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1.
Chemosphere ; 351: 141126, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38184081

RESUMO

Shortly after their production ban PBDE environmental levels retreated from their peak (circa 2000), but rates of decrease appear to be slowing. Therefore, to update environmental PBDE trends, this study re-examined a U.S. riverine system found in 1999 to have the highest PBDE fish tissue (fillet) burdens in the world. Archived 2018-2020 fish tissues were analyzed for PBDEs and results compared to 1999-2000 and 2007 levels. On a positive note, levels decreased by >75% over 20 years. However, PBDEs were still detectable at each collection site (n = 16) and in 93% of the samples. The highest PBDE level (16,300 ng g-1 lipid weight) was observed in fish from the Dan R., downstream from the Hyco R. (where the world's highest level was previously reported). Levels within Hyco R. fish have declined at an annual rate of 30% through 2007. However, reductions during the subsequent 12 years have diminished to only 1.2%. Fillet levels since 2007 actually increased at an estimated annual rate of 8% immediately downstream from the Hyco R. Congener profiles varied between species, likely due to hepatic enzyme debromination, indicating single congener-based health risk evaluations may not be sufficiently protective. Within North America, PBDE fish levels in this freshwater system were twice those of North America's Great Lakes and exceeded by 10-fold those in carp examined from Illinois, USA., another historical hotspot. Average fish PBDE levels also exceed maxima observed in European and Asian riverine systems and were 1000's of times higher than the environmental quality standard (EQS) set by European Parliament (0.0085 ng g-1 wet weight, aquatic biota). Therefore, to protect human health and the environment, PBDE monitoring should remain a priority for regulatory agencies with the goal to identify and eliminate their source and to consider their potential health impacts in the context of other co-existing (emerging and legacy) contaminants.


Assuntos
Monitoramento Ambiental , Éteres Difenil Halogenados , Animais , Humanos , Éteres Difenil Halogenados/análise , Peixes , Lagos
2.
Brain Inj ; 38(4): 267-272, 2024 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-38294172

RESUMO

OBJECTIVE: The lack of objective prognostication tools for severe traumatic brain injury (TBI) causes variability in the application of withdrawal of life-saving treatment (WLST). We aimed to determine whether WLST in persons with severe TBI is associated with known indicators of poor prognosis. METHODS: This retrospective descriptive study focused on adult (18-64 years) and geriatric (≥65 years) patients with severe TBI who were admitted between August 1, 2018 and July 31, 2021 at a Level I trauma center and subsequently underwent WLST. The data collected from the Trauma Registry and electronic health records included information regarding demographic characteristics, injury severity, clinical variables, and length of hospital stay and were used to examine the indicators of poor prognosis and WLST. RESULTS: Among the 164 participants with TBI who met the inclusion criteria, 61.0% were geriatric, and 122 (74.4%) patients had 0 or only 1 of the poor prognostic indicators prior to WLST. The non-geriatric group had more indicators of poor prognosis than the geriatric group. Participants with fewer indicators of poor prognosis had a longer length-of-stay. CONCLUSION: In severe TBI cases, standardized prognostication tools can help guide informed WLST decisions, particularly in geriatric patients, improving care consistency.


Assuntos
Lesões Encefálicas Traumáticas , Suspensão de Tratamento , Idoso , Adulto , Humanos , Estudos Retrospectivos , Lesões Encefálicas Traumáticas/terapia , Prognóstico , Tempo de Internação
3.
J Intensive Care Med ; 39(4): 320-327, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37812739

RESUMO

INTRODUCTION: The Fundamental Critical Care Support Course (FCCS) is a standardized multidisciplinary program designed to educate participants on the basics of identification and management of patients with critical illness. Our objective was to evaluate the effect of FCCS participation on confidence in the assessment and management of critically ill patients and attitudes towards multidisciplinary education and interprofessional care in a multidisciplinary group of participants. METHODS: Participants enrolled in the FCCS course from May 2018 to November 2019 were solicited to participate in a series of surveys evaluating their course experience and confidence in critical care. Attitudes towards multidisciplinary education and interprofessional care were evaluated using the Student Perceptions of Interprofessional Clinical Education-Revised Instrument version 2 (SPICE-R2) tool. A prospective pre- and post-design with a self-report survey including retrospective pre-training assessment and a 3-month follow-up was conducted. Statistical analysis was performed using descriptive statics and non-parametric methods. RESULTS: 321 (97.9%) of the course participants enrolled in the study and completed the confidence survey and SPICE-R2 tool pre-course. Nurses (113, 35.4%) and physicians (110, 34.4%) made up the largest groups of participants, although physician assistants and paramedics were also well represented. Confidence in recognition and management of critical illness significantly improved across all studied domains after course completion, with the mean total confidence score improving from 32.96 pre-course to 41.10 post-course, P < 0.001. Attitudes towards multidisciplinary education and interprofessional care also improved (mean score 41.37 pre-course vs 42.71 post-course, P < 0.001), although pre-course numbers were higher than expected which limited the significance to only certain domains. DISCUSSION: In a multidisciplinary group, completion of FCCS training led to increased confidence in all aspects of critical illness measured. A modest increase in attitudes regarding multidisciplinary education and interprofessional care was also demonstrated. Further study is needed to assess whether this increased confidence translates to improvements in patient care and outcomes.


Assuntos
Estado Terminal , Educação Interprofissional , Humanos , Estado Terminal/terapia , Estudos Prospectivos , Estudos Retrospectivos , Atitude do Pessoal de Saúde , Cuidados Críticos
4.
Environ Monit Assess ; 195(12): 1462, 2023 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-37955762

RESUMO

Crassostrea virginica is a well-established bivalve species for biomonitoring persistent organic pollutants such as polycyclic aromatic hydrocarbons (PAH) in aquatic environments. Differing biomonitoring methods employing either wild oysters inhabiting sites of interest or naïve cultured oysters deployed to sites for extended periods can be used for site evaluations. However, important differences in total contaminant concentrations accumulated have been observed between the wild and transplanted groups. Furthermore, although rearing cultured triploid oysters is widely popular in commercial farming, the difference in contaminant bioaccumulation potential between triploid and diploid cultured oysters is vastly understudied, particularly for organic contaminants such as PAH. This study explores differences in PAH kinetics between transplanted triploid and diploid cultured oysters and wild oysters at a PAH-impacted site during a 6-week field exposure study using novel immunological techniques: antibody-based biosensor technology and immunofluorescence visualization. Conventional chemical analysis of oyster tissue was also conducted for comparison. While differences were observed in the oyster interstitial fluid between the wild and transplanted oysters throughout the study, whole tissue analysis revealed differing trends at each time point. Our findings suggest that insufficient equilibration time may contribute to the differences observed between groups. Furthermore, when combined with visual evidence via immunofluorescence, internal partitioning of contaminants may be an important determinant for total concentrations measured. A better understanding of the differences observed between wild and transplanted oyster groups is necessary for improved biomonitoring. Our study highlights the value in employing novel immunological techniques to explore possible mechanisms driving these differences.


Assuntos
Ostreidae , Triploidia , Animais , Diploide , Monitoramento Ambiental , Técnicas Imunológicas
5.
Am J Infect Control ; 51(6): 644-651, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36116678

RESUMO

BACKGROUND: External ventricular drain (EVD)-associated infections have a negative impact on healthcare cost and patient outcomes. Practice variation in EVD management may place patients at increased risk for EVD-associated infection. This project aimed to evaluate the impact of implementing an interprofessional evidence-based EVD bundle of care on reduction of EVD-related ventriculitis rates. METHODS: An interprofessional team developed an evidence based EVD care bundle and order set to eliminate practice inconsistencies. Standardization of EVD equipment and optimization of the electronic health record occurred. Education and competency validation were completed with neurosurgical providers and nurses. Interprofessional rounds occur weekly for observation, recognition, and in-the-moment education. RESULTS: A pre/post intervention design was used to show that the rate of EVD-associated ventriculitis decreased from 8.8 per reported EVD days in 2019 to 0 per reported EVD days in 2021 after implementation of the EVD care bundle. CONCLUSION: Through an interprofessional team approach, reduction in EVD-associated infection rates is feasible with implementation of an evidence based EVD care bundle.


Assuntos
Infecções Relacionadas a Cateter , Ventriculite Cerebral , Humanos , Ventriculite Cerebral/epidemiologia , Ventriculite Cerebral/prevenção & controle , Ventriculite Cerebral/etiologia , Infecções Relacionadas a Cateter/etiologia , Centros de Traumatologia , Estudos Retrospectivos , Drenagem/efeitos adversos
6.
Artigo em Inglês | MEDLINE | ID: mdl-36204483

RESUMO

Conventional PAH analytical methods are time-consuming and expensive, limiting their utility in time sensitive events (i.e. oil spills and floods) or for widespread environmental monitoring. Unreliable and inefficient screening methods intended to prioritize samples for more extensive analyses exacerbate the issue. Antibody-based biosensor technology was implemented as a quantitative screening method to measure total PAH concentration in adult oysters (Crassostrea virginica) - a well-known bioindicator species with ecological and commercial significance. Individual oysters were analyzed throughout the historically polluted Elizabeth River watershed (Virginia, USA). Significant positive association was observed between biosensor and GC-MS measurements that persisted when the method was calibrated for different regulatory subsets of PAHs. Mapping of PAH concentrations in oysters throughout the watershed demonstrates the utility of this technology for environmental monitoring. Through a novel extension of equilibrium partitioning, biosensor technology shows promise as a cost-effective analysis to rapidly predict whole animal exposure to better assess human health risk as well as improve monitoring efforts.

7.
J Trauma Nurs ; 26(1): 33-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30624380

RESUMO

Decreasing hospital lengths of stay increases the burden on trauma patients after discharge. Our hypothesis was that a discharge callback protocol would decrease readmission rates. A retrospective quality improvement study evaluated all trauma patients admitted from 2012 to 2016 at a Level I trauma center. A postdischarge callback protocol was implemented in 2014, with a mature protocol in place in 2015. The precall and callback groups were compared regarding demographics, injury severity, and trauma readmission. Callback data included length of call, unsolicited patient comments, and education provided. Chi-square and Fisher's exact tests were used to compare categorical variables, whereas an independent-samples t test was used to compare continuous data. The precall program group included 4,470 admissions, and the call program group included 4,647 admissions. The precall program group had a higher injury severity score (ISS; 11.7 vs. 10.3; p < .001) and fewer males (62% vs. 65%, p = .002). In the call program group, there was a significant decrease in readmission rates (1.42% vs. 0.81%; p = .04). Patients with an unplanned readmission had a higher ISS (14.9 vs. 11.0, p < .01), a longer mean hospital length of stay during initial admission (9.3 days vs. 4.8 days, p < .01), and were more often discharged to locations with medical oversight (37.4% vs. 26.7%, p = .03). Of the patients in the call program group, 27.9% were reached. An average of 5.8 ± 2.9 min per call was calculated, equating to a 0.2 full-time equivalent. A discharge callback program for approximately 2,500 trauma patients per year leads to fewer readmissions, which financially supports the callback position.


Assuntos
Continuidade da Assistência ao Paciente , Readmissão do Paciente , Sistemas de Alerta , Ferimentos e Lesões/enfermagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Centros de Traumatologia , Virginia , Adulto Jovem
8.
Sci Total Environ ; 646: 58-67, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30048869

RESUMO

e-Waste recycling using crude techniques releases a complex, yet incompletely characterized mixture of hazardous materials, including flame retardants (FRs), to the environment. Their migration downstream and the associated risks also remain undocumented. We examined 26 FRs (18 brominated (BFRs: 12 polybrominated diphenyl ether (PBDE) congeners, plus 6 alternatives) and 8 organophosphate esters (OPEs)) in surficial sediments of the Lian River. Sampling encompassed the river's origin, through the Guiyu e-waste recycling zone, to its mouth, as well as associated tributaries. OPE exceeded BFR concentrations in most sediments, despite their far greater water solubilities. Among OPEs, tris(1-chloro-2-propyl) phosphate dominated upstream, but shifted to triphenyl phosphate in Guiyu and downstream sediments. For PBDEs, Deca-BDE dominated upstream, but Penta-BDE prevailed in Guiyu and at many downstream sites. Among emerging alternative BFRs, decabromodiphenyl ethane dominated upstream, transitioning to 1,2-bis(2,4,6,-tribromophenoxy)ethane in Guiyu sediments. Penta-BDE (BDE-47 + -99, 668-204,000 ng g-1, ∑PBDEs 2280-287,000 ng g-1), tetrabromobisphenol A (2,720-41,200 ng g-1), 1,2-bis(2,4,6,-tribromophenoxy)ethane (222-9870 ng g-1) and triphenyl phosphate (4260-1,710,000 ng g-1, OPEs 6010-2,120,000 ng g-1) concentrations in Guiyu sediments were among the highest reported in the world to date. The continuing dominance of these e-waste indicative FRs in sediments downstream of Guiyu suggested that FR migration from Guiyu occurred. Hazard quotients >1.0 indicated that the extreme sediment concentrations of individual FRs posed ecological risks in most Guiyu reach and downstream areas. Simultaneous exposure to multiple FRs likely increased risks. However, risks may be mediated if FRs were associated with strong sorbents, e.g. carbon black from burned debris, hydrophobic polymer fragments, or resided as additives within polymer fragments.

9.
Crit Care Nurse ; 39(6): 37-45, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31961935

RESUMO

Direct peritoneal resuscitation is a validated resuscitation strategy for patients undergoing damage control surgery for hemorrhage, sepsis, or abdominal compartment syndrome with open abdomen and planned reexploration after a period of resuscitation in the intensive care unit. Direct peritoneal resuscitation can decrease visceral edema, normalize body water ratios, accelerate primary abdominal wall closure after damage control surgery, and prevent complications associated with open abdomen. This review article describes the physiological benefits of direct peritoneal resuscitation, how this technique fits within management priorities for the patient in shock, and procedural components in the care of open abdomen surgical patients receiving direct peritoneal resuscitation. Strategies for successful implementation of a novel multidisciplinary intervention in critical care practice are explored.


Assuntos
Traumatismos Abdominais/cirurgia , Laparotomia/efeitos adversos , Laparotomia/métodos , Diálise Peritoneal/normas , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Ressuscitação/normas , Técnicas de Fechamento de Ferimentos Abdominais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
J Emerg Nurs ; 44(1): 19-25, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28629581

RESUMO

PROBLEM: Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. METHODS: Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. RESULTS: Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. IMPLICATIONS FOR PRACTICE: Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential.


Assuntos
Competência Clínica/estatística & dados numéricos , Enfermagem em Emergência/educação , Enfermeiras e Enfermeiros , Avaliação de Programas e Projetos de Saúde/métodos , Ressuscitação/métodos , Centros de Traumatologia , Medicina de Emergência , Humanos , Recursos Humanos de Enfermagem no Hospital/educação , Equipe de Assistência ao Paciente , Segurança do Paciente , Simulação de Paciente , Treinamento por Simulação , Sudeste dos Estados Unidos
11.
Am Surg ; 82(8): 679-84, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27657581

RESUMO

To reduce the risk of catheter-associated urinary tract infection (CAUTI), limiting use of indwelling catheters is encouraged with alternative collection methods and early removal. Adverse effects associated with such practices have not been described. We also determined if CAUTI preventative measures increase the risk of catheter-related complications. We hypothesized that there are complications associated with early removal of indwelling catheters. We described complications associated with indwelling catheterization and intermittent catheterization, and compared complication rates before and after policy updates changed catheterization practices. We performed retrospective cohort analysis of trauma patients admitted between August 1, 2009, and December 31, 2013 who required indwelling catheter. Associations between catheter days and adverse outcomes such as infection, bladder overdistention injury, recatheterization, urinary retention, and patients discharged with indwelling catheter were evaluated. The incidence of CAUTI and the total number of catheter days pre and post policy change were similar. The incidence rate of urinary retention and associated complications has increased since the policy changed. Practices intended to reduce the CAUTI rate are associated with unintended complications, such as urinary retention. Patient safety and quality improvement programs should monitor all complications associated with urinary catheterization practices, not just those that represent financial penalties.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateteres de Demora/efeitos adversos , Cateterismo Urinário/efeitos adversos , Retenção Urinária/epidemiologia , Infecções Urinárias/epidemiologia , Ferimentos e Lesões/terapia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos e Lesões/complicações
12.
J Trauma Nurs ; 23(5): 284-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27618376

RESUMO

The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period. PT consults seen within 24 hr rose from a baseline 23% pre- to 74%-94% in the 2 highest compliance postintervention months. On average, 40% of patients were daily determined to be too unstable for mobility per protocol guidelines-most often owing to elevated intracranial pressure. During PM sessions, there were no adverse events (i.e., extubation, hypoxia, fall). There were no significant differences in clinical outcomes between the 2 cohorts regarding hospital and ICU stays, average ventilator days, mortality, falls, respiratory failure, or pneumonia overall or within ventilated patients specifically. There was, however, a difference in the incidence of VTE between the preintervention cohort (21%) and postintervention cohort (7.5%) (p = .0004). A PM protocol for ICU trauma patients is safe and may reduce patient deconditioning and VTE complications in this high-risk population. Multidisciplinary commitment, daily protocol reinforcement, and active engagement of patients/families are the cornerstones to success in this ICU PM program.


Assuntos
Cuidados Críticos/métodos , Deambulação Precoce/métodos , Melhoria de Qualidade , Tromboembolia Venosa/prevenção & controle , Ferimentos e Lesões/reabilitação , Adulto , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Centros de Traumatologia , Índices de Gravidade do Trauma , Ferimentos e Lesões/diagnóstico , Adulto Jovem
14.
J Trauma Nurs ; 22(2): 78-86, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25768963

RESUMO

The creation of a consistent culture of safety and quality in an intensive care unit is challenging. We applied the Six Sigma Define-Measure-Analyze-Improve-Control (DMAIC) model for quality improvement (QI) to develop a long-term solution to improve outcomes in a high-risk neurotrauma intensive care unit. We sought to reduce central line utilization as a cornerstone in preventing central line-associated bloodstream infections (CLABSIs). This study describes the successful application of the DMAIC model in the creation and implementation of evidence-based quality improvement designed to reduce CLABSIs to below national benchmarks.


Assuntos
Bacteriemia/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Sistema Nervoso Central/lesões , Infecção Hospitalar/prevenção & controle , Unidades de Terapia Intensiva/organização & administração , Ferimentos e Lesões/terapia , Cateterismo Venoso Central/métodos , Cuidados Críticos/organização & administração , Feminino , Humanos , Controle de Infecções/métodos , Masculino , Melhoria de Qualidade , Gestão da Qualidade Total , Estados Unidos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
15.
Bull Environ Contam Toxicol ; 94(1): 23-8, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25236327

RESUMO

Systematic investigation of factors controlling supercritical fluid extraction (SFE) of spiked and naturally incurred (aged) PCBs from edible tissues of the Blue Crab (Callinectes sapidus) was undertaken. Effects of extraction pressure, temperature and time, CO2 flow rate and total volume, and collection temperature were assessed. Temperature dramatically impacted extraction efficiency, especially at lower pressures. Surprisingly, extraction of both spiked and aged PCBs was flow rate dependent, counter to prevailing views regarding the relative ease of SFE of spiked versus aged contaminants from environmental matrices. PCBs were optimally trapped on a 1:1 mixture of C18-modified and porous silica at 0°C and eluted with <2 mL isooctane at 90°C. A combined 10 min static/30 min dynamic extraction at 35.5 MPa and 150°C with a CO2 flow rate of 3 mL min(-1) yielded maximum (quantitative) recoveries of spiked and aged PCBs. Resulting solvent extracts required no cleanup and could be analyzed directly by halogen-selective GC with MS confirmation.


Assuntos
Braquiúros/metabolismo , Monitoramento Ambiental/métodos , Bifenilos Policlorados/química , Animais , Cromatografia com Fluido Supercrítico , Bifenilos Policlorados/metabolismo , Temperatura
16.
Environ Sci Technol ; 48(12): 7034-43, 2014 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-24905849

RESUMO

Few studies have addressed bioaccumulation of organic pollutants associated with land-application of biosolids. We thus examined PBDE burdens within a soil ecosystem receiving long-term sludge amendments and a reference soil ecosystem receiving only manure inputs. No PBDEs were detected in reference site samples, but sludge-amended soils contained 17 600 ± 2330 µg/kg ∑3-7PBDE (total organic carbon (TOC) basis). ∑3-7PBDE burdens were highest in soil invertebrates with the greatest contact with sludge-amended soil (e.g., ∑3-7PBDE of 10 300 ± 2670 and 3000 ± 200 µg/kg lipid for earthworms and detritivorous woodlice, respectively). PBDEs were below quantitation limits in vegetation from the sludge-amended site. Surprisingly, we measured quantifiable PBDE burdens in only a single sample of predaceous ground spiders from the sludge-amended site. BDE-209 burdens in sludge-amended soil and earthworms were 7500 ± 2800 µg/kg TOC and 6500 ± 4100 µg/kg lipid, respectively. BDE 209 was detected in fewer taxa, but the burden in a detritivorous millipede composite was high (86 000 µg/kg lipid). PBDE congener patterns differed among species, with worms and ground beetles exhibiting Penta-BDE-like patterns. Penta-BDE biota-soil accumulation factors (BSAFs) ranged from 0.006 to 1.2, while BDE-209 BSAFs ranged from 0.07 to 10.5. δ(13)C and δ(15)N isotope signatures were poorly correlated with PBDE burdens, but sludge-amended samples were significantly δ(15)N enriched.


Assuntos
Agricultura , Ecossistema , Monitoramento Ambiental , Éteres Difenil Halogenados/análise , Esgotos/química , Solo/química , Águas Residuárias/química , Animais , Artrópodes/química , Isótopos de Carbono , Análise dos Mínimos Quadrados , Isótopos de Nitrogênio , Oligoquetos/química , Plantas/química , Análise de Componente Principal , Poluentes do Solo/análise
17.
J Contin Educ Nurs ; 44(11): 484-5, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24199639

RESUMO

Initial assessment and treatment of critically injured patients is time sensitive, creating a high-stress environment for trauma team members and patients. Effective leadership, communication, and clinical acumen are essential team dynamics for best patient outcomes. Innovative multidisciplinary TeamSTEPPS(®) simulation-based training is an effective model for teams in high-risk health care settings. Use of this simulation model has led to improved trauma team performance and patient outcomes while incorporating new physician and nursing personnel into a time-sensitive, high-stress environment.


Assuntos
Educação Baseada em Competências/métodos , Educação Continuada em Enfermagem/métodos , Enfermagem em Emergência/educação , Equipe de Assistência ao Paciente , Centros de Traumatologia , Humanos
18.
Environ Sci Technol ; 47(23): 13831-9, 2013 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-24160918

RESUMO

Polybrominated diphenyl ether (PBDE) flame retardants have been used in consumer polymers at up to percent levels. While long viewed as biologically inaccessible therein, PBDEs may become bioaccessible following volatilization or polymer deterioration. PBDEs may then enter soils via polymer fragmentation or following land application of sewage sludge-derived biosolids. Studies of direct PBDE uptake from these materials by soil organisms are scarce. We thus exposed earthworms ( Eisenia fetida ) to artificial soil amended with a Class B anaerobically digested biosolid (ADB), an exceptional quality composted biosolid (CB), PBDE-containing polyurethane foam (PUF) microparticles, and Penta-BDE-spiked artificial soil (SAS). Worms accumulated mg/kg (lipid) ∑Penta-PBDE burdens from all substrates. Biota-soil accumulation factors (BSAFs) for worms exposed to ADB- and CB-amended soils were comparable after 28 d. BSAFs generally decreased with increasing congener KOW and substrate dosage. Biosolids-associated PBDE bioavailability was lower than spiked PBDEs. BSAFs for worms exposed to PUF microparticles ranged from 3.9 to 33.4, with ∑Penta-PBDE tissue burdens reaching 3740 mg/kg lipid. Congener accumulation patterns were similar in worms and polyethylene passive sampling devices immersed in ADB-amended soil coincident with exposed worms. However, passive sampler accumulation factors were lower than BSAFs. Our results demonstrate that PBDEs may accumulate in organisms ingesting soils containing biosolids or waste plastics. Such organisms may then transfer their burdens to predators or translocate them from the site of application/disposal.


Assuntos
Monitoramento Ambiental , Oligoquetos/metabolismo , Poliuretanos/química , Esgotos/química , Poluentes do Solo/metabolismo , Solo/química , Animais , Biota , Éteres Difenil Halogenados/metabolismo , Análise dos Mínimos Quadrados , Poluentes do Solo/análise
19.
Environ Sci Technol ; 46(11): 5798-805, 2012 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-22571713

RESUMO

Alternative brominated flame-retardants (BFRs), 2-ethylhexyl 2,3,4,5-tetrabromobenzoate (TBB), 2-ethylhexyl 2,3,4,5-tetrabromophthalate (TBPH), 1,2-bis(2,4,6-tribromophenoxy) ethane (BTBPE) and decabromodiphenyl ethane (DBDPE), are now being detected in the environment. However, contaminant bioavailability is influenced by the organisms' ecology (i.e., route of uptake) and in situ environmental factors. We observed that the filter-feeding bivalve (Corbicula fluminea) and grazing gastropod (Elimia proxima), collected downstream from a textile manufacturing outfall, exhibited TBB, TBPH, and BTBPE concentrations from 152 to 2230 ng g(-1) lipid weight (lw). These species also contained additional BFRs. Maximum levels of total hexabromocyclododecane diastereomers (∑HBCDs) in these species were 363,000 and 151,000 ng g(-1) lw, and those of polybrominated diphenyl ethers (∑PBDEs) were 64,900 and 47,200 ng g(-1) lw, respectively. These concentrations are among the highest reported to date worldwide. While BDE-209 was once thought to be nonbioavailable and resistant to degradation, it was the dominant BFR present and likely debromination products were detected. Contributions of α- and ß-HBCD were higher in tissues than sediments, consistent with γ-HBCD bioisomerization. Mollusk bioaccumulation factors were similar between HBCD and PBDEs with 4 to 6 bromines, but factors for TBB, TBPH, and BTBPE were lower. Despite different feeding strategies, the bivalves and gastropods exhibited similar BFR water and sediment accumulation factors.


Assuntos
Corbicula/metabolismo , Monitoramento Ambiental , Retardadores de Chama/metabolismo , Gastrópodes/metabolismo , Éteres Difenil Halogenados/metabolismo , Hidrocarbonetos Bromados/metabolismo , Animais , Biota , Bromobenzenos/metabolismo , Sedimentos Geológicos/química , North Carolina
20.
Environ Sci Technol ; 46(4): 2055-63, 2012 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-22295899

RESUMO

Polybrominated diphenyl ethers (PBDEs) have been used extensively to flame-retard polymers and textiles. These persistent chemicals enter wastewater streams following manufacture, use, and disposal, concentrating in the settled solids during treatment. Land application of stabilized sewage sludge (known as biosolids) can contribute PBDEs to terrestrial systems. Monitoring sludge/biosolids contaminant burdens may be valuable in revealing trends in societal chemical usage and environmental release. In archived Chicago area sludges/biosolids from 1975 to 2008, penta-BDE concentrations increased and then plateaued after about 2000. Penta-BDE manufacture in the United States ended in December 2004. Deca-BDE concentrations in biosolids rose from 1995 to 2008, doubling on a 5-year interval. Evaluation of U.S. Environmental Protection Agency Targeted National Sewage Sludge Survey data from 2006 to 2007 revealed highest penta-BDE biosolids levels from western and lowest from northeastern wastewater treatment plants (2120 and 1530 µg/kg, respectively), consistent with patterns reported in some recent indoor dust and human blood studies. No significant regional trends were observed for deca-BDE concentrations. Congener patterns in contemporary Chicago biosolids support the contention that BDE-209 can be dehalogenated to less brominated congeners. Biosolids application on agricultural fields increased PBDE soil concentrations. However, corn grown thereon did not exhibit measurable PBDE uptake; perhaps due to low bioavailability of the biosolids-associated flame retardants.


Assuntos
Fertilizantes/análise , Retardadores de Chama/análise , Éteres Difenil Halogenados/análise , Esgotos/análise , Poluentes Químicos da Água/análise , Grão Comestível/metabolismo , Monitoramento Ambiental , Retardadores de Chama/metabolismo , Éteres Difenil Halogenados/metabolismo , Raízes de Plantas/metabolismo , Estados Unidos , Poluentes Químicos da Água/metabolismo , Zea mays/metabolismo
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