Water, behavior, and health in Alaska

Thesis (Ph.D.) University of Alaska Fairbanks, 2014.This dissertation addresses the need for a better understanding of how water and sanitation infrastructure and water use behaviors come together to influence health. The ultimate aim is to inform water infrastructure designs and behavior change programming for the prevention of acute respiratory infections (ARIs), skin infections, and diarrhea. All three diseases are of public health significance in Alaska, and all three can be prevented by proper access and use of water and sanitation services. I begin the dissertation by illustrating that some residents who have access to treated water continue to consume untreated river water and rain. In fact, 82% of respondents (n=172) reported that some of their drinking water came from an untreated source. Motives for drinking untreated water could be categorized into six themes: chemicals, taste, health, access, tradition, and cost. The next chapter describes the design and impact of a health promotion program to increase consumption of treated water. Self-reported data revealed that from pre- to post-intervention, the proportion of households drinking mostly treated water increased by 21% (39% to 60%), p < 0.0001. The third chapter reports changes in water use and health as reported by participants who recently received modern sanitation services. Most participants (n=101; 74%) reported improved community health. A prominent theme was that better access to treated water increased children’s ability to drink treated water and perform hand washing and bathing, practices known to prevent ARIs, skin infections and diarrhea. Based on the findings, I recommend: 1) providing inhouse piped water service where feasible, 2) development of an alternative water and sanitation system that provides adequate quantities of water for homes that may not be provided in-house piped water service, and 3) providing health promotion to encourage healthy water use, either in combination with provision of in-house water service, or as a stand-alone intervention.Chapter 1: Introduction -- Chapter 2: Consuming Untreated Water in Four Southwestern Alaska Native Communities: Reasons Revealed and Recommendations for Change -- Chapter 3: Alaska Native Consumers Show Increased Treated Drinking Water Consumption Following Project Meq-Egtaq -- Chapter 4: Alaska Native Consumers of Modern Sanitation Services Provide Insights to inform Infrastructure Designs and Health Promotion Planning -- Chapter 5: Conclusion

Surface Moisture Measurement System Operation and Maintenance Manual

This operations and maintenance manual addresses deployment, equipment and field hazards, operating instructions, calibration verification, removal, maintenance, and other pertinent information necessary to safely operate and store the Surface Moisture Measurement System (SMMS) and Liquid Observation Well Moisture Measurement System (LOWMMS). These systems were developed primarily in support of Tank Waste Remediation System (TWRS) Safety Programs for moisture measurement in organic and ferrocyanide watch list tanks

The Relationship Between In-Home Water Service and the Risk of Respiratory Tract, Skin, and Gastrointestinal Tract Infections Among Rural Alaska Natives

Objectives. We investigated the relationship between the presence of in-home piped water and wastewater services and hospitalization rates for respiratory tract, skin, and gastrointestinal tract infections in rural Alaska

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status