Reducing Arsenic Exposure from Private Well Water in the United States: The Use, Effect, and Potential of Testing Requirements

Over 45 million Americans drink from unregulated private well water of unknown quality. Arsenic is the most concerning groundwater contaminant for health because of its toxicity and widespread natural occurrence. Most residential wells in arsenic-affected areas have not been tested for arsenic; the success of community programs and efforts to motivate testing is limited by a range of psychological, situational, and socioeconomic barriers. However, testing only acts as screening and does not reduce exposure without effective and consistent actions to follow. Given the limitations in relying on individual well owners to be aware, willing, and capable of testing their water, state-wide regulations like New Jersey’s Private Well Testing Act (PWTA), which requires testing during real estate transactions, have the potential to make a significant contribution towards arsenic exposure reduction by acting as a screening intervention and allowing systematic collection of water test results. This dissertation describes the findings of three studies examining the PWTA: the circumstances of its origin, its impact on mitigation, and its potential to boost screening. Chapter 2 is a comparative case study examining the context of the PWTA’s successful adoption into law, and failures to pass similar requirements in Maine. Viewed through Kingdon’s Multiple Streams framework, the PWTA was the result of problem, policy, and politics streams successfully aligned during a significant political window of opportunity. By contrast the failures in Maine highlight the considerable work remaining to facilitate or overcome the philosophical evolution required for further private well legislative action. In Chapter 3, a follow-up survey to owners of wells with \u3e 5 µg/L arsenic identified through PWTA-required tests (n=486) reveals that most current homeowners have taken some mitigation action to reduce exposure; however, without a mandate for remediation or compliance, a significant portion (28%) of surveyed households have not. Those not acting have lower perceptions of susceptibility, severity, and benefits; perceive greater barriers; and express lower levels of self-efficacy and commitment to reduce exposure than those who are taking some mitigation action. Poor monitoring and maintenance behaviors among those with arsenic treatment installed threaten to undermine mitigation intentions. Chapter 4 reports on a mailed testing intervention targeting “neighbors” of wells exceeding 5 µg/L tested under the PWTA. Overall, 16% of those notified (n=1743) of arsenic in their neighborhood requested a free test kit and 13% submitted a water sample. Significant participation differences based on wording suggested that messages of comparatively high arsenic, relative to standards, may be more compelling than messages of general risk. The intervention prompted testing among 230 households largely unreached by previous awareness-raising activities and identified problems among a significant portion (25%), demonstrating the effectiveness of targeting outreach and messages to wells at high contamination risk. Taken together, these studies demonstrate the utility and the potential, as well as the limitations, of the PWTA. The fact that 45 million Americans are excluded from the federal and state regulations that protect the right to safe drinking water in this country is an overlooked public health crisis. Practically, significant change may require many incremental, modest, and/or symbolic steps, by many local and state governments across the country; additional policy models must be tested and proven. Nevertheless, these studies demonstrate that legislation like the PWTA can make a significant contribution towards well screening and can be leveraged in many ways to reduce arsenic exposure in the private well population, beyond those directly affected by the law. It is a proven model that other states can now build on

How Can Education Improve The Recycling Behaviors And Attitudes Of Middle School Students

This research project adapted and implemented curriculum into a middle school science classroom to gauge the effect of the curriculum on the students’ behaviors and attitudes. The focus of the curriculum was on waste management and recycling. Students participated in surveys both before and after the curriculum. Their responses were compared to others in the school who did not go through the curriculum. There are not many updated curriculums available however, through this study it was concluded that education can impact the recycling behaviors and attitudes through curriculum in a positive way that makes students connect their actions to the negative effects of improper disposal of waste

Increasing acceptance of chlorination for household water treatment: observations from Bangladesh

Point-of-use water treatment, especially chlorination, is an effective intervention to reduce diarrhoea, a leading cause of death for children under five. Yet success in chlorination uptake has been limited. One obstacle is objection to treated water's taste/odour. Protective chlorine residuals that are not offensive to users require accurate dosing - a challenge in practice. Further, taste sensitivity may be different for populations never exposed to chlorinated water. Here, household chlorination trials in Bangladesh similarly revealed dissatisfaction with treated water due to taste and odour, although attempts to quantify chlorine sensitivity disputed the dissatisfaction at lower residuals. A granular activated carbon (GAC) filter fitted to the spigot of a covered tank removed the remaining chlorine residual prior to drinking and increased user satisfaction. Such a filter removes taste as a barrier and allows over-dosing contaminated water to ensure disinfection, with implications for areas with high source water variability and for emergency situations

Influences on domestic well water testing behavior in a Central Maine area with frequent groundwater arsenic occurrence

In 2001 the Environmental Protection Agency (EPA) adopted a new standard for arsenic (As) in drinking water of 10 μg/L, replacing the old standard of 50 μg/L. However, for the 12% of the U.S. population relying on unregulated domestic well water, including half of the population of Maine, it is solely the well owner's responsibility to test and treat the water. A mailed household survey was implemented in January 2013 in 13 towns of Central Maine with the goal of understanding the population's testing and treatment practices and the key behavior influencing factors in an area with high well-water dependency and frequent natural groundwater As. The response rate was 58.3%; 525 of 900 likely-delivered surveys to randomly selected addresses were completed. Although 78% of the households reported that their well has been tested, half of it was more than 5 years ago. Among the 58.7% who believe they have tested for As, most do not remember the results. Better educated, higher income homeowners who more recently purchased their homes are most likely to have included As when last testing. While households agree that water and As-related health risks can be severe, they feel low personal vulnerability and there are low testing norms overall. Significant predictors of including As when last testing include: having knowledge that years of exposure increases As-related health risks (risk knowledge), knowing who to contact to test well water (action knowledge), believing that regular testing does not take too much time (instrumental attitude), and having neighbors who regularly test their water (descriptive norm). Homeowners in As-affected communities have the tendency to underestimate their As risks compared to their neighbors. The reasons for this optimistic bias require further study, but low testing behaviors in this area may be due to the influence of a combination of norm, ability, and attitude factors and barriers

Sanitation coverage in Bangladesh since the millennium: consistency matters

Household surveys in Bangladesh between 1994 and 2009 assessed sanitation access using questions that differed significantly over time, resulting in apparently inconsistent findings. Applying the WHO and UNICEF Joint Monitoring Programme's 2008 definition for open defecation and improved sanitation facilities excluding shared facilities to the compiled data set, sensible sanitation coverage trends emerge. The percentage of households openly defecating declined at a rate of about 1.8% per year from 30% in 1994 to 6.8% in 2009, primarily due to changes in rural areas. Access to individual improved sanitation facilities nearly doubled from about 30% in 2006 to 57% in 2009, with both rural and urban areas showing impressive progress. Access to shared improved latrines also nearly doubled from about 13% in 2006 to 24% in 2009, with the urban slums recording the greatest gain from 17% in 2006 to 65% in 2009. Shared improved latrines are only slightly less clean than individual ones. Dependence on shared improved latrines increases with population density. In 2007, 20% of the poorest households still openly defecated, although more of them (38%) shared a latrine of any type. A poverty reduction program is recommended to address this equity issue, although applying consistent definitions is crucial to documenting progress

A Cross-Sectional Study of Myopia and Morning Melatonin Status in Northern Irish Adolescent Children

Purpose. Previous studies have demonstrated an association between melatonin status and both refractive error and axial length in young adult myopes. This study aimed to determine if this relationship extends to a younger adolescent cohort. Methods. Healthy children aged 12–15 years provided morning saliva samples before attending Ulster University (55°N) for cycloplegic autorefraction and axial length measures. Participants completed questionnaires describing recent sleep habits and physical activity. Salivary melatonin was quantified using high-performance liquid chromatography-tandem mass spectrometry. Data collection for all participants occurred over a 1-week period (April 2021). Results. Seventy participants aged 14.3 (95% CI: 14.2—14.5) years were categorised by spherical equivalent refraction [SER] (range: −5.38DS to +1.88DS) into two groups; myopic SER ≤ −0.50DS (n = 22) or nonmyopic −0.50DS < SER ≤ +2.00DS (n = 48). Median morning salivary melatonin levels were 4.52 pg/ml (95% CI: 2.60–6.02) and 4.89 pg/ml (95% CI: 3.18–5.66) for myopic and nonmyopic subjects, respectively, and did not differ significantly between refractive groups ( = 0.91). Melatonin levels were not significantly correlated with SER, axial length, sleep, or activity scores (Spearman’s rank, all  > 0.39). Higher levels of physical activity were associated with higher sleep quality (Spearman’s rank, ρ = −0.28,  = 0.02). Conclusion. The present study found no significant relationship between morning salivary melatonin levels and refractive error or axial length in young adolescents. This contrasts with outcomes from a previous study of adults with comparable methodology, season of data collection, and geographical location. Prospective studies are needed to understand the discrepancies between adult and childhood findings and evaluate whether melatonin levels in childhood are indicative of an increased risk for future onset of myopia and/or faster axial growth trajectories and myopia progression in established myopes. Future work should opt for a comprehensive dim-light melatonin onset protocol to determine circadian phase

Serum and cerebrospinal fluid biomarkers in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein associated disease

The term neuromyelitis optica spectrum disorder (NMOSD) describes a group of clinical-MRI syndromes characterized by longitudinally extensive transverse myelitis, optic neuritis, brainstem dysfunction and/or, less commonly, encephalopathy. About 80% of patients harbor antibodies directed against the water channel aquaporin-4 (AQP4-IgG), expressed on astrocytes, which was found to be both a biomarker and a pathogenic cause of NMOSD. More recently, antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG), have been found to be a biomarker of a different entity, termed MOG antibody-associated disease (MOGAD), which has overlapping, but different pathogenesis, clinical features, treatment response, and prognosis when compared to AQP4-IgG-positive NMOSD. Despite important refinements in the accuracy of AQP4-IgG and MOG-IgG testing assays, a small proportion of patients with NMOSD still remain negative for both antibodies and are called "seronegative" NMOSD. Whilst major advances have been made in the diagnosis and treatment of these conditions, biomarkers that could help predict the risk of relapses, disease activity, and prognosis are still lacking. In this context, a number of serum and/or cerebrospinal fluid biomarkers are emerging as potentially useful in clinical practice for diagnostic and treatment purposes. These include antibody titers, cytokine profiles, complement factors, and markers of neuronal (e.g., neurofilament light chain) or astroglial (e.g., glial fibrillary acidic protein) damage. The aim of this review is to summarize current evidence regarding the role of emerging diagnostic and prognostic biomarkers in patients with NMOSD and MOGAD

Arsenic in tube well water in Bangladesh: health and economic impacts and implications for arsenic mitigation

A national drinking water quality survey conducted in 2009 furnished data that were used to make an updated estimate of chronic arsenic exposure in Bangladesh. About 20 million and 45 million people were found to be exposed to concentrations above the national standard of 50 μg/L and the World Health Organization’s guideline value of 10 μg/L, respectively. From the updated exposure data and all-cause mortality hazard ratios based on local epidemiological studies, it was estimated that arsenic exposures to concentrations > 50 μg/L and 10–50 μg/L account for an annual 24 000 and perhaps as many as 19 000 adult deaths in the country, respectively. Exposure varies widely in the 64 districts; among adults, arsenic-related deaths account for 0–15% of all deaths. An arsenic-related mortality rate of 1 in every 18 adult deaths could represent an economic burden of 13 billion United States dollars (US$) in lost productivity alone over the next 20 years. Arsenic mitigation should follow a two-tiered approach: (i) prioritizing provision of safe water to an estimated 5 million people exposed to > 200 μg/L arsenic, and (ii) building local arsenic testing capacity. The effectiveness of such an approach was demonstrated during the United Nations Children’s Fund 2006–2011 country programme, which provided safe water to arsenic-contaminated areas at a cost of US$ 11 per capita. National scale-up of such an approach would cost a few hundred million US dollars but would improve the health and productivity of the population, especially in future generations

Optimizing CRISPR/Cas9 Editing of Repetitive Single Nucleotide Variants

CRISPR/Cas9, base editors and prime editors comprise the contemporary genome editing toolbox. Many studies have optimized the use of CRISPR/Cas9, as the original CRISPR genome editing system, in substituting single nucleotides by homology directed repair (HDR), although this remains challenging. Studies describing modifications that improve editing efficiency fall short of isolating clonal cell lines or have not been validated for challenging loci or cell models. We present data from 95 transfections using a colony forming and an immortalized cell line comparing the effect on editing efficiency of donor template modifications, concentration of components, HDR enhancing agents and cold shock. We found that in silico predictions of guide RNA efficiency correlated poorly withactivity in cells. Using NGS and ddPCR we detected editing efficiencies of 5-12% in the transfected populations which fell to 1% on clonal cell line isolation. Our data demonstrate the variability of CRISPR efficiency by cell model, target locus and other factors. Successful genome editing requires a comparison of systems and modifications to develop the optimal protocol for the cell model and locus. We describe the steps in this process in a flowchart for those embarking on genome editing using any system and incorporate validated HDR-boosting modifications for those using CRISPR/Cas9