Impact of standardized protocols for cytomegalovirus disease prevention in pediatric solid organ transplant recipients.

End-organ disease caused by CMV is a significant cause of morbidity and mortality in pediatric SOT recipients. Pediatric transplant centers have adopted various approaches for CMV disease prevention in this patient population. We observed significant practice variation in CMV testing, prophylaxis, and surveillance across SOT groups in our center. To address this, we implemented evidence-based standardized protocols and measured outcomes pre- and post-implementation of these protocols. We performed retrospective chart review for SOT recipients from 2009 to 2014 at Boston Children's Hospital. Using descriptive statistics, we measured practice improvement in provision of appropriate prophylaxis, occurrence of neutropenia and associated complications, and occurrence of CMV DNAemia and CMV disease pre- and post-intervention. The pre- and post-intervention periods included 141 and 109 patients, respectively. With the exception of kidney transplant recipients, provision of appropriate valganciclovir prophylaxis improved across SOT groups post-intervention (P < .01). Occurrence of >1 episode of neutropenia was greater in the preintervention period (30% vs 10%, P < .001). In both periods, neutropenia was associated with few episodes of invasive infections. The occurrence of CMV disease did not differ and was overall low. However, due to routine surveillance a significantly greater number of asymptomatic CMV DNAemia episodes were identified and treated in the post-intervention period. Implementation of standardized prevention protocols helped to improve the provision of appropriate prophylaxis to patients at risk for CMV acquisition, increased the diagnosis and treatment of asymptomatic CMV DNAemia, and decreased episodes of recurrent neutropenia in patients receiving prophylaxis.

The disappearing Environmental Kuznets Curve: a study of water quality in the Lower Mekong Basin (LMB).

The literature is flush with articles focused on estimating the Environmental Kuznets Curve (EKC) for various pollutants and various locations. Most studies have utilized air pollution variables; far fewer have utilized water quality variables, all with mixed results. We suspect that mixed evidence of the EKC stems from model and error specification. We analyze annual data for four water quality indicators, three of them previously unstudied - total phosphorus (TOTP), dissolved oxygen (DO), ammonium (NH4) and nitrites (NO2) - from the Lower Mekong Basin region to determine whether an Environmental Kuznets Curve (EKC) is evident for a transboundary river in a developing country and whether that curve is dependent on model specification and/or pollutant. We build upon previous studies by correcting for the problems of heteroskedasticity, serial correlation and cross-sectional dependence. Unlike multi-country EKC studies, we mitigate for potential distortion from pooling data across geographically heterogeneous locations by analyzing data drawn from proximate locations within a specific international river basin in Southeast Asia. We also attempt to identify vital socioeconomic determinants of water pollution by including a broad list of explanatory variables alongside the income term. Finally, we attempt to shed light on the pollution-income relationship as it pertains to trans-boundary water pollution by examining data from an international river system. We do not find consistent evidence of an EKC for any of the 4 pollutant indicators in this study, but find the results are entirely dependent on model and error specification as well as pollutant.

Examining the economic impacts of hydropower dams on property values using GIS.

While the era of dam building is largely over in the United States, globally dams are still being proposed and constructed. The articles in this special issue consider many aspects and impacts of dams around the world. This paper examines dam removal and the measurement of the impacts of dams on local community property values. Valuable lessons may be found. In the United States, hundreds of small hydropower dams will come up for relicensing in the coming decade. Whether or not the licenses are renewed and what happens to the dams if the licenses expires is a subject of great debate. Dams are beginning to be removed for river restoration and fisheries restoration and these "end-of-life" decisions may offer lessons for countries proposing or currently building small (and large) hydropower dams. What can these restoration stories tell us? In this paper, we examine the effects of dams along the Penobscot River in Maine (USA) on residential property values. We compare the results to findings from a similar (but ex post dam removal) data set for properties along the Kennebec river in Maine, where the Edwards Dam was removed in 1999. The Penobscot River Restoration Project, an ambitious basin-wide restoration effort, includes plans to remove two dams and decommission a third along the Penobscot River. Dam removal has significant effects on the local environment, and it is reasonable to anticipate that environmental changes will themselves be reflected in changes in property values. Here we examine historical real estate transaction data to examine whether landowners pay a premium or penalty to live near the Penobscot River or near a hydropower generating dam. We find that waterfront landowners on the Penobscot or other water bodies in our study area pay approximately a 16% premium for the privilege of living on the water. Nevertheless, landowners pay LESS to live near the Penobscot River than they do to live further away, contrary to the expectation that bodies of water function as real estate amenities and boost local property values. Results with respect to the effect of proximity to hydropower generating plants are equivocal. Homeowners pay a small premium for houses close to hydropower dams in our region, but the statistical significance of that result depends on the specific model form used to estimate the effect. Consideration of the social and economic impacts of dam removal-based river restoration can complement studies of the ecological impacts of the practice. Such studies help us understand the extent to which human society's subjective perception of value of aquatic ecosystems relates to objective measures of ecosystem health. The paper also illustrates how geographic information systems (GIS) can help inform these analyses.