Lognormality of trace contaminant concentrations in sewage effluents.

It is important to understand the statistical distribution of monitoring data for them to be of value in determining the parameters of environmental models. No such distributional information has been available for many trace contaminants in sewage effluents. This paper applies the data of a major UK sewage works' effluent monitoring programme to determine the validity of the common assumption that data are lognormally distributed. Effluent quality was monitored at 162 wastewater treatment works over 1 year, generating over 3,000 results for each of over 40 substances, including metals, trace organic substances and pharmaceuticals. It is demonstrated that the lognormal assumption is clearly justified for the great majority of substances in the spatial case-for annual average effluent concentrations across different treatment works. In the site-specific, temporal case-for individual determinations of concentration at a single site over an annual period-lognormality is generally supported but not demonstrated so unequivocally for all site/substance combinations. The principal source of uncertainty was lack of sufficient numbers of observations reported to adequately low reporting limits.

A shotgun optical map of the entire Plasmodium falciparum genome.

The unicellular parasite Plasmodium falciparum is the cause of human malaria, resulting in 1.7-2.5 million deaths each year. To develop new means to treat or prevent malaria, the Malaria Genome Consortium was formed to sequence and annotate the entire 24.6-Mb genome. The plan, already underway, is to sequence libraries created from chromosomal DNA separated by pulsed-field gel electrophoresis (PFGE). The AT-rich genome of P. falciparum presents problems in terms of reliable library construction and the relative paucity of dense physical markers or extensive genetic resources. To deal with these problems, we reasoned that a high-resolution, ordered restriction map covering the entire genome could serve as a scaffold for the alignment and verification of sequence contigs developed by members of the consortium. Thus optical mapping was advanced to use simply extracted, unfractionated genomic DNA as its principal substrate. Ordered restriction maps (BamHI and NheI) derived from single molecules were assembled into 14 deep contigs corresponding to the molecular karyotype determined by PFGE (ref. 3).

Summary of data from the UKWIR chemical investigations programme and a comparison of data from the past ten years' monitoring of effluent quality.

This paper reports summary data from a ten-year programme of investigation into the composition of wastewater treatment works' effluents in the UK. The so-called Chemical Investigations Programme focused on determinands of regulatory importance and involved monitoring of effluents for over seventy trace substances and sanitary determinands at more than 600 UK treatment works sites. The results provide a definitive overview of effluent quality. Although raw data are available, this publication of summary data provides a convenient résumé of the current state of knowledge. An analysis of changes in concentrations over the monitoring period between 2010 and 2020 shows that for several substances (nickel, diethylhexylphthalate, nonylphenol, tributyltin, the brominated diphenyl ethers and triclosan) significant reductions in wastewater concentration have occurred over the period of interest, these are likely to have resulted from a combination of tighter regulatory controls and/or improved wastewater treatment.

Assessing the impact of wastewater treatment works effluent on downstream water quality.

The impact of wastewater treatment works (WwTW) effluent on downstream river water quality is of increasing concern, particularly owing to the presence in effluents of a range of trace substances. In the case of contamination by metals the question of bioavailability has recently been accounted for in setting water quality standards for several metals. In the UK over the past decade the Chemical Investigations Programme (CIP) has generated upstream and downstream river quality data as well as associated WwTW effluent monitoring for over 600 sites, for the main contaminants of regulatory interest under the Water Framework Directive. Data presented here show that at a local level WwTW discharges have little impact for many contaminants. Soluble reactive phosphorus, hexabromocyclododecane (HBCDD), cypermethrin, perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) have been shown to be the principal substances where downstream concentrations were at least 10 % larger than the upstream value. Otherwise, poor compliance with riverine water quality standards tends to be associated with contamination at the river catchment scale, with corresponding implications for the nature of remedial actions that are likely to be successful. Compliance with water quality criteria for metals, taking account of bioavailability, is high overall.

Effects of iron dosing used for phosphorus removal at wastewater treatment works; impacts on forms of phosphorus discharged and secondary effects on concentrations and fate of other contaminants.

Iron dosing for phosphorus reduction during wastewater treatment is wide practised across the globe. However, the impacts of this dosing in terms of the speciation of phosphorus discharged and secondary effects on removing or introducing other trace elements from or into the effluent have not been studied. Results are presented for concentrations of a range of contaminants in over 600 wastewater treatment works, reported as mean concentration values derived from 20 effluent samples taken over a period of two years. Approximately half of the treatment works employed iron dosing to reduce concentrations of phosphorus in effluents. In addition to the expected effects on level of phosphorus discharged to surface waters, it is shown that these measures are shown to have unintended and beneficial consequences for concentrations of several other constituents of wastewater. Reductions of more than 40% in the concentrations of dissolved metals (copper, lead) benzo(a)pyrene and hexabromocyclododecane are observed. Lower but still significant decreases in concentration (>30%) are evident for dissolved cadmium, fluoranthene cypermethrin and biochemical oxygen demand. Small but less environmentally important increases are seen for iron and nickel, in the case of the latter this is presumably because nickel is a contaminant of the iron reagent used for dosing. These reductions are shown to offer significant benefits in terms of levels entering surface waters relating to the in-river environmental quality standards.

Perfluorinated alkyl substances: Sewage treatment and implications for receiving waters.

This study comprises a detailed analysis of data for perfluorooctanesulfonic acid (PFOS), and perfluorooctanoic acid (PFOA) for over 600 wastewater treatment works effluents (WwTW) as well as samples upstream and downstream of each discharge of effluent into its receiving water. This has allowed an investigation of not only the effectiveness of removal of the perfluoroalkyl substances (PFAS) compounds during wastewater treatment but also implications for compliance with the environmental quality standard (EQS) set for PFOS under the Water Framework Directive. It is shown that effluents contain concentrations of PFOS that exceed the annual average EQS by a factor between 1.1-fold and 40-fold. The corresponding factors for PFOA are between 2-fold and 22-fold. The presence of high concentrations upstream, means that between a quarter and a third of individual effluents are found to reduce the concentration of fluorocarbons in the river downstream of the discharge point. The elevated concentrations upstream of the studied wastewater treatment works suggest inputs of these perfluoro compounds into the aquatic environment are ubiquitous and therefore difficult to address from simply setting permit conditions for individual WwTW. The freshwater EQS set for PFOS is based on several worst-case accumulation coefficients and large safety factors, which, when combined, result in a sub ng/L EQS. Consequently, the use of the biota derived quality standard may be a more realistic measure of environmental risk. It may be prudent, to assess the effectiveness of controls implemented in the last few years before considering widespread end-of-pipe treatment.

Seasonal variation of contaminant concentrations in wastewater treatment works effluents and river waters.

Results are presented for 170 wastewater treatment works sites (20 per substance in influent, effluent and 36 per substance in river water upstream and downstream of the WwTW discharge) over a period of two years between 2015 and 2017; this comprises data for approximately 3000 samples for effluent and 6000 for river samples taken downstream of effluent discharges. Seasonal trends in contaminant concentrations for several substances are reported. Two clear patterns of seasonal variation are proposed over and above all of the variables associated with environmental data including process technology, dilution and geography. Firstly, variation of riverine concentrations caused by seasonal fluctuations in river flow (sewage flow being relatively consistent) resulting in summer maxima and winter minima. Alternatively, variation is observed that is attributable to the improved performance of wastewater treatment processes under warmer conditions. This leads to the lowest concentrations in autumn when surface water/sewage treatment temperatures tend to peak. Seasonality for trace contaminants is more difficult to characterise than that of sanitary parameters owing to the higher variability in the concentration of the substances of interest. The data also provide an insight into the amplitude of such variations. This makes it possible to assess the likely effects of seasonality and its impact on aquatic life. For example, the existence of seasonality (perhaps due only to dilution effects) might be demonstrated, but the amplitude might be too small in relation to the potential ecotoxicological effects to be of any consequence.

Modelling scenarios of environmental recovery after implementation of controls on emissions of persistent organic pollutants.

Comparison of monitoring data with toxicologically-derived environmental quality standards (EQSs) forms the basis of assessments of the quality status of the water environment. Having established the status quo, the logical next step is to address instances of non-compliance with EQSs by applying remedial measures, including reducing the use or at least the emission of the substances of concern or by taking steps to reduce concentrations already present using technological solutions such as enhanced wastewater treatment. The selection of suitable remedial measures must be a compromise between cost, likely effectiveness and the timescale over which improvements might be acceptable. The decision on overall environmental management has also to take into account the need for demonstrable progress; this might mean that it is preferable to address some more readily achievable goal rather than to attempt to solve a more serious, but ultimately intractable problem. This paper describes the development and application of a generic modelling tool that provides a way of assessing the potential requirements for remedial actions and their likely outcomes over a timescale of up to forty years taking account of sediment partitioning, environmental degradation and biological accumulation. The tool was validated using a detailed UK wastewater treatment works effluent discharge dataset. Examples involving several chemicals that are of current concern are provided. Some substances (e.g. tributyltin, PFOS) are identified as likely to meet EQS values in sediments or biota in a relatively short timescale; others (PAHs, DEHP) appear to represent more intractable problems.

Chromosome 2 sequence of the human malaria parasite Plasmodium falciparum.

Chromosome 2 of Plasmodium falciparum was sequenced; this sequence contains 947,103 base pairs and encodes 210 predicted genes. In comparison with the Saccharomyces cerevisiae genome, chromosome 2 has a lower gene density, introns are more frequent, and proteins are markedly enriched in nonglobular domains. A family of surface proteins, rifins, that may play a role in antigenic variation was identified. The complete sequencing of chromosome 2 has shown that sequencing of the A+T-rich P. falciparum genome is technically feasible.

The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis.

BACKGROUND: Child maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders. METHODS: Published cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment. RESULTS: All forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14-2.87]; sexual abuse [OR = 2.11, 1.83-2.44]; physical abuse [OR = 1.78, 1.57-2.01]; emotional abuse [OR = 2.35, 1.74-3.18]; neglect [OR = 1.65, 1.35-2.02]; and exposure to IPV [OR = 1.68, 1.34-2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders ('any child maltreatment' [OR = 1.68, 1.33-2.4]; sexual abuse [OR = 1.90, 1.6-2.25]; physical abuse [OR = 1.56, 1.39-1.76]; and neglect [OR = 1.34, 1.09-1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD). CONCLUSIONS: There is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.

The genome of the malaria parasite.

The genome of the human malaria parasite Plasmodium falciparum is being sequenced by an international consortium. Two of the parasite's 14 chromosomes have been completed and several other chromosomes are nearly finished. Even at this early stage of the project, analysis of the genome sequence has provided promising new leads for drug and vaccine development.

Towards the establishment of an environmental quality standard for aluminium in surface waters.

Steps taken to establish an environmental quality standard (EQS) for aluminium are described. The range of water types in England and Wales and the concentrations of low molecular weight (active) forms of aluminium have been assessed in order to evaluate the risk posed by aluminium in surface waters. Levels of low molecular weight forms of aluminium are mainly in the range 0-25 microg l(-1). Data suggest that dissolved aluminium might form the basis of a reasonably useful prediction of active aluminium leading to a simplified approach to compliance monitoring of an EQS set in terms of active aluminium.

Detecting environmental change: how many samples are required?

One of the most important functions of environmental monitoring is the detection of change. This can be the delineation of deteriorating circumstances or the identification of the success of remedial measures. The design of effective monitoring of change (and hence the optimisation of resources devoted to monitoring) relies on appropriate replication - knowing how many samples are required. Lack of information on the variance of the measured parameter is often a barrier to determining the optimum sampling strategy. An important new information resource on within-site variance of the concentrations of over 60 trace substances in wastewater treatment works effluents has been provided by the UK water industry research programme. This paper makes use of this resource in order to explore the potential to design monitoring programmes that will be capable of demonstrating the success of planned remedial measures that will be implemented in the coming years. Two approaches to experimental design (simple before-and-after sampling and detection of trends via correlation) are examined. It is concluded that for programmes involving numbers of samples of less than 30 the detection of a change in concentration of less than 50% might be very challenging for many of the trace substance of greatest interest. Knowledge of the difficulty of the task in hand should make it possible to design programmes that optimise the use of resources and the approaches taken, such that effects of interest are detected as soon and as economically as possible.

Cost minimization analysis of the treatment of distal radial fractures in the elderly.

AIMS: The aim of this study was to test the null hypothesis that there is no difference, from the payer perspective, in the cost of treatment of a distal radial fracture in an elderly patient, aged > 65 years, between open reduction and internal fixation (ORIF) and closed reduction (CR). MATERIALS AND METHODS: Data relating to the treatment of these injuries in the elderly between January 2007 and December 2015 were extracted using the Humana and Medicare Advantage Databases. The primary outcome of interest was the cost associated with treatment. Secondary analysis included the cost of common complications. Statistical analysis was performed using a non-parametric t-test and chi-squared test. RESULTS: Our search yielded 8924 patients treated with ORIF and 5629 patients treated with CR. The mean cost of an uncomplicated ORIF was more than a CR ($7749 versus $2161). The mean additional cost of a complication in the ORIF group was greater than in the CR group ($1853 versus $1362). CONCLUSION: These findings show that there are greater payer fees associated with ORIF than CR in patients aged > 65 years with a distal radial fracture. CR may be a higher-value intervention in these patients. Cite this article: Bone Joint J 2018;100-B:205-11.

Randomized crossover comparison of DDDR versus VDD pacing after atrioventricular junction ablation for prevention of atrial fibrillation. The atrial pacing peri-ablation for paroxysmal atrial fibrillation (PA (3)) study investigators.

BACKGROUND: Some clinical data suggest that atrial-based pacing prevents paroxysmal atrial fibrillation (AF). This study tested the hypothesis that DDDR pacing compared with VDD pacing prevents AF after atrioventricular (AV) junction ablation. METHODS AND RESULTS: Patients were randomized to DDDR pacing (n=33) or to VDD pacing (n=34) after AV junction ablation and followed every 2 months for 6 months. Patients then crossed over to the alternate pacing mode and were followed for an additional 6 months. Primary analysis included the time to first recurrence of sustained AF (duration >5 minutes), total AF burden, and the development of permanent AF. The time to first episode of AF was similar in the DDDR group (0.37 days, 95% CI 0.1 to 1.3 days) and the VDD pacing group (0.5 days, 95% CI 0.2 to 1.7 days, P=NS). AF burden increased over time in both groups (P<0.01). At the 6-month follow-up, AF burden was 6.93 h/d (95% CI 4. 37 to 10.96 h/d) in the DDDR group and 6.30 h/d (95% CI 3.99 to 9.94 h/d) in the VDD group (P=NS). Twelve (35%) patients in the DDDR group and 11 (32%) patients in the VDD group had permanent AF within 6 months of ablation. Within 1 year of follow-up, 43% of patients had permanent AF. CONCLUSIONS: DDDR pacing compared with VDD pacing does not prevent paroxysmal AF over the long term in patients in the absence of antiarrhythmic drug therapy after total AV junction ablation. Many patients have permanent AF within the first year after ablation.

Refractory paroxysmal sinus tachycardia: management by subtotal right atrial exclusion.

A 27 year old woman presented with recurrent episodes of disabling paroxysmal sinus tachycardia (150 to 180 beats/min) in the absence of identifiable organic disease. Tachycardia was resistant to all drug therapy. Programmed stimulation could not induce the tachycardia but high dose propranolol therapy failed to suppress sinus tachycardia in response to isoproterenol infusion. Because of the disability resulting from refractory tachycardia, the patient underwent a new operative procedure to create exit block around the region of abnormal impulse formation. This resulted in the appearance of a stable junctional escape rhythm at 60 beats/min. No adverse effects occurred and the patient has remained free of symptoms after a follow-up period of 10 months.

Electrocardiographic and ventriculographic recovery patterns in Q wave myocardial infarction.

To further define the capacity for recovery after acute phase electrical and mechanical injury in patients with Q wave myocardial infarction who were treated with standard measures, 120 lead body surface potential maps and radionuclide angiograms were recorded at day 5 before discharge and month 6 after infarction in 23 patients with a first infarction (12 anterior and 11 inferior by standard 12 lead electrocardiographic criteria). In addition to assessment of spatial changes in electrocardiographic and wall motion patterns, five quantitative variables were evaluated: minimal Q zone integral, sigma Q wave integral, maximal ST integral, left ventricular ejection fraction and left ventricular wall motion abnormality score. From day 5 to month 6 after infarction, the only change in the inferior infarction group was a gain in sigma Q wave (-91 +/- 40 mu V X s X 10(2) to -68 +/- 24 mu V X s X 10(2); p less than 0.05). In contrast, all variables improved over the same time period in the anterior infarction group: Q zone minimum, -34 +/- 20 to -24 +/- 13 mu V X s (p less than 0.05); sigma Q wave, -160 +/- 122 X 10(2) to -120 +/- 90 mu V X s X 10(2) (p less than 0.05); ST maximum, 44 +/- 19 to 18 +/- 9 mu V X s (p less than 0.01); ejection fraction, 54 +/- 7 to 63 +/- 17% (p less than 0.05); and wall motion score, 6 +/- 3 to 3 +/- 3 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Definition of predicted effective antiarrhythmic drug therapy for ventricular tachyarrhythmias by the electrophysiologic study approach: randomized comparison of patient response criteria.

OBJECTIVES: We sought to compare efficacies of therapy for ventricular tachyarrhythmias selected by programmed stimulation using two different patient response efficacy criteria: <5 versus <16 repetitive ventricular responses. BACKGROUND: Therapy selection for ventricular tachyarrhythmias by programmed stimulation requires definition of a patient response that predicts long-term efficacy. Such definitions have not been previously compared prospectively. METHODS: Patients with sustained ventricular tachyarrhythmias were randomized to therapy selection using either the <5 or <16 repetitive response criterion of predicted effective therapy. The primary end point was sudden death or recurrence of ventricular tachyarrhythmia requiring intervention. RESULTS: Predicted effective drug therapy was found for 23 (34%) of 68 patients randomized to the <5 criterion and 29 (36%) of 81 patients randomized to the <16 criterion (p = NS). Definition of therapy required 3.0 +/- 1.6 drug trials (mean +/- SD) in patients randomized to the <5 criterion and 2.9 +/- 1.8 trials in patients randomized to the <16 criterion (p = NS). Patients randomized to the <5 criterion had a lower 2-year probability of the primary end point (0.20 +/- 0.05) than did patients randomized to the <16 criterion (0.33 +/- 0.05, one-tailed p = 0.004). The advantage of the <5 criterion was also seen in subgroup analyses involving patients with and without an initial drug efficacy prediction. CONCLUSIONS: The programmed stimulation approach to the selection of antiarrhythmic therapy for ventricular tachyarrhythmias using a patient response criterion of <5 repetitive ventricular responses results in a lower probability of recurrence of ventricular tachyarrhythmia than does use of a <16 repetitive response criterion.

Prevention and treatment of osteoporotic fractures.

With the aging international population, osteoporosis has become an epidemic. This painless disease is characterized by a decreased bone mass, resulting in decreased structural integrity of bone, and often goes undiagnosed. Typical osteoporotic fractures include vertebrae, hip, and wrist fractures, and these may have a dramatic impact on quality of life, even if the fracture is successfully treated. Many antiresorptive agents have demonstrated the ability to reduce the risk of osteoporotic fractures, and newer anabolic agents may further reduce risk. Non-medical treatments, such as external hip protectors and balance and low-impact strength training, are also very effective in preventing fractures. Before specific treatments can be addressed, however, osteoporosis must first be considered as a diagnosis in any patient with a low-energy fracture. This requires continued public health initiatives involving patient and physician education regarding the necessity for bone mass measurement and the merits of antiresorptive therapy.

Leukemia in children and paternal radiation exposure at the Sellafield nuclear site.

Childhood cancer around nuclear installations has been studied in recent years, particularly in the United Kingdom but also in other countries. The early studies were prompted by the suggestion of a 10-fold raised level of childhood leukemia around the Sellafield nuclear site in England, which was confirmed and followed by the identification of generally smaller excesses around some (but not all) other nuclear sites in the United Kingdom. Marked excesses have not been reported in other countries. The increased leukemia rate around Sellafield has been further investigated by examining individual cases in detail in epidemiological cohort and case-control studies. The raised incidence seems to have been concentrated in children born in the local area but not among children who moved in after birth and was particularly associated with fathers who had experienced higher levels of occupational external ionizing radiation exposure at Sellafield before their children's conception. The underlying cause of this statistical association is not yet clear, but the findings have important potential implications for radiobiology and for protection of radiation workers and their children.