Emergency care patient driven solutions for severe asthma

Purpose Patients with severe asthma were choosing not to use the emergency department in extremis and were self-medicating when experiencing severe asthma, putting their lives at risk. This local issue was a reflection of a nationwide situation. The aim of this study was to better understand the reasons for this locally and consider practical solutions in a structured way with users of the service Methodology Systems thinking was used (soft systems methodology) to better understand the problem and examine possible solutions in co-production with people who live with severe asthma. Findings and Practical implications The problem was identified and fully revealed-patients felt vulnerable and fearful of the emergency department. This appeared to be a well-defined problem with possible solutions. Once this tame problem was revealed a possible solution was developed in co-production with patients. The solution was an Asthma Patient Passport (APP) which increased confidence in patient’s ability to communicate their needs in severe distress by facilitating communication of needs and decreased the work patients had to do to achieve care from twelve steps to five steps. The implementation of the APP is currently being evaluated. Value By revisiting systems thinking and identifying problems, a solution was possible. Although methods such as soft systems methodology have limitations when used to in wicked problems, such methods still appear to have merit in tame problems and could be used in these circumstances to fully understand problems and design practical solutions

ELEMENT LEVELS IN SNAKES IN SOUTH CAROLINA: DIFFERENCES BETWEEN A CONTROL SITE AND EXPOSED SITE ON THE SAVANNAH RIVER SITE

Levels of 18 elements, including lead, mercury, selenium, and uranium, were examined in three species of snakes from an exposed and reference site on the Department of Energy’s Savannah River Site in South Carolina. We tested the hypotheses that there were no differences as a function of species, and there were no difference between the exposed and control site for blood and muscle (tail) samples for banded water snake (Nerodia fasciata), brown water snake (N. taxispilota) and cottonmouth (Akistrodon piscivorous). The banded water snakes collected were significantly smaller than the other two species. For blood, there were significant species differences only for barium, copper, selenium, uranium and zinc, while for muscle tissue there were significant interspecific differences in aluminum, arsenic, barium, cobalt, cesium, copper, iron, lead, mercury, manganese, strontium, vanadium and zinc, suggesting that muscle tissue in the tail is a better indicator of potential interspecific differences. It is also easier logistically to collect tail tissue than blood. Where one species had significantly higher levels than the other species in muscle tissue levels, cottonmouth had higherlevels of five elements (aluminum, cobalt, lead, mercury, vanadium), brown water snake had two (lead, strontium), and banded water snake had only barium. There were few significant differences between the control and reference site for levels of blood, but several for muscle tissue. All three species had significantly higher levels of arsenic and manganese at Tim’s Branch than the reference site, and nickel and uranium were significantly higher for banded watersnake and cottonmouth, the larger species. Individuals with high exposure of one element were exposed to high levels of other elements

ELEMENT LEVELS IN SNAKES IN SOUTH CAROLINA: DIFFERENCES BETWEEN A CONTROL SITE AND EXPOSED SITE ON THE SAVANNAH RIVER SITE

Levels of 18 elements, including lead, mercury, selenium, and uranium, were examined in three species of snakes from an exposed and reference site on the Department of Energy’s Savannah River Site in South Carolina. We tested the hypotheses that there were no differences as a function of species, and there were no difference between the exposed and control site for blood and muscle (tail) samples for banded water snake (Nerodia fasciata), brown water snake (N. taxispilota) and cottonmouth (Akistrodon piscivorous). The banded water snakes collected were significantly smaller than the other two species. For blood, there were significant species differences only for barium, copper, selenium, uranium and zinc, while for muscle tissue there were significant interspecific differences in aluminum, arsenic, barium, cobalt, cesium, copper, iron, lead, mercury, manganese, strontium, vanadium and zinc, suggesting that muscle tissue in the tail is a better indicator of potential interspecific differences. It is also easier logistically to collect tail tissue than blood. Where one species had significantly higher levels than the other species in muscle tissue levels, cottonmouth had higherlevels of five elements (aluminum, cobalt, lead, mercury, vanadium), brown water snake had two (lead, strontium), and banded water snake had only barium. There were few significant differences between the control and reference site for levels of blood, but several for muscle tissue. All three species had significantly higher levels of arsenic and manganese at Tim’s Branch than the reference site, and nickel and uranium were significantly higher for banded watersnake and cottonmouth, the larger species. Individuals with high exposure of one element were exposed to high levels of other elements

Potential Exposure to Arsenic from Infant Rice Cereal

Background: Rice is known to be high in arsenic, including in infant rice cereal. Although arsenic in drinking water is currently regulated, there are currently no US regulations regarding arsenic concentrations in food. Objective: We used published values to estimate arsenic exposure via rice cereal relative to breast milkor formula for 6- to 12-month-old infants in the general US population. Results: We found that arsenic exposure from 3 servings of rice cereal exceeded that of formula made with water containing arsenic at 10 μg/L, the US Environmental Protection Agency maximum contaminant level. Conclusions: Our findings suggest that rice cereal can markedly increase arsenic exposure among US infants relative to breast milk and formula

Estimated Exposure to Arsenic in Breastfed and Formula-Fed Infants in a United States Cohort

Background: Previous studies indicate that concentrations of arsenic in breast milk are relatively low even in areas with high drinking-water arsenic. However, it is uncertain whether breastfeeding leads to reduced infant exposure to arsenic in regions with lower arsenic concentrations. Objective: We estimated the relative contributions of breast milk and formula to arsenic exposure during early infancy in a U.S. population. Methods: We measured arsenic in home tap water (n = 874), urine from 6-week-old infants (n = 72), and breast milk from mothers (n = 9) enrolled in the New Hampshire Birth Cohort Study (NHBCS) using inductively coupled plasma mass spectrometry. Using data from a 3-day food diary, we compared urinary arsenic across infant feeding types and developed predictive exposure models to estimate daily arsenic intake from breast milk and formula. Results: Urinary arsenic concentrations were generally low (median, 0.17 μg/L; maximum, 2.9 μg/L) but 7.5 times higher for infants fed exclusively with formula than for infants fed exclusively with breast milk (β = 2.02; 95% CI: 1.21, 2.83; p \u3c 0.0001, adjusted for specific gravity). Similarly, the median estimated daily arsenic intake by NHBCS infants was 5.5 times higher for formula-fed infants (0.22 μg/kg/day) than for breastfed infants (0.04 μg/kg/day). Given median arsenic concentrations measured in NHBCS tap water and previously published for formula powder, formula powder was estimated to account for ~ 70% of median exposure among formula-fed NHBCS infants. Conclusions: Our findings suggest that breastfed infants have lower arsenic exposure than formula-fed infants, and that both formula powder and drinking water can be sources of exposure for U.S. infants

Spatiotemporal variability in pH and carbonate parameters on the Canadian Atlantic continental shelf between 2014 and 2022

The Atlantic Zone Monitoring Program (AZMP) was established by Fisheries and Oceans Canada (DFO) in 1998 with the aim of monitoring physical and biological ocean conditions in Atlantic Canada in support of fisheries management. Since 2014, at least two of the carbonate parameters (pH; total alkalinity, TA; and dissolved inorganic carbon, DIC) have also been systematically measured as part of the AZMP, enabling the calculation of derived parameters (e.g., carbonate saturation states, Ω, and partial pressure of CO2, pCO2). The present study gives an overview of the spatiotemporal variability in these parameters between 2014 and 2022. Results show that the variability in the carbonate system reflects changes in both physical (e.g., temperature and salinity) and biological (e.g., plankton photosynthesis and respiration) parameters. For example, most of the region undergoes a seasonal warming and freshening. While the former will tend to increase Ω, the latter will decrease both TA and Ω. Spring and summer plankton blooms decrease DIC near the surface and then remineralize and increase DIC at depth in the fall. The lowest pCO2 values (down to ∼ 200 µatm) are located in the cold coastal Labrador Current, whereas the highest values (&gt;1500 µatm) are found in the fresh waters of the Gulf of St. Lawrence and the St. Lawrence Estuary. The latter is also host to the lowest pH values of the zone (7.48 in the fall of 2022). Finally, most of the bottom waters of the Gulf of St. Lawrence (&gt;90 %) are undersaturated with respect to aragonite (Ωarg&lt;1). In addition to providing a baseline of carbonate parameters for the Atlantic Zone as a whole, this comprehensive overview is a necessary and useful contribution for the modelling community and for more in-depth studies. The full dataset of measured and derived parameters is available from the Federated Research Data Repository: https://doi.org/10.20383/102.0673 (Cyr et al., 2022a).</p

Disturbance of deep-sea environments induced by the M9.0 Tohoku Earthquake

The impacts of the M9.0 Tohoku Earthquake on deep-sea environment were investigated 36 and 98 days after the event. The light transmission anomaly in the deep-sea water after 36 days became atypically greater (∼35%) and more extensive (thickness ∼1500 m) near the trench axis owing to the turbulent diffusion of fresh seafloor sediment, coordinated with potential seafloor displacement. In addition to the chemical influx associated with sediment diffusion, an influx of 13C-enriched methane from the deep sub-seafloor reservoirs was estimated. This isotopically unusual methane influx was possibly triggered by the earthquake and its aftershocks that subsequently induced changes in the sub-seafloor hydrogeologic structures. The whole prokaryotic biomass and the development of specific phylotypes in the deep-sea microbial communities could rise and fall at 36 and 98 days, respectively, after the event. We may capture the snap shots of post-earthquake disturbance in deep-sea chemistry and microbial community responses

Experiences of Receiving a Diagnosis of Autism Spectrum Disorder: A Survey of Adults in the United Kingdom

A total of 128 adults with high-functioning autism spectrum disorders were surveyed concerning the process they went through to obtain their diagnosis and the subsequent support they received. Results suggested that routes to diagnosis were quite heterogeneous and overall levels of satisfaction with the diagnostic process were mixed; 40 % of respondents were ‘very/quite’ dissatisfied, whilst 47 % were ‘very/quite’ satisfied. The extent of delays, number of professionals seen, quality of information given at diagnosis and levels of post-diagnostic support predicted overall satisfaction with the diagnostic process. Important areas and suggestions for improvement were noted for all stages of the diagnostic pathway. Respondents also displayed above average levels of depressed mood and anxiety, with greater support being requested in this area

Distribution Analysis of Hydrogenases in Surface Waters of Marine and Freshwater Environments

Background Surface waters of aquatic environments have been shown to both evolve and consume hydrogen and the ocean is estimated to be the principal natural source. In some marine habitats, H2 evolution and uptake are clearly due to biological activity, while contributions of abiotic sources must be considered in others. Until now the only known biological process involved in H2 metabolism in marine environments is nitrogen fixation. Principal Findings We analyzed marine and freshwater environments for the presence and distribution of genes of all known hydrogenases, the enzymes involved in biological hydrogen turnover. The total genomes and the available marine metagenome datasets were searched for hydrogenase sequences. Furthermore, we isolated DNA from samples from the North Atlantic, Mediterranean Sea, North Sea, Baltic Sea, and two fresh water lakes and amplified and sequenced part of the gene encoding the bidirectional NAD(P)-linked hydrogenase. In 21% of all marine heterotrophic bacterial genomes from surface waters, one or several hydrogenase genes were found, with the membrane-bound H2 uptake hydrogenase being the most widespread. A clear bias of hydrogenases to environments with terrestrial influence was found. This is exemplified by the cyanobacterial bidirectional NAD(P)-linked hydrogenase that was found in freshwater and coastal areas but not in the open ocean. Significance This study shows that hydrogenases are surprisingly abundant in marine environments. Due to its ecological distribution the primary function of the bidirectional NAD(P)-linked hydrogenase seems to be fermentative hydrogen evolution. Moreover, our data suggests that marine surface waters could be an interesting source of oxygen-resistant uptake hydrogenases. The respective genes occur in coastal as well as open ocean habitats and we presume that they are used as additional energy scavenging devices in otherwise nutrient limited environments. The membrane-bound H2-evolving hydrogenases might be useful as marker for bacteria living inside of marine snow particles