Characterising urban zinc generation to identify surface pollutant hotspots in a low intensity rainfall climate.

Characterising stormwater runoff quality provides useful insights into the dynamics of pollutant generation and wash off rates. These can be used to prioritise stormwater management strategies. This study examined the effects of a low intensity rainfall climate on zinc contributions from different impermeable urban surface types. First flush (FF) and steady state samples were collected from seven different surfaces for characterisation, and the data were also used to calibrate an event-based pollutant load model to predict individual 'hotspot' surfaces across the catchment. Unpainted galvanised roofs generated very high concentrations of zinc, primarily in the more biologically available dissolved form. An older, unpainted galvanised roof had FF concentrations averaging 32,338 µg/L, while the new unpainted roof averaged 4,782 µg/L. Roads and carparks also had elevated zinc, but FF concentrations averaged only 822-1,584 µg/L. Modelling and mapping expected zinc loads from individual impermeable surfaces across the catchment identified specific commercial roof surfaces to be targeted for zinc management. The results validate a policy strategy to replace old galvanised roof materials and avoid unpainted galvanised roofing in future urban development for better urban water quality outcomes. In the interim, readily-implemented treatment options are required to help mitigate chronic zinc impacts on receiving waterways.

A novel modelling framework to prioritize estimation of non-point source pollution parameters for quantifying pollutant origin and discharge in urban catchments.

Stormwater runoff in urban catchments contains heavy metals (zinc, copper, lead) and suspended solids (TSS) which can substantially degrade urban waterways. To identify these pollutant sources and quantify their loads the MEDUSA (Modelled Estimates of Discharges for Urban Stormwater Assessments) modelling framework was developed. The model quantifies pollutant build-up and wash-off from individual impervious roof, road and car park surfaces for individual rain events, incorporating differences in pollutant dynamics between surface types and rainfall characteristics. This requires delineating all impervious surfaces and their material types, the drainage network, rainfall characteristics and coefficients for the pollutant dynamics equations. An example application of the model to a small urban catchment demonstrates how the model can be used to identify the magnitude of pollutant loads, their spatial origin and the response of the catchment to changes in specific rainfall characteristics. A sensitivity analysis then identifies the key parameters influencing each pollutant load within the stormwater given the catchment characteristics, which allows development of a targeted calibration process that will enhance the certainty of the model outputs, while minimizing the data collection required for effective calibration. A detailed explanation of the modelling framework and pre-calibration sensitivity analysis is presented.

Deliverability and efficacy of R-CHOP chemotherapy in very elderly patients with diffuse large B-cell lymphoma: an Australian retrospective analysis.

BACKGROUND: Elderly patients with diffuse large B-cell lymphoma (DLBCL) have an inferior prognosis, due in part to advanced age and pre-existing comorbidities, with reduced tolerability and deliverability of standard R-CHOP chemotherapy. AIMS: To examine the deliverability, toxicity and efficacy of R-CHOP and the prevalence of the germinal and non-germinal phenotype DLBCL in an elderly Australian cohort. METHODS: This retrospective analysis included patients ≥75 years diagnosed with DLBCL. Comprehensive chemotherapy and toxicity data were collected for patients treated with R-CHOP. Baseline demographics and chemotherapy characteristics were compared with progression-free (PFS) and overall survival (OS). Immunohistochemical staining identified the prevalence of the non-germinal centre (non-GCB) phenotype. RESULTS: Of the 111 patients, 92 (83%) commenced R-CHOP with 26/92 (28%) receiving ≤4 cycles. Median average relative dose (ARD) was 0.80 (0.07-1.17). Median average relative dose intensity (ARDI) was 0.89 (0.33-1.18). Serious adverse events occurred in 77% of patients with ≥Gd3 adverse events in 74%. Overall response rate was 85%. Two-year PFS was 63% and OS 74%. ARD and performance status ≥2 were significant prognostic factors for PFS and OS but not ARDI. Non-GCB-phenotype was identified in 44/72 (61%) of patients with immunohistochemical data. CONCLUSION: Despite high response rates and respectable survival estimates, the absence of standard therapy in 17% of patients, and dose reductions and serious toxicity of R-CHOP in this Australian cohort highlights the need for the development of less toxic yet efficacious treatments for very elderly patients with DLBCL. The high prevalence of the non-GCB phenotype highlights the potential value of targeted biological therapy for this demographic.

Build-up dynamics of heavy metals deposited on impermeable urban surfaces.

A method using thin boards (3 cm thick, 0.56 m(2)) comprising different paving materials typically used in urban environments (2 asphalt types and concrete) was employed to specifically investigate air-borne deposition dynamics of TSS, zinc, copper and lead. Boards were exposed at an urban car park near vehicular traffic to determine the rate of contaminant build-up over a 13-day dry period. Concentration profiles from simulated rainfall wash-off were used to determine contaminant yields at different antecedent dry days. Maximum contaminant yields after 13 days of exposure were 2.7 kg ha(-1) for TSS, 35 g ha(-1) zinc, 2.3 g ha(-1) copper and 0.4 g ha(-1) lead. Accumulation of all contaminants increased over the first week and levelled off thereafter, supporting theoretical assumptions that contaminant accumulation on impervious surfaces asymptotically approaches a maximum. Comparison of different surface types showed approximately four times higher zinc concentrations in runoff from asphalt surfaces and two times higher TSS concentrations in runoff from concrete, which is attributed to different physical and chemical compositions of the pavement types. Contaminant build-up and wash-off behaviours were modelled using exponential and saturation functions commonly applied in the US EPA's Stormwater Management Model (SWMM) showing good correlation between measured and modelled concentrations. Maximum build-up, half-saturation time, build-up rate constants and wash-off coefficients, necessary for stormwater contaminant modelling, were determined for the four contaminants studied. These parameters are required to model contaminant concentrations in urban runoff assisting in stormwater management decisions.

Contaminant removal and hydraulic conductivity of laboratory rain garden systems for stormwater treatment.

In order to evaluate the influence of substrate composition on stormwater treatment and hydraulic effectiveness, mesocosm-scale (180 L, 0.17 m(2)) laboratory rain gardens were established. Saturated (constant head) hydraulic conductivity was determined before and after contaminant (Cu, Zn, Pb and nutrients) removal experiments on three rain garden systems with various proportions of organic topsoil. The system with only topsoil had the lowest saturated hydraulic conductivity (160-164 mm/h) and poorest metal removal efficiency (Cu ≤ 69.0% and Zn ≤ 71.4%). Systems with sand and a sand-topsoil mix demonstrated good metal removal (Cu up to 83.3%, Zn up to 94.5%, Pb up to 97.3%) with adequate hydraulic conductivity (sand: 800-805 mm/h, sand-topsoil: 290-302 mm/h). Total metal amounts in the effluent were <50% of influent amounts for all experiments, with the exception of Cu removal in the topsoil-only system, which was negligible due to high dissolved fraction. Metal removal was greater when effluent pH was elevated (up to 7.38) provided by the calcareous sand in two of the systems, whereas the topsoil-only system lacked an alkaline source. Organic topsoil, a typical component in rain garden systems, influenced pH, resulting in poorer treatment due to higher dissolved metal fractions.

Save the Mekong Delta from drowning.

Policy must address drivers, not just symptoms, of subsidence.

Developing a public information and engagement portal of urban waterways with real-time monitoring and modeling.

Waterways can contribute to the beauty and livelihood of urban areas, but maintaining their hydro-ecosystem health is challenging because they are often recipients of contaminated water from stormwater runoff and other discharges. Public awareness of local waterways' health and community impacts to these waterways is usually poor due to of lack of easily available information. To improve community awareness of water quality in urban waterways in New Zealand, a web portal was developed featuring a real-time waterways monitoring system, a public forum, historical data, interactive maps, contaminant modelling scenarios, mitigation recommendations, and a prototype contamination alert system. The monitoring system featured in the web portal is unique in the use of wireless mesh network technology, direct integration with online modelling, and a clear target of public engagement. The modelling aims to show the origin of contaminants within the local catchment and to help the community prioritize mitigation efforts to improve water quality in local waterways. The contamination alert system aims to keep managers and community members better informed and to provide a more timely response opportunity to avert any unplanned or accidental contamination of the waterways. Preliminary feedback has been positive and is being supported by local and regional authorities. The system was developed in a cost-effective manner providing a community focussed solution for quantifying and mitigating key contaminants in urban catchments and is applicable and transferable to other cities with similar stormwater challenges.

Osmotic potential calculations of inorganic and organic aqueous solutions over wide solute concentration levels and temperatures.

PURPOSE: To demonstrate that the authors' new "aqueous solution vs pure water" equation to calculate osmotic potential may be used to calculate the osmotic potentials of inorganic and organic aqueous solutions over wide ranges of solute concentrations and temperatures. Currently, the osmotic potentials of solutions used for medical purposes are calculated from equations based on the thermodynamics of the gas laws which are only accurate at low temperature and solute concentration levels. Some solutions used in medicine may need their osmotic potentials calculated more accurately to take into account solute concentrations and temperatures. METHODS: The authors experimented with their new equation for calculating the osmotic potentials of inorganic and organic aqueous solutions up to and beyond body temperatures by adjusting three of its factors; (a) the volume property of pure water, (b) the number of "free" water molecules per unit volume of solution, "Nf," and (c) the "t" factor expressing the cooperative structural relaxation time of pure water at given temperatures. Adequate information on the volume property of pure water at different temperatures is available in the literature. However, as little information on the relative densities of inorganic and organic solutions, respectively, at varying temperatures needed to calculate Nf was available, provisional equations were formulated to approximate values. Those values together with tentative t values for different temperatures chosen from values calculated by different workers were substituted into the authors' equation to demonstrate how osmotic potentials could be estimated over temperatures up to and beyond bodily temperatures. RESULTS: The provisional equations formulated to calculate Nf, the number of free water molecules per unit volume of inorganic and organic solute solutions, respectively, over wide concentration ranges compared well with the calculations of Nf using recorded relative density data at 20 °C. They were subsequently used to estimate Nf values at temperatures up to and excess of body temperatures. Those values, together with t values at temperatures up to and in excess of body temperatures recorded in the literature, were substituted in the authors' equation for the provisional calculation of osmotic potentials. The calculations indicated that solution temperatures and solute concentrations have a marked effect on osmotic potentials. CONCLUSIONS: Following work to measure the relative densities of aqueous solutions for the calculation of Nf values and the determination of definitive t values up to and beyond bodily temperatures, the authors' equation would enable the accurate estimations of the osmotic potentials of wide concentrations of aqueous solutions of inorganic and organic solutes over the temperature range. The study illustrates that not only solute concentrations but also temperatures have a marked effect on osmotic potentials, an observation of medical and biological significance.

Ventricular stroke work loss: validation of a method of quantifying the severity of aortic stenosis and derivation of an orifice formula.

Because aortic stenosis results in the loss of left ventricular stroke work (due to resistance to flow through the valve and turbulence in the aorta), the percentage of stroke work that is lost may reflect the severity of stenosis. This index can be calculated from pressure data alone. The relation between percent stroke work loss and anatomic aortic valve orifice area (measured by planimetry from videotape) was investigated in a pulsatile flow model. Thirteen valves were studied (nine human aortic valves obtained at necropsy and four bioprosthetic valves) at stroke volumes of 40 to 100 ml, giving 57 data points. Valve area ranged from 0.3 to 2.8 cm2 and mean systolic pressure gradient from 3 to 84 mm Hg. Percent stroke work loss, calculated as mean systolic pressure gradient divided by mean ventricular systolic pressure x 100%, ranged from 7 to 68%. It was closely related to anatomic orifice area with an inverse exponential relation and was not significantly related to flow (r = -0.15). An orifice formula was derived that predicted anatomic orifice area with a 95% confidence interval of +/- 0.5 cm2 (orifice area [cm2] = 4.82 [2.39 x log percent stroke work loss], r = -0.94, SEE = 0.029). These results support the clinical use of percent stroke work loss as an easily obtained index of the severity of aortic stenosis.

The Gorlin formula validated against directly observed orifice area in porcine mitral bioprostheses.

To assess the effect of fluid flow on orifice area and to test the Gorlin formula, six Carpentier-Edwards mitral valve prostheses were studied in a positive displacement pulse duplicator at 20 different rate-stroke volume combinations. Peak transvalvular velocity (V max) was measured by continuous wave Doppler ultrasound, and orifice area was determined from hard copy of video images. Orifice area was directly related to mean flow (Q), although cusp opening behavior was asymmetric and complex and varied among the individual valves. There was a strong correlation between measured orifice area (OA) and the modified Gorlin relation, Q/V max (r = 0.88; p less than 0.00001) given by the regression formula OA = 0.18 x Q/V max - 0.15. There was also a good correlation between measured orifice area and the conventional Gorlin relation, Q/root mean pressure drop. The derived empiric Gorlin constant did not vary significantly with flow.

Randomised controlled trial of the cost-effectiveness of water-based therapy for lower limb osteoarthritis.

OBJECTIVES: To determine the efficacy of community water-based therapy for the management of lower limb osteoarthritis (OA) in older patients. DESIGN: A pre-experimental matched-control study was used to estimate efficacy of water-based exercise treatment, to check design assumptions and delivery processes. The main study was a randomised controlled trial of the effectiveness of water-based exercise (treatment) compared with usual care (control) in older patients with hip and/or knee OA. The latter was accompanied by an economic evaluation comparing societal costs and consequences of the two treatments. SETTING: Water exercise was delivered in public swimming pools in the UK. Physical function assessments were carried out in established laboratory settings. PARTICIPANTS: 106 patients (93 women, 13 men) over the age of 60 years with confirmed hip and/or knee OA took part in the preliminary study. A similar, but larger, group of 312 patients (196 women, 116 men) took part in the main study, randomised into control (159) and water exercise (153) groups. INTERVENTIONS: Control group patients received usual care with quarterly semi-structured telephone interview follow-up only. The intervention in the main study lasted for 1 year, with a further follow-up period of 6 months. MAIN OUTCOME MEASURES: Pain score on the Western Ontario and McMaster Universities OA index (WOMAC). Additional outcome measures were included to evaluate effects on quality of life, cost-effectiveness and physical function measurements. RESULTS: Short-term efficacy of water exercise in the management of lower limb OA was confirmed, with effect sizes ranging from 0.44 [95% confidence interval (CI) 0.03 to 0.85] on WOMAC pain to 0.76 (95% CI 0.33 to 1.17) on WOMAC physical function. Of 153 patients randomised to treatment, 82 (53.5%) were estimated to have complied satisfactorily with their treatment at the 1-year point. This had declined to 28 (18%) by the end of the 6-month follow-up period, during which support for the intervention had been removed and those wishing to continue exercise had to pay their own costs for maintaining their exercise treatment. High levels of co-morbidity were recorded in both groups. Nearly two thirds of all patients had a significant other illness in addition to their OA. Fifty-four control and 53 exercise patients had hospital inpatient episodes during the study period. Water exercise remained effective in the main study but overall effect size was small, on WOMAC pain at 1 year, a reduction of about 10% in group mean pain score. This had declined, and was non-significant, at 18 months. Mean cost difference estimates showed a saving in the water exercise group of pound123--175 per patient per annum and incremental cost-effectiveness ratios ranged from pound3838 to pound5951 per quality-adjusted life-year (QALY). Net reduction in pain was achieved at a net saving of pound135--175 per patient per annum and the ceiling valuation of pound580--740 per unit of WOMAC pain reduction was favourably low. CONCLUSIONS: Group-based exercise in water over 1 year can produce significant reduction in pain and improvement in physical function in older adults with lower limb OA, and may be a useful adjunct in the management of hip and/or knee OA. The water-exercise programme produced a favourable cost--benefit outcome, using reduction in WOMAC pain as the measure of benefit. Further research is suggested into other similar public health interventions. Investigation is also needed into how general practice can best be supported to facilitate access to participants for research trials in healthcare, as well as an examination of the infrastructure and workforce capacities for physical activity delivery and the potential extent to which healthcare may be supported in this way. More detailed research is required to develop a better understanding of the types of exercise that will work for the different biomechanical subtypes of knee and hip OA and investigation is needed on access and environmental issues for physical activity programmes for older people, from both a provider and a participant perspective, the societal costs of the different approaches to the management of OA and longer term trends in outcome measures (costs and effects).

The effect of flow on Doppler estimates of bioprosthetic mitral valve function in vitro.

In order to assess the effect of flow on peak transmitral velocity and pressure half time and to test the Hatle orifice area formula, four Carpentier-Edwards mitral prostheses were studied in a positive displacement flow simulator at 20 different stroke volume/rate combinations using a constant left ventricular filling curve. Peak transmitral velocity was directly related to mean flow and differed significantly between the individual values (F79 = 38; p less than 0.00001). There was, however, no significant difference in pressure half time between the four values (F79 = 0.04; p = 0.99). Pressure half time was directly related to diastolic time interval (r = 0.98, y = 0.41x - 17.84; p less than 0.00001), but was independent of stroke volume. There was only a moderate inverse correlation between pressure half time (T1/2) and orifice area (r = 0.56, y = 0.67 + 69/T1/2; p less than 0.0001). These results are consistent with the suggestion that pressure half time is more closely related to the shape of the left ventricular filling curve than to orifice area in normally functioning bioprostheses.

Improvements in the equation for calculating the contribution to osmotic potential of the separate solutes of water solutions.

A minor conceptual improvement, the elimination of an approximation and its revision in relativistic terms, has resulted in a twofold increase in the predictability of the equation for calculating the contribution to osmotic potential of the separate solutes of water solutions. The molecular model inherent to its formulation would provide unifying principles for visualizing water movements associated with solute concentration gradients in tissues.

Blocks in choice responding as a function of age and physical fitness.

Although both physical fitness and aspects of cognitive functioning are known to be poorer among older people, there is conflicting evidence about the interaction between age and fitness. Is greater age more strongly associated with impaired cognition among less fit people than it is among more fit people? In a sample of employed men aged 17-63 years, it is shown that this interaction is significant with respect to the occurrence of exceptionally slow responses but is not significant for mean reaction time. Multiple regression analyses suggest that the former measure may be interpreted as an inability to maintain concentration over time rather than as an index of response speed.

Efficacy of aortic balloon valvoplasty: direct measurement of orificial area in a model with pulsatile flow.

The efficacy of balloon valvoplasty of calcific aortic stenosis remains controversial. We studied, therefore, 5 human aortic valves obtained at necropsy in a positive-displacement pulse duplicator which delivered stroke volumes of 40-100 ml with a quasiphysiological waveform of flow. All valves had three leaflets without commissural fusion and were preserved in antibiotic solution before study. Orificial area was planimetered from videotape of opening of the valve and varied with flow in all cases. Valvoplasty with a 20 mm diameter balloon had no effect on the orifice of the normal valve but increased the orifice of 2 mildly calcified valves from 0.70-1.77 cm2 (range) at baseline to 1.06-1.95 cm2. In 2 valves with severe calcification of the leaflets, the orifice was increased from 0.31-0.82 cm2 to 0.73-1.07 cm2. Dual balloon valvoplasty achieved a variable but small further increase in orificial area. No valve showed tears of the leaflets or fracture of calcific deposits after valvoplasty. We conclude that balloon valvoplasty can acutely increase orificial area, independently of any change in stroke volume. In valves without commissural fusion, its mechanism appears to be an increase in the pliability of the leaflets which does not require macroscopic fracture of calcific deposits.

Doppler spectral waveform generation in vitro: an aid to diagnosis of vascular disease.

This paper describes a microcomputer controlled pump which generates pulsatile flows similar to those found in the human peripheral circulation. Continuous wave Doppler ultrasound was used to investigate the flows generated by the pump and the behaviour of diagnostic indices derived from the spectra was examined. Sonograms were recorded from elastic and rigid tubes with various degrees of axisymmetric constriction. Heart rate, stroke volume, severity of vessel constriction, vessel wall elasticity, distal resistance, and systemic peripheral impedance were varied in turn and the resulting Doppler spectra compared. Indices considered were the pulsatility index, spectral broadening index and peck Doppler frequency. In general, the indices lacked the sensitivity to detect low to moderate levels of disease.

Low calcium dialysate and hyperparathyroidism.

A low calcium dialysate reduces hypercalcemia from calcium-containing phosphate binders and makes phosphate control possible without the use of aluminum salts. We asked whether this might, however, lead to hyperparathyroidism. We prospectively studied serum concentrations of parathyroid hormone levels (by an immunoreactive intact molecule assay) in 173 patients on continuous ambulatory peritoneal dialysis (CAPD) who were started on a low calcium dialysate (Ca2+ 1.25 or 1.00 mmol/L) because of hypercalcemia. Median follow-up was 13.2 months (range 1-28). Initial serum parathyroid hormone was [median(range)]: 70(5-1043) ng/L pre low calcium dialysate, and this rose to 130(5-914) ng/L at 0-6 months; 130(5-1030) ng/L at 6-12 months; 170(170-1400) ng/L at 12-18 months; and 130(5-1200) ng/L at 18-24 months (p = 0.0006). Twenty-two patients required a parathyroidectomy because of a sustained rise in parathyroid hormone that was not responsive to alfacalcidol and hypercalcemia. Initial serum parathyroid hormone was significantly higher in these patients at 359 (5-1073) ng/L as compared to a level of 69.5 (6-1147) ng/L in patients who did not have a parathyroidectomy (p = 0.0009). There was a significant sustained fall in mean serum corrected calcium from 2.77 (2.37-3.51) mmol/L to 2.53 (1.39-3.20) mmol/L at three months (p = 0.0006), a nonsignificant rise in mean serum alkaline phosphate from 179 (47-1858) mmol/L to 191 (55-1821) mmol/L (p = 0.15), and a fall in mean serum phosphate levels from 1.87 (0.59-3.18) mmol/L to 1.68 (0.45-3.6) mmol/L (p = 0.76). Our data suggest that the benefits of a low calcium dialysate in CAPD patients are balanced by an increased risk of hyperparathyroidism, and that this risk is higher in patients with an initially high serum parathyroid hormone level.

Flash burns to the face.

A characteristic 'crow's foot' pattern is seen around the eye in many flash burns. The protective blink reflex underlies this, and the injury is due to convected rather than radiant energy.

A comparison of the effects of two commonly used vasoconstrictors on nasal mucosal blood flow and nasal airflow.

This study compared two commonly used vasoconstrictors, cocaine and xylometazoline. Non-invasive techniques of measurement were utilised, with active anterior rhinomanometry indirectly assessing changes in nasal mucosal blood volume, and laser Doppler flowmetry assessing changes in nasal mucosal blood flow. Twelve healthy volunteers received 0.1 ml of the topical vasoconstrictor at the anterior end of both inferior turbinates. Following the application of xylometazoline, a significant rise in nasal airflow (p less than 0.005), and a significant fall in blood flux occurred in the probe nostril (p less than 0.05). Following the application of cocaine, no significant change in nasal airflow occurred (p less than 0.05), but a significant fall in blood flux occurred in the probe nostril (p less than 0.02). A comparison of the paired data for the same subject demonstrated no significant difference in the change in blood flux produced by xylometazoline and cocaine, but a significant difference in the change in airflow produced by the two vasoconstrictors (p less than 0.005).