Impacts of groundwater dynamics around a macro-tidal river on agricultural soil salinity.

Estuaries are vulnerable to oceanic and atmospheric climate change. Much of the research investigating climate change impacts on estuaries is focused on saltwater intrusion within surface water due to drought and rising sea levels, with implications for ecosystems and humans. Groundwater and soil near estuaries may also be influenced, as estuary salinity and hydraulic head changes can impact soils and aquifers not previously at risk of salinization. This study was conducted to address knowledge gaps related to present and future groundwater salinity distribution in a groundwater system connected to a macro-tidal estuary. The studied estuary experiences a tidal bore due to its hydraulic connection to the Bay of Fundy in Nova Scotia, Canada. A parcel of agricultural land adjacent to the estuary was selected to assess the groundwater response to episodic fluctuations in estuary water levels and salinity. Groundwater monitoring and electromagnetic surveys were conducted to map soil and groundwater salinity patterns. A numerical model of groundwater flow and solute transport informed by field data was used to investigate how varying estuary salinity due to droughts and sea-level rise could impact groundwater salinity. Results showed that, in contrast to salt wedges observed along marine coasts, the saline groundwater existed as a plume immediately around the estuary. Model simulations showed that short-term droughts had an insignificant impact on the adjacent groundwater salinity. However, permanent increases in salinity caused by sea-level rise increased the plume volume by 86 %, or an additional ∼11 m horizontally and âˆ¼ 4.5 m vertically. Our results suggest that increased river salinity in this setting would not result in widespread salinization of porewater and agricultural soils, but more extensive salinization may be experienced in permeable aquifers or along more saline estuarine zones. Findings may inform land management decisions in regions exposed to increased salinity in the future.

Simulating fate and transport of non-steroidal anti-inflammatory drugs using Root Zone Water Quality Model 2.

The fate and transport of non-steroidal anti-inflammatory drugs (NSAIDs) in soil are determined by various processes, and the complexity of the system lends itself to the use of computer simulation models to help understand it. This study demonstrated the first attempt to use empirical data from lab incubation and field studies to parameterize and test a process-based agricultural systems model, Root Zone Water Quality Model 2 (RZWQM2), to simulate the fate and transport of naproxen (NPX), ibuprofen (IBF), and ketoprofen (KTF) in field-based lysimeters amended with alkaline-treated biosolids (ATBs). The model calibrated for the soil-water balance module and contaminant transport module was used to predict water seepage through the soil profile in 2017 and 2018 within a 15% error of the field measured data, with model performance statistics such as Nash-Sutcliffe model efficiency (NSE) and R2 all greater than 0.70. The overall predicted percent recovery of initial spiked NSAIDs in both soil and water samples, after further calibration of the contaminant transport module, was within the same order of magnitude as the measured data. The model underestimated the percent recovery of initial spiked NSAIDs at the 30- to 55-cm soil depth for all treatments on day 3. The calibrated soil subsurface aerobic half-lives of NPX and IBF were found to be considerably lower than their laboratory-measured half-lives obtained from the incubation study. The overall performance of RZWQM2 in simulating the soil hydrology and behavior of NSAIDs in soil profiles receiving various rates of ATB amendments was satisfactory.

Impacts of repeated coastal flooding on soil and groundwater following managed dike realignment.

Coastal defense structures (e.g., dikes, seawalls) protect vulnerable communities along marine coastlines and estuaries from the physical and chemical influences of adjacent water bodies. These structures are susceptible to overtopping or breaching by tides and waves, with risks amplified by climate change-induced sea-level rise. Repeated inundation by saline water can contaminate freshwater resources and salinize soil, impacting land-use activities, including agricultural productivity. Managed ecosystem-based dike realignment and salt marsh restoration can provide alternatives to traditional coastal adaptation approaches. We assess the changes to soil salinity at a managed dike realignment project prior to the transformation from a diked terrestrial environment to an estuarine environment. Baseline data are compared to conditions following 8-10 months of intermittent flooding at spring tides. Results show that an increase in salinity occurred over the entire site in the shallow subsurface, with the most significant contamination occurring in low-lying areas. Bulk soil electrical conductivity (salinity proxy) measured from geophysical surveys increased from the previous freshwater condition of ∼300 µS/cm to over 6000 µS/cm following <20 flood events, while successive flooding resulted in increased soil moisture as infiltrated floodwater propagated to greater depths. Sediment deposition occurred at high rates, with up to 4 cm of sediment deposited per flood, converting much of the previously cultivated land into tidal mudflats. Deeper sediments and groundwater (i.e., >1.8 m depth) were not impacted over the time scale of this research. This study demonstrates that intermittent shallow flooding can rapidly increase moisture content and soil salinity in surficial sediments and, in turn, adversely impact conditions suitable for agricultural crop production. The realignment zone serves as an engineered analog of coastal flooding, presenting an opportunity to investigate how low-lying coastal environments may experience regular flooding in the future due to sea-level rise and intensifying coastal storms.

Application of the paleolimnological method to assess metal contaminant distribution (As, Cu, Pb, Zn) in pulp mill stabilization basin sediments, Nova Scotia, Canada.

The paleolimnological method was used to decouple geogenic and anthropogenic metal (loids) contributions in a sediment stabilization basin (Boat Harbour) located in Nova Scotia, Canada. Boat Harbour has been impacted by industrial effluents discharged by a bleached kraft pulp mill (1967 to 2019) and a chlor-alkali plant (1971 to 1992). The former estuary now contains >577,000 m3 of unconsolidated sediment, impacted by inorganic and organic contaminants, including metal[loid]s, polycyclic aromatic hydrocarbons and polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans. Previous studies indicated significant knowledge gaps in our understanding of the spatial, stratigraphic, and temporal variation of sediment contamination. Twenty-five lakebed sediment gravity cores were obtained between 2016 and 2019 to determine spatiotemporal distribution of sediment As, Cu, Pb, and Zn concentrations which consistently exceeded guidelines for aquatic sediments. Results demonstrate there is no distinct spatial trend in metal concentrations despite point source effluent inputs. High and variable concentrations of Cu and Zn in contaminated sediment likely represent a combination of cation capture by highly organic sediment and influence of pulp mill on lakebed sediment chemistry. Elevated Pb in contaminated sediment is the result of atmospheric deposition from combustion of fossil fuels and bioaccumulation in effluent feedstock. Average sedimentation rate (1 cm every 3 years) is high compared to a nearby freshwater lake and is enhanced by increased nutrient loading and more productive water column conditions associated with effluent introduction. Temporal trends indicate significantly higher concentrations of Zn and Cu in top sediment samples consistent with changes in effluent treatment procedures as well as composition of effluent solids. Comparison of geochemistry of effluent influenced sediment and pre-effluent substate sediment at Boat Harbour to freshwater and marine reference was required to understand the degree to which geogenic and anthropogenic sources of metal(loids) have influenced effluent chemistry. This study demonstrates that undisturbed, time transgressive samples from both impacted sites and reference sites combined with non-destructive, rapid, small sample analytical techniques such as X-ray fluorescence, provide an accurate assessment of sediment metal contaminant distribution, data required to guide remediation and environmental effects monitoring and compliance.

Fate and distribution of determinants of antimicrobial resistance in lateral flow sand filters used for treatment of domestic wastewater.

Residuals of antimicrobial products from anthropogenic uses can create a selective environment in domestic wastewater treatment systems and receiving environments and contribute to the spread of antimicrobial resistance (AMR). On-site wastewater treatment systems are widely used for domestic wastewater management in rural and remote regions, but the fate of determinants of AMR in these types of environments has received little attention. In this study, the mechanisms responsible for the attenuation of determinants of AMR in lateral flow sand filters were explored using a combination of lab, field and modeling investigations. The degradation kinetics and adsorption potential in the sand filter medium of three antibiotic resistance genes (ARGs; sul1, tetO, and ermB) and culturable bacteria resistant to sulfamethoxazole, tetracycline, and erythromycin were measured using lab experiments. The spatial distribution of ARGs and antibiotic resistant bacteria were also assessed in field scale sand filters, and mechanistic modeling was conducted to characterize filtration processes. The results indicated that the primary mechanisms responsible for AMR attenuation within the sand filters were degradation and filtration. The spatial distribution of AMR determinants illustrated that attenuation was occurring along the entire length of each filter. This study provides new insights on primary mechanisms of AMR attenuation in on-site wastewater treatment systems and supports the use of conservative design guidelines and separation distances for reducing AMR transmission.

Characterization and spatial distribution of organic-contaminated sediment derived from historical industrial effluents.

Organic sediment contaminants [polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans (PCDD/Fs), and polycyclic aromatic hydrocarbons (PAHs)] were assessed using secondary monitoring data from a former tidal estuary (Boat Harbour) impacted by historical industrial effluents. Spatiotemporal characterization of PCDD/Fs and PAHs in sediments was conducted to inform a sediment remediation program designed to return this contaminated aquatic site back to a tidal lagoon. Spatiotemporal variations of sediment PCDD/F and PAH concentrations across Boat Harbour and off-site reference locations were assessed using secondary monitoring data collected between 1992 and 2015. Sediment PCDD/F toxic equivalency (TEQ) and PAH concentrations were compared to sediment quality guidelines. Sediment PCDD/F concentrations exceeded the highest effect thresholds posing severe ecological health risks. High sediment PCDD/F concentrations have persisted in Boat Harbour despite implementation of Pulp and Paper Mill Effluent Chlorinated Dioxins and Furans Regulations in 1992. PAH concentrations varied greatly. Five individual PAH compounds frequently exceeded severe effect thresholds, in contrast to total PAHs, which were below severe effect thresholds. Forensic analysis using PAH diagnostic ratios suggests pyrogenic PAHs derived from wood processes or coal combustion were likely sources. Twenty-five years of monitoring data revealed large data gaps in our understanding of sediment characteristics in Boat Harbour. Gaps included spatial (vertical and horizontal) and temporal variations, presenting challenges for remediation to accurately delineate sediment contaminants. Deeper horizons were poorly characterized compared to shallow sediments (0-15 cm). Historical secondary monitoring data showed that spatial coverage across Boat Harbour was inadequate. Due to severe ecological health risks associated with high sediment PCDD/F concentrations, remediation of the entire sediment inventory is recommended. Detailed vertical and horizontal sampling within Boat Harbour, establishment of local baseline concentrations, and additional sampling in down-gradient-receiving environments for a suite of contaminants are required to better characterize sediments prior to remediation.

Lateral flow sand filters are effective for removal of antibiotic resistance genes from domestic wastewater.

The ability of lateral flow sand filters, used as on-site wastewater treatment systems (OWTS), to remove antibiotic resistance genes (ARGs), antibiotic resistant bacteria (ARB), and other relevant genetic markers (HF183, 16S rRNA, and int1) was assessed. Municipal wastewater was settled in a septic tank prior to loading into six pilot-scale lateral flow sand filters comprised of three different sand media types, at 5 and 30% slopes. The sand filters were sampled bi-weekly for: 9 ARGs and 3 other complimentary gene markers (sul1, sul2, qnrS, tetO, ermB, blaTEM, blaCTX-M, mecA, vanA, int1, HF183, 16S rRNA), and conventional microbial and water quality indicators, from July to November in 2017, and four times in the summer of 2018. The sand filters were observed to attenuate 7 of the ARGs to mostly below 2 log gene copies per mL. Log reductions ranging from 2.9 to 5.4 log were observed for the removal of absolute abundances of ARGs from septic tank effluent in 5 of the 6 sand filters. The fine-grained filter on the 5% slope did not perform as well for ARG attenuation due to hydraulic failure. The apportionment of cell-associated versus cell-free DNA was determined for the gene markers and this indicated that the genes were primarily carried intracellularly. Average log reductions of ARB with resistance to either sulfamethoxazole, erythromycin, or tetracycline were approximately 2.3 log CFU per mL within the filters compared to the septic tank effluent. This field study provides in-depth insights into the attenuation of ARB, ARGs, and their genetic compartmentalization in variably saturated sand OWTS. Overall, this type of OWTS was found to pose little risk of antimicrobial resistance contamination spread into surrounding environments when proper hydraulic function was maintained.

Development of a leaching procedure to assess the risk of uranium leaching due to construction and demolition waste disposal.

Naturally-occurring uranium can be found at elevated concentrations in groundwater throughout the world, with the potential to cause kidney damage in chronically exposed individuals. Empirical evidence shows that uranium mobilization can be enhanced in the presence of ions that are associated with leachate from construction and demolition (C&D) disposal sites. There is need for a simple and effective procedure to evaluate soil and rock formations for uranium mobility prior to the permitting of waste disposal facilities which could alter groundwater chemistry. A series of leachate extractions were performed to represent the impact of C&D leachate on uranium-bearing rocks, focusing on the impact of calcium, sodium, chloride, sulphate, and bicarbonate concentrations on uranium mobilization. Based on these observations a uranium leaching procedure (ULP) was developed and compared to the synthetic precipitation leaching procedure (SPLP). The ULP was capable of mobilizing an order of magnitude more uranium than the SPLP from six rock samples and shows promise as a tool for assessing the risk of groundwater contamination by C&D waste through uranium mobilization.

Spatiotemporal assessment (quarter century) of pulp mill metal(loid) contaminated sediment to inform remediation decisions.

A bleached kraft pulp mill in Nova Scotia has discharged effluent wastewater into Boat Harbour, a former tidal estuary within Pictou Landing First Nation since 1967. Fifty years of effluent discharge into Boat Harbour has created >170,000 m3 of unconsolidated sediment, impacted by inorganic and organic contaminants, including metal[loid]s, polycyclic aromatic hydrocarbons (PAHs), dioxins, and furans. This study aimed to characterize metal(loid)-impacted sediments to inform decisions for a $89 million CAD sediment remediation program. The remediation goals are to return this impacted aquatic site to pre-mill tidal conditions. To understand historical sediment characteristics, spatiotemporal variation covering ~quarter century, of metal(loid) sediment concentrations across 103 Boat Harbour samples from 81 stations and four reference locations, were assessed by reviewing secondary data from 1992 to 2015. Metal(loid) sediment concentrations were compared to current Canadian freshwater and marine sediment quality guidelines (SQGs). Seven metal(loid)s, As, Cd, Cr, Cu, Pb, Hg, and Zn, exceeded low effect freshwater and marine SQGs; six, As, Cd, Cr, Pb, Hg, and Zn, exceeded severe effect freshwater SQGs; and four, Cd, Cu, Hg, and Zn, exceeded severe effect marine SQGs. Metal(loid) concentrations varied widely across three distinct temporal periods. Significantly higher Cd, Cu, Pb, Hg, and Zn concentrations were measured between 1998 and 2000, compared to earlier, 1992-1996 and more recent 2003-2015 data. Most samples, 69%, were shallow (0-15 cm), leaving deeper horizons under-characterized. Geographic information system (GIS) techniques also revealed inadequate spatial coverage, presenting challenges for remedy decisions regarding vertical and horizontal delineation of contaminants. Review of historical monitoring data revealed that gaps still exist in our understanding of sediment characteristics in Boat Harbour, including spatial, vertical and horizontal, and temporal variation of sediment contamination. To help return Boat Harbour to a tidal estuary, more detailed sampling is required to better characterize these sediments and to establish appropriate reference (background) concentrations to help develop cost-effective remediation approaches for this decades-old problem.

Bacterial Pathogen Indicator Transport from Livestock Mortality Biopiles.

Biopiles can be used to dispose of slaughterhouse residuals (SLRs); however, the fate of pathogenic bacteria (e.g., pathogenic strains of , ) in these systems is not well understood. The transport of these bacteria in water leaching from the biopile could represent a significant contamination source. This research examined the transport of Enterobacteriaceae and Enterococcaceae indicator bacteria from SLR biopiles. Three biopiles (2.6 m wide by 4.6 m long by 1.8 m high) were formed on soil layers in concrete cells that allowed for real-time monitoring of environmental parameters, hydrologic flux, and indicator bacteria levels in effluent leaching from the piles. In biopile effluent, indicator bacteria populations decreased exponentially following biopile formation. Indicator bacteria loads in effluent constituted <0.01% of the initial indicator bacteria levels in the biopiles, which was attributed to retention, inactivation, and death. Nearly 90% of the total indicator bacteria loads coincided with large precipitation events (>15 mm d). Movement of the indicator bacteria through the biopiles and underlying soil appeared to be consistent with preferential flow phenomena. The populations of the Enterobacteriaceae indicators remained low in conditions of higher soil water content and lower biopile temperatures, whereas the Enterococcaceae indicator appeared to regrow in these conditions. This indicated that bacterial pathogen transport from a biopile could be a concern after the disappearance of conventional bacterial indicators, such as . Management considerations should attempt to divert excess water from entering a biopile, such as locating a biopile under a roof. Unsaturated biopile and soil conditions should be maintained to impede water flow through preferential pathways in the soil underneath a biopile.

The Effects of Dosed versus Gravity-Fed Loading Methods on the Performance and Reliability of Contour Trench Disposal Fields Used for Onsite Wastewater Treatment.

In Nova Scotia, Canada, contour trench disposal fields are the most common type of onsite wastewater system. In this study, two identical contour trench disposal fields were monitored for 3 yr to compare performance under gravity-fed versus periodically dosed loading conditions. Influent and effluent from both systems were analyzed for a suite of water quality parameters, and the hydraulics of the systems were assessed using tracer studies and measurements of ponded water depth in the distribution trenches. Ponded water depths in the distribution trench of the gravity-fed disposal field were observed to increase steadily during the monitoring period, indicating progressive clogging. This was not observed in the periodically dosed field. Regarding treatment, both systems performed well, consistently producing effluent with 5-d biochemical oxygen demand and total suspended solids (TSS) concentrations <10 mg L and achieving >5 log reductions in . However, the gravity-fed system produced statistically lower average effluent concentrations for total P and TSS. It is speculated that the slightly better treatment performance achieved by the gravity-fed system is due to enhanced biomat formation. This study demonstrated adequate treatment of residential wastewater by contour trench disposal fields regardless of loading method. However, because the hydraulic performance of these systems is heavily dependent on pretreatment and loading methods, it is recommended that a dosing system be used to distribute wastewater to contour trench disposal fields to help prevent hydraulic failure.

Modeling E.coli fate and transport in treatment wetlands using the water quality analysis and simulation program.

Treatment wetlands can be a viable wastewater treatment option, especially in rural and remote regions where centralized wastewater treatment is not feasible. Bacteria fate and transport modeling within wetlands requires further development if they are to become a more reliable and predictable form of wastewater treatment. The goal of this paper was to calibrate and test an unsteady state numerical model for the simulation of E. coli fate and transport within full-scale surface flow (SF) wetlands treating domestic wastewater. The Water Quality Analysis and Simulation Program (WASP) was used to develop the model. Accurately predicting E. coli effluent concentrations using WASP was difficult due to the dynamic nature of the wetland environment including hydraulics, seasonal variability, and wetland maturity. WASP was successful in predicting average E. coli effluent concentrations but did not accurately forecast maximum and minimum values. The model produced better fits with observed E. coli effluent concentrations during the summer months, when observed effluent concentrations were less variable. Hydraulic tracer studies and model results suggest that preferential flow pathways may be affecting E. coli removal due to reduced retention times. Flow channelling or short circuiting may have been caused by high flow conditions and/or dense cattail growth. A more detailed understanding of treatment wetland hydraulics is required before we can accurately predict treatment performance.

National health spending by medical condition, 1996-2005.

This study responds to recent calls for information about how personal health expenditures from the National Health Expenditure Accounts are distributed across medical conditions. It provides annual estimates from 1996 through 2005 for thirty-two conditions mapped into thirteen all-inclusive diagnostic categories. Circulatory system spending was highest among the diagnostic categories, accounting for 17 percent of spending in 2005. The most costly conditions were mental disorders and heart conditions. Spending growth rates were lowest for lung cancer, chronic obstructive pulmonary disease, pneumonia, coronary heart disease, and stroke, perhaps reflecting benefits of preventive care.

Quantifying national spending on wellness and prevention.

PURPOSE: We estimate national health expenditures on prevention using precise definitions, a transparent methodology, and a subdivision of the estimates into components to aid researchers in applying their own concepts of prevention activities. METHODOLOGY/APPROACH: We supplemented the National Health Expenditure Accounts (NHEA) with additional data to identify national spending on primary and secondary prevention for each year from 1996 to 2004 across eight spending categories. FINDINGS: We estimate that NHEA expenditures devoted to prevention grew from $83.2 billion in 1996 to $159.8 billion in 2004, in current dollars. As a share of NHEA, this represents an increase from 7.8 percent in 1996 to 8.6 percent in 2004. This share peaked at 9 percent in 2002 and then declined due to reductions in public health spending as a percent of NHEA between 2002 and 2004. Primary prevention represents about half the expenditures, consisting largely of public health expenditures--the largest prevention element. ORIGINALITY/VALUE OF PAPER: Our 2004 estimate that 8.6 percent of NHEA goes to prevention is nearly three times as large as the commonly cited figure of 3 percent, but depends on the definitions used: our estimate falls to 8.1 percent when the research component is excluded, 5.1 percent when consideration is limited to primary prevention plus screening, 4.2 percent for primary prevention alone, and 2.8 percent if we count only public health expenditures. These findings should contribute to a more informed discussion of our nation's allocation of health care resources to prevention.

Impact of the expanded criteria donor allocation system on candidates for and recipients of expanded criteria donor kidneys.

BACKGROUND: A national policy to allocate kidneys from expanded criteria donors (ECD) took effect October 31, 2002. METHODS: To assess its impact, we analyzed data from the Scientific Registry of Transplant Recipients for ECD kidney candidates and recipients between November 1999 and October 2005. RESULTS: The likelihood of being listed for ECD transplant, of receiving any transplant, and of receiving an ECD transplant were assessed using logistic regression models. As of October 31, 2005, 42.6% of candidates were listed with an ECD designation (range by donation service area [DSA], 1.9% to 94.9%). ECD-listed candidates were likely to be older, diabetic, and sensitized. By October 31, 2005, candidates listed for ECD as of November 1, 2002 were 41% more likely to receive any kidney transplant than those not ECD-listed. Among ECD-listed recipients, 30.1% received an ECD transplant and 69.9% a non-ECD transplant. Recipients more likely to receive an ECD transplant were significantly older and in DSAs where a high percentage of ECD transplants were performed and/or a low percentage of candidates were ECD-listed. CONCLUSIONS: A large, regionally variable fraction of candidates are opting to receive ECD offers. Listing with an ECD designation increases the likelihood of transplantation in selected populations. Selective listing of ECD candidates is associated with a higher likelihood of receiving an ECD transplant.

Assessment of two thermally treated drill mud wastes for landfill containment applications.

Offshore oil and gas drilling operations generate significant amounts of drill mud waste, some of which is transported onshore for subsequent thermal treatment (i.e. via thermal remediation). This treatment process results in a mineral waste by-product (referred to as thermally treated drill mud waste; TTDMW). Bentonites are originally present in many of the drill mud products and it is hypothesized that TTDMW can be utilized in landfill containment applications (i.e. cover or base liner). The objective of this paper is to examine the feasibility of this application by performing various physical and chemical tests on two TTDMW samples. It is shown that the two TTDMW samples contained relatively small amounts of clay-sized minerals although hydraulic conductivity values are found to be less than 10(-8) m/s. Organic carbon contents of the samples were approximately 2%. Mineralogy characterization of the samples confirmed varying amounts of smectite, however, peak friction angles for a TTDMW sample was greater than 36 degrees. Chemical characterization of the TTDMW samples show potential leaching of barium and small amounts of other heavy metals. Discussion is provided in the paper on suggestions to assist in overcoming regulatory issues associated with utilization of TTDMW in landfill containment applications.

Impact of the expanded criteria donor allocation system on the use of expanded criteria donor kidneys.

BACKGROUND: The U.S. Organ Procurement and Transplantation Network recently implemented a policy allocating expanded criteria donor (ECD) kidneys by waiting time alone. ECD kidneys were defined as having a risk of graft failure > or = 1.7 times that of ideal donors. ECDs include any donor > or = 60 years old and donors 50 to 59 years old with at least two of the following: terminal creatinine >1.5 mg/dL, history of hypertension, or death by cerebrovascular accident. The impact of this policy on use of ECD kidneys is assessed. METHODS: The authors compared use of ECD kidneys recovered in the 18 months immediately before and after policy implementation. Differences were tested using t test and chi2 analyses. RESULTS: There was an 18.3% increase in ECD kidney recoveries and a 15.0% increase in ECD kidney transplants in the first 18 months after policy implementation. ECD kidneys made up 22.1% of all recovered kidneys and 16.8% of all transplants, compared with 18.8% (P<0.001) and 14.5% (P<0.001), respectively, in the prior period. The discard rate was unchanged. The median relative risk (RR) for graft failure for transplanted ECD kidneys was 2.07 versus 1.99 in the prepolicy period (P=not significant); the median RR for procured ECD kidneys was unchanged at 2.16. The percentage of transplanted ECD kidneys with cold ischemia times (CIT) <12 hr increased significantly; the corresponding percentage for CIT > or = 24 hr decreased significantly. CONCLUSIONS: The recent increase in ECD kidney recoveries and transplants appears to be related to implementation of the ECD allocation system.