Temporally dense monitoring of pathogen occurrence at four drinking-water well sites - Insights and Implications.

Yearlong, event based, microbiological and chemical sampling was conducted at four public water supply well sites spanning a range of geologic settings and well depths to look for correlation between precipitation events and microbial occurrence. Near-continuous monitoring using autosamplers occurred just before, during, and after 5-7 sampling events triggered by rainfall and/or snowmelt. Microbial genetic material was noted at all four locations during all but one sampling event, but was exceedingly variable in time, where one sample would have no detections and the next sample could be a relatively high concentration. The highest microbial sums (microbial concentrations summed over an event) were observed during months in which precipitation exceeded historical averages. Extended wet conditions through the spring thaw resulted in the highest percentage of microbial positive samples, though at relatively low concentrations. Sampling events that followed drier than normal periods showed longer lag times between the onset of precipitation and microbial occurrence, as well as lower microbial detection rates. Although a general lag time pattern was observed at each site, the largest offset in time was observed at the site with the greatest depth to water. The study's temporally dense representation of drinking water pathogen characterization suggests that single event or infrequent periodic sampling of a drinking water supply cannot provide a representative characterization of the probability that pathogens are present, which likely has ramifications for calculating health risk assessments.

Risk factors for Cryptosporidium contamination in Minnesota public supply wells.

In a recent monitoring study of Minnesota's public supply wells, Cryptosporidium was commonly detected with 40% of the wells having at least one detection. Risk factors for Cryptosporidium occurrence in drinking water supply wells, beyond surface water influence, remain poorly understood. To address this gap, physical and chemical factors were assessed as potential predictors of Cryptosporidium occurrence in 135 public supply wells in Minnesota. Univariable analysis, regression techniques, and classification trees were used to analyze the data. Many variables were identified as significant risk factors in univariable analysis and several remained significant throughout the succeeding analysis techniques. These factors fell into general categories of well use and construction, aquifer characteristics, and connectedness to the land surface, well capture zones, and land use therein, existence of potential contaminant sources within 200-feet of the well, and variability in the chemical and isotopic parameters measured during the study. These risk categories, and the specific variables and threshold values we have identified, can help guide future research on factors influencing Cryptosporidium contamination of wells and can be used by environmental health programs to develop risk-based sampling plans and design interventions that reduce associated health risks.

Enteric pathogen reduction targets for onsite non-potable water systems: A critical evaluation.

Onsite non-potable water systems (ONWS) collect and treat local source waters for non-potable end uses such as toilet flushing and irrigation. Quantitative microbial risk assessment (QMRA) has been used to set pathogen log10-reduction targets (LRTs) for ONWS to achieve the risk benchmark of 10-4 infections per person per year (ppy) in a series of two efforts completed in 2017 and 2021. In this work, we compare and synthesize the ONWS LRT efforts to inform the selection of pathogen LRTs. For onsite wastewater, greywater, and stormwater, LRTs for human enteric viruses and parasitic protozoa were within 1.5-log10 units between 2017 and 2021 efforts, despite differences in approaches used to characterize pathogens in these waters. For onsite wastewater and greywater, the 2017 effort used an epidemiology-based model to simulate pathogen concentrations contributed exclusively from onsite waste and selected Norovirus as the viral reference pathogen; the 2021 effort used municipal wastewater pathogen data and cultivable adenoviruses as the reference viral pathogen. Across source waters, the greatest differences occurred for viruses in stormwater, given the newly available municipal wastewater characterizations used for modeling sewage contributions in 2021 and the different selection of reference pathogens (Norovirus vs. adenoviruses). The roof runoff LRTs support the need for protozoa treatment, but these remain difficult to characterize due to the pathogen variability in roof runoff across space and time. The comparison highlights adaptability of the risk-based approach, allowing for updated LRTs as site specific or improved information becomes available. Future research efforts should focus on data collection of onsite water sources.

Statewide Quantitative Microbial Risk Assessment for Waterborne Viruses, Bacteria, and Protozoa in Public Water Supply Wells in Minnesota.

Infection risk from waterborne pathogens can be estimated via quantitative microbial risk assessment (QMRA) and forms an important consideration in the management of public groundwater systems. However, few groundwater QMRAs use site-specific hazard identification and exposure assessment, so prevailing risks in these systems remain poorly defined. We estimated the infection risk for 9 waterborne pathogens based on a 2-year pathogen occurrence study in which 964 water samples were collected from 145 public wells throughout Minnesota, USA. Annual risk across all nine pathogens combined was 3.3 × 10-1 (95% CI: 2.3 × 10-1 to 4.2 × 10-1), 3.9 × 10-2 (2.3 × 10-2 to 5.4 × 10-2), and 1.2 × 10-1 (2.6 × 10-2 to 2.7 × 10-1) infections person-1 year-1 for noncommunity, nondisinfecting community, and disinfecting community wells, respectively. Risk estimates exceeded the U.S. benchmark of 10-4 infections person-1 year-1 in 59% of well-years, indicating that the risk was widespread. While the annual risk for all pathogens combined was relatively high, the average daily doses for individual pathogens were low, indicating that significant risk results from sporadic pathogen exposure. Cryptosporidium dominated annual risk, so improved identification of wells susceptible to Cryptosporidium contamination may be important for risk mitigation.

Viral, bacterial, and protozoan pathogens and fecal markers in wells supplying groundwater to public water systems in Minnesota, USA.

Drinking water supply wells can be contaminated by a broad range of waterborne pathogens. However, groundwater assessments frequently measure microbial indicators or a single pathogen type, which provides a limited characterization of potential health risk. This study assessed contamination of wells by testing for viral, bacterial, and protozoan pathogens and fecal markers. Wells supplying groundwater to community and noncommunity public water systems in Minnesota, USA (n = 145) were sampled every other month over one or two years and tested using 23 qPCR assays. Eighteen genetic targets were detected at least once, and microbiological contamination was widespread (96% of 145 wells, 58% of 964 samples). The sewage-associated microbial indicators HF183 and pepper mild mottle virus were detected frequently. Human or zoonotic pathogens were detected in 70% of wells and 21% of samples by qPCR, with Salmonella and Cryptosporidium detected more often than viruses. Samples positive by qPCR for adenovirus (HAdV), enterovirus, or Salmonella were analyzed by culture and for genotype or serotype. qPCR-positive Giardia and Cryptosporidium samples were analyzed by immunofluorescent assay (IFA), and IFA and qPCR concentrations were correlated. Comparisons of indicator and pathogen occurrence at the time of sampling showed that total coliforms, HF183, and Bacteroidales-like HumM2 had high specificity and negative predictive values but generally low sensitivity and positive predictive values. Pathogen-HF183 ratios in sewage have been used to estimate health risks from HF183 concentrations in surface water, but in our groundwater samples Cryptosporidium oocyst:HF183 and HAdV:HF183 ratios were approximately 10,000 times higher than ratios reported for sewage. qPCR measurements provided a robust characterization of microbiological water quality, but interpretation of qPCR data in a regulatory context is challenging because few studies link qPCR measurements to health risk.

Cryptosporidium Incidence and Surface Water Influence of Groundwater Supplying Public Water Systems in Minnesota, USA.

Regulations for public water systems (PWS) in the U.S. consider Cryptosporidium a microbial contaminant of surface water supplies. Groundwater is assumed free of Cryptosporidium unless surface water is entering supply wells. We determined the incidence of Cryptosporidium in PWS wells varying in surface water influence. Community and noncommunity PWS wells ( n = 145) were sampled ( n = 964) and analyzed for Cryptosporidium by qPCR and immunofluorescence assay (IFA). Surface water influence was assessed by stable isotopes and the expert judgment of hydrogeologists using site-specific data. Fifty-eight wells (40%) and 107 samples (11%) were Cryptosporidium-positive by qPCR, and of these samples 67 were positive by IFA. Cryptosporidium concentrations measured by qPCR and IFA were significantly correlated ( p < 0.001). Cryptosporidium incidence was not associated with surface water influence as assessed by stable isotopes or expert judgment. We successfully sequenced 45 of the 107 positive samples to identify species, including C. parvum (41), C. andersoni (2), and C. hominis (2), and the predominant subtype was C. parvum IIa A17G2R1. Assuming USA regulations for surface water-supplied PWS were applicable to the study wells, wells positive for Cryptosporidium by IFA would likely be required to add treatment. Cryptosporidium is not uncommon in groundwater, even when surface water influence is absent.

Development of a core set of outcome measures for OAB treatment.

INTRODUCTION AND HYPOTHESIS: Standardized measures enable the comparison of outcomes across providers and treatments giving valuable information for improving care quality and efficacy. The aim of this project was to define a minimum standard set of outcome measures and case-mix factors for evaluating the care of patients with overactive bladder (OAB). METHODS: The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group (WG) of leading clinicians and patients to engage in a structured method for developing a core outcome set. Consensus was determined by a modified Delphi process, and discussions were supported by both literature review and patient input. RESULTS: The standard set measures outcomes of care for adults seeking treatment for OAB, excluding residents of long-term care facilities. The WG focused on treatment outcomes identified as most important key outcome domains to patients: symptom burden and bother, physical functioning, emotional health, impact of symptoms and treatment on quality of life, and success of treatment. Demographic information and case-mix factors that may affect these outcomes were also included. CONCLUSIONS: The standardized outcome set for evaluating clinical care is appropriate for use by all health providers caring for patients with OAB, regardless of specialty or geographic location, and provides key data for quality improvement activities and research.

From the editor's desk: Common errors in submission of case reports.

Case reports remain an invaluable resource in the literature, and they continue to serve an equally important role in scientific advancement. They record discoveries, report the unexpected, and spark further research. Preparation of a case report can be a great learning experience, especially for medical students, residents, and young physicians. It serves as an excellent introduction to academic writing, familiarizing them with all aspects of publishing, from a structured case presentation and literature review to submitting and revising a manuscript. It can also stimulate an interest in a specific topic and gradually lead to more involved and complex academic endeavors.

Intimate partner violence within law enforcement families.

Using data from the Baltimore Police Stress and Domestic Violence study, the authors examined how exposure to stressful events on the job affects law enforcement employees' physical aggression toward domestic partners, evaluating the role of negative emotions and authoritarian spillover in mediating the impact of such task-related stress. The authors consulted general strain theory and angry aggression theory to explain domestic violence in police families. Significant positive effects on physical aggression toward an intimate partner were found for variables measuring authoritarian spillover and negative emotions. However, these effects were different for different gender and racial groups.

Clinical utility of urine pregnancy assays to determine medical abortion outcome is limited.

BACKGROUND: Determining medical abortion outcome commonly includes a costly evaluation such as ultrasonography or serial serum hCG testing. Urine pregnancy testing may represent a less costly alternative. METHODS: This prospective diagnostic test evaluation study was part of a multisite randomized trial of 1080 women undergoing medical abortion up to 63 days' gestation who returned 1 and 2 weeks after receiving mifepristone. Low-sensitivity (LS) and high-sensitivity (HS) urine pregnancy tests were performed at each visit, and the results were compared to ultrasonography. Sensitivity, specificity, predictive values and likelihood ratios of each urine test were determined. RESULTS: In the first week following abortion, 14.8% of the LS tests and 7.9% of the HS tests correctly predicted outcome. None of the LS tests and only 0.2% of the HS tests were falsely negative; however, 85.2% of the LS tests and 91.8% of the HS tests were falsely positive. In the second week following abortion, 39.1% of the LS tests and 33.8% of the HS tests correctly predicted the medical abortion outcome. Only 0.2% of the LS tests and 0.3% of the HS were falsely negative; however, 60.8% of the LS tests and 65.8% of the HS tests were falsely positive. CONCLUSIONS: Both LS and HS urine pregnancy assays reliably assess clinical outcomes of medical abortions in cases of negative test results. However, the clinical utility of urine assay testing is limited because of the high rate of false-positive results.

Teaching the psychology of women: an interdisciplinary approach.

This paper explores the development of a college freshman level course entitled, "Psychology of Women" at the University of the Incarnate Word in San Antonio, Texas. Interdisciplinary focus groups were held that included female professors from various disciplines, i.e., business, education, English literature, biology, nursing, and religious studies. The critical question posed to the group was: In this era of globalization and diversity, what issues and topics should be covered in a class that explores the psychology of women across the lifespan? The importance of studying womanhood within the context of nationality, religion, race, ethnicity, socioeconomic status, age, and physical ability was highlighted.