Mercury trends in fish from rivers and lakes in the United States, 1969–2005

A national dataset on concentrations of mercury in fish, compiled mainly from state and federal monitoring programs, was used to evaluate trends in mercury (Hg) in fish from US rivers and lakes. Trends were analyzed on data aggregated by site and by state, using samples of the same fish species and tissue type, and using fish of similar lengths. Site-based trends were evaluated from 1969 to 2005, but focused on a subset of the data from 1969 to 1987. Data aggregated by state were used to evaluate trends in fish Hg concentrations from 1988 to 2005. In addition, the most recent Hg fish data (1996–2005) were compared to wet Hg deposition data from the Mercury Deposition Network (MDN) over the same period. Downward trends in Hg concentrations in fish from data collected during 1969–1987 exceeded upward trends by a ratio of 6 to 1. Declining Hg accumulation rates in sediment and peat cores reported by many studies during the 1970s and 1980s correspond with the period when the most downward trends in fish Hg concentrations occurred. Downward Hg trends in both sediment cores and fish were also consistent with the implementation of stricter regulatory controls of direct releases of Hg to the atmosphere and surface waters during the same period. The southeastern USA had more upward Hg trends in fish than other regions for both site and state aggregated data. Upward Hg trends in fish from the southeastern USA were associated with increases in wet deposition in the region and may be attributed to a greater influence of global atmospheric Hg emissions in the southeastern USA. No significant trends were found in 62% of the fish species from six states from 1996 to 2005. A lack of Hg trends in fish in the more recent data was consistent with the lack of trends in wet Hg deposition at MDN sites and with relatively constant global emissions during the same time period. Although few significant trends were observed in the more recent Hg concentrations in fish, it is anticipated that Hg concentrations in fish will respond to changes in atmospheric Hg deposition, however, the magnitude and timing of the response is uncertain

Methyl <i>tert</i>-Butyl Ether (MTBE) in Public and Private Wells in New Hampshire: Occurrence, Factors, and Possible Implications

Methyl <i>tert</i>-butyl ether (MTBE) concentrations ≥0.2 µg/L were found in samples of untreated water in 18% of public-supply wells (<i>n</i> = 284) and 9.1% of private domestic wells (<i>n</i> = 264) sampled in 2005 and 2006 in New Hampshire. In counties that used reformulated gasoline (RFG), MTBE occurred at or above 0.2 µg/L in 30% of public- and 17% of private-supply wells. Additionally, 52% of public-supply wells collocated with fuel storage and 71% of mobile home park wells had MTBE. MTBE occurrence in public-supply wells was predicted by factors such as proximity to sources of fuel, land use, and population density, as well as low pH and distance from mapped lineaments. RFG use, land-use variables, and pH were important predictors of private-well MTBE occurrence. Variables representing sources of MTBE, such as the distance to known fuel sources, were not significant predictors of MTBE occurrence in private-supply wells. It is hypothesized that private wells may become contaminated from the collective effects of sources in high population areas and from undocumented incidental releases from onsite or proximal gasoline use. From 2003 to 2005, MTBE occurrence decreased in 63 public-supply wells and increased in 60 private-supply wells, but neither trend was statistically significant

Methyl <i>tert</i>-Butyl Ether (MTBE) in Public and Private Wells in New Hampshire: Occurrence, Factors, and Possible Implications

Methyl <i>tert</i>-butyl ether (MTBE) concentrations ≥0.2 µg/L were found in samples of untreated water in 18% of public-supply wells (<i>n</i> = 284) and 9.1% of private domestic wells (<i>n</i> = 264) sampled in 2005 and 2006 in New Hampshire. In counties that used reformulated gasoline (RFG), MTBE occurred at or above 0.2 µg/L in 30% of public- and 17% of private-supply wells. Additionally, 52% of public-supply wells collocated with fuel storage and 71% of mobile home park wells had MTBE. MTBE occurrence in public-supply wells was predicted by factors such as proximity to sources of fuel, land use, and population density, as well as low pH and distance from mapped lineaments. RFG use, land-use variables, and pH were important predictors of private-well MTBE occurrence. Variables representing sources of MTBE, such as the distance to known fuel sources, were not significant predictors of MTBE occurrence in private-supply wells. It is hypothesized that private wells may become contaminated from the collective effects of sources in high population areas and from undocumented incidental releases from onsite or proximal gasoline use. From 2003 to 2005, MTBE occurrence decreased in 63 public-supply wells and increased in 60 private-supply wells, but neither trend was statistically significant

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London