Use of viral indicators to assess public health risk to shellfish growing areas: A case study from Blaine, Washington

A hydrographic dye study of effluent from the Lighthouse Point Water Reclamation Facility in Blaine, Washington, was conducted in November 2012. Six cages filled with oysters were deployed at various locations (stations) along the anticipated path of the effluent to correlate the dye concentrations found at the cages with the indicator bacteria and viral findings in the oysters. Sampling was also conducted at the plant to assess bacteria and virus removal efficiencies through the treatment process. The study objectives were to: (1) determine the bacterial and viral conditions in the influent and effluent and removal efficiencies for a WWTP using membrane filtration (2) determine the bacterial and viral conditions that could arise in receiving waters under a short term lapse in treatment at the WWTP; (3) provide guidance to the Washington Department of Health (WA DOH) regarding the WWTP closure zone based on dilution of effluent (4) research the dilution level needed to achieve reduction in viruses to ensure the safety of shellfish harvested near WWTPs as part of FDA’s dilution guidance The proposed presentation addresses the session theme based on the following features: (1) A description of tools and methodology currently used by FDA to assess risk from wastewater outfalls to commercial shellfish growing areas, including development of an GIS application for mapping dye plumes in real time, (2) Current efforts by FDA to develop an easily quantifiable viral indicator (MS2 Coliphage) and how this indicator correlates with presence of viral pathogens such as Adenovirus and Norovirus in oysters, (3) Evaluation fecal coliform bacteria indicator to assess public health risk from viral pathogens with wastewater plants employing membrane filtration treatment, and (4) Since Blaine sits on the border between the US and Canada, the case study also highlights transborder pollution issues

Dye and microbial study in response to outbreak of norovirus-like illnesses from consumption of shellfish from Hammersley Inlet, Washington

The Hammersley Inlet Growing Area has experienced several clusters of norovirus-like illness in recent years. This presentation will describe a recent study to help evaluate how likely the Shelton WWTP is a potential source of viral loading to the growing area. A hydrographic dye study of the WWTP effluent was conducted by injecting dye at the WWTP at a continuous rate over a full tidal cycle (approximately 24 hours) to approximate steady state concentrations. Sampling of wastewater was also done to evaluate microbial removal across the treatment train. Sentinel shellfish cages are also deployed to measure bioaccumulation of microbial indicators. Plume tracking was conducted for 5 days to determine the extent of excursion of dye as well as the overall dilution of wastewater effluent. The goals of the study are: • Determine the steady state dilution, travel time and dilution of effluent that would be discharged during a failure of the Shelton WWTP over the first ebbing tide and subsequent tides; • Quantify MSC removal efficiency of Shelton WWTP under different operational conditions; • Examine MSC loadings from WWTP under different operational conditions and relate those to MSC levels in shellfish tissue. Deployed shellfish are replenished for microbial analysis every few weeks during the study period. Overall, this study will assist WADOH and FDA in the understanding of the accumulation of bacterial and viral indicators and pathogens in shellfish at various dilutions with respect to a wastewater effluent discharge and the operational performance of the WWTP.

Modeling Wastewater Discharge with a Hybrid Nearfield and Farfield Approach

In November of 2012 the U.S. Food and Drug Administration (FDA) assisted the Washington Department of Health with a dye release experiment at the Chambers Creek Wastewater facility near Steilacoom, WA and in the vicinity of geoduck tracks. Dye was released by being pumped in via the waste stream for over a day, and the effluent tracked by three boats equipped with tracking sensors (fluorometers). We present results from an effort to model this event using a combination of a nearfield (CORMIX) and farfield (GEMSS) models. The nearfield model is used to set the plume stratification over the tidal and meteorological conditions present during the experiment. That output is fed at 15-minute intervals into a pre-existing farfield model (GEMSS) that Ecology had previously calibrated. Because the farfield model was developed for another purpose, the grid cell size was not optimized for the application. How well did this work? Results over the tidal cycle are presented along with a discussion of numerical dispersion inherent in the farfield model. Can numerical dispersion be compensated for and the approach used to explore other plan discharge scenarios

Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation

Introduction: Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.Methods: Patients who sustained blunt or penetrating trauma with signs of hemorrhagic shock from June 2014 through July 2018 were considered for TXA treatment. A retrospective control group was formed from patients seen in the same past five years who were not administered TXA and matched based on age, gender, Injury Severity Score (ISS), and mechanism of injury (blunt vs penetrating trauma). The primary outcome of this study was mortality measured at 24 hours, 48 hours, and 28 days. Secondary outcomes included total blood products transfused, hospital length of stay (LOS), intensive care unit LOS, and adverse events. We conducted three pre-specified subgroup analyses to assess outcomes of patients, including (1) those who were severely injured (ISS >15), (2) those who sustained significant blood loss (≥10 units of total blood products transfused), and (3) those who sustained blunt vs penetrating trauma.Results: Propensity matching yielded two cohorts: the hospital TXA group (n = 280) and a control group (n = 280). The hospital TXA group had statistically lower mortality at 28 days (1.1% vs 5%, odds ratio [OR] [0.21], (95% confidence interval [CI], 0.06, 0.72)) and used fewer units of blood products (median = 4 units, interquartile range (IQR) = [1, 10] vs median=7 units, IQR = [2, 12.5] for the hospital TXA and control groups, respectively, (95% CI for the difference in median, -3 to -1). There were no statistically significant differences between groups with regard to 24-hour mortality (1.1% vs 1.1%, OR = 1, 95% CI, 0.20, 5.00), 48-hour mortality (1.1% vs 1.4%, OR [0.74], 95% CI, 0.17, 3.37), hospital LOS (median= 9 days, IQR = (5, 16) vs median =12 days IQR = (6, 22.5) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-5 to 0)), and incidence of thromboembolic events (eg, deep vein thrombosis, pulmonary embolism) during hospital stay (0.7% vs 0.7% for the hospital TXA and control group, respectively, OR [1], 95% CI, 0.14 to 7.15). We conducted subgroup analyses on patients with ISS>15, patients transfused with ≥10 units of blood products, and blunt vs penetrating trauma. The results indicated lower 28-day mortality for ISS>15 (1.8% vs 7.1%, OR [0.23], 95% CI, 0.06 to 0.81) and blunt trauma  (0.6% vs 6.3%, OR [0.09], 95% CI, 0.01 to 0.75); fewer units of blood products for penetrating trauma (median = 2 units, IQR = (1, 8) vs median = 8 units, IQR = (5, 15) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-6 to -3)), and ISS>15 (median = 7 units, IQR = (2, 14) vs median = 8.5 units, IQR = (4, 16) for the hospital TXA and control groups, respectively, 95% CI for the difference in median, -3 to 0).Conclusion: The current study demonstrates a statistically significant reduction in mortality after TXA administration at 28 days, but not at 24 and 48 hours, in patients with traumatic hemorrhagic shock

Demographic Responses of Least Terns and Piping Plovers to the 2011 Missouri River Flood—A Large-Scale Case Study

2011 led to substantial changes in abundance and distribution of unvegetated sand habitat. This river system is a major component of the breeding range for interior Least terns (Sternula antillarum; “terns”) and piping plovers (Charadrius melodus; “plovers”), both of which are Federally listed ground-nesting birds that prefer open, unvegetated sand and gravel nesting substrates on sandbars and shorelines. The 2011 flood inundated essentially all tern and plover nesting habitat during 2011, but it had potential to generate post-flood habitat conditions that favored use by terns and plovers in subsequent years. We compared several tern and plover demographic parameters during the pre-flood and post-flood periods on the Garrison Reach and Lake Sakakawea, North Dakota, to determine how this event influenced these species (both species on the Garrison Reach, and plovers only on Lake Sakakawea). The principal parameters we measured (nest survival, chick survival, and breeding population) showed spatial and temporal variation typical of opportunistic species occupying highly variable habitats. There was little evidence that nest survival of least terns differed between pre- and post-flood. During 2012 when habitat was most abundant on the Garrison Reach and Lake Sakakawea, piping plover nest survival was higher than in any other year in the study, but returned to rates comparable to pre-flood years in 2013. Chick survival for terns on the Garrison Reach and plovers on Lake Sakakawea showed a similar pattern to plover nest survival, with the 2012 rate exceeding all other years of the study, and the remaining pre-flood and post-flood years being generally similar but slightly higher in post-flood years. However, plover chick survival on the Garrison Reach in 2012 was similar to pre-flood years, and increased annually thereafter to its highest rate in 2014. Although wide confidence intervals precluded firm conclusions about flood effects on breeding populations, the general pattern suggested lower populations of plovers but higher populations of least terns immediately after the flood. Despite near total absence of breeding habitat on either study area during the flood of 2011, populations of both species persisted after the flood due to their propensity to disperse and/or forgo breeding for at least a year. Tern and plover populations have similarly persisted and recovered after the flood, but their mechanisms for persistence likely differ. Data on tern dispersal is generally lacking, but they are thought to show little fidelity to their natal grounds, have a propensity to disperse potentially long distances, and routinely forgo breeding until their second year, thus a lost opportunity to breed in a given area may be easily overcome. Plovers exhibit stronger demographic ties to the general area in which they previously nested, yet they occupy much broader nesting habitat features than terns and exploit three major landforms in the Dakotas (free-flowing rivers, reservoir shorelines, and wetland shorelines). Consequently, dispersal to and from non-Missouri River habitats and potential to exploit non-traditional habitats likely sustained the Northern Great Plains population through the flood event. Terns and plovers normally occupy similar habitats on the Missouri River and both species experienced similar loss of a breeding season due to the flood. Persistence of these populations after the flood underscores the importance of understanding their unique demographic characteristics and the context within which the Missouri River operates

Test of a Workforce Development Intervention to Expand Opioid Use Disorder Treatment Pharmacotherapy Prescribers: Protocol for a Cluster Randomized Trial

Background: Overdoses due to non-medical use of prescription opioids and other opiates have become the leading cause of accidental deaths in the USA. Buprenorphine and extended-release naltrexone are key evidence-based pharmacotherapies available to addiction treatment providers to address opioid use disorder (OUD) and prevent overdose deaths. Treatment organizations’ efforts to provide these pharmacotherapies have, however, been stymied by limited success in recruiting providers (physicians, nurse practitioners, and physician assistants) to prescribe these medications. Historically, the addiction treatment field has not attracted physicians, and many barriers to implementing OUD pharmacotherapy exist, ranging from lack of confidence in treating OUD patients to concerns regarding reimbursement. Throughout the USA, the prevalence of OUD far exceeds the capacity of the OUD pharmacotherapy treatment system. Poor access to OUD pharmacotherapy prescribers has become a workforce development need for the addiction treatment field and a significant health issue. Methods: This cluster randomized controlled trial (RCT) is designed to increase buprenorphine and extended-release naltrexone treatment capacity for OUD. The implementation intervention to be tested is a bundle of OUD pharmacotherapy capacity building practices called the Prescriber Recruitment Bundle (PRB), which was developed and piloted in a previous statewide buprenorphine implementation study. For this cluster RCT, organizational sites will be recruited and then randomized into one of two arms: (1) control, with treatment as usual and access to a website with PRB resources, or (2) intervention, with organizations implementing the PRB using the Network for the Improvement of Addiction Treatment organizational change model over a 24-month intervention period and a 10-month sustainability period. The primary treatment outcomes for each organizational site are self-reported monthly counts of buprenorphine slots, extended-release naltrexone capacity, number of buprenorphine patients, and number of extended-release naltrexone patients. This trial will be conducted in Florida, Ohio, and Wisconsin, resulting in 35 sites in each arm, for a total sample size of 70 organizations. Discussion: This study addresses three issues of substantial public health significance: (1) the pressing opioid misuse epidemic, (2) the low uptake of OUD treatment pharmacotherapies, and (3) the need to increase prescriber participation in the addiction treatment workforce. Trial Registration: ClinicalTrials.gov NCT02926482

J1649+2635: A Grand-Design Spiral with a Large Double-Lobed Radio Source

We report the discovery of a grand-design spiral galaxy associated with a double-lobed radio source. J1649+2635 (z = 0.0545) is a red spiral galaxy with a prominent bulge that it is associated with a L$_{1.4{\rm GHz}}\sim$10$^{24}$WHz$^{-1}$ double-lobed radio source that spans almost 100kpc. J1649+2635 has a black hole mass of M$_{\rm BH} \sim$ 3--7 $\times$ 10$^8$M$_{\odot}$ and SFR$\sim$ 0.26 -- 2.6M$_{\odot}$year$^{-1}$. The galaxy hosts a $\sim$96kpc diffuse optical halo, which is unprecedented for spiral galaxies. We find that J1649+2635 resides in an overdense environment with a mass of M$_{dyn} = 7.7^{+7.9}_{-4.3} \times 10^{13}$M$_{\odot}$, likely a galaxy group below the detection threshold of the ROSAT All-Sky Survey. We suggest one possible scenario for the association of double-lobed radio emission from J1649+2635 is that the source may be similar to a Seyfert galaxy, located in a denser-than-normal environment. The study of spiral galaxies that host large-scale radio emission is important because although rare in the local Universe, these sources may be more common at high-redshifts.Comment: 11 pages, 9 figures, Accepted for publication in MNRA

Amalgame: Cosmological Constraints from the First Combined Photometric Supernova Sample

Future constraints of cosmological parameters from Type Ia supernovae (SNe Ia) will depend on the use of photometric samples, those samples without spectroscopic measurements of the SNe Ia. There is a growing number of analyses that show that photometric samples can be utilised for precision cosmological studies with minimal systematic uncertainties. To investigate this claim, we perform the first analysis that combines two separate photometric samples, SDSS and Pan-STARRS, without including a low-redshift anchor. We evaluate the consistency of the cosmological parameters from these two samples and find they are consistent with each other to under $1\sigma$. From the combined sample, named Amalgame, we measure $\Omega_M = 0.328 \pm 0.024$ with SN alone in a flat $\Lambda$CDM model, and $\Omega_M = 0.330 \pm 0.018$ and $w = -1.016^{+0.055}_{-0.058}$ when combining with a Planck data prior and a flat $w$CDM model. These results are consistent with constraints from the Pantheon+ analysis of only spectroscopically confirmed SNe Ia, and show that there are no significant impediments to analyses of purely photometric samples of SNe Ia.Comment: Submitting to MNRAS; comments welcom