Enterococci pathways to coastal waters and implications of sea level rise.

Highly urban coastal communities in low lying areas and with high water tables are vulnerable to sea-level rise and to corresponding increases in coastal groundwater levels. Stormwater conveyance systems are under increased risk. Rising groundwater levels affect the hydraulics of the stormwater system thereby increasing contaminant transport, for example the fecal indicator bacteria enterococci, to coastal waters. This study offers a unique opportunity to evaluate the impacts of increased contaminant transport on marine coastal environments. Here we assessed historic and recent coastal water quality, stormwater sampling data, groundwater monitoring and tidal elevations near the coastline, in the context of altered hydraulics within the system. Two pathways of enterococci to marine waters were identified. Direct discharge of contaminated stormwater runoff via the stormwater outfalls and tidally driven contaminated groundwater discharge. As sea level continues to rise, we hypothesize that a diminished unsaturated zone coupled with altered hydraulic conditions at the coastal groundwater zone will facilitate the transport of enterococci from urban sediments to the study site (Park View Waterway in Miami Beach, FL USA). We recommend improvements to the stormwater conveyance system, and maintenance of the sanitary sewer system to mitigate these impacts and minimize transport of enterococci, and other stormwater pollutants to coastal waters. The results of this study can be useful to interpret high enterococci levels in low lying coastal areas where groundwater is influenced by rising sea water levels.

Prevalence of Incidental Extraspinal Findings on MR Imaging of the Lumbar Spine in Adults: A Systematic Review and Meta-analysis.

BACKGROUND: Low back pain is common worldwide. MR imaging may identify extraspinal findings that are not related to the proposed clinical question. The prevalence of extraspinal incidental findings and their clinical significance has not been well-established. PURPOSE: This review aimed to evaluate the prevalence of extraspinal findings on MR imaging of the lumbar spine in adults and the prevalence of clinically significant incidental findings. DATA SOURCES: A systematic search of MEDLINE and EMBASE was performed, including studies published before June 14, 2023. STUDY SELECTION: Studies presenting a prevalence of extraspinal findings in patients 16 years of age or older were included. DATA ANALYSIS: A random effects meta-analysis was used to generate composite prevalence measures of extraspinal findings, patients with extraspinal findings, and clinically significant findings. DATA SYNTHESIS: Sixteen studies were included in this meta-analysis, with a total of 19,593 patients and 6,006 extraspinal incidental findings. The overall prevalence of extraspinal findings was 19.9% (95% CI, 11.1%-30.7%). Overall, 26.7% of patients had an extraspinal finding identified (95% CI, 14.8%-40.6%). The most common subgroup of extraspinal findings was genitourinary findings in males (27.1%; 95% CI, 25.6%-28.8%). Data from 8 studies demonstrated the prevalence of clinically significant findings at 5.4% (95% CI, 3.2%-8.1%). LIMITATIONS: Retrospective populations with small numbers of participants in clinically relevant subgroups may result in heterogeneity and imprecision within composite outcome measures. CONCLUSIONS: Extraspinal findings are common, detected in more than one-quarter of patients. Five percent of findings are clinically significant and may require further action.

Fostering Community Engagement and Acquiring Understanding of Health Needs through a Participatory Rural Appraisal in Haiti.

BACKGROUND: Haiti has a population of 10 million people, and is the poorest country in the Western Hemisphere. Individuals living in rural and geographically isolated areas of Haiti are particularly vulnerable to chronic illness secondary to unmet health needs. Participatory Rural Appraisals (PRA) can be conducted to rapidly gain knowledge while empowering locals to participate in the identification and prioritization of their health needs. OBJECTIVES: The purpose of this report was to gain a more thorough understanding of the comprehensive health needs of the rural village of Beloc, Haiti, and to engage and empower the community to be effective agents of change. Results of this appraisal will be used to develop a sustainable community-based health intervention. METHODS: PRA methodology was conducted in one geographically isolated village in Haiti. The research team trained local participants to implement PRA tools to collect data from their community. United States and Haitian participants collaboratively conducted the PRA activities, analyzed results, and shared findings within the community. RESULTS: Key findings from this research include validation of the use of the PRA method to gain a deeper understanding of the needs of a community before developing a community-based health intervention. Needs were identified, prioritized, and used as the framework for a collaborative action plan. CONCLUSIONS: The PRA process was an effective strategy to engage and empower the community leaders to identify, define, and prioritize their resources, goals, and areas for growth. This article discusses the process, advantages, challenges, and implications of a participatory health assessment.

Confidence of Nursing Personnel in Their Understanding Of the Psychosocial Impact of Prostate Cancer.

Nurses must be equipped with skills to support men diagnosed with prostate cancer. Implementation of a unit-specific, evidence-based education program had significant, positive effects on the confidence of nurses who care for veterans who experience a psychosocial impact of prostate cancer treatment.

Enhanced allergen-induced airway inflammation in paucity of lymph node T cell (plt) mutant mice.

BACKGROUND: Dendritic cells and lymphocytes play a central role in allergic asthma. Chemokines for these cells include the CCR7 agonists secondary lymphoid chemokine/CCL21 and EBV-induced lymphoid chemokine/CCL19, but their role in allergic asthma is poorly understood. OBJECTIVE: We sought to determine the effects of abrogation of lymphoid tissue expression of CCR7 agonists on allergic airway responses. METHODS: Paucity of lymphocyte T cell (plt) mutant mice, deficient in EBV-induced lymphoid chemokine/CCL19 and the lymphoid form of secondary lymphoid chemokine/CCL21, were evaluated in an established ovalbumin (OVA)-induced asthma model (plt-OVA group) and compared with similarly immunized +/+ BALB/c mice (+/+OVA group). RESULTS: APTI responses to methacholine increased similarly in OVA-challenged plt and +/+ mice. However, airway inflammation was strikingly enhanced in plt-OVA mutants over +/+OVA mice and included increased numbers of eosinophils, CD4 and B cells, neutrophils, and total leukocytes in bronchoalveolar lavage fluid and inflammatory cell cuffing around pulmonary arterioles. Enhanced airway inflammation was accompanied by an increase in lung T(H)2 activity, with increased levels of IL-4 and monocyte-derived chemoattractant/CCL22. CONCLUSIONS: Induction of allergic asthma in mutant mice with impaired CCR7 responses results in characteristics that resemble severe asthma in human subjects, including severe bronchial lymphocytosis, eosinophilia, and neutrophilia, but not in enhancement in airway hyperreactivity. CLINICAL IMPLICATIONS: Disruption of chemokines responsible for trafficking of antigen-processing cells and lymphocytes to the draining lymph nodes might lead to enhanced allergic airway responses.