This essay is part of a series of essays that are based on interviews conducted for this special issue with people who practice risk communication related to human or natural hazards as part of their ...professions.
Many nations are faced with the need to remediate large contaminated sites following World War II, the Cold War, and abandoned industrial sites, and to return them to productive land uses. In the ...United States, the Department of Energy (DOE) has the largest cleanup challenge, and its Hanford Site in the state of Washington has the most extensive and most expensive cleanup task. Ideally, the risk to ecological resources on remediation sites is evaluated before, during, and after remediation, and the risk from, or damage to, ecological resources from contaminants should be lower following remediation. In this paper, we report the risk to ecological resources before, during, and as a consequence of remediation on contaminated units requiring cleanup, and then examine the causes for changes in risk by evaluating 56 cleanup evaluation units (EUs) at the Hanford Site. In this case, remediation includes a restoration phase. In general, the risk to ecological and eco-cultural resources is currently not discernible or low at most contaminated units, increases during remediation, and decreases thereafter. Remediation often causes physical disruption to ecosystems as it reduces the risk from exposure to contaminants. Most new remediation projects at the Hanford Site include ecological restoration. Ecological restoration results in the potential for the presence of higher quality resources after remediation than currently exists on these contaminated lands and facilities. Although counter-intuitive, our evaluation of the risk to ecological resources following remediation indicated that a significant percentage of units (61%) will be at increased risk in the post-remediation period. This increased risk is due to DOE's successful remediation and restoration that results in a higher percent of native vegetation and higher ecological value on the sites in the post-remediation period than before. These newly-created resources can then be at risk from post-remediation activities. Risks to these new higher quality resources include the potential for spread of invasive species and of noxious grasses used in previous cleanup actions, disruption of ecosystems (including those with state or federally listed species and unique ecosystems), compaction of soil, use of pesticides to control invasive species, and the eventual need for continued monitoring activities. Thus, by greatly improving the existing habitat and health of eco-receptors, and maintaining habitat corridors between high quality habitats, the ecological resources in the post-remediated units are at risk unless care is taken to protect them. Many of the negative effects of both remediation and future monitoring (or other future land uses) can be avoided by planning and management early in the remediation process. We suggest DOE and other agencies convene a panel of managers, remediation scientists, regulators, environmental and ecological scientists, Native Americans, economists, and the public to develop a generic list of performance metrics for the restoration phase of remediation, including evaluation of success, which could be applied across the DOE complex.
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•Many DOE contaminated sites are in need of remediation.•During cleanup, humans and the environment must be protected.•On many DOE sites, remediation includes restoration of natural resources.•Physical disruption (not radionuclide exposure) is the major threat to eco-resources.•Risks to eco-resources can be higher after remediation due to disruption of newly restored ecosystems.
The U.S. and other developed nations are faced with many contaminated sites remaining from World War II, the Cold War, and abandoned industries, that require remediation and restoration to allow ...future land uses with minimum acceptable risk to humans and ecological resources. For large Department of Energy (DOE) sites with massive remediation tasks remaining, it is important for managers to be able to assure regulators, Tribal Nations, and the public that human and ecological health are protected. Hanford Site has the largest and most expensive cleanup task within the DOE complex; cleanup will continue beyond 2090. Cleanup involves the use of operating facilities, which also may present a risk to humans or ecological resources. We present a brief description of a methodology to evaluate risks to ecological receptors at the Hanford Site from remaining remediation tasks, and evaluate the risk to ecological resources that operating facilities present currently, during active cleanup of these facilities, and during the post cleanup period. Operating facilities include current, active operations that are located on the site and aid in site cleanup, including both storage and treatment operations. At the Hanford Site, they include waste treatment plants, sludge basins, waste trenches, Central Waste Complex, storage facilities, and disposal facilities, among others. Risk ratings for ecological resources are highest during the remediation phase. Risk ratings for the operating facilities at the Hanford Site range from not discernible to medium currently, from not discernible (ND) to high during active cleanup, and from not discernible to medium following cleanup. The highest ratings are for the Waste Treatment and Immobilization Plant that is being constructed to stabilize radioactive and chemical wastes, and the Liquid Effluent Retention and Treatment Facility that removes and deactivates hazardous contaminants from waste water. Higher ratings in the post-cleanup period are largely due to restoration of ecological resources during cleanup, which increases the potential for injury (if these resources are harmed) because a site will then have higher quality resources after cleanup than it did before. Assessing the value of ecological resources, and determining potential consequences during active remediation and after remediation is essential for compliance with state and federal laws. Understanding the risks to ecological resources from now until clean-up is completed at these facilities is important because of the potential for ecological resources of high value to be degraded, and because cleanup completion is not expected until 2090 or later. The methodology can be applied to any contaminated site requiring a rapid method of assessing potential damages to ecological resources from proposed management actions.
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•Many contaminated sites are in need of remediation.•During cleanup, humans and the environment must be protected.•A method to evaluate risk to ecological resources is presented.•Risks are highest during remediation, and lower thereafter.•Disruption during cleanup is the major threat to eco-resources.
Mitochondrial Enoyl CoA Reductase Protein-Associated Neurodegeneration (MEPAN) syndrome is a rare inherited metabolic condition caused by
gene mutations. This gene encodes a protein essential for ...fatty acid synthesis, and defects cause progressively worsening childhood-onset dystonia, optic atrophy, and basal ganglia abnormalities. Deep brain stimulation (DBS) has shown mixed improvement in other childhood-onset dystonia conditions. To the best of our knowledge, DBS has not been investigated as a treatment for dystonia in patients with MEPAN syndrome.
Two children with MEPAN were identified as possible DBS candidates due to severe generalized dystonia unresponsive to pharmacotherapy. Temporary depth electrodes were placed in six locations bilaterally and tested during a 6-day hospitalization to determine the best locations for permanent electrode placement. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Barry-Albright Dystonia Scale (BADS) were used for preoperative and postoperative testing to quantitatively assess dystonia severity changes. Patient 1 had permanent electrodes placed at the globus pallidus internus (GPi) and pedunculopontine nucleus (PPN). Patient 2 had permanent electrodes placed at the GPi and ventralis intermedius nucleus of the thalamus (VIM).
Both patients successfully underwent DBS placement with no perioperative complications and significant improvement in their BFMDRS score. Patient 2 also demonstrated improvement in the BADS.
We demonstrated a novel application of DBS in MEPAN syndrome patients with childhood-onset dystonia. These patients showed clinically significant improvements in dystonia following DBS, indicating that DBS can be considered for dystonia in patients with rare metabolic disorders that currently have no other proven treatment options.
Remediation and restoration of the Nation's nuclear legacy of radiological and chemical contaminated areas is an ongoing and costly challenge for the U.S. Department of Energy (DOE). For large sites, ...such as the Hanford and Savannah River Sites, successful remediation involves complex decisions related to remedies, end-states, timing, and sequencing of cleanup of separate and related contaminated units within a site. Hanford Site cannot clean up every unit simultaneously due to limits in funding, personnel, and technology. This paper addresses one of the major considerations - the consequences of delaying remediation of a unit on different receptors (e.g. people, ecological, and eco-cultural resources), using the DOE Hanford Site as a case study. We develop a list of attributes that managers should consider for successful remediation, examine how delaying remediation could affect workers, the public and ecological resources (including water resources), and use some examples to illustrate potential effects of delays. The factors to consider when deciding whether and how long to delay remediation of a unit include personnel, information and data, funding, equipment, structural integrity, contaminant source, and resource vulnerability. Each of these factors affects receptors differently. Any remediation task may be dependent on other remediation projects, on the availability of transport, containers, interim storage and ultimate disposition decisions, or the availability of trained personnel. Delaying remediation may have consequences for people (e.g. workers, site neighbors), plants, animals, ecosystems, and eco-cultural resources (i.e. those cultural values that depend upon ecological resources). The risks, benefits, and uncertainties for evaluating the consequences of delaying remediation are described and discussed. Assessing the advantages and disadvantages of delaying remediation is important for health professionals, ecologists, resource trustees, regulators, Tribal members, recreationists, fishermen, hunters, conservationists, and a wide range of other stakeholders.
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•The Department of Energy has the largest remediation task in the World.•A methodology for evaluating delays in remediation was developed.•Delaying remediation has costs and benefits to human and ecological health.•Delaying remediation of deteriorating facilities increases risks of human accidents.•Delaying remediation of recovering ecosystems retards recovery.
Despite consensus recommendations from the American College of Emergency Physicians (ACEP), the Centers for Disease Control and Prevention, and the surgeon general to dispense naloxone to discharged ...ED patients at risk for opioid overdose, there remain numerous logistic, financial, and administrative barriers to implementing “take-home naloxone” programs at individual hospitals. This article describes the recent collective experience of 7 Chicago-area hospitals in implementing take-home naloxone programs. We highlight key barriers, such as hesitancy from hospital administrators, lack of familiarity with relevant rules and regulations in regard to medication dispensing, and inability to secure a supply of naloxone for dispensing. We also highlight common facilitators of success, such as early identification of a “C-suite” champion and the formation of a multidisciplinary team of program leaders. Finally, we provide recommendations that will assist emergency departments planning to implement their own take-home naloxone programs and will inform policymakers of specific needs that may facilitate dissemination of naloxone to the public.
Objective To systematically review fully randomised patient preference trials and to explore the impact of preferences on attrition and outcome by meta-analysis of patient level data.Data sources ...Citation search using Science Citation Index and Google Scholar and search of the main electronic databases (Medline, CINAHL, Embase, and AMED) with a combination of key words.Study selection Fully randomised patient preference trials that compared treatments for any clinical condition were included. Other types of preference trials and crossover trials were excluded. Other inclusion criteria: participants aged 16 years and over; primary, self-reported outcomes measured on a continuous numerical scale. From 167 studies identified and screened, 17 were identified as fully randomised patient preference trials.Data synthesis Of the 17 trials identified, 11 authors provided raw data for the meta-analysis. Data collected were baseline and follow-up data for the main outcome, randomised allocation data, preference data, and demographic data. Baseline and first post-intervention follow-up data for the main outcome were standardised. To improve homogeneity, data for only the eight musculoskeletal trials (n=1594) were combined. To estimate the effects of preferences on outcomes and attrition, three groups were compared: patients who had a preference and were randomly allocated to their preferred treatment; patients who had a preference and were randomly allocated to the treatment they did not prefer; and patients who had no preference.Results Patients who were randomised to their preferred treatment had a standardised effect size greater than that of those who were indifferent to the treatment assignment (effect size 0.162, 95% confidence interval 0.011 to 0.314; P=0.04). Participants who received their preferred treatment also did better than participants who did not receive their preferred treatment (effect size 0.152, −0.035 to 0.339), although this was not statistically significant (P=0.11). Participants allocated to their undesired treatment had outcomes that were no different from those who were indifferent. Participants who were allocated to their undesired treatment were less likely to be lost to first follow-up compared with indifferent participants (odds ratio 1.70, 1.076 to 2.693; P=0.02). No difference was found in attrition between patients allocated to their preference and those who were indifferent.Conclusions Preferences among patients in musculoskeletal trials are associated with treatment effects. In open randomised trials, preferences should be ascertained before randomisation.
This study examined the course of antidepressant use, sleep quality, and depression severity from pregnancy through 6-month postpartum in women with and without a depressive disorder during ...pregnancy. Women (
N
= 215) were interviewed during pregnancy, 1- and 6-month postpartum. Mixed linear models were used to examine the longitudinal course and inter-relationships for the time-varying variables of antidepressant use, subjective sleep quality, and depression severity. Pregnant women with a depressive disorder who did not use antidepressants had more variable depression severity over time with improvements in depression severity by 6-month postpartum. In contrast, the depression severity of their medicated counterparts remained stable and high throughout. Pregnant women without a depressive disorder had worse sleep quality when using antidepressants compared with when they were not. Antidepressant use significantly strengthened the magnitude of the effect of sleep quality on depression severity in women with a depressive disorder during pregnancy. When prenatally depressed women use antidepressants, their sleep disturbance is more highly linked to depression severity than when they do not. Furthermore, antidepressants are not adequately treating the sleep disturbance of these women or their remitted counterparts, leaving both groups vulnerable to significant negative mental and physical health outcomes.
Introduction Few studies have investigated sleep effects of prenatal antidepressant use and those that exist lack control groups and include other substance exposure. In neonates, increased REM sleep ...and decreased total sleep time have been linked with exposure but longitudinal effects are unknown. Gaining a more accurate understanding of neurodevelopmental effects of prenatal antidepressant exposure on children and how these effects compare with the effects of untreated maternal depression will aid pregnant, depressed women in making informed treatment decisions. Methods Participants were 30 children and their mothers who participated in the Fetal and Infant Response to SRI Treatment (FIRST) study, a longitudinal investigation of the effects of antidepressants used during pregnancy. The present study examined child sleep parameters at 18 and 36 months utilizing a multimodal sleep assessment including sleep recordings, wrist and crib actigraphy, as well as sleep diary and questionnaires. Mothers-child pairs were categorized as: 1) No depression or ADs during pregnancy (NoEXP); 2) Depression, no ADs (DEP); 3) Depression with ADs (AD). Results Accounting for concurrent maternal depression severity, 18-month-olds with prenatal antidepressant exposure woke up 90 minutes earlier on average than same-age children without AD exposure (p = .07) and experienced an average nightly sleep duration that was 2 hours less than same-age children without AD exposure (p < .05). Also accounting for concurrent maternal depression severity, at 36 months, AD-exposed children went to bed on average 75 minutes before same-age unexposed children (p < .05). Conclusion Children of mothers using antidepressants during pregnancy go to bed earlier, wake up earlier, and are in bed fewer hours per night than children without prenatal antidepressant exposure. Further investigation of the circadian and sleep effects of prenatal antidepressant exposure is merited as well as other neurodevelopmental effects that might be related. Support (If Any) NIH R01MH079033 to Amy Salisbury.
Age and gender differences are prominent in the temperament literature, with the former particularly salient in infancy and the latter noted as early as the first year of life. This study represents ...a meta-analysis utilizing Infant Behavior Questionnaire-Revised (IBQ-R) data collected across multiple laboratories (N = 4438) to overcome limitations of smaller samples in elucidating links among temperament, age, and gender in early childhood. Algorithmic modeling techniques were leveraged to discern the extent to which the 14 IBQ-R subscale scores accurately classified participating children as boys (n = 2,298) and girls (n = 2,093), and into three age groups: youngest (< 24 weeks; n = 1,102), mid-range (24 to 48 weeks; n = 2,557), and oldest (> 48 weeks; n = 779). Additionally, simultaneous classification into age and gender categories was performed, providing an opportunity to consider the extent to which gender differences in temperament are informed by infant age. Results indicated that overall age group classification was more accurate than child gender models, suggesting that age-related changes are more salient than gender differences in early childhood with respect to temperament attributes. However, gender-based classification was superior in the oldest age group, suggesting temperament differences between boys and girls are accentuated with development. Fear emerged as the subscale contributing to accurate classifications most notably overall. This study leads infancy research and meta-analytic investigations more broadly in a new direction as a methodological demonstration, and also provides most optimal comparative data for the IBQ-R based on the largest and most representative dataset to date.
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