Potential health implications of water resources depletion and sewage discharges in the Republic of Macedonia.

Potential health implications of deficient sanitation infrastructure and reduced surface water flows due to climate change are examined in the case study of the Republic of Macedonia. Changes in surface water flows and wastewater discharges over the period 1955-2013 were analyzed to assess potential future surface water contamination trends. Simple model predictions indicated a decline in surface water hydrology over the last half century, which caused the surface waters in Macedonia to be frequently dominated by >50% of untreated sewage discharges. The surface water quality deterioration is further supported by an increasing trend in modeled biochemical oxygen demand trends, which correspond well with the scarce and intermittent water quality data that are available. Facilitated by the climate change trends, the increasing number of severe weather events is already triggering flooding of the sewage-dominated rivers into urban and non-urban areas. If efforts to develop a comprehensive sewage collection and treatment infrastructure are not implemented, such events have the potential to increase public health risks and cause epidemics, as in the 2015 case of a tularemia outbreak.

Adult Blood Lead Levels in Minnesota: Rates and Trends, 2005-2012.

Lead exposure is associated with a number of adverse health events including peripheral neuropathy, anemia, renal damage and cognitive impairment. The vast majority of adult lead exposures occur in the workplace. By statute, all results from blood lead level (BLL) tests performed in Minnesota are submitted to the Minnesota Department of Health for surveillance purposes. We analyzed that data to examine lead exposure trends from 2005 through 2012. We found that an average of 548 persons 16 years of age and older had a BLL greater than 10 µg/dL each year during that period. Analysis of the prevalence rate of elevated BLLs among adults for the years 2005-2012 showed a modest, nonsignificant decline among those with BLLs greater than 1O µg/dL. Much has been done to reduce exposures and BLLs among young children. However, the policies and standards that protect workers have not been similarly adjusted, and many workers remain at risk of exposure. Although OSHA is responsible for developing and implementing policies and standards to protect workers, health care providers can play a critical role in identifying cases of lead exposure by asking patients about their occupation and industry. Those working in high-risk industries should be tested to determine whether they have been exposed and intervention is warranted.

Clinical Characteristics and Nonconvulsive Seizures in Young Children With Abusive Head Trauma.

AIM: We aimed to evaluate putative predictors of symptoms and signs at admission for nonconvulsive seizure and to examine the impact of nonconvulsive seizures on short-term outcomes. METHOD: We retrospectively collected consecutive abusive head trauma patients (<36 months of age) from the trauma registry at Children's Healthcare of Atlanta between 2009 and 2014. Multiple logistic regression was performed to assess the putative predictors for the occurrence of nonconvulsive seizures including clinical seizures, altered mental status, respiratory difficulty, and cardiac arrest at admission, while controlling for age, sex, and injury severity. The Mann-Whitney U test and the Fisher exact test were used to compare the short-term outcomes between patients with and without nonconvulsive seizures. RESULTS: Two hundred seventy patients with abusive head trauma were identified (male = 55.6%). The median age was 4 months (interquartile range = 2-8 months). Among 70 patients who underwent continuous electroencephalography (EEG), 40 had nonconvulsive seizures (57%) and 21 developed nonconvulsive status epilepticus (30%). Altered mental status at admission was associated with the occurrence of nonconvulsive seizures (odds ratio = 6.8, 95% confidence interval = 1.2-38.2, P = .03). Comparing patients with no seizures, those with nonconvulsive seizures were more likely to stay longer at hospital (9 days vs 14 days, P = .04) and to need rehabilitation (50.0% vs 63.2%, P = .03). CONCLUSIONS: Nonconvulsive seizures and nonconvulsive status epilepticus was highly prevalent in young pediatric patients with abusive head trauma. Presenting with altered mental status at admission was found to predict the occurrence of nonconvulsive seizures. Nonconvulsive seizures had an unfavorable impact on short-term outcomes.

Risk Factors for Seizures Among Young Children Monitored With Continuous Electroencephalography in Intensive Care Unit: A Retrospective Study.

Objective: cEEG is an emerging technology for which there are no clear guidelines for patient selection or length of monitoring. The purpose of this study was to identify subgroups of pediatric patients with high incidence of seizures. Study Design: We conducted a retrospective study on 517 children monitored by cEEG in the intensive care unit (ICU) of a children's hospital. The children were stratified using an age threshold selection method. Using regression modeling, we analyzed significant risk factors for increased seizure risk in younger and older children. Using two alternative correction procedures, we also considered a relevant comparison group to mitigate selection bias and to provide a perspective for our findings. Results: We discovered an approximate risk threshold of 14 months: below this threshold, the seizure risk increases dramatically. The older children had an overall seizure rate of 18%, and previous seizures were the only significant risk factor. In contrast, the younger children had an overall seizure rate of 45%, and the seizures were significantly associated with hypoxic-ischemic encephalopathy (HIE; p = 0.007), intracranial hemorrhage (ICH; p = 0.005), and central nervous system (CNS) infection (p = 0.02). Children with HIE, ICH, or CNS infection accounted for 61% of all seizure patients diagnosed through cEEG under 14 months. Conclusions: An extremely high incidence of seizures prevails among critically ill children under 14 months, particularly those with HIE, ICH, or CNS infection.

The municipal solid waste system and solid waste characterization at the municipality of Veles, Macedonia.

A short-term study to characterize the solid waste stream in the Municipality of Veles, Macedonia, was performed during a 1 week period in the summer of 2002. In this study, several important parameters of the municipal solid waste stream were assessed. It was estimated that the average daily generation rate is 1.06+/-0.56 kg/cap/day, while the specific weights of the uncompacted and compacted solid waste are approximately 140.5 kg/m3 and 223 kg/m3, respectively. Furthermore, it was estimated that the daily generated volume of uncompacted waste is 7.5+/-4 L/cap/day. Although the short-term study is characterized by numerous limitations, in the absence of other existing data, such a study with direct measurements could significantly contribute to the development of an efficient solid waste management system in countries with economies in transition like Macedonia.

Utility of gray-matter segmentation of ictal-Interictal perfusion SPECT and interictal 18F-FDG-PET in medically refractory epilepsy.

PURPOSE: We present a method of gray-matter segmentation of functional neuroimaging for localization of seizure onset zone (SOZ) in epilepsy surgery. 18F-FDG-PET hypometabolism and ictal SPECT hyperperfusion may correspond to SOZ. We hypothesize that limiting functional images to gray matter improves identification of small, subtle, or obscure cortical volumes of 18F-FDG-PET hypometabolism and eliminates hyperperfused seizure propagation pathways within white matter in ictal perfusion SPECT. METHODS: Twenty-five adult and pediatric patients age 2-48 years with epilepsy surgery evaluations consisting of MRI, 18F-FDG-PET, ictal and interictal perfusion SPECT, and intracranial EEG (iEEG) monitoring were selected. MRI gray matter segmentation was used to identify cortical regions in coregistered 18F-FDG-PET and Ictal-Interictal SPECT Analysis by SPM (ISAS) as volumes of interest (VOI). VOIs in 18F-FDG-PET and SPECT perfusion clusters were compared to iEEG localization. The level of VOI concordance between two modalities was recorded as the same subgyrus (highest concordance), gyrus, sublobe, lobe, hemisphere, or no concordance. RESULTS: With segmentation, 84% (21/25) of cases had at least one area identified on 18F-FDG-PET scan concordant with iEEG SOZ at sublobar or higher levels, and 72% (18/25) of cases had subgyral concordance with iEEG SOZ. Without segmentation, 60% (15/25) of cases had at least one area in 18F-FDG-PET scan concordant with iEEG SOZ at sublobar or higher levels, and 32% (8/25) with subgyral concordance. 83% (10/12) of seizure free patients had subgyral concordance on segmented 18F-FDG-PET. Both segmented and nonsegmented ictal-interictal SPECT perfusion clusters had 56% (14/25) of cases with at least sublobar concordance. Subgyral concordance was achieved by 28% (7/25) of segmented and 20% (5/25) of nonsegmented SPECTs. DISCUSSION: Segmented 18F-FDG-PET scans frequently result in high correspondence to iEEG onset zones with localizations exactly concordant with iEEG SOZ- more than twice as often as without segmentation. Segmentation allows for the identification of small or subtle areas of hypometabolism that are often unappreciated or are obscured by normally hypometabolic white matter. Segmentation of ictal-interictal SPECT clusters did not significantly increase localization with iEEG SOZ over nonsegmented clusters.

Ranking nano-enabled hybrid media for simultaneous removal of contaminants with different chemistries: Pseudo-equilibrium sorption tests versus column tests.

The underlying hypothesis of this study was that pseudo-equilibrium and column testing conditions would provide the same sorbent ranking trends although the values of sorbents' performance descriptors (e.g. sorption capacity) may vary because of different kinetics and competition effects induced by the two testing approaches. To address this hypothesis, nano-enabled hybrid media were fabricated and its removal performances were assessed for two model contaminants under multi-point batch pseudo-equilibrium and continuous-flow conditions. Calculation of simultaneous removal capacity indices (SRC) demonstrated that the more resource demanding continuous-flow tests are able to generate the same performance rankings as the ones obtained by conducing the simpler pseudo-equilibrium tests. Furthermore, continuous overlap between the 98% confidence boundaries for each SRC index trend, not only validated the hypothesis that both testing conditions provide the same ranking trends, but also pointed that SRC indices are statistically the same for each media, regardless of employed method. In scenarios where rapid screening of new media is required to obtain the best performing synthesis formulation, use of pseudo-equilibrium tests proved to be reliable. Considering that kinetics induced effects on sorption capacity must not be neglected, more resource demanding column test could be conducted only with the top performing media that exhibit the highest sorption capacity.

Localization of epileptic foci using multimodality neuroimaging.

Approximately 30% of epilepsy patients are medically intractable. Epilepsy surgery may offer cure or palliation, and neuromodulation and direct drug delivery are being developed as alternatives. Successful treatment requires correct localization of seizure onset zones and understanding surrounding functional cortex to avoid iatrogenic disability. Several neurophysiologic and imaging localization techniques have inherent individual weaknesses which can be overcome by multimodal analysis. We review common noninvasive techniques, then illustrate the value of multimodal analysis to localize seizure onset for targeted treatment.

Arsenate removal by nanostructured ZrO2 spheres.

A new zirconium oxide-based media for arsenate removal from water was fabricated and evaluated in batch and continuous flow experiments. Highly porous (epsilonp approximately 0.9) nanostructured zirconium oxide spheres were fabricated by the impregnation of macroporous ion-exchange media (CalRes 2103, Calgon) with zirconium salt; the media was then ashed at T > 750 +/- 50 degrees C to remove the organic polymer resin and obtain ZrO2 spheres. The spheres generally ranged from 200 to 800 microm in diameter, and consisted of ZrO2 nanoastructures generally ranging between 20 and 100 nm. They also exhibited monoclinic and tetragonal crystalline structures, and had an isoelectric point of 5.6. Equilibrium batch experiments were conducted in 10 mM NaHCO3 buffered nanopure water at three pH values (6.4,7.3, and 8.3) with 120 microg/L As(V). Data were fit with the Freundlich isotherm equation (q(e) = Kx CE(1/n)), resulting in an intensity parameter (1/n) of approximately 0.33 and capacity parameters (K) ranging from 115 to 400 (microg As(V) g(-1) dry media)(L microg(-1))1/n. The pore diffusion coefficient and toruosity were estimated to be 6.4 x 10(-6) cm2 s(-1) and 1.3, respectively. For a packed bed adsorbent operating at a loading rate of 11.5 m3 m(-2) hr(-1) in a realistic continuous flow experiment, the external mass transport coefficient was estimated to be kf approximately 6.3 x 10(-3) cm s(-1). The pore diffusion coefficient and the external mass transport coefficient were used with the pore surface diffusion model (PSDM) to predict the arsenate breakthrough curve. A short bed adsorbent (SBA) test was conducted under the same conditions to validate the model. In this study, surface diffusion was ignored because the particles have a very high porosity. The validated model was used to predict arsenate breakthrough in a simulated full-scale system. The overall combined use of modeling, material characterization, equilibria, and kinetics tests determined the suitability of the media for arsenate treatment cheaper, easier, faster, and with less media than a long duration pilot test would have. Although the fabricated zirconium oxide spheres exhibited adsorption capacity comparable to some commercially available media such as iron based (hydr)oxides, the high cost of fabrication may render the media not feasible for wide use in commercial applications. However, the very high porosity of this media provides for improved pore diffusion and faster overall mass transport, which may be critical for applications where mass transport is the limiting factor.

Subthreshold changes of voltage-dependent activation of the K(V)7.2 channel in neonatal epilepsy.

Benign familial neonatal convulsions (BFNC) is an epileptic disorder caused by dominant mutations in the genes KCNQ2 and KCNQ3 encoding the K+ channels K(V)7.2 and K(V)7.3. We identified two novel KCNQ2 mutations in two BFNC families. One mutation predicted a truncated protein (S247X) that lacks the channel's pore region, the other resulted in the amino acid substitution S122L in the S2 segment of K(V)7.2. In comparison to wild-type (WT) K(V)7.2, functional analysis of S122L mutant channels in Xenopus oocytes revealed a significant positive shift and increased slope of the activation curve leading to significant current reduction in the subthreshold range of an action potential (75% reduction at -50 mV). Our results establish an important role of the K(V)7.2 S2 segment in voltage-dependent channel gating and demonstrate in a human disease that subthreshold voltages are likely to represent the physiologically relevant range for this K+ channel to regulate neuronal firing.