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Sea-level rise (SLR) will cause coastal groundwater to rise in many coastal urban environments. Inundation of contaminated soils by groundwater rise (GWR) will alter the physical, biological, and geochemical conditions that influence the fate and transport of existing contaminants. These transformed products can be more toxic and/or more mobile under future conditions driven by SLR and GWR. We reviewed the vulnerability of contaminated sites to GWR in a US national database and in a case comparison with the San Francisco Bay region to estimate the risk of rising groundwater to human and ecosystem health. The results show that 326 sites in the US Superfund program may be vulnerable to changes in groundwater depth or flow direction as a result of SLR, representing 18.1 million hectares of contaminated land. In the San Francisco Bay Area, we found that GWR is predicted to impact twice as much land area as inundation from SLR, and 5,282 additional state-managed sites of contamination may be vulnerable to inundation from GWR in a 1.0 m SLR scenario. Increases of only a few centimeters of elevation can mobilize soil contaminants, alter flow directions in a heterogeneous urban environment with underground pipes and utility trenches, and result in new exposure pathways. Pumping for flood protection will elevate the saltwater interface, changing groundwater salinity and mobilizing metals in soil. Socially vulnerable communities are disproportionately exposed to this risk at both the national scale and in a regional comparison with the San Francisco Bay Area.

Introduction: Due to conduction disease and dyssynchrony in transthyretin amyloid cardiomyopathy (ATTR-CM), cardiac resynchronization therapy (CRT) may be beneficial. We aimed to determine the impact of CRT on clinical outcomes in ATTR-CM. Methods: We studied 116 consecutive ATTR-CM patients, 23 of whom underwent CRT (70% CRT + defibrillator, median 10 months (IQR 4-20) from ATTR-CM diagnosis). Outcome was a composite of 1 st cardiovascular hospitalization or all-cause mortality. CRT was treated as a time dependent co-variate and entered into multivariate Cox proportional hazards model. Results: Both groups were similar at diagnosis except for a higher proportion with atrial fibrillation (AF) and lower ejection fraction among those who underwent CRT ( Table 1) . CRT indication in 80% was progressive LV dysfunction with wide QRS [mean 152 ± 36 msec] and the remaining at time of AV node ablation for AF. Half of CRT group were ≥ NYHA class III at device implantation. Older age, higher National Amyloidosis Cohort (NAC) ATTR stage, and not taking tafamidis were significantly associated with the outcome. On multivariate analysis, CRT was associated with a HR of 0.6 (95% CI: 0.32 - 1.16) for all-cause mortality or cardiovascular hospitalization after adjusting for age at diagnosis, NAC ATTR stage, and tafamidis use ( Figure 1). Conclusion: CRT implantation maybe associated with improved outcomes in ATTR-CM. Larger prospective randomized, sham-controlled trials are warranted to confirm these findings.

Total oxidisable precursor assay (TOP assay) can degrade and convert “unknown” per- and polyfluoroalkyl substances (PFAS) to detectable PFAS. However, the detailed degradation pathway is still not known, particularly when the TOP assay is applied to analyse complex samples such as aqueous film-forming foam (AFFF). To gain insights into the pathway and the effectiveness of the TOP assay, several “known” compounds are first tested as controls, including sodium dodecyl benzene sulphate (SDBS), perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS). Secondly, the test is expanded to several PFAS precursors such as 6:2 fluorotelomer sulfonate (6:2 FTS), 8:2 fluorotelomer sulfonate (8:2 FTS), and a cationic surfactant N-ethyl-N-(2-hydroxyethyl) perfluorooctyl sulfonamide (EtFOSE). Thirdly, the TOP assay is used to test “unknown” PFAS samples that have been previously used as AFFF in Australia. The degradation products are monitored, to compare the mass balance and propose the degradation pathway. While HPLC-MS/MS is typically employed to detect the individual TOP assay products, most of which are perfluoroalkyl carboxylic acids (PFCA), an app-based smartphone sensor can also provide semi-quantitative results as a sum. Overall, the results indicate the effectiveness of the TOP assay to assess the presence of PFAS precursors in the AFFF samples, with some variations in the end products. Recommendations for enhancement of the TOP assay are also provided.

Our ability to develop reliable, cost effective solutions for remediation and protection of water resources has matured in recent decades due to various factors, including advances in engineering techniques, improved monitoring capabilities, and access to numerous case studies, historical datasets, and research to aid in the selection and evaluation of mitigation/remediation approaches. Traditionally, historical baseline conditions, and reasonable projections of future conditions provide significant input into the decision-making process. The variability, and unpredictable nature of climate change now requires that the inherent uncertainty of future conditions (both short- and long-term) be incorporated in our remedial decision-making. From an engineering perspective, this may include more flexible (and likely more costly) remedial designs, or a shift from current preferences for longer-term passive approaches to consecutive, shorter-term active alternatives. Incorporating an economic decision-making tool provides a means to parametrize the uncertainties associated with climate change, and may identify “tipping points” where our decisions may change. Different communities, whose interpretations of and costs of resource protection may acutely reflect their own unique cultural values, incomes, or beliefs in the future, can evaluate feasible engineering/water resource protection strategies even in the absence of certainty about future climate conditions. The combined approach merges evaluation of traditional engineering/performance metrics with an economic model that we anticipate will improve the success of water management strategies.

Introduction::During deployment following Hurricane Ike in September 2008, bites from domestic animals were among the top three trauma complaints seen at the National Disaster Medical System (NDMS) Disaster Medical Assistance Team (DMAT) base of operations.Problem::Unlike previous reports of frightened, misplaced dogs and cats biting strangers and rescue workers, there was an increase in bites associated with presumed non-rabid pets who were known to the bite victim.Methods:This was an observational sampling of all patients presenting for medical care during deployment to the AL-3 DMAT base of operations in Webster, Texas, following Hurricane Ike. Findings were compared with unofficial local norms and observations from the literature.Results:Of the people with animal bites presenting to the field hospital, dog bites accounted for 55%, cat bites, 40%, and snake bites, 5%. Most of the wounds required suturing and were not simple punctures. Most bites (70%) involved the hand(s). Some patients presented > 24 hours after the bite, and already had developed cellulitis. One patient required transfer and inpatient admission for intravenous antibiotics and debridement of a hand injury with spread into the metacarpophalangeal space.Conclusions:Most of the bites were severe and occurred within the first 72 hours after the hurricane, and waned steadily over the following weeks to baseline levels. No animal bites caused by misplaced dogs and cats biting strangers were seen. There was an increase in bites associated with domesticated pets known to the bite victim. The current NDMS cache is stocked adequately to care for most wounds caused by animal bites. However post-exposure rabies treatment is not part of the routine medications offered. For future disaster preparedness training, pet owners should be aware of the increased potential for dog and cat bites.

A permeable treatment wall (PTW) was designed and installed at the West Valley Development Project (WVDP), a former commercial nuclear fuel reprocessing facility in New York, to passively remove and contain the expansion of strontium-90 (Sr-90) in the site groundwater. AMEC engineers and geologists have collaborated with researchers at the State University of New York at Buffalo (UB) and West Valley Environmental Services LLC to design and install an approximately 260 meter (860-foot) long by 0.9 meter (3-foot) thick zone of granular zeolite (a natural aggregate composed of approximately 85 percent of the mineral clinoptilolite) that will remove Sr-90 in situ from groundwater through ion-exchange reactions. The PTW was designed to meet the functional objectives for up to 20 years; performance monitoring will be conducted regularly and will be used to assess the lifetime efficacy of the PTW. The zeolite-filled PTW was the selected remedial alternative due to its hydraulically passive operations and lower life-cycle cost over other more traditional active treatment alternatives such as pump and treat. The design relied heavily on detailed site characterization of site soils and groundwater conditions and bench and pilot scale evaluations of various zeolite materials. The design specified the use of a one-pass trencher to simultaneously remove unconsolidated aquifer material composed of glaciofluvial-derived silt, sand, and gravel from ground surface to depths up to approximately 9 meters (30 feet) and replace the excavated zone with zeolite along the entire alignment while keying the PTW at least 0.9 meter (3 feet) into the underlying low-permeability glacial till. Several technology demonstrations were conducted to assess implementability using the one-pass trencher prior to completing the final design. During full-scale implementation, excavated sediment was conveyed directly into a prefabricated containment structure pending final disposition. The passive design provides a cost effective and sustainable alternative for treatment of Sr-90 and potentially other exchangeable radioactive ions in groundwater where these constituents migrate in unconsolidated materials.Copyright © 2011 by ASME

Objective:The impact of the use of mask continuous positive airway pressure (CPAP) on patients with acute respiratory distress in the prehospital, rural setting has not been defined. The goal was to test the use of CPAP using the Respironics® WhisperFlow® CPAP in patients presenting with acute respiratory distress. This was a collaborative evaluation of CPAP involving a rural EMS agency and the regional medical center. Patient outcomes including the overall rate of intubation-both in the field and in the emergency department (ED), and length of stay in the hospital and Intensive Care Unit (ICU) were tracked.Methods:The study was an eight-month, crossover, observational, non-blinded study.Results:During the four months of baseline data collection, 7.9% of patients presenting with respiratory distress were intubated within the first 48 hours of care. Their average ICU length of stay was 8.0 days. During the four months of data collection when CPAP was available in the prehospital setting, intubation was not required for any patients in the field or in the ED. Admissions to the ICU decreased. Those patients admitted to the ICU, the average ICU length of stay deceased to 4.3 days.Conclusions:The use of the CPAP in the prehospital setting is beneficial for patients in acute respiratory distress.

In particle image velocimetry (PIV), the number of particle images per interrogation region, or particle image density, impacts the strength of the correlation and, as a result, the number of valid vectors and the measurement uncertainty. For some uncertainty methods, an a priori estimate of the uncertainty of PIV requires knowledge of the particle image density. An autocorrelation-based method for estimating the local, instantaneous, particle image density is presented. The method assumes that the particle images are diffraction limited and thus Gaussian in shape. Synthetic images are used to develop an empirical relationship between the autocorrelation peak magnitude and the particle image density, particle image diameter, particle image intensity, and interrogation region size. This relationship is tested using experimental images. The experimental results are compared to particle image densities obtained through implementing a local maximum method and are found to be more robust. The effect of varying particle image intensities was also investigated and is found to affect the measurement of the particle image density. Knowledge of the particle image density in PIV facilitates uncertainty estimation, and can alert the user that particle image density is too low or too high, even if these conditions are intermittent. This information can be used as a new vector validation criterion for PIV processing. In addition, use of this method is not limited to PIV, but it can be used to determine the density of any image with diffraction limited particle images.

According to Intergovernmental Maritime Consultative Organization protocols (MARPOL 73/78), clean ballast water (producing no surface sheen and/or containing less than 15 parts per million total oil) from crude oil cargo tanks of tankers can be discharged into coastal waters. As part of an assessment of the potential impact of clean ballast water discharges on Red Sea coral reefs, we have determined the hydrocarbon composition of clean ballast water from crude oil cargo tanks and have determined its rate of dilution following discharge to coastal waters at Yanbu, Kingdom of Saudi Arabia. In 52 clean ballast water samples from 10 crude oil tankers, total petroleum hydrocarbon concentrations, measured by gas chromatography, ranged from 0.09 to 11 milligrams/liter (ppm). In most cases, the dominant hydrocarbons in the samples were Cll through C20 n-paraffins. Up to 58 micrograms/liter (ppb) total naphthalenes and 744 μg/l benzene, toluene, and ethylbenzene combined were detected in some samples. Clean ballast water was diluted rapidly upon discharge to the ocean. Dilutions of 100-fold or greater were observed within 10 to 20 meters of the discharge and dilutions of 500 to 1,000-fold were measured 1,500 to 2,000 meters downcurrent and within two to four hours of the discharge. Based on these results, it is predicted that discharge of clean ballast water to the coastal waters of the Red Sea in compliance with MARPOL 73/78 rules will have little or no adverse impact on coral reefs of the area.

The purposes of this study were to 1) identify the major factors that influence the retention of Black undergraduate nursing students in baccalaureate nursing programs; 2) compare and contrast the major retention problems of Black baccalaureate nursing students in predominantly white universities with those of all Black students in similar institutions; and 3) generate questions for further study in the area of student retention. The study used a convenience sample which included one private university and one public state university with baccalaureate nursing programs from the Eastern, Southern, Midwest, and Western regions in the country. Contact persons at each institution were asked to administer questionnaires to Black nursing students enrolled in the professional sequence of the curriculum, Black nursing faculty and administrators, and White nursing faculty and administrators. Data analysis consisted of a comparison between the responses of students, faculty, and administrators in 1980 and those of nursing students, faculty and administrators in 1984 to identified admission-retention barriers and possible remedies.

An ultraviolet detector was shown to be highly satisfactory for the selective determination of aromatic components in jet fuels. The detector was operated at 208 nm and used with a glass capillary column gas chromatographic system. The detector gave a linear response in the range of interest and could detect individual benzenes and naphthalenes in jet fuels at levels down to 0.1% and 0.02% respectively. a photoionization detector having a 9.5 ev source was found to be not sufficiently selective for aromatic hydrocarbons to be of value for fuel characterization. (Author)