Kinetics of chlorine and chloramine reactions in reverse osmosis permeate and their impact on radical formation during UV/chlorine advanced oxidation for potable reuse.

Knowledge of the speciation of chlorine and chloramines in reverse osmosis (RO) permeate is needed to estimate the performance (i.e., pollutant log reduction) of subsequent UV/chlorine advanced oxidation processes (AOPs). To accurately predict the speciation, a previously reported breakpoint chlorination kinetic model was experimentally validated for pH 5.5 and reaction times < 3 min and used to predict the kinetics of breakpoint chlorination in RO permeate. The predictions showed that eliminating chloramines by adding chlorine at a dose beyond the chlorine-to-nitrogen (Cl/N) breakpoint ratio is not practical due to the high breakpoint Cl/N ratio for RO permeate (∼3.0 molar ratio) and an estimated > 40 min reaction time. The conversion from monochloramine (NH2Cl) to dichloramine (NHCl2) is the major process involved, and either or both free chlorine and chloramines may be the major species present, depending on the Cl/N ratio. Model simulations showed that increasing the oxidant dose may not always enhance the performance of UV/chlor(am)ine in RO permeate, due to the need for a low free chlorine dose for optimal •OH exposure in RO permeate. Further UV/AOPs modelling showed that it is important to control the NH2Cl concentration to improve the UV/AOP performance in RO permeate, which may be achieved by extending the reaction time after chlorine is added or increasing the applied Cl/N ratio (e.g., increasing chlorine dose). However, these measures only enhance the pollutant percentage removal by about 5 % under the conditions modelled. A simulation tool was developed and is provided to predict the speciation of chlor(am)ine in RO permeate.

Creating an Innovative Global Health Clinical Experience During the COVID-19 Pandemic.

When the COVID-19 pandemic hit and international travel was halted, nursing faculty were challenged to transform the in-person global health clinical experience with travel to a new virtual format. The virtual experience would need to meet the learning objectives and provide a global health perspective. This article describes the process of transforming the in-person clinical experience to a virtual format to provide a rich global learning opportunity for the students without travel to the host country. Virtual global health experiences can successfully help students understand the health of populations with a global perspective.

On the increasing competitiveness of UV/Cl to UV/H2O2 advanced oxidation as the organic carbon concentration increases.

UV/Cl and UV/H2O2 are advanced oxidation processes (AOPs) used for drinking water treatment and water reuse. This work explored the hypothesis that UV/Cl becomes more competitive to UV/H2O2 at neutral-to-high pH as the concentration of total organic carbon (TOC) increases. Lab experiments and kinetic modelling were used to compare initial pseudo first-order contaminant decay rate coefficients between the AOPs at various pH and TOC conditions. The relative effect of increasing TOC concentrations on UV/Cl vs. UV/H2O2 depended on the pH, contaminant, and organic matter reactivity towards radicals. For example, while the reaction rate coefficients during both AOPs generally decreased with increasing TOC, the UV/Cl reaction rate coefficients for the solely •OH-reactive sucralose decreased 41-138% less than the UV/H2O2 coefficients as the TOC concentration was increased from 0 to 5 mg-C L-1. However, UV/Cl was more affected than UV/H2O2 when targeting caffeine (a contaminant reactive to chlorine radicals). The data were used to define TOC-pH conditions for which either AOP would be more energy-efficient, under a set of standard conditions. The results suggest that UV/Cl may be competitive to UV/H2O2 under a wider range of treatment scenarios than has been conventionally thought based on tests in pure water.

Comparison of Two Manufacturing Processes of Daprodustat for Bioequivalence and Dissolution in Healthy Volunteers: A Randomized Crossover Study.

Daprodustat, an orally bioavailable hypoxia-inducible factor-prolyl hydroxylase enzyme inhibitor, has recently completed phase 3 clinical development for treating anemia of chronic kidney disease. Part A of this 2-part, randomized, double-blind, single-dose, cross-over study (NCT04640311) compared pharmacokinetic properties of a single oral dose of daprodustat 4 mg tablets manufactured via twin-screw wet granulation (process 1) to 2 sets of 4 mg tablets manufactured via high-shear wet granulation (process 2), to assess the impact of different dissolution profiles on pharmacokinetics. Part B assessed the bioequivalence of daprodustat tablets manufactured via process 1 with tablets manufactured via process 2 at 5 different dose strengths (1, 2, 4, 6, and 8 mg). In part A, mean plasma concentrations of daprodustat were comparable over a 24-hour period despite differences in manufacturing processes and dissolution profiles. In part B, the 90% confidence intervals of the ratios of the least squared means for area under the concentration-time curve and maximum observed plasma concentration fell within the 0.8-1.25 bioequivalence range for all doses, except for maximum observed plasma concentration at 8 mg. A prespecified sensitivity analysis jointly assessing all doses showed bioequivalence for all doses tested. No new safety concerns for daprodustat were identified.

Thiol Reactome: A Nontargeted Strategy to Precisely Identify Thiol Reactive Drinking Water Disinfection Byproducts.

The precise identification of predominant toxic disinfection byproducts (DBPs) from disinfected water is a longstanding challenge. We propose a new acellular analytical strategy, the 'Thiol Reactome', to identify thiol-reactive DBPs by employing a thiol probe and nontargeted mass spectrometry (MS) analysis. Disinfected/oxidized water samples had reduced cellular oxidative stress responses of 46 ± 23% in Nrf2 reporter cells when preincubated with glutathione (GSH). This supports thiol-reactive DBPs as the predominant drivers of oxidative stress. This method was benchmarked using seven classes of DBPs including haloacetonitriles, which preferentially reacted with GSH via substitution or addition depending on the number of halogens present. The method was then applied to chemically disinfected/oxidized waters, and 181 tentative DBP-GSH reaction products were detected. The formulas of 24 high abundance DBP-GSH adducts were predicted, among which nitrogenous-DBPs (11) and unsaturated carbonyls (4) were the predominant compound classes. Two major unsaturated carbonyl-GSH adducts, GSH-acrolein and GSH-acrylic acid, were confirmed by their authentic standards. These two adducts were unexpectedly formed from larger native DBPs when reacting with GSH. This study demonstrated the "Thiol Reactome" as an effective acellular assay to precisely identify and broadly capture toxic DBPs from water mixtures.

Pharmacokinetics of Daprodustat and Metabolites in Individuals with Normal and Impaired Hepatic Function.

Daprodustat is a hypoxia-inducible factor-prolyl hydroxylase inhibitor in development for treatment of anemia of chronic kidney disease. We evaluated the role of hepatic impairment on daprodustat pharmacokinetics, pharmacodynamics, and tolerability. Participants with mild (Child-Pugh Class A, score 5-6) and moderate (Child-Pugh Class B, score 7-9) hepatic impairment and matched healthy controls were administered single 6-mg doses of daprodustat. Exposure parameters were determined for daprodustat and its six metabolites. Comparisons resulted in 1.5- and 2.0-fold higher daprodustat Cmax and area under the curve (AUC) exposures in participants with mild and moderate hepatic impairment, respectively, versus controls; Cmax in mild hepatic impairment was comparable to controls. Similarly, aligned with parent drug, unbound daprodustat Cmax and AUC exposures increased 1.6- to 2.3-fold in hepatic-impaired participants versus controls, and metabolite exposures were 1.2- to 2.0-fold higher in participants with hepatic impairment. Erythropoeitin (EPO) baseline-corrected AUC exposures were between 0.3-fold lower and 2.2-fold higher in matched controls versus hepatic-impaired participants. No serious or study drug-related adverse events were reported. Daprodustat exposure was increased in participants with moderate and mild hepatic impairment compared with matched controls; however, no meaningful differences in EPO were observed and no new safety concerns were identified (ClinicalTrials.gov: NCT03223337).

Empatia em estudantes de Medicina: efeitos de um programa de gerenciamento do estresse / Empathy in medical students: effects of a stress management program

Resumo: Introdução: O curso de graduação em Medicina expõe os alunos a uma quantidade significativa de estresse, o que pode gerar consequências negativas para o aprendizado, a motivação e o contato com os pacientes. A falta de empatia na relação médico-paciente pode dificultar a adesão ao tratamento e os resultados nele. Algumas técnicas e práticas de medicina integrativa (mente e corpo) têm sido indicadas para auxiliar no manejo e na redução do estresse. Essas intervenções que envolvem práticas de meditação e que já são utilizadas em escolas médicas podem auxiliar no desenvolvimento da empatia e na visão da integralidade do cuidado. Objetivo: Este estudo teve como objetivo investigar o efeito de um programa de Redução de Estresse e Desenvolvimento da Empatia na Medicina (Redemed©) no nível de empatia de estudantes de graduação em Medicina. Método: O programa foi composto por oito encontros de duas horas cada, envolvendo práticas de meditação, posturas de ioga e atividades de grupo direcionadas ao aperfeiçoamento de interações interpessoais. O grupo intervenção foi composto por 47 alunos, e o grupo controle, por 40 estudantes. Utilizou-se a Escala Jefferson de Empatia Médica, versão para estudantes (JSPE-S), para avaliar o nível de empatia antes e depois da intervenção. Resultado: O aumento do nível de empatia no grupo que recebeu a intervenção foi significativo quando comparado ao grupo controle (p: 0,000). Conclusão: A participação no programa Redemed© se mostrou eficaz no aumento da empatia entre estudantes de graduação de um curso de Medicina.

Abstract: Introduction: The undergraduate medical course exposes students to a significant amount of stress, which can have negative consequences for learning, motivation and contact with patients. Lack of empathy in the doctor-patient relationship can hinder adherence and treatment results. Some techniques and practices of integrative medicine (mind and body) have been indicated as aiding the management and reduction of stress. These interventions that involve meditation practices, and which are already used in medical schools, can help in the development of empathy and in the vision of comprehensive care. Objective: Investigate the effect of the Stress Reduction and Empathy Development in Medicine Program (REDEMED©) on empathy levels in undergraduate medical students. Method: The program consisted of eight 2-hour sessions with practices involving meditation, yoga postures, and group activities aimed at improving interpersonal interactions. The intervention group consisted of 47 students and the control group 40 students. Empathy was evaluated before and after intervention using the Jefferson Scale of Empathy - version for medical students (JSE-S). Result: Empathy level significantly increased in the group who received intervention compared to the control group (p: 0.000). Conclusion: Participation in the REDEMED© program showed an increase in empathy in undergraduate medical students.

Clinical Pharmacokinetics of Daprodustat: Results of an Absorption, Distribution, and Excretion Study With Intravenous Microtracer and Concomitant Oral Doses for Bioavailability Determination.

Daprodustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, is being investigated for treatment of anemia in chronic kidney disease. This phase 1, nonrandomized, 2-period, crossover study in 6 healthy men characterized the absorption, distribution, and excretion of daprodustat when administered as oral and intravenous (IV) doses of unlabeled and radiolabeled daprodustat ([14 C]-GSK1278863). Tolerability and pharmacokinetic properties of daprodustat, and its 6 metabolites in the systemic circulation, were also evaluated. The mean recovery of radiolabeled daprodustat was ≈95% by day 5, with the majority in feces and minor renal elimination, indicating that daprodustat and metabolites are primarily eliminated via hepatobiliary and fecal routes. Approximately 40% of total circulating radioactivity in plasma following both IV and oral administration was daprodustat; thus, 60% was attributed to metabolites. It was estimated that ≈80% of daprodustat was absorbed across the gastrointestinal tract, and ≈18% cleared by hepatic extraction. Pharmacokinetics were essentially dose proportional, with moderate (≈66%) oral tablet bioavailability. Following IV administration, daprodustat plasma clearance (19.3 L/h) and volume of distribution (14.6 L) were low, suggesting low tissue distribution outside systemic circulation with likely low penetration into tissues. Daprodustat was generally well tolerated, with no deaths or serious or significant adverse events reported.

Assessment of safety and tolerability of remogliflozin etabonate (GSK189075) when administered with total daily dose of 2000 mg of metformin.

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) are characterized by an elevated glycemic index and are at a higher risk for complications such as cardiovascular disease, nephropathy, retinopathy and peripheral neuropathy. Normalization of glycemic index can be achieved by dosing combinations of metformin with other anti-diabetic drugs. The present study (Clintrials number NCT00519480) was conducted to evaluate the safety, tolerability, pharmacokinetics and pharmacodynamics of remogliflozinetabonate, an SGLT2 inhibitor, withdoses (500 mg and 750 mg BID) greater than the commercial dose (100 mg BID)in combination with metformin with minimum daily dose of 2000 mg given in two divided doses. METHODS: This was a randomized, double-blinded, repeat dose study in 50 subjects with T2DM. The study was conducted in three phases; run-in, randomization, and treatment. All subjects were on a stable metformin dosing regimen. Cohort 1 subjects were randomly allocated to receive either remogliflozin etabonate 500 mg BID or placebo BID (2:1) in addition to metformin. Cohort 2 subjects were administered with either remogliflozin etabonate 750 mg BID or placebo BID (2:1) in addition to metformin for 13 days. All the subjects were assessed for safety (adverse events, lactic acid levels, vital signs, electrocardiogram [ECG]), pharmacokinetic evaluation, and pharmacodynamics (Oral Glucose Tolerance Testing) parameters. RESULTS: Co-administration of remogliflozin etabonate and metformin was well tolerated in all subjects during the observation period. There were no severe or serious adverse events (SAEs) and no increase in lactic acid concentration was reported during the study. The statistical results showed that concomitant administration of remogliflozin etabonate, either 500 mg or 750 mg BID, with metformin had no effect on the pharmacokinetics of metformin. The accumulation ratios, Day 13 vs. Day 1, for AUC values of remogliflozin etabonate and its metabolites were all very close to 1, indicating no accumulation in plasma concentrations of remogliflozin etabonate and its metabolites. Mean glucose values from baseline and glucose and insulin values following oral glucose tolerance test (OGTT) were decreased in all treatment groups. CONCLUSION: Co-administration of doses of remogliflozin etabonate (500 mg BID or 750 mg BID) greater than the commercial dose (100 mg BID) with metformin (2000 mg BID) was shown to be safe and effective during the observation period. TRIAL REGISTRATION: ClinicalTrials.gov , NCT00519480 . Registered:22 August 2007.

Effective enzyme activity: A proposed monitoring methodology for biofiltration systems with or without ozone.

"Effective Enzyme Activity", or simply "Effective Activity", is proposed as a biofiltration monitoring tool which combines enzyme activity with empty bed contact time (EBCT) to quantify biodegradation potential. The primary objective of this study was to evaluate the applicability of the Effective Activity concept for predicting water quality in biofiltration systems. This pilot-scale study evaluated eight different biofilter configurations in order to quantify impacts associated with filter media (anthracite/sand or granular activated carbon), pre-treatment (settled water with or without ozonation) and operating conditions (15- and 30-min EBCT, and backwash with or without chlorine). Microbial characterization included biomass concentration, as measured by adenosine triphosphate (ATP), in addition to esterase and phosphatase activity. Water quality parameters included dissolved organic carbon (DOC), trihalomethane (THM) formation potential (FP), haloacetic acid (HAA) FP, haloacetonitrile (HAN) FP, iodinated DBP FP (THMs and HAAs) and inorganic nutrients (phosphorus and nitrogen). Results confirmed the benefits to treated water quality associated with the application of an ozone residual of 0.5 mg/L, utilization of GAC filter media, eliminating chlorinated backwash, and extending EBCT. This study demonstrated a good relationship between effective esterase activity and reductions in DOC and THM FP, including those systems which incorporate pre-ozonation. As such, this study showed that Effective Activity may be appropriate for relating biomass characterization to treated water quality and highlights the importance of quantifying biomass activity in addition to quantity.

Hyperbaric oxygen therapy for mild traumatic brain injury persistent postconcussion syndrome: a randomized controlled trial.

Persistent postconcussion syndrome (PPCS) after mild traumatic brain injury (mTBI) is a significant public health and military problem for which there is limited treatment evidence. The aim of this study was to determine whether forty 150 kPa hyperbaric oxygen therapies (HBOTs) can improve symptoms and cognitive function in subjects with the PPCS of mTBI, using a randomized controlled crossover design with 2-month follow-up. Sixty-three civilian and military subjects with mTBI/PPCS were randomized to either 40 HBOTs at 150 kPa/60 minutes, once daily, 5 days per week in 8 weeks or an equivalent no-treatment control period. The Control Group was then crossed over to HBOT. Subjects underwent symptom, neuropsychological, and psychological testing, before and after treatment or control with retesting 2 months after the 40th HBOT. Fifty subjects completed the protocol with primary outcome testing. HBOT subjects experienced significant improvements in Neurobehavioral Symptom Inventory, Memory Index, Automated Neuropsychological Assessment Metrics, Hamilton Depression Scale, Hamilton Anxiety Scale, Post-Traumatic Stress Disorder Checklist, Pittsburgh Sleep Quality Index, and Quality Of Life after Brain Injury compared to the Control Group. After crossing over to HBOT the Control Group experienced near-identical significant improvements. Further improvements were experienced by both groups during the 2-month follow-up period. These data indicate that 40 HBOTs at 150 kPa/60 minutes demonstrated statistically significant improvements in postconcussion and Post-Traumatic Stress Disorder symptoms, memory, cognitive functions, depression, anxiety, sleep, and quality of life in civilian and military subjects with mTBI/PPCS compared to controls. Improvements persisted at least 2 months after the 40th HBOT. The study was registered on ClinicalTrials.gov (NCT02089594) on March 18, 2014 and with the U.S. Food and Drug Administration under Investigational New Drug #113823. The Institutional Review Boards of the United States Army Medical Research and Materiel Command Office of Research Protections Human Research Protection Office and the Louisiana State University School of Medicine (approval No. 7381) approved the study on May 13, 2014 and December 20, 2013, respectively.

Impact of backwash on biofiltration-related nitrogenous disinfection by-product formation.

Previous studies have reported that biofilm extracted from full-scale biofilters can serve as nitrogenous disinfection by-product (N-DBP) precursors. Detached biofilm materials could escape during filter ripening and form N-DBP upon chloramination. This study examined the potential breakthrough of biofilm and N-DBP precursors during filter ripening at two water treatment plants (WTPs). The presence of biofilm material in aqueous samples was estimated by total adenosine triphosphate (tATP) levels; N-DBP formation potential (FP) tests were conducted under uniform formation conditions to quantify N-nitrosodimethylamine (NDMA) and haloacetonitrile (HAN4) precursors. While tATP peaks in filter effluent were observed post backwash at both WTPs, temporary increases of effluent NDMA FP were only observed during filter ripening where particle-associated NDMA precursors served as the dominant contributor. Overall, biofilters examined in this study demonstrated a consistent removal of NDMA FP regardless of the filter ripening process.

Chlorine is preferred over bisulfite for H2O2 quenching following UV-AOP drinking water treatment.

Drinking water treatment using UV/H2O2 advanced oxidation typically results in residual H2O2 that requires quenching to minimize its interference with downstream processes. Chemical quenching using chlorine or bisulfite are options, but there is some uncertainty in the literature about the kinetics of the bisulfite reaction, with some reports quoting the reaction as fast, and others as slow. Part of the contradictory information may be due to interference in H2O2 analysis by bisulfite. An analytical method was developed to avoid this interference, in which monochloramine first selectively quenched bisulfite, and then H2O2 was measured spectrometrically using titanium(IV) oxysulfate for color development. The confirmatory experiments suggested that the bisulfite reaction with H2O2 is actually relatively slow, with a half-life in the order of hours to days depending on the pH and the reagent concentrations. As a result, within the typical pH range of drinking water treatment (e.g., 6-9), chlorine is preferred over bisulfite as the H2O2 quenching agent on the basis of reaction kinetics. However, a decrease in pH will lead to an increase in the bisulfite-H2O2 reaction rate along with a decrease in the Cl2-H2O2 reaction rate, such that at pH < 5.7 bisulfite is the faster reagent. Both bisulfite and chlorine were observed to react with H2O2 following a stoichiometric ratio of 1:1 in the natural water matrix tested.

Full-scale comparison of UV/H2O2 and UV/Cl2 advanced oxidation: The degradation of micropollutant surrogates and the formation of disinfection byproducts.

The photolysis of chlorine by UV light leads to the formation of the hydroxyl radicals (OH) as well as reactive chlorine species (RCS) that can be effective as advanced oxidation processes (AOPs) for water treatment. Much of the research to date has been done at laboratory- or bench-scale. This study reports results from a model that demonstrates that the relative effectiveness of the UV/Cl2 AOP compared to the more traditional UV/H2O2 AOP is a function of optical path length. As such, the relative effectiveness of the two treatment options evaluated at small scale may not reflect the relative performance at full-scale, making results previously obtained at small-scale potentially less scalable. This study therefore compares the performance of UV/Cl2 to UV/H2O2 at a full-scale water treatment plant, using sucralose and caffeine as spiked surrogates for contaminants that are reactive solely to OH radicals, and to both OH and RCS, respectively. pH was varied between 6.5 and 8.0. The results demonstrated that when using a medium pressure UV lamp, UV/Cl2 might lead to approximately twice the production of OH radicals as UV/H2O2 at pH 6.5 when using the same molar oxidant concentration, but adding chlorine to the UV reactor at pH 8.0 had a negligible impact on OH radical concentration in comparison to UV alone. The study also confirmed previous small-scale results that RCS can be a major contributor to UV/Cl2 treatment for compounds such as caffeine that are susceptible to RCS, with UV/Cl2 effective at both pH 6.5 and 8.0 for such compounds. Disinfection byproducts were monitored, with adsorbable organohalide (AOX) formation increasing by approximately 10 µg-Cl/L due to chlorine photolysis, but only at pH 6.5 and not at pH 8.0. This implies that UV/Cl2 might increase AOX mostly due to reaction between OH and organic precursors to make them more reactive with chlorine, and not due to RCS. The formation of specific DBPs of current or emerging regulatory interest was minimal under all conditions, except for chlorate. Chlorate yields were in the order of 6-18% of the photolysed chlorine.

Existe Alteração em Marcadores Inflamatórios em Estudantes de Medicina após Participação em Programa Mente-Corpo? / Is There Any Change in Inflammatory Markers in Medical Students after Participating in a Mind-Body Program?

RESUMO Introdução Estudantes do curso de Medicina estão expostos a carga elevada de estresse, desencadeada por terem que lidar com adoecimento e morte dos pacientes, extensa carga horária, privação de sono, competitividade, cobrança, responsabilidade e medo de errar, entre outros fatores. Algumas técnicas e práticas como a meditação têm sido utilizadas para auxiliar no manejo e redução de estresse, já sendo utilizadas em escolas médicas. O estresse pode ativar componentes do sistema inflamatório, desencadeando uma série de doenças. As desordens causadas pelo estresse podem ser mensuradas por meio de marcadores sorológicos, sendo que os biológicos são os principais utilizados. Objetivo Avaliar os efeitos de um programa de práticas mente-corpo, Redução de Estresse e Desenvolvimento da Empatia na Medicina (Redemed©), nos níveis dos marcadores pró- e anti-inflamatórios de estudantes de medicina. Metodologia Trata-se de um estudo quase-experimental, composto por 86 estudantes, sendo 44 do grupo intervenção, que participaram do programa Redemed© com oito encontros semanais, englobando técnicas de meditação e exercícios de vivências interpessoais, e 42 estudantes do grupo controle. Ambos os grupos, antes e após o curso, coletaram sangue para análise dos marcadores: proteína C reativa (PCR), fator de necrose tumoral-alfa (TNF-alfa), interleucina 06 (IL06) e interleucina 10 (IL10). Resultados Neste estudo, não foi observada alteração estatisticamente significativa nas citocinas pró-inflamatórias: PCR, TNF-α e IL06. No entanto, a IL-10, que é uma citocina anti-inflamatória, apresentou uma variação positiva e estatisticamente significativa (p: 0,009). Ela tem sido utilizada em estudos com práticas integrativas e complementares a fim de demonstrar seus benefícios. Conclusão O programa Redemed© parece beneficiar os estudantes de Medicina por meio da modulação inflamatória e como grupo de acolhimento no qual eles puderam compartilhar seu estresse e treinar estratégias de enfrentamento. Este estudo, mesmo não tendo encontrado diferença estatística significativa nos marcadores pesquisados, com exceção da IL10, traz à tona este tema importante do grande estresse vivenciado por estudantes de Medicina e a necessidade de as escolas médicas terem maior cuidado com seus alunos, acolhendo e trabalhando o estresse desses estudantes de forma a reduzir e gerenciar melhor este fator de adoecimento em suas vidas.

ABSTRACT Introduction Medical students are exposed to high stress levels, triggered by having to deal with their illness and death of their patients, extensive workloads, sleep deprivation, competition, having to fulfil demanding duties, responsibility, and fear of making mistakes, among other factors. Some techniques and practices, such as meditation, are used in medical schools to help manage and reduce stress. Stress can activate components of the inflammatory system, triggering a series of pathologies. The disorders caused by stress can be measured by means of serological markers, with biological markers being the main ones used. Objective. To evaluate the effects of a program of mind-body practices, Reduction of Stress and Development of Empathy in Medicine (REDEMED ©), on pro- and anti-inflammatory markers of medical students. Methodology This is a quasi-experimental study, composed of 86 students: 44 in the intervention group, who participated in the REDMED© program with eight-weekly meetings that included meditation techniques and exercises of interpersonal experiences, and 42 students in the control group. Before and after the course, blood was collected from both groups for analysis of the markers: C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL06) and interleukin-10 (IL10). Results No statistically significant changes were observed in the proinflammatory cytokines CRP, TNF-α and IL06. However, IL-10, an anti-inflammatory cytokine, showed a positive and statistically significant variation (p: 0.009). It has been used in studies with integrative and complementary practices to demonstrate its benefits. Conclusion The REDEMED© program seems to benefit medical students through inflammatory modulation and as a group that provides a forum to share their stress and receive coaching in coping strategies. This study, even though it did not find a statistically significant difference in the markers studied, with the exception of IL10, raises the important theme of the high levels of stress that medical students experience, and the need for medical schools to take greater care of their students, addressing stress in order better manage it in their own lives.

The contribution of biofilm to nitrogenous disinfection by-product formation in full-scale cyclically-operated drinking water biofilters.

Biofiltration has been shown to be effective for disinfection by-product (DBP) precursor control, however few studies have considered its role in the potential formation of DBPs. Biofilm is composed of heterogeneous bacteria as well as extracellular polymeric substances (EPS). The objective of this study was to determine the contribution of biofilm-related materials such as EPS to form nitrogen-containing DBPs upon chloramination, and to determine the influence of cyclical (scheduled on-off) biofilter operation on DBP precursor removal. Biologically active media was sampled from a full-scale biofilter operating under cold-water conditions (3.6 ±â€¯0.5 °C) and extracted using a cation exchange resin into a phosphate buffer solution. Biomass concentrations, as determined using adenosine triphosphate (ATP) measurements, remained stable at 298 ±â€¯55 ng ATP/g media over the trial period. N-nitrosodimethylamine (NDMA) and haloacetonitrile (HAN4) formation potential (FP) tests conducted under uniform formation conditions (UFC) using extracted biofilm yielded 0.80 ±â€¯0.27 ng NDMA/g media and 18.7 ±â€¯3.3 ng dichloroacetonitrile (DCAN)/g media. Further analyses of extracted biofilm using fluorescence spectroscopy and liquid chromatography-organic carbon detection indicated the presence of proteins above 20 kDa and humic-like substances. Extracted proteins (93.5 ±â€¯8.1 µg/g media) correlated well (R = 0.90) with UV 280 measurements, indicating that spectrophotometry may serve as a valuable tool to quantify proteins in extracted biofilms. While substances in biofilms can serve as NDMA and DCAN precursors, the full-scale cyclically-operated biofilter that was examined did not show release of NDMA precursors during start-up following stagnation periods of 6 h or more. These biofilters consistently removed 6.9 ±â€¯4.3 ng/L of NDMA precursors; typical NDMA UFC-FP of biofilter effluent was 8.5 ±â€¯2.6 ng/L.

Pilot-scale comparison of cyclically and continuously operated drinking water biofilters: Evaluation of biomass, biological activity and treated water quality.

The objective of this pilot study was to evaluate the impact of cyclical (operated 8-12 h per day) and continuous biofilter operation with respect to biomass development, biological enzyme activity and treated water quality (in terms of organics, nutrients and disinfection by-product (DBP) formation potential). Continuously operated biofilters developed greater densities of biomass, as measured by ATP, when compared to cyclically operated filters; reducing the empty bed contact time (EBCT) increased biomass density under continuous flow conditions. However, once normalized to biomass, it was shown that cyclically operated filters exhibited higher enzyme activity, indicating that this method of operation may improve bacterial function. Reduction of organics was generally similar for both continuous and cyclical filters with the same EBCT, however, cyclical filters demonstrated higher variability during the first 4 h following start-up. Overall, HAA formation potential was better controlled by continuously operated filters, due to poor performance by the cyclical filters upon start-up while THM precursors were removed equally well by all filters. To understand the removal capacity for NDMA precursors through biological filters, both naturally occurring NDMA FP and NDMA FP resulting from spiked anthropogenic precursors was monitored through the filter depth. All the filters removed 90% of the naturally occurring NDMA FP within the first 45 cm; cyclical operation resulted in higher reduction of spiked anthropogenic NDMA precursors (50% higher than continuously operated) demonstrating the advantage of routine shut down on overall microbial activity. Tools to monitor and predict biofilter performance are in high demand. Here we present an "effective activity" term which combines enzyme activity with contact time (EBCT). Effective esterase activity was strongly correlated to DOC reduction as a function of filter operation (cyclical or continuous) and EBCT; effective phosphatase activity was indicative of phosphate removal. The results of this study indicate that routine shut down of the filters as this location improved enzyme activity without compromising control of chlorinated DBPs (THMs and HAAs) or NDMA derived from natural and anthropogenic precursors.

Removal of natural organic matter and disinfection byproduct precursors from drinking water using photocatalytically regenerable nanoscale adsorbents.

Disinfection byproduct precursors (DBPs) were removed from raw surface water obtained from two Canadian drinking water treatment plants via adsorption to two regenerable linear engineered TiO2 nanomaterials (LENs). The temperature employed in the final heating step of the LEN synthesis procedure was varied to produce two distinct nanomaterials, NB 550 and NB 700. The LENs had similar dimensions but differed in terms of surface characteristics, surface area, and crystal structure. Unlike the commercial TiO2 nanoparticles, both LENs were easily removed from the treated water via settling or filtration. Although neither of the LENs were as effective for NOM adsorption as commercial nanoparticles, both were able to remove substantial amounts of DBP precursors. NB 550 reduced the trihalomethane (THM) formation potential of both water sources by up to 40% and their haloacetic acid (HAA) formation potential by approximately 50%. NB 700 reduced the THM formation potential of one water source by 25% and that of the other by 40%. HAA precursor removal by NB 700 ranged from 25% to 30%. The adsorption of DOC, UV254, THM precursors, and HAA precursors by commercial nanoparticles and the LENs fit a modified Freundlich adsorption isotherm model. When the LENs were regenerated via exposure to UVA light they experienced a gradual loss in adsorption capacity of up to 50% over five regeneration cycles. This loss occurred more quickly for the less photoactive of the two nanomaterials, and was affected by water source, suggesting that components of the water matrices may have interfered with regeneration.

Modeling the exposure of wild fish to endocrine active chemicals: Potential linkages of total estrogenicity to field-observed intersex.

Decades of studies on endocrine disruption have suggested the need to manage the release of key estrogens from municipal wastewater treatment plants (WWTP). However, the proposed thresholds are below the detection limits of most routine chemical analysis, thereby restricting the ability of watershed managers to assess the environmental exposure appropriately. In this study, we demonstrated the utility of a mechanistic model to address the data gaps on estrogen exposure. Concentrations of the prominent estrogenic contaminants in wastewaters (estrone, estradiol, and ethinylestradiol) were simulated in the Grand River in southern Ontario (Canada) for nine years, including a period when major WWTP upgrades occurred. The predicted concentrations expressed as total estrogenicity (E2 equivalent concentrations) were contrasted to a key estrogenic response (i.e., intersex) in rainbow darter (Etheostoma caeruleum), a wild sentinel fish species. A predicted total estrogenicity in the river of ≥10 ng/L E2 equivalents was associated with high intersex incidence and severity, whereas concentrations <0.1 ng/L E2 equivalents were associated with minimal intersex expression. Exposure to a predicted river concentration of 0.4 ng/L E2 equivalents, the environmental quality standard (EQS) proposed by the European Union for estradiol, was associated with 34% (95% CI:30-38) intersex incidence and a very low severity score of 0.6 (95% CI:0.5-0.7). This exposure is not predicted to cause adverse effects in rainbow darter. The analyses completed in this study were only based on the predicted presence of three major estrogens (E1, E2, EE2), so caution must be exercised when interpreting the results. Nevertheless, this study illustrates the use of models for exposure assessment, especially when measured data are not available.