Pharmaceutical pollution of the world's rivers.

Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

Family experiences of tissue donation in Australia.

CONTEXT: Although research exists examining the experiences of organ donor families, little is known about the specific needs of tissue donor families. Understanding family experiences in tissue donation is important to improve the process and potentially increase the number of families who consent to tissue donation. OBJECTIVE: To examine the experiences of recent tissue donor families and to identify potential areas for improvement of the donation process. DESIGN: Cross-sectional survey by mailed questionnaire. SETTING AND PARTICIPANTS: Participants were families who had been approached by DonateWest, the coordinating organization in Western Australia, and had agreed to tissue donation. MAIN OUTCOME MEASURES: Quantitative and qualitative analysis of data with regards to satisfaction with the approach method, reasons for consent, and appropriateness of support services. RESULTS: Seventy-seven of 140 mailed questionnaires were returned. Almost all respondents expressed satisfaction with the approach to donate, and this did not differ with the mode of approach, that is, by phone or in person. The most common reason for agreeing to donation was that it was known to be the donor's wish. The majority of respondents felt they had sufficient time and information to decide to donate, and almost all were happy with their decision and thought they had received adequate support during and after the process.