Coal Mine Remediation as a Tool to Improve Disparate Coal Mining Impacts in Appalachian Communities Utilizing a Community Health Assessment Conceptual Model

The coalfields region of central Appalachia bears the unfortunate hallmark characteristics of low socioeconomic status, poor health outcomes, and some of the lowest life expectancies in the United States, making some residents potentially part of vulnerable health populations. Vulnerability impacts the ability of individuals to respond or recover from stressors--- particularly environmental pollution---not as well as other individuals. Moreover, the economic outlook for the region is grim, given that the international coal mining industry has experienced serious recent downturns, and increased production from the natural gas sector has made coalfired power production domestically less competitive. As a result, many of the larger coal companies are in or have recently been in bankruptcy, leaving coal mining states at risk for large-scale forfeitures and abandoned coal mines. In 2016, the West Virginia Department of Environmental Protection (WVDEP) estimated that coal operators in the bankruptcy process held over 900 mine site permits, leaving sites in various stages of mining. Unremediated coal mines may pose a risk for safety and discharge pollutants into surface waters, potentially impacting water quality. Given that the communities near coal mines may constitute vulnerable health populations, the impacts of pollution stressors pose a serious public health concern. Coal mining states should prioritize the remediation of forfeited and abandoned coal mines due to these concerns. However, serious financial limitations may impact the states\u27 abilities to remediate these sites.;Under the Surface Mining Control and Reclamation Act (SMCRA), coal mine operators are required to post full financial assurance that the mine site will be remediated to environmental performance standards. If a coal mine operator abandons a site without fully remediating the environmental impacts, the state becomes responsible for the reclamation. However, due to the ways states administer the bond programs under SMCRA, they may have limited financial and administrative resources to remediate all existing abandoned coal mines, and the possibility of future abandoned sites may strain those resources further. These issues of available remediation resources is compounded by the disparate impacts of coal mining between the counties, as well the watersheds. In West Virginia, disparities exists between the counties for the amount of acres impacted by coal mining, with higher levels of mined acres occurring in counties with the poorest health rankings. In addition, some counties and watersheds are much more impacted by the costs of under-secured reclamation bonding. Counties with the worst health outcome rankings have the greatest amounts of potential risks for under-secured coal mine bonding. As a result, vulnerable health populations may live in areas where the state does not have adequate financial assurance to remediate abandoned coal mines and the watersheds heavily impacted by mining, placing these residents at further risk for long-term environmental stressors.;Surface water pollution presents one source of environmental stressor. Long-term surface water quality issues may already exist at many coal mine sites, as evidenced by a history of longterm pollutant discharge violations under the Clean Water Act (CWA). Over 43% of the individual coal mine sites that West Virginia Department of Environmental Protection (WVDEP) certified would meet water quality standards and nearly half of the total WVDEP coal mining state water quality certifications issued in order for the sites (or portions of the sites) to be constructed under the CWA resulted in consent decrees or other types of settlements for violations of state water quality standards. These pollutant discharge violations were also from larger acre sites with that predominantly drain into the Coal, Upper Guyandotte, Upper Kanawha, Lower Guyandotte, and other watersheds that are currently listed with impaired status under the CWA. CWA violation consent decrees involving 5 of the largest coal operators in West Virginia occurred in areas of the state with the worst health rankings.;With limited financial and administrative resources, WVDEP is currently responsible for remediation at 192 post-SMCRA forfeited mines with water pollution discharges, at an estimated initial cost of {dollar}35.5 million and {dollar}6.7 million in annual treatment costs. WVDEP has not completed remediation at these sites. Because of the need for prioritization of the state\u27s cleanup of these forfeited mines, regulations require that WVDEP maintain a priority listing of forfeited sites based upon (1) the severity of the water discharges, (2) the quality of the receiving stream, (3) the effects on downstream water users, and (4) other factors determined to affect the priority ranking. Surface coal mine remediation presents an excellent opportunity to improve both the environment of the coalfields and the health in communities surrounded by coal mines and downstream of polluted mining water discharges. By utilizing a community health impacts assessment conceptual model tailored to the concerns of West Virginia and central Appalachia, WVDEP can identify the existing pollution burdens on communities and vulnerable health populations to utilize community health as one factor in prioritizing mine remediation. By utilizing data that the state---specifically WVDEP---already collects and maintains, as well as other easily-accessible and publicly available information, WVDEP can utilize this community health assessment conceptual model framework to objectively consider characteristics of the coalfield communities. This conceptual model is objective and tailored to mine remediation. It fits within existing West Virginia laws and regulations and would not require Legislative rulemaking to incorporate into practice

The Scopes Monkey Trial Revisited: How the Coal Industry and the Surface Mining States Ignore Science to the Detriment of the Appalachian Environment

Over the past decade, scientists and environmental advocacy groups have challenged the proliferation of surface mining and especially mountaintop removal ( MTR ) in Appalachia. However, MTR has been viable simply because the industry has not been required to meet the basic requirements of the Clean Water Act ( CWA )--a costly endeavor for any industry, but particularly the surface coal mining industry. The West Virginia Division of Mining and Reclamation in the Department of Environmental Protection ( WVDEP ) has failed to include permit limits for surface coal mining operations for pollutants that these operations had areasonable potential to exceed water quality-based standards. This is a violation of both the CWA and the Surface Mining Control and Reclamation Act ( SMCRA ), as well as the state laws and regulations implementing the state programs

Writing a Check that the State Can\u27t Cash: Water Pollution from Coal Mining and the Imminent and Inevitable Failure of the West Virginia Special Reclamation Fund

After decades of financial decadence and total dominance over political processes, coal companies have hit desperate times. Cheap, abundant natural gas recently emerged, driving demand for coal for energy production and coal prices down. The United States Environmental Protection Agency (EPA) finally moved to more stringent emissions limitations for coal-fired power plants under the Clean Air Act. Concurrently, the public demanded improvements in safety technology after several tragic mining accidents resulted from lax safety measures and a corporate culture of recklessness. During this time, environmental citizen groups worked to ensure that mining companies no longer violated the Clean Water Act (CWA), particularly with the mountaintop removal (MTR) mining method. Mining companies that previously enjoyed lax enforcement of water violations by state environmental protection agencies and the EPA can no longer discharge unlawful levels of pollutants into streams without facing lawsuits by citizen groups. Mining companies pay steep penalties for these violations. Courts are increasingly skeptical of the practice of MTR and its compatibility with the CWA, concluding that what the law requires is sometimes contrary to “substantial scientific evidence.” Academic research on stream form and function concluded that streams buried through MTR cannot be adequately mitigated or replaced by manmade streams under United States Army Corps of Engineers permitting. Coal companies rely upon stream mitigation as an essential component for the continued viability of MTR. The environmental challenges over the last decade have been expensive. Mine site water treatment costs millions of dollars to construct and operate. Several large coal companies have posted significant quarterly losses. One large company has filed for bankruptcy and agreed to cease MTR mining. Layoffs abound. Despite the grim outlook for coal companies, Appalachian coal-mining states face worse situations

A conceptual model for integrating community health in managing remediation of West Virginia and central Appalachia’s abandoned coal mines

The decline of the coal industry and the associated ongoing bankruptcies of large coal companies create a serious concern that surface coal mining states may inherit large-scale liabilities for unremediated coal mines. These states may also have limited funding to remediate all abandoned mines at once, requiring prioritization of the cleanup of coal mines. In West Virginia and central Appalachia, these coal mines are often located in areas ranked as having poor public health outcomes, poor health factors, and extremely low-socioeconomic status. Epidemiological research has associated poor health outcomes for residents located near coal mining. Coal mine remediation presents an opportunity to improve the environment of the coalfields and perhaps improve health in communities surrounded by coal mines, as well as those downstream of polluted mining water discharges. By examining factors uniquely associated with the central Appalachia and West Virginia coalfields, a conceptual model that demonstrates how community health can be considered as a factor for prioritization of resources in remediation of abandoned coal mines was developed. The model utilizes health concerns specific to West Virginia and central Appalachia, relies on data already collected by the state, and identifies areas of the state with vulnerable health populations. Because this conceptual model is tailored to specific state concerns and existing state data, this model would be cost-effective as an off-the-shelf model for state agencies, and it could also be prospectively used when permitting new pollutant sources, such as new coal mines or natural gas drill sites and pipelines

Occupational Exposure to Blood and Bodily Fluids Among Health Care Workers in a Medical Teaching Hospital

The objective of this study was to evaluate blood and bodily fluids exposure through needlestick injuries (NSI) and non-percutaneous incidents among healthcare workers (HCWs). This project utilized a dataset collected from J. W. Ruby Memorial Hospital in Morgantown, West Virginia, between January 1, 2014 and August 15, 2017. Data included de-identified codes of employees, occupations, types of exposure to bloodborne pathogens, routes of exposure, infectious disease exposures, and time incidents. During this time period, 655 incident reports were documented and finalized in regards to blood or body fluid exposure. HCWs had 506 (77.25%) NSIs and 149 (22.74%) non-percutaneous incidents. The majority of the HCWs (331,50.53%) were nurses who were occupationally exposed, with 239 (47.23%) incidents reporting NSIs and 92 (61.74%) incidents reporting non-percutaneous exposures. Chi-square tests were used, and there was a statistically significant association between occupations and exposure incidents (P-value p=\u3c.0001). Occupations and shift time were statistically associated with the routes of exposure (p=\u3c.0001). NSIs had higher incidents than non-percutaneous exposures. Exposure to bloodborne pathogens largely occurred among nurses and physicians. Future research should assess the type and duties of nurses and physicians, as well as examine differences in the characteristics of HCWs regarding of the characteristics of shifts (such as time and length) which lead to NSIs

Quantification of corticosteroid-induced skin vasoconstriction: visual ranking, chromameter measurement or digital image analysis

Topical corticosteroid formulations have been evaluated by visual grading protocols for many years. Toward a more objective methodology, several instrumental methods have been evaluated for applicability in quantifying the vasoconstriction side-effect that follows corticosteroid application to the skin. Although the chromameter has been adopted by regulatory bodies throughout the world as the current standard for topical bioequivalence determinations, there is considerable criticism of this instrument from several quarters. A preliminary comparison reported here indicates that digital image analysis provides statistically significant results that are similar to those obtained by visual assessment techniques, and shows considerably greater precision than that obtained by the chromameter. Continued evaluation of objective assessment techniques, such as digital imaging, and continued modernisation of regulatory bioequivalence requirements will assist in protecting patients and optimising clinical results

The space shuttle launch vehicle aerodynamic verification challenges

The Space Shuttle aerodynamics and performance communities were challenged to verify the Space Shuttle vehicle (SSV) aerodynamics and system performance by flight measurements. Historically, launch vehicle flight test programs which faced these same challenges were unmanned instrumented flights of simple aerodynamically shaped vehicles. However, the manned SSV flight test program made these challenges more complex because of the unique aerodynamic configuration powered by the first man-rated solid rocket boosters (SRB). The analyses of flight data did not verify the aerodynamics or performance preflight predictions of the first flight of the Space Transportation System (STS-1). However, these analyses have defined the SSV aerodynamics and verified system performance. The aerodynamics community also was challenged to understand the discrepancy between the wind tunnel and flight defined aerodynamics. The preflight analysis challenges, the aerodynamic extraction challenges, and the postflight analyses challenges which led to the SSV system performance verification and which will lead to the verification of the operational ascent aerodynamics data base are presented

Bioequivalence testing of topical dermatological formulations, the gap between science and legislation

Bioavailability concerns for topical dermatological products are complex and it is especially difficult to determine the bioequivalence of similar topical formulations. Since only small amounts of drug dispersed in an appropriate vehicle are applied to the skin, the amount of drug that actually reaches the systemic circulation is often too small to be easily quantified. Additionally, it can be argued that the relevance of any serum/plasma concentration-time curve of a topical agent is questionable, since the curve reflects the amount of drug after the active moiety has left the site of action. For some topical drugs e.g., topical corticosteroids, it is possible to perform a pharmacodynamic bioassay to obtain acceptable bioequivalence data. In this case, the intensity of the side effect of blanching (vasoconstriction) in the skin caused by topical corticosteroids can be measured. The response is directly proportional to the clinical efficacy, and the skin blanching assay has proved to be a reliable procedure for the determination of topical corticosteroid bioavailability. Recently, we had sight of the results of a topical bioequivalence study, which was conducted for the registration of a new generic corticosteroid cream formulation. In this trial the new formulation was compared to two equivalent product from the local market and bioequivalence was demonstrated by the investigators for all three products. These results were examined with interest as the respective reference products have been used repeatedly as standard formulations in our laboratory. However, one of these reference formulations has consistently shown superior bioavailability in our trials, but was not demonstrated to be superior in the study results examined. In the present publication an overview of topical bioequivalence testing in general is given and the difficulties occurring in practice, for topical corticosteroid formulations in particular, are demonstrated

Analysis of chromameter results obtained from corticosteroid-induced skin blanching assay: comparison of visual and chromameter data

In a Guidance document, the American FDA recommends the use of a Minolta chromameter rather than the human eye for the quantitative assessment of the pharmacodynamic blanching response produced by topical application of corticosteroids. The purpose of this study was to compare the appropriateness of the human eye and two models of chromameter for the estimation of skin blanching, in terms of the quality of the data generated by each method. The corticosteroid-induced skin blanching from four different betamethasone 17-valerate cream formulations was compared in a typical human skin blanching trial. The optimized assay methodology routinely practised in our laboratories was utilized. The blanching responses were assessed visually by three trained, independent observers and recorded by two chromameters (Minolta model CR-200 and model CR-300). The topical availability of the four creams was determined using visual scoring and chromameter measurements. All data were manipulated in such a manner as to produce a blanching response versus time profile from which AUBC analysis could be performed. Good correlation was observed between the visual assessments made by three independent observers. In contrast, moderate correlation was determined between visual, CR-200 and CR-300 measurements. Surprisingly, no direct linear relationship between the AUBCs produced by the two chromameters was observed indicating that the quality of the data obtained from the two instruments may not be equal. This investigation also indicated that the use of the chromameter is not completely objective. Visual scoring and chromameter measurement produce data sets that differ in quality. Each procedure needs to be validated and investigators have to be trained for both visual assessment and the operation of the chromameter, particularly with regard to the manipulation of the measuring head of the instrument

Chromametry: measuring precision of diurnal and local variation of human forearm skin colour

Chromameters are compact portable instruments used for the assessment of surface colour based on the tristimulus analysis of a reflected xenon light pulse, and have been used for the quantification of erythema in the study of irritant dermatitis, and corticosteroid-induced skin blanching in the vasoconstriction assay. The variability and the reproducibility of chromameter results were investigated since it is known that the location and application force of the measuring head on the skin and the orthostatic maneuver of the arms influence the colour measurement. Furthermore the diurnal variation and the homogeneity of forearm skin colour were investigated