Smoking Modifies the Association Between Radon Exposure and Incident Ischemic Stroke: The REGARDS Study.

BACKGROUND: Exposure to radon has been linked to lung cancer and other lung diseases. Although biologically plausible, research of residential radon exposure in relation to stroke risk is scarce. METHODS: Study participants were from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort (n=30 239), which consisted of male and female non-Hispanic Black and White adults aged 45 and older. After excluding participants with baseline stroke and transient ischemic attack, and missing information on exposure and outcome of interest, the final sample size was 26 950. The primary outcome was time to the first ischemic stroke through September 30, 2020. County-level radon measures from Lawrence Berkeley National Laboratory were linked to each participant based on their geocoded residential history. We used Cox proportional hazards regression models with a time-dependent exposure to estimate hazard ratios and 95% CIs for the association. RESULTS: After controlling for potential confounding factors including demographic, lifestyle, clinical variables, and PM2.5, radon exposure was significantly associated with incident ischemic stroke among never-smokers (hazard ratio, 1.39 [95% CI, 1.01-1.90]) but not ever-smokers. The results were generally consistent in the sensitivity analysis when using radon measures from state/Environmental Protection Agency residential radon survey. CONCLUSIONS: Findings from this study suggest that the association between residential radon exposure and incidence of ischemic stroke varies by smoking status and may be prominent in never-smokers. Further studies incorporating indoor-radon measures are needed to confirm these findings.

Telehealth Utilization Is Associated with Lower Risk of Discontinuation of Buprenorphine: a Retrospective Cohort Study of US Veterans.

OBJECTIVE: Treatment for opioid use disorder (OUD) may include a combination of pharmacotherapies (such as buprenorphine) with counseling services if clinically indicated. Medication management or engagement with in-person counseling services may be hindered by logistical and financial barriers. Telehealth may provide an alternative mechanism for continued engagement. This study aimed to evaluate the association between telehealth encounters and time to discontinuation of buprenorphine treatment when compared to traditional in-person visits and to evaluate potential effect modification by rural-urban designation and in-person and telehealth combination treatment. METHODS: A retrospective cohort study of Veterans diagnosed with OUD and treated with buprenorphine across all facilities within the Veterans Health Administration (VHA) between 2008 and 2017. Exposures were telehealth and in-person encounters for substance use disorder (SUD) and mental health, treated as time-varying covariates. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year. RESULTS: Compared to in-person encounters, treatment discontinuation was lower for telehealth for SUD (aHR: 0.69; 95%CI: 0.60, 0.78) and mental health (aHR: 0.69; 95%CI: 0.62, 0.76). There was no evidence of effect modification by rural-urban designation. Risk of treatment discontinuation appeared to be lower among those with telehealth only compared to in-person only for both SUD (aHR: 0.48, 95%CI: 0.37, 0.62) and for mental health (aHR: 0.46; 95%CI: 0.33, 0.65). CONCLUSIONS: As telehealth demonstrated improved treatment retention compared to in-person visits, it may be a suitable option for engagement for patients in OUD management. Efforts to expand services may improve treatment retention and health outcomes for VHA and other health care systems.

Does protracted radon exposure play a role in the development of dementia?

Radon is a ubiquitous radioactive gas that decays into a series of solid radioactive decay products. Radon, and its decay products, enter the human body primarily through inhalation and can be delivered to various tissues including the brain through systemic circulation. It can also reach the brain by neuronal pathways via the olfactory system. While ionizing radiation has been suggested as a risk factor of dementia for decades, studies exploring the possible role of radon exposure in the development of Alzheimer's Diseases (AD) and other dementias are sparse. We systematically reviewed the literature and found several lines of evidence suggesting that radon decay products (RDPs) disproportionally deposit in the brain of AD patients with selective accumulation within the protein fractions. Ecologic study findings also indicate a significant positive correlation between geographic-level radon distribution and AD mortality in the US. Additionally, pathologic studies of radon shed light on the potential pathways of radon decay product induced proinflammation and oxidative stress that may result in the development of dementia. In summary, there are plausible underlying biological mechanisms linking radon exposure to the risk of dementia. Since randomized clinical trials on radon exposure are not feasible, well-designed individual-level epidemiologic studies are urgently needed to elucidate the possible association between radon (i.e., RDPs) exposure and the onset of dementia.

Preparation of high orbital angular momentum Rydberg states by optical-millimeter-wave STIRAP.

Rydberg states of molecules are intrinsically challenging to study due to the presence of fast non-radiative decay pathways, such as predissociation. However, selectively exciting Rydberg states with values of the orbital angular momentum (ℓ) ℓ ≳ 3 is a productive strategy to minimize this rapid decay and to populate molecular Rydberg states with lifetimes that approach those of atoms. In this proof-of-principle demonstration, we transfer population to an nf Rydberg state of the calcium atom by stimulated Raman adiabatic passage, in which an optical and a millimeter-wave field couple the initial and final states via an intermediate nd Rydberg state. Numerical simulations reproduce the observed time and frequency dependences of the population transfer and suggest the utility of this scheme to populate high-ℓ Rydberg states of molecules.

A Retrospective Cohort Study Comparing the Functional and General Health Outcomes of Staged vs Simultaneous Bilateral Primary Total Knee.

BACKGROUND: Bilateral primary total knee replacements (TKRs) can be performed simultaneously (under the same anaesthetic) or staged (on separate occasions). Patients who undergo simultaneous biltateral TKRs only have one anaesthetic, operation and hospital stay. This reduces overall time in pain, rehabilitation time and total days in hospital with cost-saving implications. Despite the benefits, simultaneous bilateral TKRs are not routinely performed due to fear of worse outcomes. AIM: This paper assesses the long-term functional and general health outcomes between the two approaches. METHODS: We undertook a retrospective cohort study. Patients who underwent a bilateral TKR in our centre from 2012-2014 were included. The validated Oxford Knee and EuroQol scores were used to assess function and general health outcomes. These were assessed at baseline and 1-year along with satisfaction scores. RESULTS: 41 simultaneous bilateral TKRs and 43 staged bilateral TKRs met the inclusion criteria. Patients were age and sex matched. The Oxford Knee Score increase at one year was equivalent in both groups (20.1 vs. 18.1, p=0.170), suggesting no difference in long-term function. The EuroQol Score increase at one year was equivalent in both groups (0.41 vs. 0.48, p=0.350), suggesting no difference in long-term general health. Satisfaction was comparable between the two groups (88.8 vs. 86.2, p=0.52). CONCLUSIONS: There is no difference in functional and general health outcomes between staged and simultaneous bilateral knee replacements. In patients with bilateral knee arthritis, simultaneous bilateral TKRs should be considered.

Anomalous Intensities in the 2+1 REMPI Spectrum of the E 1Π-X 1Σ+ Transition of CO.

We report on one-color experiments near 214 nm involving the photodissociation of jet-cooled OCS to produce high rotational states (40 < J < 80) of CO (X 1Σ+, v = 0, 1) which were then ionized by 2+1 resonance-enhanced multiphoton ionization via the E 1Π state. The nominally forbidden Q-branch of the two-photon E 1Π-X 1Σ+ transition is observed with intensity comparable to the allowed R-branch. The bright character of the high- J Q-branch lines can be described quantitatively as intensity borrowing due to mixing of the E 1Π and C 1Σ+ states, using J-dependent mixing coefficients extrapolated from the observed Λ-doubling in the lower rotational levels of the E state. In addition to the significant enhancement of Q-branch intensities above the values predicted by conventional two-photon line strengths for a 1Π-1Σ+ transition, the high- J lines of the R- and P-branches appear to be suppressed in intensity by approximately a factor of 3 compared to the unperturbed low- J line strengths, most likely due to perturbations associated with a 1Σ- state. The E-state rotational term values for J < 80, v = 0 derived from the present spectra agree within our measurement and calibration uncertainties with the extrapolations based on the molecular constants previously derived from rotational levels with J < 50. The E-X transition is attractive for future application to photodissociation dynamics and rotational polarization measurements of CO photofragments, with convenient access to state-selective probing on multiple rotational branches, which exhibit different sensitivity to fragment alignment.

Lack of impact of nil-per-os (NPO) time on goal-directed fluid delivery in first case versus afternoon case starts: a retrospective cohort study.

BACKGROUND: Goal Directed Fluid Therapy (GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. METHODS: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr., and total ml/kg/hr. between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. RESULTS: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr., or ml/kg/hr., the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p = 0.64 and p = 0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. CONCLUSIONS: This study showed NPO periods do not influence a patient's volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

Experimental studies of the NaCs 12(0+) [71Σ+] state: Spin-orbit and non-adiabatic interactions and quantum interference in the 12(0+) [71Σ+] and 11(0+) [53Π0] emission spectra.

We present results from experimental studies of the 11(0+) and 12(0+) electronic states of the NaCs molecule. An optical-optical double resonance method is used to obtain Doppler-free excitation spectra. Selected data from the 11(0+) and 12(0+) high-lying electronic states are used to obtain Rydberg-Klein-Rees and Inverse Perturbation Approach potential energy curves. Interactions between these two electronic states are evident in the patterns observed in the bound-bound and bound-free fluorescence spectra. A model, based on two separate interaction mechanisms, is presented to describe how the wavefunctions of the two states mix. The electronic parts of the wavefunctions interact via spin-orbit coupling, while the individual rotation-vibration levels interact via a second mechanism, which is likely to be non-adiabatic coupling. A modified version of the BCONT program was used to simulate resolved fluorescence from both upper states. Parameters of the model that describe the two interaction mechanisms were varied until simulations were able to adequately reproduce experimental spectra.

Characteristics of Four Upward-Pointing Cosmic-Ray-like Events Observed with ANITA.

We report on four radio-detected cosmic-ray (CR) or CR-like events observed with the Antarctic Impulsive Transient Antenna (ANITA), a NASA-sponsored long-duration balloon payload. Two of the four were previously identified as stratospheric CR air showers during the ANITA-I flight. A third stratospheric CR was detected during the ANITA-II flight. Here, we report on characteristics of these three unusual CR events, which develop nearly horizontally, 20-30 km above the surface of Earth. In addition, we report on a fourth steeply upward-pointing ANITA-I CR-like radio event which has characteristics consistent with a primary that emerged from the surface of the ice. This suggests a possible τ-lepton decay as the origin of this event, but such an interpretation would require significant suppression of the standard model τ-neutrino cross section.

Clinical effectiveness of a sedation protocol minimizing benzodiazepine infusions and favoring early dexmedetomidine: a before-after study.

INTRODUCTION: Randomized controlled trials suggest clinical outcomes may be improved with dexmedetomidine as compared with benzodiazepines; however, further study and validation are needed. The objective of this study was to determine the clinical effectiveness of a sedation protocol minimizing benzodiazepine use in favor of early dexmedetomidine. METHODS: We conducted a before-after study including adult surgical and medical intensive care unit (ICU) patients requiring mechanical ventilation and continuous sedation for at least 24 hours. The before phase included consecutive patients admitted between 1 April 2011 and 31 August 31 2011. Subsequently, the protocol was modified to minimize use of benzodiazepines in favor of early dexmedetomidine through a multidisciplinary approach, and staff education was provided. The after phase included consecutive eligible patients between 1 May 2012 and 31 October 2012. RESULTS: A total of 199 patients were included, with 97 patients in the before phase and 102 in the after phase. Baseline characteristics were well balanced between groups. Use of midazolam as initial sedation (58% versus 27%, P <0.0001) or at any point during the ICU stay (76% versus 48%, P <0.0001) was significantly reduced in the after phase. Dexmedetomidine use as initial sedation (2% versus 39%, P <0.0001) or at any point during the ICU stay (39% versus 82%, P <0.0001) significantly increased. Both the prevalence (81% versus 93%, P =0.013) and median percentage of days with delirium (55% (interquartile range (IQR), 18 to 83) versus 71% (IQR, 45 to 100), P =0.001) were increased in the after phase. The median duration of mechanical ventilation was significantly reduced in the after phase (110 (IQR, 59 to 192) hours versus 74.5 (IQR, 42 to 148) hours, P =0.029), and significantly fewer patients required tracheostomy (20% versus 9%, P =0.040). The median ICU length of stay was 8 (IQR, 4 to 12) days in the before phase and 6 (IQR, 3 to 11) days in the after phase (P =0.252). CONCLUSIONS: Implementing a sedation protocol that targeted light sedation and reduced benzodiazepine use led to significant improvements in the duration of mechanical ventilation and the requirement for tracheostomy, despite increases in the prevalence and duration of ICU delirium.

Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study.

OBJECTIVES: To describe whether body mass index (BMI) is a clinically meaningful predictor of patient reported outcomes following primary total hip replacement (THR) surgery. DESIGN: Combined data from prospective cohort studies. We obtained information from four cohorts of patients receiving primary THR for osteoarthritis: Exeter Primary Outcomes Study (EPOS) (n = 1431); EUROHIP (n = 1327); Elective Orthopaedic Centre (n = 2832); and St. Helier (n = 787). The exposure of interest was pre-operative BMI. Confounding variables included: age, sex, SF-36 mental health, comorbidities, fixed flexion, analgesic use, college education, OA in other joints, expectation of less pain, radiographic K&L grade, ASA grade, years of hip pain. The primary outcome was the Oxford Hip Score (OHS). Regression models describe the association of BMI on outcome adjusting for all confounders. RESULTS: For a 5-unit increase in BMI, the attained 12-month OHS decreases by 0.78 points 95%CI (0.27-1.28), P-value 0.001. Compared to people of normal BMI (20-25), those in the obese class II (BMI 35-40) would have a 12-month OHS that is 2.34 points lower. Although statistically significant this effect is small and not clinically meaningful in contrast to the substantial change in OHS seen across all BMI groupings. In obese class II patients achieved a 22.2 point change in OHS following surgery. CONCLUSIONS: Patients achieved substantial change in OHS after THR across all BMI categories, which greatly outweighs the small difference in attained post-operative score. The findings suggest BMI should not present a barrier to access THR in terms of PROMs.

Utility of death certificate data in predicting cancer incidence.

BACKGROUND: Studies often rely on death certificates to identify cancer occurrence. This research assessed the death certificate's ability to reflect cancer incidence and factors that influence agreement with cancer registry data. METHODS: This study compared death certificates to cancer incidence data for an occupational cohort of 1,795 deceased workers who were registered by the Iowa Cancer Registry (ICR) between 1973 and 2005. Logistic regression models examined the effects of factors such as survival time, age at diagnosis, and gender on the odds of agreement between death certificate and incidence data. RESULTS: Death certificates under-reported cancer incidence by 10-100%, depending on site. A 1-year increase in survival decreased the odds of agreement between death certificate and ICR data by 18%. Younger and female workers had increased odds of agreement. CONCLUSIONS: Death certificates can be useful predictors of cancer incidence, particularly for diseases with shorter survival and among subjects diagnosed earlier in life.

FT-spectroscopy of the 12C18O rare isotopologue and deperturbation analysis of the A1Π(v = 3) level.

Research on 12C18O was carried out using two complementary Fourier-transform methods: (1) vacuum-ultraviolet absorption spectroscopy, with an accuracy ca. 0.03 cm-1 on the DESIRS beamline (SOLEIL synchrotron) and (2) visible emission spectroscopy with an accuracy of about 0.005-0.007 cm-1 by means of the Bruker IFS 125HR spectrometer (University of Rzeszów). The maximum rotational quantum number of the energy levels involved in the observed spectral lines was Jmax = 54. An effective Hamiltonian and the term-value fitting approach were implemented for the precise analysis of the A1Π(v = 3) level in 12C18O. It was performed by means of the PGOPHER code. The data set consisted of 571 spectral lines belonging to the A1Π-X1Σ+(3, 0), B1Σ+-A1Π(0, 3), C1Σ+-A1Π(0, 3) bands and several lines involving states that perturb the A1Π(v = 3) level as well as to the previously analysed B1Σ+-X1Σ+(0, 0) and C1Σ+-X1Σ+(0, 0) transitions. A significantly extended quantum-mechanical description of the A1Π(v = 3) level in 12C18O was provided. It consists of the 5 new unimolecular interactions of the spin-orbit and rotation-electronic nature, which had not been taken into account previously in the literature. The ro-vibronic term values of the A1Π(v = 3, Jmax = 55), a'3Σ+(v = 13), D1Δ(v = 4) and I1Σ-(v = 5) levels were determined with precision improved by a factor of 10 relative to the previously known values.

Using the POD sampler for quantitative diffusive (passive) monitoring of volatile and very volatile organics in ambient air: Sampling rates and analytical performance.

POD diffusive samplers loaded with Carbopack X and Carbograph 5TD were exposed to certified calibration mixtures containing a total of 110 different ozone precursor and air toxic compounds. Constant sampling rates were identified for 39 ozone precursors and 33 air toxics. As 9 of these compounds were included in both mixtures, this meant a total of 63 different volatile and very volatile compounds were sampled using the POD with overall expanded uncertainties below 30 % for the sampling rate associated with the whole range of sampling times from 2 to 24 h. Carbograph 5TD exhibited superior performance for diffusive sampling of oxygenated and halogenated compounds in the air toxics mixture, while Carbopack X showed higher sampling efficiencies for aliphatic and aromatic hydrocarbons, as well as halogenated compounds derived from benzene and C2 carbon number hydrocarbons. A model has been developed and applied to estimate sampling rates, primarily for the more volatile and weakly adsorbed compounds, as a function of the collected amount of analyte and the exposure time. For an additional 9 ozone precursors on Carbopack X, and 11 air toxics on Carbograph 5TD, the expanded uncertainties of modelled sampling rates were reduced to below 30 % and have a significantly reduced uncertainty compared to those associated with an averaged sampling rate. The paper provides Freundlich's isotherm parameters for the estimated (modelled) sampling rates and defines a pragmatic approach to their application. It does so by identifying the best sampling time to use for the expected exposure concentrations and associated analyte masses. This allows for expansion of the sampling concentration range from hundreds ng m-3 to mg m-3, while avoiding saturation of the adsorbent. Finally, field measurement comparisons of POD samplers, pumped tube samplers and online gas chromatography (GC), for sampling periods of 3 and 7 days in a semi-rural background area, showed no significant differences between reported concentrations.

Military concerns for chronic pain stimulator devices.

Spinal cord stimulators (SCS) and peripheral nerve stimulators (PNS) are increasingly used in the treatment of chronic pain, allowing more patients to resume working and return to activities. Military service members face environmental and occupational hazards that expose them to mechanical and electromagnetic forces, both clinical and industrial, that could potentially alter their function. While there are reports of individual hazards, the risk appears to be nominal based on the large number of devices in use and the limited reported complications with these devices. Since a variety of hazards encountered by military patients have the potential to alter SCS and PNS devices, a brief discussion of each patient's specific exposures and related hazards should occur prior to placement. Overall, these devices have demonstrated safety in hazardous areas and few military patients have contraindications for placement based on these factors alone.

Environmental and Economic Impact of Using a Higher Efficiency Ventilator and Vaporizer During Surgery Under General Anesthesia: A Randomized Controlled Prospective Cohort.

Background Compared to traditional breathing circuits, low-volume anesthesia machines utilize a lower-volume breathing circuit paired with needle injection vaporizers that supply volatile agents into the circuit mainly during inspiration. We aimed to assess whether or not low-volume anesthesia machines, such as the Maquet Flow-i C20 anesthesia workstation (MQ), deliver volatile anesthetics more efficiently than traditional anesthesia machines, such as the GE Aisys CS2 anesthesia machine (GE), and, secondarily, whether this was in a meaningful economic or environmentally conscious way. Methodology Participants enrolled in the study (Institutional Review Board Identifier: 2014-1248) met the following inclusion criteria: 18-65 years old, scheduled for surgery requiring general anesthesia at the University of California Irvine Health, and expected to receive sevoflurane for the duration of the procedure. Exclusion criteria included age <18 years old, a history of chronic obstructive pulmonary disorder, cardiovascular disease, sevoflurane sensitivity, body mass index >30 kg/m2, American Society of Anesthesiologists >2, pregnancy, or surgery scheduled <120 minutes. We calculated the total amount of sevoflurane delivered and consumption rates during induction and maintenance periods and compared the groups using one-sided parametric testing (Student's t-test). There was no suspicion that the low-volume circuit could use more sevoflurane and that the outcome did not answer our research question. One-sided testing allowed for more power to be more certain of smaller differences in our results. Results In total, 103 subjects (MQ: n = 52, GE: n = 51) were analyzed. Seven subjects were lost to attrition of different types. Overall, the MQ group consumed significantly less sevoflurane (95.5 ± 49.3 g) compared to the GE group (118.3 ± 62.4 g) (p = 0.043), corresponding to an approximately 20% efficiency improvement in overall agent delivery. When accounting for the fresh gas flow setting, agent concentration, and length of induction, the MQ delivered the volatile agent at a significantly lower rate compared to the GE (7.4 ± 3.2 L/minute vs. 9.1 ± 4.1 L/minute; p = 0.017). Based on these results, we estimate that the MQ can save an estimated average of $239,440 over the expected 10-year machine lifespan. This 20% decrease in CO2 equivalent emissions corresponds to 201 metric tons less greenhouse gas emissions over a decade compared to the GE, which is equivalent to 491,760 miles driven by an average passenger vehicle or 219,881 pounds of coal burned. Conclusions Overall, our results from this study suggest that the MQ delivers statistically significantly less (~20%) volatile agent during routine elective surgery using a standardized anesthetic protocol and inclusion/exclusion criteria designed to minimize any patient or provider heterogeneity effects on the results. The results demonstrate an opportunity for economic and environmental benefits.

Prevalence of neonicotinoid insecticides in paired private-well tap water and human urine samples in a region of intense agriculture overlying vulnerable aquifers in eastern Iowa.

A pilot study among farming households in eastern Iowa was conducted to assess human exposure to neonicotinoids (NEOs). The study was in a region with intense crop and livestock production and where groundwater is vulnerable to surface-applied contaminants. In addition to paired outdoor (hydrant) water and indoor (tap) water samples from private wells, urine samples were collected from 47 adult male pesticide applicators along with the completions of dietary and occupational surveys. Estimated Daily Intake (EDI) were then calculated to examine exposures for different aged family members. NEOs were detected in 53% of outdoor and 55% of indoor samples, with two or more NEOs in 13% of samples. Clothianidin was the most frequently detected NEO in water samples. Human exposure was ubiquitous in urine samples. A median of 10 different NEOs and/or metabolites were detected in urine, with clothianidin, nitenpyram, thiamethoxam, 6-chloronicotinic acid, and thiacloprid amide detected in every urine samples analyzed. Dinotefuran, imidaclothiz, acetamiprid-N-desmethyl, and N-desmethyl thiamethoxam were found in ≥70% of urine samples. Observed water intake for study participants and EDIs were below the chronic reference doses (CRfD) and acceptable daily intake (ADI) standards for all NEOs indicating minimal risk from ingestion of tap water. The study results indicate that while the consumption of private well tap water provides a human exposure pathway, the companion urine results provide evidence that diet and/or other exposure pathways (e.g., occupational, house dust) may contribute to exposure more than water contamination. Further biomonitoring research is needed to better understand the scale of human exposure from different sources.

Juxtaposition of intensive agriculture, vulnerable aquifers, and mixed chemical/microbial exposures in private-well tapwater in northeast Iowa.

In the United States and globally, contaminant exposure in unregulated private-well point-of-use tapwater (TW) is a recognized public-health data gap and an obstacle to both risk-management and homeowner decision making. To help address the lack of data on broad contaminant exposures in private-well TW from hydrologically-vulnerable (alluvial, karst) aquifers in agriculturally-intensive landscapes, samples were collected in 2018-2019 from 47 northeast Iowa farms and analyzed for 35 inorganics, 437 unique organics, 5 in vitro bioassays, and 11 microbial assays. Twenty-six inorganics and 51 organics, dominated by pesticides and related transformation products (35 herbicide-, 5 insecticide-, and 2 fungicide-related), were observed in TW. Heterotrophic bacteria detections were near ubiquitous (94 % of the samples), with detection of total coliform bacteria in 28 % of the samples and growth on at least one putative-pathogen selective media across all TW samples. Health-based hazard index screening levels were exceeded frequently in private-well TW and attributed primarily to inorganics (nitrate, uranium). Results support incorporation of residential treatment systems to protect against contaminant exposure and the need for increased monitoring of rural private-well homes. Continued assessment of unmonitored and unregulated private-supply TW is needed to model contaminant exposures and human-health risks.

What is a good patient reported outcome after total hip replacement?

OBJECTIVES: There is an increasing movement to collect and report patient reported outcome measures (PROM's) following total hip replacement (THR). In the UK, the procedure specific PROM of choice is the Oxford Hip Score (OHS). It is currently unclear how to use this information to determine outcome following surgery. The aim of this study was to define a threshold for the OHS that is correlated with patient satisfaction. DESIGN: Prospective cohort study. SETTING: A district general hospital (St. Helier Hospital, Carshalton, UK). PARTICIPANTS: 799 patients receiving THR from 1995 to 2004. MAIN OUTCOME MEASURES: At 12 and 24 months after surgery patients were asked if they were satisfied with surgery and completed the OHS. Receiver operating characteristic (ROC) analyses were used to identify thresholds of follow-up OHS, which best discriminated patient satisfaction. Analyses were stratified by age, sex, body mass index (BMI), baseline OHS and patient expectations. RESULTS: 91.9% of patients were satisfied with THR at 12 months (92.8% at 24 months). Using the ROC technique, the OHS at 12 months associated with patient satisfaction was 38 and at 24 months 33. The OHS at 24 months associated with satisfaction was higher in those with highest tertile of baseline OHS (30, 33, 43 respectively), and lowest tertile of BMI. CONCLUSIONS: We have identified a value of the OHS that predicts patient satisfaction 12-24 months following THR within a standard clinical setting. However, this threshold is markedly influenced by pre-operative OHS and should be stratified accordingly.