Integrated tire wear buildup and rainfall-runoff model to simulate tire wear particles in stormwater.

This paper presents an approach to integrate tire wear buildup and rainfall-runoff models to simulate tire wear buildup on road surfaces and its subsequent transport in stormwater runoff events. To do so, a buildup model is presented based on vehicle kilometers traveled, vehicle type, vehicle speed, and road roughness within a watershed. This buildup model was integrated into an EPA SWMM model that simulated the runoff of tire wear particles in twelve watersheds in the San Francisco, CA bay area. Results demonstrate that tire wear particle buildup within the watersheds ranged between 0.4 and 0.51 (kg/km2) per hour. Applied to the SWMM model, total event mean tire wear concentrations ranged between 0.5 and 67 µg/L. These concentrations were linearly correlated to depth-integrated samples collected at the outlet of each of the watersheds (R2 = 0.66). The proposed modeling approach can ultimately be applied to create solutions to an emerging stormwater contaminant.

Hydrologic and water quality performance of a subsurface gravel wetland treating stormwater runoff.

Subsurface gravel wetlands are an emerging type of green infrastructure that can be used to manage stormwater through the capture and slow release of runoff. They are unique to other types of green infrastructure in that they have a distinct fully saturated gravel layer below an occasionally saturated soil layer that influences pollutant removal processes. While they have been widely applied to treat wastewater, our understanding of their efficiency in treating stormwater with variable pollutant inputs is limited. To fill this gap, this study monitored the flow and water quality (total suspended solids, total nitrogen, total phosphorus, and chloride) in a subsurface gravel wetland in Oshkosh, Wisconsin at the influent, effluent, and in an observation well. Results from nine storm events indicated that the wetland had a median volume reduction of 74% and a median peak flow reduction of 89%. The reduction in pollutant concentrations where highly dependent upon the influent concentration. Average reductions of total suspended solids, total nitrogen, and total phosphorus were 49%, -21% and -0.2%, respectively, indicating an increase in nutrients; however, where influent concentrations were above irreducible levels, total phosphorus was reduced by 45% (influent ≥0.25 mg/L) and total nitrogen was reduced by 38% (influent ≥2.5 mg/L). Overall, this study shows that the subsurface gravel wetland performed similar to other types of green infrastructure and could be a good management practice to mitigate the harmful effects of stormwater runoff.

Antibiotic resistance genes in an urban stream before and after a state fair.

The global spread of antibiotic resistance genes (ARGs) concomitant with a decrease in antibiotic effectiveness is a major public health issue. While research has demonstrated the impact of various urban sources, such as wastewater treatment plant (WWTP) effluent, stormwater runoff, and industrial discharge on ARG abundance in receiving waters, the impact of short-term gatherings such as state fairs is not comprehensively understood. The objective of this research was to explore the impact of a 2-week Wisconsin State Fair gathering - over 1.1 million visitors and 7,100 farm animals - on the abundance of the ARG blaTEM, the integrase of the class 1 integron (intI1), a marker for horizontal gene transfer, and the 16S rRNA gene, a marker for total biomass, in an urban stream receiving runoff from the state fair. Stream samples downstream of the state fair were taken before and after the event and quantified via a droplet digital polymerase chain reaction. The absolute abundance of all genes was significantly higher (p<0.05) following the event. This research showcases the prevalence and persistence of ARG contamination in an urban stream before and after a state fair gathering, suggesting that short-term events can be a significant source of ARGs into the environment.

Environmental drivers impact the accumulation and diversity of antibiotic resistance in green stormwater infrastructure.

Antibiotic resistance poses an urgent public health concern, with the environment playing a crucial role in the development and dissemination of resistant bacteria. There is a growing body of research indicating that stormwater is a significant source and transport vector of resistance elements. This research sought to characterize the role of green stormwater infrastructure (GSI), designed for stormwater infiltration, in accumulating and propagating antibiotic resistance in the urban water cycle. Sampling included 24 full-scale GSI systems representing three distinct types of GSI - bioswales, bioretention cells, and constructed wetlands. The results indicated that GSI soils accumulate antibiotic resistance genes (ARGs) at elevated concentrations compared to nonengineered soils. Bioretention cells specifically harbored higher abundances of ARGs, suggesting that the type of GSI influences ARG accumulation. Interestingly, ARG diversity in GSI soils was not impacted by the type of GSI design or the diversity of the microbial community and mobile genetic elements. Instead, environmental factors (catchment imperviousness, metals, nutrients, and salts) were identified as significant drivers of ARG diversity. These findings highlight how environmental selective pressures in GSI promote ARG persistence and proliferation independently of the microbial community. Therefore, GSI systems have the potential to be a substantial contributor of abundant and diverse ARGs to the urban water cycle.

Impact of traffic on air pollution in a mid-sized urban city during COVID-19 lockdowns.

In this study, we evaluated the changes in air pollutant concentrations around Milwaukee, WI, during and after lockdown due to the COVID-19 pandemic for a period of 126 days. Measurements of particulate matter (PM1, PM2.5, and PM10), NH3, H2S, and O3 + NO2, were made on a 74-km route of arterial and highway roads from April to August 2020 using a Sniffer 4D sensor mounted to a vehicle. Traffic volume during measurement periods were estimated from smartphone-based traffic data. From lockdown (March 24, 2020-June 11, 2020) to post-lockdown (June 12, 2020-August 26, 2020) median traffic volume increased roughly 30-84%, depending upon the road type. In addition, increases in mean concentrations of NH3 (277%), PM (220-307%), and O3 + NO2 (28%) were also observed. For both traffic and air pollutants, abrupt changes in the data were observed mid-June, shortly after lockdown measures were lifted in Milwaukee County. Indeed, traffic was able to explain up to 57% of PM, 47% of NH3, and 42% of O3 + NO2 variance in pollutant concentrations on arterial and highway road segments. Two arterial roads that did not have statistically significant changes in traffic patterns during the lockdown exhibited no statistically significant trends between traffic and air quality parameters. This study demonstrated that COVID-19 lockdowns in Milwaukee, WI, caused significant decreases in traffic, which in turn had a direct impact on air pollutants. It also highlights the need for traffic volume and air quality data at relevant spatial and temporal scales for accurately assessing source apportionment of combustion-based air pollutants, which cannot be captured with typical ground-based sensor systems.

Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest.

Professional medical associations (PMAs) play an essential role in defining and advancing health care standards. Their conferences, continuing medical education courses, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public. Because many PMAs receive extensive funding from pharmaceutical and device companies, it is crucial that their guidelines manage both real and perceived conflict of interests. Any threat to the integrity of PMAs must be thoroughly and effectively resolved. Current PMA policies, however, are not uniform and often lack stringency. To address this situation, the authors first identified and analyzed conflicts of interest that may affect the activities, leadership, and members of PMAs. The authors then went on to formulate guidelines, both short-term and long-term, to prevent the appearance or reality of undue industry influence. The recommendations are rigorous and would require many PMAs to transform their mode of operation and perhaps, to forgo valuable activities. To maintain integrity, sacrifice may be required. Nevertheless, these changes are in the best interest of the PMAs, the profession, their members, and the larger society.

The Charter on Professionalism for Health Care Organizations.

In 2002, the Physician Charter on Medical Professionalism was published to provide physicians with guidance for decision making in a rapidly changing environment. Feedback from physicians indicated that they were unable to fully live up to the principles in the 2002 charter partly because of their employing or affiliated health care organizations. A multistakeholder group has developed a Charter on Professionalism for Health Care Organizations, which may provide more guidance than charters for individual disciplines, given the current structure of health care delivery systems.This article contains the Charter on Professionalism for Health Care Organizations, as well as the process and rationale for its development. For hospitals and hospital systems to effectively care for patients, maintain a healthy workforce, and improve the health of populations, they must attend to the four domains addressed by the Charter: patient partnerships, organizational culture, community partnerships, and operations and business practices. Impacting the social determinants of health will require collaboration among health care organizations, government, and communities.Transitioning to the model hospital described by the Charter will challenge historical roles and assumptions of both its leadership and staff. While the Charter is aspirational, it also outlines specific institutional behaviors that will benefit both patients and workers. Lastly, this article considers obstacles to implementing the Charter and explores avenues to facilitate its dissemination.

Council ofMedical Specialty Societies: committed to continuing medical education reform.

The Council of Medical Specialty Societies (CMSS) recognizes the need for continuing medical education (CME) reform and intends to be actively engaged in that process. While recognizing that CME reform must involve many organizations, the CMSS and particularly the 23 societies that make up the CMSS are in a position to affect many of the needed changes. Of these, perhaps the most important is the need to link CME to a change in physician behavior and patient outcomes. Other important tasks involve the expansion and improvement of available needs assessment modalities, the development and updating of curricula, the official recognition of multiple modalities available for physician learning, the broadening of the CME research agenda, and the need to explore alternate ways of financing lifelong learning. With the accomplishment of these reforms, medical education may finally be viewed as a continuum from undergraduate education through education of the practicing physician, and patient safety will be favorably impacted. Education will change from an episodic experience to a continuous process and one that is based on the realities of practice. These reforms will take time to accomplish and to be accepted by a profession that currently views itself as besieged by regulatory agencies and without the time and resources needed to comply with the changes.

Perspective: Organizational professionalism: relevant competencies and behaviors.

The professionalism behaviors of physicians have been extensively discussed and defined; however, the professionalism behaviors of health care organizations have not been systemically categorized or described. Defining organizational professionalism is important because the behaviors of a health care organization may substantially impact the behaviors of physicians and others within the organization as well as other institutions and the larger community. In this article, the authors discuss the following competencies of organizational professionalism, derived from ethical values: service, respect, fairness, integrity, accountability, mindfulness, and self-motivation. How nonprofit health care organizations can translate these competencies into behaviors is described. For example, incorporating metrics of population health into assessments of corporate success may increase collaboration among regional health care organizations while also benefiting the community. The unique responsibilities of leadership to model these competencies, promote them in the community, and develop relevant organizational strategies are clarified. These obligations elevate the importance of the executive leadership's capacity for self-reflection and the governing boards' responsibility for mapping operational activities to organizational mission. Lastly, the authors consider how medical organizations are currently addressing professionalism challenges. In an environment made turbulent by regulatory change and financial constraints, achieving proficiency in professionalism competencies can assist nonprofit health care organizations to promote population health and the well-being of their workforces.