"The communication and support from the health professional is incredibly important": A qualitative study exploring the processes and practices that support parental decision-making about postmortem examination.

BACKGROUND: Consent rates for postmortem (PM) examination in the perinatal and paediatric setting have dropped significantly in the United Kingdom, the United States, and the Western Europe. We explored the factors that act as facilitators or barriers to consent and identified processes and practices that support parental decision-making. METHODS: A qualitative study conducted with bereaved parents, parent advocates, and health care professionals in the United Kingdom. Analysis was conducted on 439 free-tect comments within a cross-sectional survey, interviews with a subset of 20 survey respondents and 25 health professionals, and a focus group with five parent advocates. RESULTS: Three broad parental decision-making groups were identified: 1, "Not open to postmortem examination"; 2, "Consent regardless of concerns"; and 3, "Initially undecided." Decisional drivers that were particularly important for this "undecided" group were "the initial approach," "adjustment and deliberation," "detailed discussion about the procedure," and "formal consent." The way in which these were managed by health care staff significantly impacted whether those parents' consented to PM, particularly for those who are ambivalent about the procedure. CONCLUSIONS: We propose a set of recommendations to improve the way PM counselling and consent is managed. Adopting such measures is likely to lead to improved family experience and more consistent and high-quality discussion regarding PM.

Influence of a chlor-alkali superfund site on mercury bioaccumulation in periphyton and low-trophic level fauna.

In Berlin, New Hampshire, USA, the Androscoggin River flows adjacent to a former chlor-alkali facility that is a US Environmental Protection Agency Superfund site and source of mercury (Hg) to the river. The present study was conducted to determine the fate and bioaccumulation of methylmercury (MeHg) to lower trophic-level taxa in the river. Surface sediment directly adjacent to the source showed significantly elevated MeHg (10-40× increase, mean ± standard deviation [SD]: 20.1 ± 24.8 ng g(-1) dry wt) and total mercury (THg; 10-30× increase, mean ± SD: 2045 ± 2669 ng g(-1) dry wt) compared with all other reaches, with sediment THg and MeHg from downstream reaches elevated (3-7× on average) relative to the reference (THg mean ± SD: 33.5 ± 9.33 ng g(-1) dry wt; MeHg mean ± SD: 0.52 ± 0.21 ng g(-1) dry wt). Water column THg concentrations adjacent to the point source for both particulate (0.23 ng L(-1)) and dissolved (0.76 ng L(-1)) fractions were 5-fold higher than at the reference sites, and 2-fold to 5-fold higher than downstream. Methylmercury production potential of periphyton material was highest (2-9 ng g(-1) d(-1) dry wt) adjacent to the Superfund site; other reaches were close to or below reporting limits (0. 1 ng g(-1) d(-1) dry wt). Total Hg and MeHg bioaccumulation in fauna was variable across sites and taxa, with no clear spatial patterns downstream of the contamination source. Crayfish, mayflies, and shiners showed a weak positive relationship with porewater MeHg concentration.

Effects of urbanization on mercury deposition and accumulation in New England.

We compare total mercury (HgT) loading and methylmercury (MeHg) accumulation in streams and lakes from an urbanized area (Boston, Massachusetts) to rural regions of southern New Hampshire and Maine. The maximum HgT loading, as indicated by HgT atmospheric deposition, HgT emissions, and sediment HgT concentrations, did not coincide with maximum MeHg concentrations in fish. Urbanized ecosystems were areas of high HgT loading but had low MeHg concentrations in fish. Controls on MeHg production and accumulation appeared to be related primarily to HgT loading in undeveloped areas, while ecosystem sensitivity to MeHg formation appeared to be more important in regulating accumulation of MeHg in the urban area.

Streamwater fluxes of total mercury and methylmercury into and out of Lake Champlain.

From 2000 to 2004, we sampled for total mercury (THg) and methylmercury (MeHg) in inlet streams to Lake Champlain, targeting high flow periods to capture increases in THg and MeHg concentrations with increasing flow. We used these data to model stream THg and MeHg fluxes for Water Years 2001 through 2009. In this mountainous forested basin with a high watershed-to-lake area ratio of 18, fluvial export from the terrestrial watershed was the dominant source of Hg to the lake. Unfiltered THg and MeHg fluxes were dominated by the particulate fraction; about 40% of stream THg was in the filtered (<0.4 µm) phase. THg flux from the watershed to the lake averaged 2.37 µg m(-2) yr(-1), or about 13% of atmospheric Hg wet and dry deposition to the basin. THg export from the lake represented only about 3% of atmospheric Hg input to the basin.

Mercury in the pelagic food web of Lake Champlain.

Lake Champlain continues to experience mercury contamination resulting in public advisories to limit human consumption of top trophic level fish such as walleye. Prior research suggested that mercury levels in biota could be modified by differences in ecosystem productivity as well as mercury loadings. We investigated relationships between mercury in different trophic levels in Lake Champlain. We measured inorganic and methyl mercury in water, seston, and two size fractions of zooplankton from 13 sites representing a range of nutrient loading conditions and productivity. Biomass varied significantly across lake segments in all measured ecosystem compartments in response to significant differences in nutrient levels. Local environmental factors such as alkalinity influenced the partitioning of mercury between water and seston. Mercury incorporation into biota was influenced by the biomass and mercury content of different ecosystem strata. Pelagic fish tissue mercury was a function of fish length and the size of the mercury pool associated with large zooplankton. We used these observations to parameterize a model of mercury transfers in the Lake Champlain food web that accounts for ecosystem productivity effects. Simulations using the mercury trophic transfer model suggest that reductions of 25-75% in summertime dissolved eplimnetic total mercury will likely allow fish tissue mercury concentrations to drop to the target level of 0.3 µg g(-1) in a 40-cm fish in all lake segments. Changes in nutrient loading and ecosystem productivity in eutrophic segments may delay any response to reduced dissolved mercury and may result in increases in fish tissue mercury.

Mercury trends in fish from rivers and lakes in the United States, 1969-2005.

A national dataset on concentrations of mercury in fish, compiled mainly from state and federal monitoring programs, was used to evaluate trends in mercury (Hg) in fish from US rivers and lakes. Trends were analyzed on data aggregated by site and by state, using samples of the same fish species and tissue type, and using fish of similar lengths. Site-based trends were evaluated from 1969 to 2005, but focused on a subset of the data from 1969 to 1987. Data aggregated by state were used to evaluate trends in fish Hg concentrations from 1988 to 2005. In addition, the most recent Hg fish data (1996-2005) were compared to wet Hg deposition data from the Mercury Deposition Network (MDN) over the same period. Downward trends in Hg concentrations in fish from data collected during 1969-1987 exceeded upward trends by a ratio of 6 to 1. Declining Hg accumulation rates in sediment and peat cores reported by many studies during the 1970s and 1980s correspond with the period when the most downward trends in fish Hg concentrations occurred. Downward Hg trends in both sediment cores and fish were also consistent with the implementation of stricter regulatory controls of direct releases of Hg to the atmosphere and surface waters during the same period. The southeastern USA had more upward Hg trends in fish than other regions for both site and state aggregated data. Upward Hg trends in fish from the southeastern USA were associated with increases in wet deposition in the region and may be attributed to a greater influence of global atmospheric Hg emissions in the southeastern USA. No significant trends were found in 62% of the fish species from six states from 1996 to 2005. A lack of Hg trends in fish in the more recent data was consistent with the lack of trends in wet Hg deposition at MDN sites and with relatively constant global emissions during the same time period. Although few significant trends were observed in the more recent Hg concentrations in fish, it is anticipated that Hg concentrations in fish will respond to changes in atmospheric Hg deposition, however, the magnitude and timing of the response is uncertain.

Ultraviolet absorbance as a proxy for total dissolved mercury in streams.

Stream water samples were collected over a range of hydrologic and seasonal conditions at three forested watersheds in the northeastern USA. Samples were analyzed for dissolved total mercury (THg(d)), DOC concentration and DOC composition, and UV(254) absorbance across the three sites over different seasons and flow conditions. Pooling data from all sites, we found a strong positive correlation of THg(d) to DOC (r(2)=0.87), but progressively stronger correlations of THg(d) with the hydrophobic acid fraction (HPOA) of DOC (r(2)=0.91) and with UV(254) absorbance (r(2)=0.92). The strength of the UV(254) absorbance-THg(d) relationship suggests that optical properties associated with dissolved organic matter may be excellent proxies for THg(d) concentration in these streams. Ease of sample collection and analysis, the potential application of in-situ optical sensors, and the possibility for intensive monitoring over the hydrograph make this an effective, inexpensive approach to estimate THg(d) flux in drainage waters.

Comparison of total mercury and methylmercury cycling at five sites using the small watershed approach.

The small watershed approach is well-suited but underutilized in mercury research. We applied the small watershed approach to investigate total mercury (THg) and methylmercury (MeHg) dynamics in streamwater at the five diverse forested headwater catchments of the US Geological Survey Water, Energy, and Biogeochemical Budgets (WEBB) program. At all sites, baseflow THg was generally less than 1ng L(-1) and MeHg was less than 0.2ng L(-1). THg and MeHg concentrations increased with streamflow, so export was primarily episodic. At three sites, THg and MeHg concentration and export were dominated by the particulate fraction in association with POC at high flows, with maximum THg (MeHg) concentrations of 94 (2.56)ng L(-1) at Sleepers River, Vermont; 112 (0.75)ng L(-1) at Rio Icacos, Puerto Rico; and 55 (0.80)ng L(-1) at Panola Mt., Georgia. Filtered (<0.7microm) THg increased more modestly with flow in association with the hydrophobic acid fraction (HPOA) of DOC, with maximum filtered THg concentrations near 5ng L(-1) at both Sleepers and Icacos. At Andrews Creek, Colorado, THg export was also episodic but was dominated by filtered THg, as POC concentrations were low. MeHg typically tracked THg so that each site had a fairly constant MeHg/THg ratio, which ranged from near zero at Andrews to 15% at the low-relief, groundwater-dominated Allequash Creek, Wisconsin. Allequash was the only site with filtered MeHg consistently above detection, and the filtered fraction dominated both THg and MeHg. Relative to inputs in wet deposition, watershed retention of THg (minus any subsequent volatilization) was 96.6% at Allequash, 60% at Sleepers, and 83% at Andrews. Icacos had a net export of THg, possibly due to historic gold mining or frequent disturbance from landslides. Quantification and interpretation of Hg dynamics was facilitated by the small watershed approach with emphasis on event sampling.

Helping bereaved children and parents.

When a child dies, or is bereaved of a parent or sibling, it changes a family for ever. Grief affects different family members in different ways and may prevent them from supporting one another effectively. An understanding and well informed approach from health professionals can help the family manage their grief and adjust to their new life without the person who has died.

Estimation and mapping of wet and dry mercury deposition across northeastern North America.

Whereas many ecosystem characteristics and processes influence mercury accumulation in higher trophic-level organisms, the mercury flux from the atmosphere to a lake and its watershed is a likely factor in potential risk to biota. Atmospheric deposition clearly affects mercury accumulation in soils and lake sediments. Thus, knowledge of spatial patterns in atmospheric deposition may provide information for assessing the relative risk for ecosystems to exhibit excessive biotic mercury contamination. Atmospheric mercury concentrations in aerosol, vapor, and liquid phases from four observation networks were used to estimate regional surface concentration fields. Statistical models were developed to relate sparsely measured mercury vapor and aerosol concentrations to the more commonly measured mercury concentration in precipitation. High spatial resolution deposition velocities for different phases (precipitation, cloud droplets, aerosols, and reactive gaseous mercury (RGM)) were computed using inferential models. An empirical model was developed to estimate gaseous elemental mercury (GEM) deposition. Spatial patterns of estimated total mercury deposition were complex. Generally, deposition was higher in the southwest and lower in the northeast. Elevation, land cover, and proximity to urban areas modified the general pattern. The estimated net GEM and RGM fluxes were each greater than or equal to wet deposition in many areas. Mercury assimilation by plant foliage may provide a substantial input of methyl-mercury (MeHg) to ecosystems.

Factors influencing mercury in freshwater surface sediments of northeastern North America.

We report on an inventory and analysis of sediment mercury (Hg) concentrations from 579 sites across northeastern North America. Sediment Hg concentrations ranged from the limit of detection ca. 0.01-3.7 microg g(-1) (dry weight, d.w.), and the average concentration was 0.19 microg g(-1) (d.w.) Sediment methylmercury concentrations ranged from 0.15 to 21 ng g(-1) (d.w.) and the mean concentration was 3.83 ng g(-1) (d.w.). Total Hg concentrations (HgT) were greatest in lakes > reservoirs > rivers, although the proportion of Hg as methylmercury showed an inverse pattern. Total Hg was weakly and positively correlated with the sediment organic matter and percent of watershed as forested land, and weakly and negatively correlated with sediment solids content, drainage area, and agricultural land. Sediment methylmercury concentrations were weakly and positively correlated to wetland area, and weakly and negatively correlated to drainage area. Methylmercury, expressed as a percentage of HgT was positively correlated to agricultural land area. For sites with co-located sediment and fish-tissue sampling results, there was no relationship between sediment Hg and fish-tissue Hg. Finally, our data indicate that at least 44% of waters across the region have sediment HgT concentrations in excess of Canadian and United States minimum sediment contaminant guidelines for the protection of aquatic biota.

Distribution patterns of mercury in lakes and rivers of northeastern North America.

We assembled 831 data points for total mercury (Hg(t)) and 277 overlapping points for methyl mercury (CH3Hg+) in surface waters from Massachussetts, USA to the Island of Newfoundland, Canada from State, Provincial, and Federal government databases. These geographically indexed values were used to determine: (a) if large-scale spatial distribution patterns existed and (b) whether there were significant relationships between the two main forms of aquatic Hg as well as with total organic carbon (TOC), a well know complexer of metals. We analyzed the catchments where samples were collected using a Geographical Information System (GIS) approach, calculating catchment sizes, mean slope, and mean wetness index. Our results show two main spatial distribution patterns. We detected loci of high Hg(t) values near urbanized regions of Boston MA and Portland ME. However, except for one unexplained exception, the highest Hg(t) and CH3Hg+ concentrations were located in regions far from obvious point sources. These correlated to topographically flat (and thus wet) areas that we relate to wetland abundances. We show that aquatic Hg(t) and CH3Hg+ concentrations are generally well correlated with TOC and with each other. Over the region, CH3Hg+ concentrations are typically approximately 15% of Hg(t). There is an exception in the Boston region where CH3Hg+ is low compared to the high Hg(t) values. This is probably due to the proximity of point sources of inorganic Hg and a lack of wetlands. We also attempted to predict Hg concentrations in water with statistical models using catchment features as variables. We were only able to produce statistically significant predictive models in some parts of regions due to the lack of suitable digital information, and because data ranges in some regions were too narrow for meaningful regression analyses.

Physical controls on total and methylmercury concentrations in streams and lakes of the northeastern USA.

The physical factors controlling total mercury (HgT) and methylmercury (MeHg) concentrations in lakes and streams of northeastern USA were assessed in a regional data set containing 693 HgT and 385 corresponding MeHg concentrations in surface waters. Multiple regression models using watershed characteristics and climatic variables explained 38% or less of the variance in HgT and MeHg. Land cover percentages and soil permeability generally provided modest predictive power. Percent wetlands alone explained 19% of the variance in MeHg in streams at low-flow, and it was the only significant (p < 0.02) predictor for MeHg in lakes, albeit explaining only 7% of the variance. When stream discharge was added as a variable it became the dominant predictor for HgT in streams, improving the model r2 from 0.19 to 0.38. Stream discharge improved the MeHg model more modestly, from r2 of 0.25 to 0.33. Methylation efficiency (MeHg/HgT) was modeled well (r2 of 0.78) when a seasonal term was incorporated (sine wave with annual period). Physical models explained 18% of the variance in fish Hg concentrations in 134 lakes and 55% in 20 reservoirs. Our results highlight the important role of seasonality and short-term hydrologic changes to the delivery of Hg to water bodies.