Deciphering dueling analyses of clean water regulations Boyle, Kevin J.; Kotchen, Matthew J.; Smith, V. Kerry
Science (American Association for the Advancement of Science),
10/2017, Volume:
358, Issue:
6359
Journal Article
Peer reviewed
Hundreds of millions of dollars in benefits were discarded
Government agencies are often required to conduct benefit-cost analyses for major regulatory actions (
1
). When benefit-cost analysis is ...consistent with best practices, it provides a systematic and science-based approach for informing policy and regulatory decisions. It has been particularly important for health and environmental regulations. Yet the wide disparity between the quantified benefits in two recent and conflicting regulatory impact analyses (RIAs) related to the U.S. Clean Water Act (CWA) has the potential to undermine the credibility of agencies' benefit-cost analyses. It also highlights the need for a more systematic protocol that ensures the information base is adequate and appropriately applied to support agency analyses and public decision-making. This includes applications in the context of the CWA, which is the focus of an 11 October hearing in the U.S. Supreme Court.
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BFBNIB, NMLJ, NUK, ODKLJ, PNG, SAZU, UL, UM, UPUK
An anhydrous route for the synthesis of amine-capped coinage-metal nanoparticles (NP) has been developed using coinage-metal mesityl (mesityl = 2,4,6-Me3C6H2) derivatives. Under an argon atmosphere, ...crystalline Cu(μ-mesityl)5, Ag(μ-mesityl)4, and Au(μ-mesityl)5 were readily dissolved in octylamine (0.3 M solution) and subsequently injected into a heated hexadecylamine solution (300 °C), generating the corresponding metal nanoparticles. After washing with methanol and extracting with toluene, oxide-free coinage NPs were isolated and characterized by UV−vis spectroscopy and transmission electron microscopy. Under these conditions, the spherical NPs were found to be 8−9 nm in size for Cu° (no surface oxide present), 9 nm for Ag°, and 8−80 nm for Au°. Reducing the concentration of the precursor solution, the temperature of the solution, and the time of reaction led to the synthesis of Au° NPs that were 12 ± 1 nm in size.
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IJS, KILJ, NUK, PNG, UL, UM
Background
Venom immunotherapy (VIT) is commonly used for preventing further allergic reactions to insect stings in people who have had a sting reaction. The efficacy and safety of this treatment has ...not previously been assessed by a high‐quality systematic review.
Objectives
To assess the effects of immunotherapy using extracted insect venom for preventing further allergic reactions to insect stings in people who have had an allergic reaction to a sting.
Search methods
We searched the following databases up to February 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), AMED (from 1985), LILACS (from 1982), the Armed Forces Pest Management Board Literature Retrieval System, and OpenGrey. There were no language or publication status restrictions to our searches. We searched trials databases, s from recent European and North American allergy meetings, and the references of identified review articles in order to identify further relevant trials.
Selection criteria
Randomised controlled trials of venom immunotherapy using standardised venom extract in insect sting allergy.
Data collection and analysis
Two authors independently undertook study selection, data extraction, and assessment of risk of bias. We identified adverse events from included controlled trials and from a separate analysis of observational studies identified as part of a National Institute for Health and Clinical Excellence Health Technology Assessment.
Main results
We identified 6 randomised controlled trials and 1 quasi‐randomised controlled trial for inclusion in the review; the total number of participants was 392. The trials had some risk of bias because five of the trials did not blind outcome assessors to treatment allocation. The interventions included ant, bee, and wasp immunotherapy in children or adults with previous systemic or large local reactions to a sting, using sublingual (one trial) or subcutaneous (six trials) VIT. We found that VIT is effective for preventing systemic allergic reaction to an insect sting, which was our primary outcome measure. This applies whether the sting occurs accidentally or is given intentionally as part of a trial procedure.
In the trials, 3/113 (2.7%) participants treated with VIT had a subsequent systemic allergic reaction to a sting, compared with 37/93 (39.8%) untreated participants (risk ratio RR 0.10, 95% confidence interval CI 0.03 to 0.28). The efficacy of VIT was similar across studies; we were unable to identify a patient group or mode of treatment with different efficacy, although these analyses were limited by small numbers. We were unable to confirm whether VIT prevents fatal reactions to insect stings, because of the rarity of this outcome.
Venom immunotherapy was also effective for preventing large local reactions to a sting (5 studies; 112 follow‐up stings; RR 0.41, 95% CI 0.24 to 0.69) and for improving quality of life (mean difference MD in favour of VIT 1.21 points on a 7‐point scale, 95% CI 0.75 to 1.67).
We found a significant risk of systemic adverse reaction to VIT treatment: 6 trials reported this outcome, in which 14 of 150 (9.3%) participants treated with VIT and 1 of 135 (0.7%) participants treated with placebo or no treatment suffered a systemic reaction to treatment (RR 8.16, 95% CI 1.53 to 43.46; 2 studies contributed to the effect estimate). Our analysis of 11 observational studies found systemic adverse reactions occurred in 131/921 (14.2%) participants treated with bee venom VIT and 8/289 (2.8%) treated with wasp venom VIT.
Authors' conclusions
We found venom immunotherapy using extracted insect venom to be an effective therapy for preventing further allergic reactions to insect stings, which can improve quality of life. The treatment carries a small but significant risk of systemic adverse reaction.
The accurate assessment of a patient's conscious state using the Glasgow Coma Scale (GCS) is an important skill for paramedics as it may determine the patient's initial and ongoing management. The ...objective of this study was to determine if undergraduate paramedic students from a large Australian University were able to accurately interpret a variety of conscious states.
A prospective double-blinded observational pilot study requiring students to interpret the conscious state of four adult patients using the GCS by viewing a simulation DVD package.
There were 137 students who participated in the study, of whom 65% (n=87) were female students. The results demonstrated that undergraduate paramedic students were unable to accurately interpret a number of patient conscious states with only 20% and 37% of students able to accurately identify the GCS of patients 2 (GCS=12) and 3 (GCS=7). The motor component of the GCS appeared to be the component where the least accurate interpretation occurred, with only 47% of students being able to accurately identify the criteria that patient 3 displayed. Participants were however able to accurately interpret the GCS of both patient 1 (GCS=14) (86%) and patient 4 (GCS=15) (92%).
This pilot study demonstrates that undergraduate paramedic students from an Australian university were unable to accurately interpret a patient's conscious state if their GCS score was <14. These findings have provided academic staff with important information for considering alternative teaching and learning strategies and approaches in conscious state assessment in current paramedic curricula.
The objective of this study was to determine if undergraduate paramedics could accurately perform common drug calculations and basic mathematical computations normally required in the workplace.
A ...descriptive paper-based questionnaire collecting demographical data, student attitudes regarding their drug calculation performance, and answers to a series of basic mathematical and drug calculation questions was administered to undergraduate paramedic students.
The mean score was 39.5% with only 3.3% of students (n=3) scoring greater than 90%, and 63% (n=58) scoring 50% or less. Conceptual errors made up 48.5%, arithmetical 31.1% and computational 17.4%.
This study suggests undergraduate paramedics have deficiencies in performing accurate calculations with conceptual errors indicating a fundamental lack of mathematical understanding.
► Highly hydrophilic surface alumina nanoparticles coated onto fabric. ► Cysteic acid surface stabilized alumina nanoparticles. ► Flux measurements with water, brine, and hydrocarbons. ► ...Organic/water separation using macroscopic pore sized membranes.
The fabrication of surface functionalized alumina fabric composite membranes using hydrophilic cysteic acid surface stabilized alumina nanoparticles (alumoxanes) have been investigated. Contact angle measurements for a range of carboxylic acids functionalized onto alumina coated silicon wafers was investigated to determine the functionalization that results in the most hydrophilic surface. Highly porous Nomex
® fabric was utilized as a membrane support for an alumoxane nanoparticle derived membrane filter. The flux differentiation of heavy hydrocarbons from water, and the separation of oil/water emulsions were studied. Coating techniques utilizing pH control were investigated. Retention coefficients and flux values indicate that surface chemistry of the fabric may be altered by coating with chemically functionalized alumina nanoparticles to provide selective flow of water versus hydrocarbons.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
A convenient, simple, single-source solution synthesis of Ge nanocrystals via thermal reduction of Ge(II) precursor GeN(SiMe3)22 in a non-coordinating solvent at 300 degrees C and 1 atm Ar is ...described.
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