Early Initiation of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Reduces Length of Stay: A Quality Improvement Project.

Infants born at ≤32weeks gestation are at risk of developmental delays. Review of the literature indicates NIDCAP improves parental satisfaction, minimizes developmental delays, and decreases length of stay, thus reducing cost of hospitalization. Half (50.6%) of the infants admitted to this 84-bed Level IV Neonatal Intensive Care Unit (NICU) with a gestational age of ≤32weeks were referred for NIDCAP. The specific aims of this quality improvement project were to 1) compare the age at discharge for infants meeting inclusion criteria enrolled in NIDCAP with the age at discharge for those eligible infants not enrolled in NIDCAP; and 2) investigate the timing of initiation of NIDCAP (e.g., within six days of admission) on age at discharge. During the 12month period of data collection, infants enrolled in NIDCAP (M=27.85weeks, SD=1.86) were 2.02weeks younger than those not enrolled in NIDCAP (M=29.87weeks, SD=2.49), and were 2.32weeks older at discharge (M=38.28weeks, SD=5.10) than those not enrolled in NIDCAP (M=35.96weeks, SD=5.60). Infants who enrolled within 6days of admission were discharged an average of 25days sooner (p=0.055), and at a younger post-menstrual age (by 3.33weeks on average), than those enrolled later (p=0.027).

Electronic capture and communication of synoptic cancer data elements from pathology reports: results of the Reporting Pathology Protocols 2 (RPP2) project.

Pathology reports represent a rich data source for cancer registries. The College of American Pathologists (CAP) Cancer Checklists present pathology reports in synoptic form and allow registries to be updated electronically. To assess the challenge of employing the CAP Cancer Checklists in pathology laboratories and transmitting that information to cancer registries, we conducted a pilot project: the Reporting Pathology Protocols project (RPP2). The RPP2 project was a multi-year, "proof of concept" demonstration that assessed pathology report-generated data for 3 CAP Cancer Checklists (breast, prostate, and melanoma) in several different cancer registry-pathology laboratory combinations in 3 states. Collaborating pathology laboratories and state cancer registries in California, Maine, and Pennsylvania identified key questions (queries) to address in the course of the project, developed and tested standardized HL7 messaging specifications to link senders and recipients, and then assessed the actual process results using either parallel reporting or retrospective-prospective cases for each tumor type. Successful electronic transfer and capture of pertinent data elements for numerous examples of each tumor type was accomplished in each participating cancer registry/reporting laboratory/information system combination. We noted shortcomings in the electronically encoded CAP Checklists as opposed to text-based reports, particularly for breast cancers. We uncovered opportunities to improve Checklists and the information systems that incorporate them. Workflow, productivity, and timeliness of reporting are areas where electronically encoded reports may enhance cancer registry processes. The accuracy and completeness of electronically encoded data appears largely comparable to text-based data, but subject to the degree of synchrony between the formats of text-based and electronic reports.

Analysis for perfluorocarboxylic acids/anions in surface waters and precipitation using GC--MS and analysis of PFOA from large-volume samples.

The presence of perfluorocarboxylates (PFCAs) in the environment is of increasing concern, following the discovery of perfluoroalkyl acids (PFAs) in wildlife and human samples. Here we report a method forthe determination of (C2-C9) PFCAs by preparing the 2,4-difluoroanilides of the acids and analyzing by using GC-MS. Detector response was linear over the range 0.1 -1000 pg of each perfluoroalkyl anilide. A complete suite of PFCAs can be analyzed in an individual sample with the PFCAs detected at levels similar to or lower than those determined by other methods. For a comparison between the present method and the more common LC-MS/MS method, 10 replicates of a sewage treatment plant discharge were analyzed for perfluoro-octanoic acid (PFOA) using both methods. Results were nearly identical with low standard deviation (GC-MS 30.9 +/- 1.88 ng/L; while the LC-MS/MS 34.7 +/- 3.05 ng/L). PFCA concentrations for water samples collected from depth profiles in mid-Lake Ontario were analyzed by GC-MS with most PFCAs (C2-C8) present above the detection limit (0.5 ng/L). Major PFCAs were trifluoroacetate (TFA) (100 ng/L) and perfluorobutanoate (PFBA) (> 5 ng/L). Results for PFOA (2.5 ng/L) were in good agreement with recent analyses by LC-MS/MS. PFCAs were also detected in the precipitation samples at concentrations lower than those of the samples from the lake profiles or sewage treatment plants (STPs) effluent. Since PFOA levels may be less than the lower detection limit (<0.5 ng/L) in 1 L samples, a method for large volumes using XAD-7 resin was developed that allows detection to 0.01 ng/L. This method was applied to Lake Superior samples which produced good agreement for C6-C9 PFCAs between regular analysis (GC-MS) and the XAD-7 followed by GC-MS analysis.

Occurrence and persistence of perfluorooctanesulfonate and other perfluorinated surfactants in groundwater at a fire-training area at Wurtsmith Air Force Base, Michigan, USA.

Various formulations of fire-extinguishing materials, including aqueous film-forming foams (AFFFs), were used as part of fire-training exercises conducted at Wurtsmith Air Force Base (WAFB) in northeastern Michigan from the 1950s until the base was decommissioned in 1993. As a result of past fire-training exercises, AFFF-laden wastewater containing fuels, solvents, and other materials directly entered groundwater without prior treatment. Perfluorinated surfactants are key components in some AFFF formulations. In this study, groundwater was analyzed for perfluoroalkanesulfonates and perfluorocarboxylates. Perfluoroalkanesulfonates were directly detected using negative-ion electrospray ionization mass spectrometry. Derivatized perfluorocarboxylates were detected using electron impact gas chromatography-mass spectrometry. Groundwater from wells around fire-training area FTA-02 at WAFB contained four perfluorinated surfactants ranging in concentration from 3 to 120 microg L(-1): perfluorooctanesulfonate (PFOS); perfluorohexanesulfonate; perfluorooctanoate; and perfluorohexanoate. This is the first report demonstrating that PFOS, recently shown to be toxic to organisms ranging from zooplankton to primates, is still present in groundwater in measurable quantities five or more years after its last known use.

Monitoring perfluorinated surfactants in biota and surface water samples following an accidental release of fire-fighting foam into Etobicoke Creek.

Perfluorinated surfactants have emerged as priority environmental contaminants due to recent reports of their detection in environmental and biological matrices as well as concerns regarding their persistence and toxicity. In June 2000, 22000 L of fire retardant foam containing perfluorinated surfactants was accidentally released at L. B. Pearson International Airport, Toronto, ON, and subsequently entered into Etobicoke Creek, a tributary to Lake Ontario. A suite of analytical tools that include liquid chromatography/tandem mass spectrometry (LC/MS/MS) and 19F NMR were employed to characterize fish (common shiner, Notropus cornutus) and surface water samples collected following the discharge of the perfluorinated material. Total perfluoroalkanesulfonate (4, 6, and 8 carbons) concentrations in fish liver samples ranged from 2.00 to 72.9 microg/g, and total perfluorocarboxylate (5-14 carbons) concentrations ranged from 0.07 to 1.02 microg/g. In addition to fish samples, total perfluoroalkanesulfonate (6 and 8 carbons) concentrations were detected in creek water samples by LC/MS/MS over a 153 day sampling period with concentrations ranging from <0.017 to 2260 microg/L; perfluorooctanoate concentrations (<0.009-11.3 microg/L) were lower than those observed for the perfluoroalkane-sulfonates. By 19F NMR, the total perfluorinated surfactant concentrations in surface water samples ranged from < 10 to 17000 microg/L. A bioaccumulation factor range of 6300-125000 was calculated for perfluorooctanesulfonate, based on concentrations in fish liver and surface water. The residence time of perfluorooctanesulfonate in Etobicoke Creek as well as the high bioaccumulation in fish liver suggests that perfluorinated surfactants will persist and bioaccumulate following release into the aquatic environment.

Collection of airborne fluorinated organics and analysis by gas chromatography/chemical ionization mass spectrometry.

The ubiquitous detection of perfluorooctane sulfonate (PFOS) in humans and animals has produced a need for sensitive and compound-specific analytical methods to determine the environmental distribution of fluorinated organic contaminants. A suite of potential PFOS precursors (sulfonamides) and fluorotelomer alcohols (FTOHs) were separated by gas chromatography and detected by chemical ionization mass spectrometry (GC/CI-MS). Full-scan spectra were collected in both positive and negative chemical ionization (PCI and NCI, respectively) mode to determine retention time windows and fragmentation patterns. In selected ion monitoring (SIM) mode, instrumental detection limits ranged from 0.2 to 20 pg for individual analytes, depending on ionization mode. PCI mode was preferred for routine analysis because of the simple mass spectra produced, typified by the presence of a major molecular ion [M + H]+. High-volume air samplers collected gaseous and particle-bound fluoroorganics on composite media consisting of XAD-2, polyurethane foam (PUF), and quartz-fiber filters. The combined collection efficiency for individual analytes was 87 to 136% in breakthrough experiments. Application of the method to the analysis of ambient air from urban and rural sites confirmed the presence of six novel fluorinated atmospheric contaminants at picogram per meter3 concentrations. Low concentrations of fluoroorganics were consistently detected in blanks (<4 pg m(-3)); however, this did not prevent confirmation or quantification of environmental concentrations.