Clinical Profiles and Symptom Burden Estimates to Support Decision-Making Using the Urinary Symptom Questionnaire for People with Neurogenic Bladder (USQNB) using Intermittent Catheters.

OBJECTIVE: To describe the scoring approach, considering interpretability, validity, and use, of a new patient-centered patient reported outcome (PRO), the Urinary Symptom Questionnaire for Neurogenic Bladder-Intermittent Catheter version (USQNB-IC). DESIGN: Subject matter experts (researchers, clinicians, a consumer, a psychometrician) classified USQNB-IC items. Profiles were then composed based on self-management decisions made by patients; patient management decisions made by clinicians; and research-oriented decisions made by investigators. Participants in an 18-month pilot study completed the USQNB-IC every week. Differences in decisions based on traditional 'total scores' and profiles were examined. Validity was defined based on alignment of scoring method with decisions. SETTING: A new set of patient-centered PROs enable monitoring and decision-making around urinary signs and symptoms among people with neurogenic bladder (NB). PARTICIPANTS: Classifications of USQNB-IC items by subject matter experts. Utility of the classifications and profiles that were created was assessed using weekly responses from the 6-month baseline period from 103 participants in a pilot study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Classification of the 29 symptoms resulted in four categories with exchangeability within-category and nonexchangeability across categories. The burden of each symptom type is one approach to scoring the USQNB-IC. Five profiles, based on these categories, emerged based on, and supportive of, decisions to be made according to symptoms, representing a categorical approach to scoring the USQNB-IC. RESULTS: USQNB-IC items are not all exchangeable. Four symptom classifications comprise within-class exchangeable items. Five profiles emerged to summarize these items to promote decision-making and identification of change over time. Both ways to "score" the USQNB-IC are described and discussed. CONCLUSIONS: "Profiling" promotes valid and interpretable decisions by patients and clinicians, based on a patient's urinary symptoms with the USQNB-IC cross-sectionally and longitudinally. Alternatively, four subsets of the 29 USQNB-IC symptoms can be used as continuous outcomes representing "burden" in clinical management or research.

Fate of flame retardants and the antimicrobial agent triclosan in planted and unplanted biosolid-amended soils.

A comprehensive understanding of the fate of contaminant-laden biosolids is needed to fully evaluate the environmental impacts of biosolid land application. The present study examined the fate of several flame retardants and triclosan in biosolid-amended soil in a 90-d greenhouse experiment. Objectives included evaluating the persistence of these compounds in soil, their phytoaccumulation potential by alfalfa (Medicago sativa), and potential degradation reactions. Concentrations of the polybrominated diphenyl ether (PBDE) congeners BDE-47 and BDE-209 and the antimicrobial triclosan declined significantly over time in biosolid-amended soil planted with alfalfa and then reached a steady state by day 28. In contrast, no significant losses of those analytes were observed from soil in nonvegetated pots. The amount of an analyte lost from vegetated soil ranged from 43% for the flame retardant di(2-ethylhexyl)-2,3,4,5-tetrabromophthalate to 61% for triclosan and was significantly and negatively related to the log octanol-water partition coefficient. Alfalfa roots and shoots were monitored for the compounds, but no clear evidence of phytoaccumulation was observed. Methyl triclosan formation was observed in the biosolid-amended soils during the study period, indicating in situ biotransformation of triclosan. The present study demonstrates that, although they are highly recalcitrant, PBDEs, selected alternate brominated flame retardants, and triclosan are capable of undergoing dissipation from biosolid-amended soils in the presence of plants.

Measurement of flame retardants and triclosan in municipal sewage sludge and biosolids.

As polybrominated diphenyl ethers (PBDEs) face increasing restrictions worldwide, several alternate flame retardants are expected to see increased use as replacement compounds in consumer products. Chemical analysis of biosolids collected from wastewater treatment plants (WWTPs) can help determine whether these flame retardants are migrating from the indoor environment to the outdoor environment, where little is known about their ultimate fate and effects. The objective of this study was to measure concentrations of a suite of flame retardants, and the antimicrobial compound triclosan, in opportunistic samples of municipal biosolids and the domestic sludge Standard Reference Material (SRM) 2781. Grab samples of biosolids were collected from two WWTPs in North Carolina and two in California. Biosolids samples were also obtained during three subsequent collection events at one of the North Carolina WWTPs to evaluate fluctuations in contaminant levels within a given facility over a period of three years. The biosolids and SRM 2781 were analyzed for PBDEs, hexabromobenzene (HBB), 1,2-bis(2,4,6-tribromophenoxy)ethane (BTBPE), 2-ethylhexyl 2,3,4,5-tetrabromobenzoate (TBB), di(2-ethylhexyl)-2,3,4,5-tetrabromophthalate (TBPH), the chlorinated flame retardant Dechlorane Plus (syn- and anti-isomers), and the antimicrobial agent 5-chloro-2-(2,4-dichlorophenoxy)phenol (triclosan). PBDEs were detected in every sample analyzed, and ΣPBDE concentrations ranged from 1750 to 6358ng/g dry weight. Additionally, the PBDE replacement chemicals TBB and TBPH were detected at concentrations ranging from 120 to 3749 ng/g dry weight and from 206 to 1631 ng/g dry weight, respectively. Triclosan concentrations ranged from 490 to 13,866 ng/g dry weight. The detection of these contaminants of emerging concern in biosolids suggests that these chemicals have the potential to migrate out of consumer products and enter the outdoor environment.

Photodegradation pathways of nonabrominated diphenyl ethers, 2-ethylhexyltetrabromobenzoate and di(2-ethylhexyl)tetrabromophthalate: identifying potential markers of photodegradation.

Photodegradation kinetics of several polybrominated diphenyl ethers (PBDEs), particularly decabromodiphenyl ether (BDE 209), have been reported in various matrixes, demonstrating that it photodegrades primarily via debromination. However, it has been difficult to determine the primary pathways by which bromine is cleaved from BDE 209 to form nona- and octabrominated congeners. In this study, photodegradation of the three nonaBDE congeners (i.e., BDE 206, 207, and 208) was examined individually in three different solvents exposed to natural sunlight and then analyzed to identify the primary degradation products. Rapid degradation of nonaBDEs (half-lives ranging from 4.25 to 12.78 min) was observed coincident with formation of octa- and heptabrominated PBDEs. BDE 207 photodegraded most rapidly while BDE 206 photodegraded the slowest. The photodegradation pathways of each nonaBDE congener were consistent among the different solvent matrixes tested; however, mass balances were found to vary with the type of solvent used in the experiment (recovery ranging from 76 to 95%). The octabrominated congener, BDE 202, and the ratio of BDE197 to BDE 201,were identified as congeners that may serve as environmental markers of photolytic debromination of decaBDE. Additional photodegradation studies were conducted with two new brominated flame retardants used in replacements for pentaBDE mixtures: 2-ethylhexyltetrabromobenzoate (TBB) and di(2-ethylhexyl)-tetrabromophthalate (TBPH). Both TBB and TBPH underwent photolysis more slowly than nonaBDEs (half-lives ranging from 85.70 to 220.17 min) and primarily formed debrominated products.