotu Archipelago, French Polynesia. Six months later, the extent of bleaching-induced coral mortality was assessed at three sites. Corals in the fast-growing genus Pocillopora had experienced >99% mortality. Many large colonies of the slow-growing genus Porites (mean horizontal cross-sectional area 5.8 m²) had also died - a phenomenon not previously observed in French Polynesia and virtually unprecedented world-wide. At one site, 25% of colonies, or 44% of the pre-bleaching cover of living Porites, experienced whole-colony mortality. At the two other sites, recently dead Porites accounted for 41% and 82% of the pre-bleaching live cover. Mortality in Porites was negatively correlated with depth between 1.5 and 5 m. Using a 50-year dataset of mean monthly sea surface temperature (SST), derived from ship- and satellite-borne instruments, we show that bleaching occurred during a period of exceptionally high summer SST. 1998 was the first year in which mean monthly SSTs exceeded the 1961-1990 upper 95% confidence limit (29.4°C) for a period of three consecutive months. We suggest that the sustained 3-month anomaly in local summer SST was a major cause of coral mortality, but do not discount the synergistic effect of solar radiation. Recovery of the size-frequency distribution of Porites colonies to pre-bleaching levels may take at least 100 years.     

Acid soil indicators in forest soils of the Cherry River Watershed, West Virginia

Declining forest health has been observed during the past several decades in several areas of the eastern USA, and some of this decline is attributed to acid deposition. Decreases in soil pH and increases in soil acidity are indicators of potential impacts on tree growth due to acid inputs and Al toxicity. The Cherry River watershed, which lies within the Monongahela National Forest in West Virginia, has some of the highest rates of acid deposition in Appalachia. East and West areas within the watershed, which showed differences in precipitation, stream chemistry, and vegetation composition, were compared to evaluate soil acidity conditions and to assess their degree of risk on tree growth. Thirty-one soil pits in the West area and 36 pits in the East area were dug and described, and soil samples from each horizon were analyzed for chemical parameters. In A horizons, East area soils averaged 3.7 pH with 9.4 cmol_c kg^???1 of acidity compared to pH 4.0 and 6.2 cmol_c kg^???1 of acidity in West area soils. Extractable cations (Ca, Mg, and Al) were significantly higher in the A, transition, and upper B horizons of East versus West soils. However, even with differences in cation concentrations, Ca/Al molar ratios were similar for East and West soils. For both sites using the Ca/Al ratio, a 50% risk of impaired tree growth was found for A horizons, while a 75% risk was found for deeper horizons. Low concentrations of base cations and high extractable Al in these soils translate into a high degree of risk for forest regeneration and tree growth after conventional tree harvesting.