Microbial Contamination of Drinking Water Supplied by Private Wells after Hurricane Harvey.

Hurricane Hurricane Harvey made landfall on the Texas Gulf Coast on August 25, 2017, as a Category 4 hurricane and caused widespread flooding. We explored spatial and temporal distributions of well testing and contamination rates; relationships between contamination and system characteristics and recovery behaviors; and efficacy of mitigation strategies. We estimated that over 500 000 well users (∼130 000 to 260 000 wells) may have been affected, but only around 15 000 well users (∼3800 to 7500 wells) had inundated systems based on inundation maps. Local health departments and our team sampled 8822 wells in 44 counties in the 10 months that followed. Total coliform occurrence was 1.5 times and Escherichia coli was 2.8 times higher after Hurricane Harvey compared to baseline levels. Microbial contamination was more likely (1.7-2.5 times higher) when wells were inundated and/or residents felt their water was unsafe. Although more wells in urban counties were affected, E. coli rates were higher in wells in rural counties. Disinfection did not always eliminate contamination, highlighting concerns about the implementation and efficacy of chlorination procedures. Despite this extensive well testing conducted after Hurricane Harvey, we estimate that only 4.1% of potentially affected wells were tested, underscoring the magnitude of recovery assistance needed to assist well users after flooding events.

Evaluation of Preparedness and Recovery Needs of Private Well Users After the Great Louisiana Flood of 2016.

CONTEXT: The August 2016 Louisiana flood marked the second 500-year flood in the state in 1 year. OBJECTIVE: The aim of this study was to identify private well user needs in the aftermath of the flood and to develop disaster planning and recovery recommendations for flood-prone well-reliant communities. DESIGN: A descriptive cross-sectional study was conducted to collect information from a convenience sample of flood-impacted well users via surveys and water sampling kits, which were distributed to well users 9 to 11 weeks after floodwaters receded (n = 106). SETTING: Surveys and kits were distributed at roadside flood response and recovery stations set up by local churches in French Settlement, Livingston Parish, Louisiana, an area at the epicenter of the flood-impacted area. PARTICIPANTS: Subjects were included if they self-reported having a flood-impacted well. MAIN OUTCOME MEASURES: Surveys collected information to characterize knowledge gaps, risk perceptions, flood impacts, resource accessibility, and well maintenance barriers. Well water tests evaluated total coliform and Escherichia coli. RESULTS: Among those in low-risk flood zones (n = 22), 27% were in areas designated as having flooded. Among flood-impacted wells that were shock chlorinated after the flood (n = 16), 31.3% tested positive for total coliform and 12.5% for E coli. Only 26% of respondents received well-related information after the disaster. CONCLUSIONS: Results highlight critical needs for disaster planning and well user education in flood-prone areas, changes to flood risk maps, and concerns with the efficacy of disinfection strategies. Information and resources needs for flood-impacted well users are presented and recommendations on how to improve flood preparedness and recovery are made.

The Environmental Health Impact of Hurricane Katrina on New Orleans.

Hurricane Katrina caused unprecedented flood damage to New Orleans, Louisiana, and has been the costliest hurricane in US history. We analyzed the environmental and public health outcomes of Hurricane Katrina by using Internet searches to identify epidemiological, sociodemographic, and toxicological measurements provided by regulatory agencies.Atmospheric scientists have now warned that global warming will increase the proportion of stronger hurricanes (categories 4-5) by 25% to 30% compared with weaker hurricanes (categories 1-2).With the new $14.6 billion Hurricane Storm Damage Risk Reduction System providing a 100-year storm surge-defensive wall across the Southeast Louisiana coast, New Orleans will be ready for stronger storms in the future.

Understanding lead in water and avoidance strategies: a United States perspective for informed decision-making.

The pervasiveness of lead in drinking water poses a significant public health threat, which can be reduced by implementing preventive measures. However, the causes of elevated lead in water and the benefits of lead in water avoidance strategies are often misunderstood. Based on experiences in the United States, this paper describes an oversimplified 'lead in water equation' to explain key variables controlling the presence of lead in drinking water to better inform public health practitioners, government officials, utility personnel, and concerned residents. We illustrate the application of the equation in Flint, Michigan and explore the primary household-level water lead avoidance strategies recommended during the crisis, including flushing, filtration, bottled water use, and lead pipe removal. In addition to lead reduction, strategies are evaluated based on costs and limitations. While these lead avoidance strategies will reduce water lead to some degree, the costs, limitations, and effectiveness of these strategies will be site- and event-specific. This paper presents a simplified approach to communicate key factors which must be considered to effectively reduce waterborne lead exposures for a wide range of decision makers.

Evaluation of available data sources to prioritize parishes for arsenic monitoring and outreach related to private well drinking water.

OBJECTIVE: The objective of this assessment was to identify and evaluate data sets for use in the surveillance of arsenic hazards and private well drinking water use in Louisiana. DESIGN: Features, strengths, and limitations of the data sets are described, and prioritization criteria are applied to identify areas in need of further monitoring or outreach. SETTING: Recent efforts have been made by the Environmental Public Health Tracking Network to evaluate the quality of private well water data for the purpose of supporting state and national surveillance activities. Like most states, Louisiana does not collect or mandate reporting of private well water quality data. Therefore, responding to public concerns about private well water quality requires an identification and evaluation of existing data. MAIN OUTCOME MEASURES: Data evaluated include measures of arsenic in groundwater and soil, private well water use, and biomonitoring results. RESULTS: The Environmental Protection Agency's Safe Drinking Water Information System and the US Geological Survey's Water Use data set were the most informative, nationally available data sets for conducting private well water arsenic surveillance. Three priority parishes were identified on the basis of a selection criteria, although all parishes require more private well sampling data. CONCLUSION: While the data reviewed enabled preliminary identification of parishes in need of monitoring and outreach, data limitations (particularly, a lack of statewide well water quality data) prevent a comprehensive evaluation of well water arsenic hazards and private well water use. A large number of unregistered wells further impede risk determination. Reliance on existing data sources is necessary, but development of metadata documentation is essential to prevent data misinterpretation. Increased outreach and policies to promote or mandate private well testing and reporting are needed to enable a comprehensive private well water tracking system.

Prioritization of Louisiana Parishes based on Industrial Releases of Known or Suspected Carcinogens.

This investigation evaluated the geographic distribution of carcinogen releases by Louisiana industries to prioritize areas for regulatory oversight, research and monitoring, and to promote clinician awareness and vigilance. Data on estimated industry releases for the period between 1996 and 2011 were obtained from the US Environmental Protection Agency's Toxics Release Inventory. Chemicals associated with cancers of the prostate, lung, bladder, kidney, breast and non-Hodgkin lymphoma were identified. The Risk Screening Environmental Indicators model was used to derive measures or model scores based on chemical toxicity, fate and transport, and population characteristics. Parishes, chemicals, industries and media generating the highest model scores were identified. Parishes with the highest model scores were East Baton Rouge, Calcasieu, Caddo and St. John the Baptist. Clinicians should carefully monitor cancer cases in these areas, and if patients reside near or work in industry, an occupational and environmental history should be considered.

Emergency department visits for carbon monoxide poisoning in LA.

Carbon monoxide (CO) poisoning is preventable, yet it remains one of the most common causes of poisoning in the United States. This analysis was performed to estimate the number of emergency department (ED) visits in 2010 in Louisiana for all-cause (fire-related, non-fire, and unknown) unintentional CO poisoning. Results demonstrate approximately 1,696,746 total ED visits occurred in 2010. Among these, an estimated 116 individuals were diagnosed with CO poisoning (68 CO cases per million ED visits; 26.2 CO cases per million population). Emergency Department visits for CO poisoning occurred most frequently in the winter months. Caddo, Jefferson, and Orleans parishes had the highest numbers of CO poisonings in 2010. The most common symptoms included headache, hypertension, nausea, and dizziness. The ED database presented more cases of the most common CO poisoning cases (non-fatal) than previously used surveillance databases. This study demonstrated the utility and importance of ED data as a surveillance tool.

Louisiana Guestworker Health and Safety a Necessary Component of Health Equity: Lessons From the COVID-19 Pandemic.

Guestworkers are a critical labor component of many industries considered essential to U.S. infrastructure. Despite their essential role in the U.S. labor force, guestworkers are vulnerable to exploitative labor practices. The COVID-19 pandemic compounded guestworkers' vulnerability to include a lack of public health protective measures in addition to longstanding labor abuses. The pandemic has created greater public health awareness about structural determinants of health inequities, such as unsafe and exploitative working conditions. As public health increases its focus on social and structural determinants of health, it can contribute to improved labor conditions for guestworkers. This article highlights guestworkers' experiences in Louisiana's crawfish industry to demonstrate the marginalized role of guestworker labor in a major Louisiana industry. This article also examines local public health approaches that can bring attention and resources to labor issues.

Fishing, fish consumption and advisory awareness among Louisiana's recreational fishers.

This paper presents results from the first known population-based survey of recreational fishers in Louisiana (n=1774). The ultimate goal of this study was to obtain data in support of the development of regional advisories for a high exposure population with unique seafood consumption patterns. Between July and August of 2008, a survey was mailed to a random sample of licensed recreational fishers to characterize local fishing habits, sportfish consumption, and advisory awareness. Eighty-eight percent of respondents reported eating sportfish. Respondents ate an estimated mean of four fish meals per month, of which, approximately half were sportfish. Over half of all sportfish meals (54%) were caught in the Gulf of Mexico or bordering brackish areas. Sportfish consumption varied by license and gender; and was highest among Sportsman's Paradise license holders (2.8±0.2 meals per month), and males (2.2±0.1 meals per month). The most frequently consumed sportfish species were red drum, speckled trout, catfish, bass, crappie and bream. Advisory awareness rates varied by gender, ethnicity, geographic area, license type, age and education; and were lowest among women (53%), African-Americans (43%), fishers from the southeast of Louisiana (50%), holders of Senior Hunting and Fishing licenses (51%), individuals between 15 and 19 years of age (41%), and individuals with less than a high school education (43%). Results were used to identify ways to optimize monitoring, advisory development and outreach activities.

Panic in the Streets-Pandemic and Protests: A Manifestation of a Failure to Achieve Democratic Ideals.

America is at a critical crossroads in history as the COVID-19 pandemic expands. We argue that the failure to respond effectively to the pandemic stems from the nation's protracted divergence from the democratic ideals, we purport to value. Structural racism and class-based political and economic inequity are sustained through the failings of the nation's democratic institutions and processes. The situation has, in turn, fostered further inequity and undermined science, facts, and evidence in the name of economic and political interests, which in turn has encouraged the spread of the pandemic, exacerbated health disparities, and escalated citizen tensions. We present a broad vision of reforms needed to achieve democratic ideals which we believe is the most important first step to achieving true political representation, achieving a resilient and sustainable economy, and fostering the health of vulnerable communities, workers, and the planet.

Improving state-level emergency well disinfection strategies in the United States.

After flooding events, well users are encouraged to disinfect their private wells. However, well disinfection strategies are not consistently applied or proven effective. This study examines the science-based evidence that disinfection procedures reduce microbial loading in well water; reviews inclusion of disinfection principles in state-level emergency protocols; and explores research gaps potentially hindering disinfection efficacy. Emergency well disinfection protocols from 34 states were reviewed based on instructions for creating chlorine solutions; circulating chlorine solutions throughout the distribution system; achieving effective CT disinfection (chlorine dose*contact time); and post-disinfection guidance. Many protocols were missing key information about fundamentals of disinfection. Only two protocols instructed well users to verify chlorine residuals and three protocols instructed users to measure water pH. Most protocols recommended that high chlorine doses be introduced into the well, circulated throughout the system, and stagnated for several hours. A CT value estimated to inactivate at least 99.9% (3-log removal) of Cryptosporidium (255 mg-hr/L) was predicted to be achieved by 72.7% of protocols, and estimated CT values ranged from 35 to 16,327 mg-hr/L. Two research gaps identified were determining whether chlorine doses should differ based on well water chemistries and evaluating the appropriate chlorine dose that should be recommended for inactivating pathogens. This effort underscores a need for consistent, evidence-based messaging in emergency well disinfection protocols.

Disparities in well water outreach and assistance offered by local health departments: A North Carolina case study.

Drinking water supplied by private wells is a national concern that would benefit from improved outreach and support to ensure safe drinking water quality. In North Carolina (NC), local health departments (LHDs) have private well programs that enforce statewide well construction standards, offer water testing services, and provide well water outreach and assistance. Programs were evaluated to determine their capacity and capability for well water outreach and assistance and identify differences among programs. All LHDs reported overseeing the construction of new wells as required by law. However, services provided to existing well users were offered infrequently and/or inconsistently offered. Lack of uniformity was observed in the number of LHD staff and their assigned responsibilities; the costs and availability of well water testing; and the comfort of LHD staff communicating with well owners. While the total number of staff was lower in LHDs in rural counties, the number of outreach activities and services offered was typically not related to the number of well users served. Variations in structure and capacity of well programs at LHDs have created unequal access to services and information for well users in NC. This research underscores the need to examine infrastructure that supports the well water community on a national scale.

Metal fume fever: a review of the literature and cases reported to the Louisiana Poison Control Center.

Metal fume fever (MFF) is an important occupational-related illness resulting from inhalation of volatile metal oxides, especially zinc, that are produced during welding or cutting of metal materials. Onset of MFF is rapid, occurring within a few hours after inhalation of the fumes. Symptoms include fever, chills, cough, dyspnea, headache, myalgia, and malaise. Symptoms are self-limiting and typically resolve within 24 hours with a subsequent short-lived tolerance to zinc oxide fumes that disappears after one to two days of avoidance. In this report, we present an overview of MFF's history, pathogenesis, clinical presentation, regulatory guidelines, and prevention recommendations. This review is followed by a description of MFF cases reported by the Louisiana Poison Control Center to the Louisiana Office of Public Health's Section of Environmental Epidemiology and Toxicology during a two-year period.

Effectiveness of Prevailing Flush Guidelines to Prevent Exposure to Lead in Tap Water.

Flushing tap water is promoted as a low cost approach to reducing water lead exposures. This study evaluated lead reduction when prevailing flush guidelines (30 s⁻2 min) are implemented in a city compliant with lead-associated water regulations (New Orleans, LA, USA). Water samples (n = 1497) collected from a convenience sample of 376 residential sites (2015⁻2017) were analyzed for lead. Samples were collected at (1) first draw (n = 375) and after incremental flushes of (2) 30⁻45 s (n = 375); (3) 2.5⁻3 min (n = 373), and (4) 5.5⁻6 min (n = 218). There was a small but significant increase in water lead after the 30 s flush (vs. first draw lead). There was no significant lead reduction until the 6 min flush (p < 0.05); but of these samples, 52% still had detectable lead (≥1 ppb). Older homes (pre-1950) and low occupancy sites had significantly higher water lead (p < 0.05). Each sample type had health-based standard exceedances in over 50% of sites sampled (max: 58 ppb). While flushing may be an effective short-term approach to remediate high lead, prevailing flush recommendations are an inconsistently effective exposure prevention measure that may inadvertently increase exposures. Public health messages should be modified to ensure appropriate application of flushing, while acknowledging its short-comings and practical limitations.

Knowledge, attitudes and beliefs of women about the importance of prostate cancer screening.

OBJECTIVES: To understand women's knowledge, attitudes and beliefs about prostate cancer. METHODS: A survey was self-administered to 324 women age >18 years. It contained 42 questions that assessed women's knowledge about prostate cancer, possible risk factors, and opinions regarding screening and early detection. Women were grouped as married or unmarried for convenient comparisons. Chi-squared and F statistics were performed. RESULTS: Ninety-seven percent of married women reported having some influence over the healthcare decisions of their spouse. Married women's worst fear about their spouse or family member's diagnosis of prostate cancer was death. The most important benefit of prostate cancer screening was the possibility of cure, while the main hindrance was fear of the digital rectal exam. Marital status, age, educational level and income were all significantly associated with women's knowledge about prostate cancer (p<0.001). CONCLUSIONS: Women play an important role in health-related matters in the home. Educating women on prostate cancer may improve early detection efforts and reduce the devastating impact of this disease on their family.

An evaluation of mercury levels in Louisiana fish: trends and public health issues.

To characterize statewide fish tissue mercury levels in edible finfish the first comprehensive analysis of Louisiana's fish tissue mercury database was conducted. Analyses were based on fifteen years of fish tissue mercury data collected from 368 waterbodies between 1994 and 2008 (n=14,344). The overall objectives of this study were to establish baseline fish tissue mercury levels; and evaluate species-specific temporal and spatial trends in fish tissue mercury levels. Fish tissue mercury levels ranged from 0.001 ppm (the detection limit) to 5.904 ppm for king mackerel; with an overall geometric mean of 0.218 ppm. Ninety-five percent of samples had mercury levels below the FDA's action level of 1.0 ppm for methylmercury in commercial food. Forty-four percent of all samples had mercury levels above the U.S. EPA's methylmercury fish tissue criterion of 0.3 ppm for sportfish. Species of potential concern include cobia, king mackerel, blackfin tuna, greater amberjack, spotted bass, bowfin, largemouth bass and freshwater drum. There was a significant but small decline in statewide length-adjusted largemouth bass mercury levels between 1994-1999 to 2003-2008 (p<0.05). The highest fish mercury levels were observed in Pearl, Calcasieu, Mermentau, Ouachita, Pontchartrain and Sabine basins. Length-adjusted largemouth bass mercury levels were significantly higher in wetlands and rivers/streams vs. lakes; and in wetlands vs. estuaries (p<0.05). Data were analyzed from a public health perspective to make recommendations for optimizing monitoring and outreach.

A recombinant adenovirus expressing p7(Kip1) induces cell cycle arrest and apoptosis in human 786-0 renal carcinoma cells.

PURPOSE: We evaluated the effects of the over expression of p27Kip1, a cyclin dependent kinase inhibitor and tumor suppressor protein, on the 786-0 human renal carcinoma cell line. MATERIALS AND METHODS: The recombinant adenovirus Adp27Kip1 was evaluated for the induction of p27 protein expression in 786-0 renal carcinoma cells. Expression time and optimal vector concentration were determined. Growth curve studies, cell cycle analysis and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling were done to determine the effects of p27Kip1 on the cell cycle. Cyclin dependent protein kinase (Cdk) inhibitor (CDKI) activity assays were done to determine the expression/activities of Cdks and Western blot analysis was performed to determine the presence of CDKIs and other cell cycle regulator proteins. Nude mouse xenografts were established to demonstrate the in vivo efficacy of Adp27Kip1. RESULTS: p27Kip1 protein expression was detected within 12 hours after Adp27Kip1 infection and it remained stable for at least 48 hours. Growth studies demonstrated that Adp27Kip1 infection resulted in the inhibition of proliferation by 3 days after infection and cell death was detected by day 5. Cell cycle analysis of DNA content indicated an accumulation of cells in the G1 phase of Adp27Kip1 infected cells and a corresponding decrease in S phase cells within 48 hours after infection. Cdk activity was determined, and Cdk2, Cdk4 and Cdc2 kinase activities were inhibited, consistent with p27Kip1 over expression. The levels of the CDKIs p16 and p18 were elevated 24 hours after Adp27Kip1 infection, while p21 levels remained unchanged. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling revealed that Adp27Kip1 infection but not infection by control virus induced detectable apoptosis within 24 hours. Adp27Kip1 significantly caused the reduction in the size of tumors of the renal cell carcinoma xenografts. CONCLUSIONS: This study demonstrates the potential effectiveness of Adp27Kip1 as a vector for gene therapy studies of renal cell carcinoma.

Induction of cell cycle arrest and apoptosis in human prostate carcinoma cells by a recombinant adenovirus expressing p27(Kip1).

BACKGROUND: Adp27(Kip1), a recombinant adenovirus, was evaluated for expression of p27, a cyclin-dependent kinase inhibitor (CDKI) and tumor suppressor protein, in human prostate carcinoma cells. Effects of p27(Kip1) on cell cycle and apoptosis were analyzed. METHODS: We evaluated the effects of overexpression of p27(Kip1) in the human prostate carcinoma cell lines LNCaP, DU-145, and PC-3 in vitro and in vivo. Growth curve studies, cell cycle analysis, terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL), and annexin V-fluorescein isothiocyanate apoptosis analyses were conducted to determine effects of p27(Kip1) on cell cycle. CDKI activity assays and Western blots were conducted to determine presence/activities of CDKIs. RESULTS: Adp27(Kip1)-induced protein levels increased in a dose-dependent manner; p27(Kip1) protein was detected within 6 hr of infection with Adp27(Kip1) and remained stable for at least 48 hr. The activities of Cdk2, Cdk4, and Cdc2 kinases were inhibited 24 hr after infection with Adp27(Kip1). Bromodeoxyuridine incorporation demonstrated a dose-dependent decrease in S-phase cells 24 hr postinfection. TUNEL analysis revealed an induction of apoptosis (10 pfu/cell) within 48 hr of infection in all cell lines. Growth curve analyses demonstrated that Adp27(Kip1) infection inhibited proliferation of all cell lines tested and decreased cell numbers for Adp27(Kip1)-infected LNCaP and PC-3 cells by 96 hr. Cell cycle analysis of DNA content demonstrated an accumulation of cells in G0/G1-phase 24-120 hr after Adp27(Kip1)-infection. In vivo studies demonstrated a reduction in LNCaP xenograft tumor growth rates in mice injected with Adp27(Kip1). CONCLUSION: Exogenous p27(Kip1) overexpression results in cell cycle regulation in the human prostate carcinoma cell lines tested, representing the first use of this vector on prostate cancer cell lines in vitro and in vivo. Moreover, p27(Kip1) expression is associated with an increase in early apoptosis, which represents a recently discovered function for this protein. It also represents the first time this association has been observed in prostate carcinoma cell lines. This study provides support for the further development of Adp27(Kip1) as a potential therapeutic vector in the treatment of adenocarcinoma of the prostate.

Establishment and characterization of a primary androgen-responsive African-American prostate cancer cell line, E006AA.

BACKGROUND: Establishment of human prostate cancer cell lines is essential to advance our understanding of complex processes associated with the initiation and progression of the disease. In the present study, we report the establishment of a primary African-American prostate cancer cell line (E006AA) as well as its associated stromal cells (S006AA). METHODS: E006AA cell line was established as a spontaneously immortalized cells from a patient with a clinically localized prostate cancer. Extensive characterization of the cells was accomplished using androgen-dependent growth and sensitivity assays, Western analyses, RT-PCR/real-time PCR, cytogenetic analyses, and tumorigenicity in nude mice. RESULTS: E006AA cell line shows androgen-dependent growth, expresses PSA and the androgen receptor (AR) with 26 CAG repeats in exon 1 of AR. Cytogenetic analyses revealed a hypertriploid karyotype with additional numerical gains in chromosomes 5, 6, 8, 10, 17, 20, 21 and a marker chromosome of unknown origin as well as structural abnormalities in chromosomes 4, 5, 8, 9, 11-14, 18, and 20. This cell line is not tumorigenic in nude mice. S006AA cell line, isolated from the same tumor specimen, also expresses AR and shows the morphological characteristics of smooth muscle cells of prostatic stroma. CONCLUSIONS: These cell lines are the first available primary epithelial and stromal cells derived from an African-American patient with organ-confined prostate cancer and in conjunction with other established cell lines, could provide an in vitro model system to investigate early transforming events in prostate cancer.