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National fish consumption advisories that are based solely on assessment of risk of exposure to contaminants without consideration of consumption benefits result in overly restrictive advice that discourages eating fish even in areas where such advice is unwarranted. In fact, generic fish advisories may have adverse public health consequences because of decreased fish consumption and substitution of foods that are less healthy. Public health is on the threshold of a new era for determining actual exposures to environmental contaminants, owing to technological advances in analytical chemistry. It is now possible to target fish consumption advice to specific at-risk populations by evaluating individual contaminant exposures and health risk factors. Because of the current epidemic of nutritionally linked disease, such as obesity, diabetes, and cardiovascular disease, general recommendations for limiting fish consumption are ill conceived and potentially dangerous.

The influence of different reaction conditions on the effectiveness of Fenton's reagent in degrading atrazine was investigated. Optimal degradation was observed with 2.69 mM (1:1) FeSO4:H2O. At this level, atrazine was completely degraded to 2-chloro-4,6-diamino-s-triazine and 2-acetamido-4-amino-6-chloro-s-triazine in less than or equal to 30 seconds. This indicated that additional post-treatments may be needed to eliminate residual chloro-s-triazines.

High-throughput methods are now routinely used to rapidly screen chemicals for potential hazard. However, hazard-based decision-making excludes important exposure considerations resulting in an incomplete estimation of chemical safety. Models to estimate exposure exist, but are generally unsuited to keep up with high-throughput demands. The High-Throughput Exposure Assessment Tool (HEAT) is designed to efficiently predict near-field exposure to consumers and workers via inhalation, oral and dermal routes. HEAT is based on well-known modeling algorithms and provides default model parameters to support reasonably conservative exposure estimates. Underlying chemical-specific data are uploaded or entered by the end user. HEAT's main strength is the flexible tiered screening functionality, which enables exposure estimates for single or multiple chemicals simultaneously. Hypothetical case examples highlighting the application of HEAT to more complex exposure estimates for alternative and aggregate assessments are provided. [ABSTRACT FROM AUTHOR]

Providing efficient, accurate, and timely patient health information is the overriding aim of an electronic health record (EHR) documentation system. As new technologies evolve and regulatory requirements continue to change, administrators who find limitations in earlier iterations of EHR systems may need to rethink existing systems and processes. Seeking to optimize quality of patient care, the leadership of the Department of Physical Medicine and Rehabilitation at an academic medical center initiated a quality improvement project utilizing Lean methodology to guide redesign of an inefficient, first-generation EHR documentation system. Baseline data were collected using therapist/EHR interaction time studies, therapist productivity measurements, and stakeholders' surveys. Existing documentation templates, available technology, and regulatory requirements were evaluated. Outcomes included mean reductions in time spent using the EHR from 2.8 hours per day to 1.9 hours per day per therapist, increases in patient care time from 53 percent to 71 percent, and overall improvements in internal and external stakeholders' satisfaction from 17 percent to 97.4 percent and 43 percent to 80.3 percent, respectively. The implementation of Lean methodology applied to EHR documentation template inefficiencies proved to be an effective way of reducing time spent in the EHR by therapists, improving therapist productivity, and increasing satisfaction of internal and external stakeholders. [ABSTRACT FROM AUTHOR]

Background and Aims: Our aim was to ascertain the opinions and preferences of physical therapists with regard to use of peripheral nerve blocks and their impact on the recovery of patients undergoing total joint replacement., Methods: We conducted an anonymous 24-question survey of 20 full-time inpatient physical therapists at a single tertiary care medical center., Results: One respondent indicated they never work with patients who have undergone total joint replacement surgery. Nineteen questionnaires were included in the final analysis. Questions omitted by respondents or with write-in answers were not included in the analysis. A majority of respondents (15 [78.9%]) agreed nerve blocks somewhat to greatly improve a patient's pain after total joint replacement surgery. Most respondents answered that nerve blocks somewhat to greatly impede a patient's ability to participate in physical therapy (14 [73.6%]) and make therapy somewhat to very difficult for them as physical therapists (16 [84.2%]). When asked about specific surgeries, (17/18 [94.4%]) and (14/18 [77.8%]) of respondents would prefer that their patients receive periarticular infiltration or no block at all after total knee arthroplasty or total hip arthroplasty, respectively. All respondents (19 [100%]) answered that they thought lower extremity nerve blocks increased a patient's risk of falling after surgery., Conclusions: According to the physical therapists we surveyed, nerve blocks impede patient recovery and increase the risk of falls, despite their positive impact on pain control. When considering surgery for themselves, therapists indicated they would not want a nerve block., Competing Interests: Conflict of interest Nothing to declare