In the United States, coal consumption in the last 12 years has declined from 1,045,140 million short tons in 2007 to 539,420 million short tons in 2019, a decrease of almost 50%. During that period ...the number of electric power coal generators has declined from 1,470 to 738 accounting for 21% of capacity. An even more dramatic decrease in coal use has occurred in Western Europe. This significant reduction in coal use and the concomitant closure of coal mines and coal-burning power plants will result in substantially cleaner air, reductions in respiratory problems such as asthma, less heart disease, fewer hospitalizations, and other health benefits, as well as a reduction in occupational health problems such as silicosis and Coal Workers’ Pneumoconiosis (Black Lung Disease). However, in China, India, Russia and in several other Asian countries some projections indicate an increase in coal production and use. In some situations, the coal is burned in old, highly polluting power plants. In these regions the health impacts of coal use could worsen. In addition, millions of people in these regions still burn coal in their homes resulting in maximal exposure to the pollutants such as arsenic, selenium, fluorine, and mercury released from coal combustion.
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•Impact of coal mining and coal use on Future Environmental and Health Impacts.•Positive and negative impacts and of the dynamic changes in coal mining and use.•Dramatically different approaches of coal mining and use in different parts of the globe.
Discussion of prognosis is an essential component of decision-making family conferences in critical care. We do not know how clinicians convey prognosis to families of critically ill children. We, ...therefore, aimed to evaluate the frequency of prognostic statements and the message and meaning conveyed through each statement during PICU family conferences.
Retrospective, mixed-methods study.
PICU of a single quaternary medical center.
Critically ill children and their families participating in PICU family conferences of critical medical decision-making.
None.
We analyzed 72 transcripts from audio-recorded PICU family conferences to identify prognostic statements. Descriptive, thematic content analysis was used to elucidate the message and meaning of each prognostic statement. Prognosis was not discussed in 26% (19/72) of family conferences. Of the other (53/72) conferences where prognostic statements were made, 60% (67/112) of statements conveyed a message (i.e., prognostic medical information) and a meaning (i.e., anticipated impact on patient/family). "Messages" of prognostic statements fell within eight themes: uncertain recovery, delayed recovery, progressive decline, escalation of support, attributable complications, no progress, irreversible, and probability of death. "Meanings" of prognostic statements fell within six themes: restoration of health, activities of daily living, additional equipment, prolonged care needs, brain dysfunction, and death. Broadly, clinicians discussed prognostic information in three categories: loss of Time (i.e., prolonged care needs), Function (i.e., additional medical equipment), or Cure (i.e., death).
Nearly in half of discussions (32/72, 44%) where families were asked to make critical medical decisions, clinicians did not provide a prognostic statement including a message and meaning. When discussed, prognostic information was conveyed in three categories: loss of time, function, or cure. Providing families context in this framework, particularly in times of uncertainty, may improve the family's ability to make informed, value-driven medical decisions for their child.
An investigation of road sediment in Gary, Indiana revealed high levels of various trace metals such as Zn, Mn, and Cr, often exceeding those of background reference concentrations as shown through ...geoaccumulation indices and contamination factors. The hazard index (HI) value for Mn in children was >1 (1.7), suggesting possible long-term non-carcinogenic health risk. Mn HI for children is even higher for the five samples closest to a US Steel facility, with an HI of 2.8. Through SEM-EDS analysis, the prevalence of small particulates (PM2.5 and PM2.5–10) containing potentially harmful elements such as Mn and Pb illustrate a health risk through direct inhalation or ingestion. The small nature of particulates in general may also pose an increased health risk for respiratory diseases such as asthma. Mn concentrations in the road sediment were particularly high, with 30 out of 32 samples exceeding 1800 ppm. Mn and V concentrations show a strong spatial trend of decreasing concentration away from a US Steel facility. These spatial trends along with correlation plots of the bulk chemistry suggest that industrial steel manufacturing, particularly US Steel in Gary, is a major contributing source of Mn and V. Fe and Cr show a moderate decrease in concentrations away from the US Steel facility, which suggests some sourcing from the steel facility when coupled with bulk chemistry plots. Zn and Cu do not show much evidence of sourcing from the US Steel facility, likely due to increased mixing from other sources. Further work constraining anthropogenic sources, the bioaccessible fraction of metals, and analysis of direct atmospheric particulates can help with remedial activity and risk assessment.
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•Metal pollution of elements such as Cr, Mn, and Zn is prominent in road sediment.•Several trace metals decrease in concentration away from a US Steel facility.•Bulk chemistry correlations such as Mn vs V suggest largely steel facility sourcing.•SEM revealed prevalence of PM2.5 and PM10 in the road sediment.•Mn hazard index (HI) values in Gary, IN are high for children (1.7).
We evaluated water quality characteristics in the northern Raton Basin of Colorado and documented the response of the Poison Canyon aquifer system several years after upward migration of methane gas ...occurred from the deeper Vermejo Formation coalbed production zone. Results show persistent secondary water quality impacts related to the biodegradation of methane. We identify four distinct characteristics of groundwater–methane attenuation in the Poison Canyon aquifer: (i) consumption of methane and sulfate and production of sulfide and bicarbonate, (ii) methane loss coupled to production of higher molecular weight (C2+) gaseous hydrocarbons, (iii) patterns of 13C enrichment and depletion in methane and dissolved inorganic carbon, and (iv) a systematic shift in sulfur and oxygen isotope ratios of sulfate, indicative of microbial sulfate reduction. We also show that the biogeochemical response of the aquifer system has not mobilized naturally occurring trace metals, including arsenic, chromium, cobalt, nickel, and lead, likely due to the microbial production of hydrogen sulfide which favors stabilization of metals in aquifer solids.
The North Star ambulatory assessment (NSAA) is a functional motor outcome measure in Duchenne muscular dystrophy (DMD), widely used in clinical trials and natural history studies, as well as in ...clinical practice. However, little has been reported on the minimal clinically important difference (MCID) of the NSAA. The lack of established MCID estimates for NSAA presents challenges in interpreting the significance of the results of this outcome measure in clinical trials, natural history studies and clinical practice. Combining statistical approaches and patient perspectives, this study estimated MCID for NSAA using distribution-based estimates of 1/3 standard deviation (SD) and standard error of measurement (SEM), an anchor-based approach, with six-minute walk distance (6MWD) as the anchor, and evaluation of patient and parent perception using participant-tailored questionnaires. The MCID for NSAA in boys with DMD aged 7 to 10 years based on 1/3 SD ranged from 2.3-2.9 points, and that on SEM ranged from 2.9-3.5 points. Anchored on the 6MWD, the MCID for NSAA was estimated as 3.5 points. When the impact on functional abilities was considered using participant response questionnaires, patients and parent perceived a complete loss of function in a single item or deterioration of function in one to two items of the assessment as an important change. Our study examines MCID estimates for total NSAA scores using multiple approaches, including the impact of patient and parent perspective on within scale changes in items based on complete loss of function and deterioration of function, and provides new insight on evaluation of differences in these widely used outcome measure in DMD.
Biocides used in unconventional oil and gas (UOG) practices, such as hydraulic fracturing, control microbial growth. Unwanted microbial growth can cause gas souring, pipeline clogging, and ...microbial-induced corrosion of equipment and transportation pipes. However, optimizing biocide use has not been a priority. Moreover, biocide efficacy has been questioned because microbial surveys show an active microbial community in hydraulic fracturing produced and flowback water. Hydraulic fracturing produced and flowback water increases risks to surface aquifers and rivers/lakes near the UOG operations compared with conventional oil and gas operations. While some biocides and biocide degradation products have been highlighted as chemicals of concern because of their toxicity to humans and the environment, the selective antimicrobial pressure they cause has not been considered seriously. This perspective article aims to promote research to determine if antimicrobial pressure in these systems is cause for concern. UOG practices could potentially create antimicrobial resistance hotspots under-appreciated in the literature, practice, and regulation arena, hotspots that should not be ignored. The article is distinctive in discussing antimicrobial resistance risks associated with UOG biocides from a biological risk, not a chemical toxicology, perspective. We outline potential risks and highlight important knowledge gaps that need to be addressed to properly incorporate antimicrobial resistance emergence and selection into UOG environmental and health risk assessments.
Risk and resilience in an uncertain world Dale, Virginia H; Jager, Henriette I; Wolfe, Amy K ...
Frontiers in ecology and the environment,
02/2018, Letnik:
16, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The need to proactively address risk and resilience is more pressing than ever. Managing complex ecosystems to maintain essential characteristics in the face of an uncertain future is challenging. ...Therefore, we offer a perspective on risk and resilience that encompasses interactions among ecosystems, social systems, infrastructure, and evolving technological capabilities. Management decisions need to concentrate on three topic areas: (1) risk assessment, monitoring, and mitigation; (2) natural resource use and ecosystem service management; and (3) linkages among humans, technologies, and emerging ecosystems. More effectively managing natural resources and the ecosystem services they provide requires that scientists and managers anticipate shifts in disturbance regimes and analyze risk and resilience from broader perspectives. Whether and when risks and associated losses in ecosystem services are amplified or attenuated by future disturbances depends on how the environment, society, the economy, and technology respond. We cannot assume that practices that have worked in the past will be effective in the future. Just as future disturbance regimes differ from those of the past, tools to analyze, monitor, and manage them are also changing.
OBJECTIVES:
This study had three aims: 1) quantify the difference in stress levels between low and high stress roles during simulated critical communication encounters using objective physiologic ...data (heart rate variability HRV) and subjective measures (State-Trait Anxiety Inventory STAI), 2) define the relationship between subjective and objective measures of stress, and 3) define the impact of trainee preparedness and reported self-efficacy on stress levels.
DESIGN:
Mixed methods simulation-based study.
SETTING:
Single center.
PATIENTS:
Pediatric critical care fellows and faculty (
n
= 12).
INTERVENTIONS:
Subjects participated in six simulated scenarios in both high stress “hot seat” and low stress “observer” roles.
MEASUREMENTS AND MAIN RESULTS:
Subjective stress was measured using the STAI at baseline and after each scenario. Objective stress was measured continuously using a wearable biometric device measuring HRV. Previous residency communication training and self-confidence surrounding various communication topics were collected via questionnaire. Significant changes in subjective (STAI) and objective stress (HRV) measurements in the low- versus high-stress roles were observed. STAI scores increased 8 points during low stress and 12 points during high stress role (
p
= 0.021) compared with baseline. Two specific HRV markers, root mean square of successive differences between normal heartbeats, a marker of parasympathetic tone, and the low frequency/high frequency (LF/HF) ratio, a marker of sympathetic activation, were significantly correlated with STAI levels (–0.032,
p
= 0.001; 1.030,
p
= 0.002, respectively). Participants who reported increased confidence in discussing code status had a significant decrease in stress response (measured via LF/HF ratio) during both the observer (
p
= 0.033) and hot seat roles (
p
= <0.001).
CONCLUSIONS:
Communicating life-altering news in a simulated environment is a stressful experience. This stress results in physiologic changes that can be measured continuously using HRV. HRV measurement may serve as a novel method in evaluating the effectiveness of communication training programs and measuring future stress-reduction interventions.
Oxidative dissolution experiments were carried out on pyrite from multiple petrogenetic environments (hydrothermal, sedimentary, and coal-related nodules) to investigate possible variations in the ...iron isotopic composition of pyrite and the products of pyrite dissolution. The experimental materials were leached under carefully controlled abiotic conditions, and a subset of leachates and starting materials from these experiments was analyzed for 56Fe/54Fe by multicollector ICP-MS. Bulk pyrite δ56Fe values (relative to IRMM-014) ranged from −0.1 to +1.3‰, with hydrothermal bulk pyrite values <+0.5‰ and those of coal and sedimentary nodular pyrite ≥+0.5‰, higher than most previously measured values for Phanerozoic sedimentary pyrite. We suggest that this reflects precipitation of coal pyrite from a high-δ56Fe continental source, such as Fe derived from dissolution of Fe(III) oxides. This interpretation is consistent with pyrite rare earth element (REE) patterns. This could allow differentiation of Fe contributed from coal- and shale-related pyrite at abandoned mine drainage sites. Leachates from oxidative dissolution of the pyrite at pH=3 yielded, with few exceptions, δ56Fe values equal to or lower than those of the coexisting bulk pyrite, by up to about 1‰. These shifts are consistent in direction (but not magnitude) with equilibrium isotope fractionation predictions from theory, with possible second order effects from isotopic heterogeneity within individual natural pyrite samples.
•Iron isotope data are reported from abiotic oxidative dissolution experiments on sedimentary and hydrothermal pyrite.•The δ56Fe values of pyrite leachate solutions generally decreased over the course of the 24h experiments.•The Fe isotope trends are consistent with equilibrium fractionation, with possible contributions from sample heterogeneity.•High δ56Fe values of Phanerozoic coal-related pyrite could result from a high-Fe(III) continental source.•Rare earth element (REE) patterns in pyrite appear to reflect the likely host rock.
Various studies, mostly with animals, have provided evidence of adverse impacts of fluoride (F-) on bone density, collagen and microstructure, yet its effects on overall bone quality (strength) has ...not been clearly or extensively characterized in human populations.
In this observational study, we assessed variation in an integrated measures of bone quality in a population exposed to wide-ranging F- levels (0.3 to 15.5 mg/L) in drinking water, using a novel application of non-ionizing ultrasonic method.
We collected 871 speed of sound (SOS) measurements from 341 subjects residing in 25 communities, aged 10–70 years (188 males and 153 females). All subjects received scans of the cortical radius and tibia, and adults over the age of 19 received an additional scan of the phalanx. Associations between F- in drinking water and 24-h urine samples, and SOS as a measure of bone quality, were evaluated in bivariate and multivariable regressions adjusting for age, sex, BMI, smoking, and toothpaste use.
We found negative associations between F- exposure and bone quality at all three bones. Adult tibial SOS showed the strongest inverse association with F- exposure, which accounted for 20% of the variance in SOS measures (r = 0.45; n = 199; p < 0.0001). In adjusted analysis, a 1 mg/L increase in F- in drinking water was related to a reduction of 15.8 m/s (95% CI: −21.3 to −10.3), whereas a 1 mg/L increase in 24-h urinary F- (range: 0.04–39.5 mg/L) was linked to a reduction of 8.4 m/s (95% CI: −12.7, −4.12) of adult tibial SOS. Among adolescents, in contrast, weaker and non-significant inverse associations between F- exposure and SOS were found, while age, gender, and BMI were more significant predictors than in adults.
These results are indicative of a fluoride-induced deterioration of bone quality in humans, likely reflecting a combination of factors related to SOS: net bone loss, abnormal mineralization and collagen formation, or altered microarchitecture. The portable and low-cost ultrasound technique appears potentially useful for assessment of bone quality, and should be tested in other locations and for other bone-related disorders, to assess the feasibility of its more extensive diagnostic use in hard-to-reach rural regions.
•A novel ultrasonic bone quality biomarker was tested in a population with low to high exposure to F.-•Negative associations were found between F- exposure and bone quality•Decreased bone quality reflects net bone loss, abnormal mineralization and altered collagen.•The finding highlights that F- exposure has complex effects on bone quality that go beyond changes in bone density alone.
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