Health impact assessment of coal-fired boiler retirement at the Martin Drake and Comanche power plants

Includes bibliographical references.Health impact assessment (HIA) is a suite of tools used to characterize potential health effects of policies, projects, or regulations. The objective of this HIA was to understand the impact of decommissioning units at two large coal-fired power plants on mortality and morbidity in the Southern Front Range region of Colorado. Based on Community Multiscale Air Quality (CMAQ) chemical transport models of fine particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) and ozone (O3), we modeled five potential emissions reductions scenarios and estimated the potential health benefits of reduced exposures to PM2.5 and ozone for premature deaths, cardiovascular and respiratory hospitalizations, and other health outcomes for ZIP codes in the Southern Front Range region, including the cities of Denver, Colorado Springs, and Pueblo. Health Benefits Scenarios 1 and 2 estimated the health benefits of shutting down most units at the Comanche plant in Pueblo, CO (one newer unit remained operational) relative to a baseline scenario using emissions from 2011 (Scenario 1) or a counterfactual baseline scenario that accounted for sulfur dioxide emissions controls (scrubbers) installed at the Martin Drake plant in Colorado Springs in 2016 (Scenario 2). Health Benefits Scenario 3 estimated the benefits of shutting down the Martin Drake plant relative to the 2011 baseline. Health Benefits Scenario 4 estimated the health benefits of shutting down the Martin Drake power plant and shutting down all but one boiler at the Comanche power plant relative to a 2011 emissions baseline. Health Benefits Scenario 5 estimated the marginal health benefits of decommissioning these plants (with one remaining coal-fired boiler at Comanche) relative to a counterfactual baseline year that considered emissions controls installed at the Martin Drake facility in 2016. In addition to estimating the number of deaths, hospitalizations, and other health outcomes that would potentially be avoided by reducing emissions at these facilities, we also estimated the monetary impact using outcome valuations typically used in US EPA health benefits analyses and examined the environmental justice implications of reduced emissions and exposures across the Southern Front Range. • For Health Benefits Scenario 1 (Comanche Units 3 and 4 were “zeroed out” and compared to a baseline where all other emissions were at 2011 levels), we estimated that reducing population exposures to PM2.5 would result in 1 (95% CI: 0 - 1) fewer premature death each year. Reductions in PM2.5 and O3 exposures would also result in fewer restricted activity days among adults [5 (95% CI: -3 – 95)] and fewer missed school days for children [27 (95% CI: -19- 582)]. Benefits of retiring the Comanche units were similar when emissions controls at Martin Drake are taken into account (Health Benefits Scenario 2). • For Health Benefits Scenario 3 (emissions at Martin Drake were “zeroed out”), we estimated that reducing population exposures to PM2.5 and O3 would result in 4 (95% CI: 2 - 5) and < 1 (95% CI: 0 - 1) fewer premature deaths each year, respectively. Reductions in PM2.5 and O3 exposures would also result in fewer restricted activity days among adults [10 (95% CI: 0 – 74)] and fewer missed school days for children [4 (95% CI: 2- 5)]. • For Health Benefits Scenario 4, we estimated that reducing population exposures to PM2.5 and O3 would result in 4 (95% CI: 2 - 6) and < 1 (95% CI: 0 - 1) fewer premature deaths each year, respectively. Among the largest annual health benefits are avoided asthma symptom days among children [16 (95% CI: -1 – 141) due to PM2.5 and 13 (95% CI: -348 - 972) due to O3] and minor restricted activity days among adults [69 (95% CI: 0 - 488) due to PM2.5 and 71 (95% CI: -31 - 750) due to O3]. We also estimated that, for Health Benefits Scenario 1, children in the study area would miss 77 (95% CI: -77 - 1180) fewer days of school each year due to lower O3 exposures. • Annual health benefits were lower for Health Benefits Scenario 5 compared to Scenario 4 due to the smaller change in exposure concentration after accounting for the control technologies installed at Martin Drake in 2016. For Health Benefits Scenario 5, we estimated that reducing population exposures to PM2.5 and O3 would result in 2 (95% CI: 1 - 3) and < 1 (95% CI: 0 - 1) fewer premature deaths each year, respectively. Other annual benefits under Health Benefits Scenario 2 included 2 (95% CI: -17 – 44) and 9 (-242 – 678) avoided asthma symptom days due to PM2.5 and O3 exposures, respectively; 28 (95%CI: -2 – 188) and 48 (95%CI: -16 – 513) minor restricted activity days due to PM2.5 and O3 exposures; and 53 (95% CI: -48 – 833) avoided school absences among children due to O3 exposures. • Monetized health benefits when both plants were “zeroed out” ranged from $4.2 million (95$2.1 million - $7.2 million) for Health Benefits Scenario 4 to$1.7 million (95% CI: $0.8 million – 3.2 million) for Health Benefits Scenario 5. Benefits tended to be smaller when only one plant was considered. In all of the analyses, the monetized impacts were driven by the value of avoided premature mortality. In addition, we found that ZIP codes with lower median incomes tended to receive a greater share of the health benefits of decreasing exposures to PM2.5 and O3 resulting from power plant shutdowns. This finding suggests that reducing emissions at the power plants could potentially alleviate some environmental justice concerns in the area

Obstructive jaundice due to forgotten biliary stent- a rare case report

There are many studies about the biliary stents, however there is a little information about the long-term complications of forgotten biliary stents except a few case reports. We present a 68-years-old female patient who presented with abdominal pain, vomiting and jaundice. The patient had had a biliary prosthesis inserted 114 months (9.5 years) earlier for treatment of multiple common bile duct calculi, post cholecystectomy done in 1993. Imaging investigations evidenced the presence of obstructive jaundice and the biliary stent with gall stones adherent on its surface. After the failure of an endoscopic extraction attempt, surgical intervention ensured the removal of the stent and the gallstones formed on its surface. This case represents the rarity of such a complication after biliary stenting. At the same time, it emphasizes the need for postoperative follow-up, to avoid this kind of complication.

Giant haemorrhagic retroperitoneal mesothelial cyst: a rare case report

A peritoneal cystic mesothelioma is a very rare mesenteric cyst of mesothelial origin. The size of this lesion usually ranges between a few centimetres and 10 cm. It is usually asymptomatic, but occasionally presents with various, non-specific symptoms. We present a 24-years-old woman with vague abdominal discomfort and associated distension for 6 months, with generalized weakness with no significant past medical history. This is an unusual case of a giant peritoneal mesothelioma which is hemorrhagic nature which could be the first such case reported.

A rare case of tubeculous mesenteric cyst

We report a case of 17 year old female weighing 85 kg with chronic abdominal pain. Radiological imaging techniques revealed it as an enteric duplication cyst or mesenteric cyst. Diagnostic laparoscopy confirmed the cyst originating from mesentery. After laparoscopic excision of this cyst histopathology report was unusual, as a tuberculous mesenteric cyst

Intussusception due to caecal carcinoma in a young man: unusual cause of presentation a case report

A young 26 year male patient admitted with colicky pain in right iliac fossa with well palpable tender lump. After radiological investigation lump was diagnosed as ileocaecal intussusception. Patient underwent laparoscopy which diagnosed as intussusception due to caecal carcinoma. Laparoscopy again proved to be useful diagnostic tool over imaging techniques in this case. Laparoscopic assisted surgery of right radical hemicolectomy done successfully

Squamous cell carcinoma in left flank due to saree: Largest reported case

Saree is a female costume unique for Indian ladies. This includes a superficial cloth and a skirt underneath which is fastened securely to the waist by a cord. Persistent and long term wearing of this costume has resulted in waist dermatoses. Waist dermatoses theoretically may present with malignant transformation. Here we present a case of 60 year old female who presented with left flank ulcer following chronic irritation from saree, biopsy was taken and it showed squamous cell carcinoma (SCC). We decided to do wide excision with tension free suturing. Post operatively the patient followed up for 12 week and has shown to be disease free. This turns out to be the third case being reported and the largest ever to be reported in the literature

Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open-label Trial

Background: Thirty percent of children with acute otitis media (AOM) experience symptoms \u3c 7 days after initiating treatment, highlighting the importance of comprehensive discharge instructions. Methods: We randomized caregivers of children 6 months to 17 years presenting to the emergency department (ED) with AOM to discharge instructions using a video on management of pain and fever to a paper handout. The primary outcome was the AOM Severity of Symptom (AOM-SOS) score at 72 hours postdischarge. Secondary outcomes included caregiver knowledge (10-item survey), absenteeism, recidivism, and satisfaction (5-item Likert scale). Results: A total of 219 caregivers were randomized and 149 completed the 72-hour follow-up (72 paper and 77 video). The median (IQR) AOM-SOS score for the video was significantly lower than paper, even after adjusting for preintervention AOM-SOS score and medication at home (8 [7–11] vs. 10 [7–13], respectively; p = 0.004). There were no significant differences between video and paper in mean (±SD) knowledge score (9.2 [±1.3] vs. 8.8 [±1.8], respectively; p = 0.07), mean (±SD) number of children that returned to a health care provider (8/77 vs. 10/72, respectively; p = 0.49), mean (±SD) number of daycare/school days missed by child (1.2 [±1.5] vs. 1.1 [±2.1], respectively; p = 0.62), mean (±SD) number of workdays missed by caregiver (0.5 [±1] vs. 0.8 [±2], respectively; p = 0.05), or median (IQR) satisfaction score (5 [4–5] vs. 5 [4–5], respectively; p = 0.3). Conclusions: Video discharge instructions in the ED are associated with less perceived AOM symptomatology compared to a paper handout

Optogenetic inhibitor of the transcription factor CREB

Current approaches for optogenetic control of transcription do not mimic the activity of endogenous transcription factors, which act at numerous sites in the genome in a complex interplay with other factors. Optogenetic control of dominant negative versions of endogenous transcription factors provides a mechanism for mimicking the natural regulation of gene expression. Here we describe opto-DN-CREB, a blue light controlled inhibitor of the transcription factor CREB created by fusing the dominant negative inhibitor A-CREB to photoactive yellow protein (PYP). A light driven conformational change in PYP prevents coiled-coil formation between A-CREB and CREB, thereby activating CREB. Optogenetic control of CREB function was characterized in vitro, in HEK293T cells, and in neurons where blue light enabled control of expression of the CREB targets NR4A2 and c-Fos. Dominant negative inhibitors exist for numerous transcription factors; linking these to optogenetic domains offers a general approach for spatiotemporal control of native transcriptional events

Optogenetic inhibitor of the transcription factor CREB

Current approaches for optogenetic control of transcription do not mimic the activity of endogenous transcription factors, which act at numerous sites in the genome in a complex interplay with other factors. Optogenetic control of dominant negative versions of endogenous transcription factors provides a mechanism for mimicking the natural regulation of gene expression. Here we describe opto-DN-CREB, a blue light controlled inhibitor of the transcription factor CREB created by fusing the dominant negative inhibitor A-CREB to photoactive yellow protein (PYP). A light driven conformational change in PYP prevents coiled-coil formation between A-CREB and CREB, thereby activating CREB. Optogenetic control of CREB function was characterized in vitro, in HEK293T cells, and in neurons where blue light enabled control of expression of the CREB targets NR4A2 and c-Fos. Dominant negative inhibitors exist for numerous transcription factors; linking these to optogenetic domains offers a general approach for spatiotemporal control of native transcriptional events