Incidence and public health burden of sunburn among beachgoers in the United States.

The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n = 75,614), were pooled to evaluate sunburn incidence 10-12 days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13-18 years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending ≥5 h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio = 0.45 (95% Confidence Interval:0.27-0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers

Treating Substance Use Disorders: Enhancing Attendance at the Weekly Inpatient Medication Assisted Treatment Group

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline. A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%. A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to address these. Among them were the initiation of a KPI to collect patient attendance data and the creation of an IMAT order in EPIC. Since the IMAT order went “live” in EPIC and other countermeasures were started, the goal of 50% has been surpassed. Next steps include ongoing nurse, physician and care management education, and work with nursing informatics to develop an appointment feature for the IMAT order in EPIC

Chesapeake Bay benthic community restoration goals

Benthic macroinvertebrate assemblages have been an integral part of the Chesapeake Bay monitoring program since its inception due to their ecological importance and their value as biological indicators. The condition of benthic assemblages reflects an integration of temporally variable environmental conditions and the effects of multiple types of environmental stresses. As such, benthic assemblages provide a useful complement to more temporally variable chemical and water quality monitoring measures. While assessments using benthic monitoring data have been useful for characterizing changes in environmental conditions at individual sites over time, and for relating the condition of sites to pollution loadings and sources, the full potential of these assessments for addressing larger management questions, such as What is the overall condition of the Bay? or How does the condition of various tributaries compare? has not yet been realized. Regional-scale assessments of ecological status and trends using benthic assemblages are limited by the fact that benthic assemblages are strongly influenced by naturally varying habitat elements, such as salinity, sediment type, and depth. Such natural variability confounds interpretation of differences in the benthic community differences as simple responses to anthropogenic environmental perturbations. An additional limitation is that different sampling methodologies used in various programs often constrain the extent to which the benthic data can be integrated for a unified assessment. The objective of this project was to develop a practical and conceptually sound framework for assessing benthic environmental conditions in Chesapeake Bay that would address the general constraints and limitations just described. This was accomplished by standardizing benthic data from several different monitoring programs to allow their integration into a single, coherent data base. From that data base a set of measures (Chesapeake Bay Benthic Restoration Goals) was developed to describe characteristics of benthic assemblages expected at sites having little evidence of environmental stress or disturbance. Using these goals, benthic data from any part of the Bay could be compared to determine whether conditions at that site met, were above, or were below expectations defined for reference sites in similar habitats

Nicotine Replacement Therapies to Decrease Withdrawal Symptoms and Improve Patient Experience

Smoking is one the leading causes of preventable death in the United States. Patient centered care revolves around encouraging patients to reduce their chances of preventable disease and death. To that end, nicotine replacement therapy (NRT) prescribed within 24 hours of hospital admission increases the chance of quitting and decreases the chance of nicotine withdrawal. A pilot performance improvement project was initiated on two cardiac units at an academic tertiary medical center. The goal the project was to have NRT ordered within 24 hours of admission 100% of the time. Baseline metrics demonstrated admission NRT orders were below acceptable levels and subsequent root cause analyses showed barriers to reaching the established goal. Several countermeasures were initiated to include several KPIs. Post rollout, a significant increase in NRT orders was demonstrated. Next steps include educating staff on all hospital units as well as adding tobacco assessment to the yearly competency policy

Correlation between Quantitative PCR and Culture-Based Methods for Measuring Enterococcus spp. over Various Temporal Scales at Three California Marine Beaches

ABSTRACT Several studies have examined how fecal indicator bacteria (FIB) measurements compare between quantitative PCR (qPCR) and the culture methods it is intended to replace. Here, we extend those studies by examining the stability of that relationship within a beach, as affected by time of day and seasonal variations in source. Enterococcus spp. were quantified at three southern California beaches in the morning and afternoon using two qPCR assays, membrane filtration, and defined-substrate testing. While qPCR and culture-based measurements were consistently and significantly correlated, strength of the correlation varied both among and within beaches. Correlations were higher in the morning (0.45 < ρ < 0.74 [ P < 0.002]) than in the afternoon (0.18 < ρ < 0.45 [ P < 0.021]) and higher when the fecal contamination was concentrated (0.38 < ρ < 0.83 [ P < 0.001]) than when it was diffuse (0.19 < ρ < 0.34 [ P < 0.003]). The ratios of culture-based and qPCR results (CFU or most probable number [MPN] per calibrator cell equivalents [CCE]) also varied spatially and temporally. Ratios ranged between 0.04 and 0.85 CFU or MPN per CCE and were lowest at the beach affected by diffuse pollution. Patterns in the ratios over the course of the day were dissimilar across beaches, increasing with time at one beach and decreasing at another. The spatial and temporal variability we observed indicate that the empirical relationship between culture-based and qPCR results is not universal, even within a beach

Virulence Genes among Enterococcus faecalis

Most Enterococcus faecalis and E. faecium are harmless to humans; however, strains harboring virulence genes, including esp, gelE, cylA, asa1, and hyl, have been associated with human infections. E. faecalis and E. faecium are present in beach waters worldwide, yet little is known about their virulence potential. Here, multiplex PCR was used to compare the distribution of virulence genes among E. faecalis and E. faecium isolated from beaches in Southern California and Puerto Rico to isolates from potential sources including humans, animals, birds, and plants. All five virulence genes were found in E. faecalis and E. faecium from beach water, mostly among E. faecalis. gelE was the most common among isolates from all source types. There was a lower incidence of asa1, esp, cylA, and hyl genes among isolates from beach water, sewage, septage, urban runoff, sea wrack, and eelgrass as compared to human isolates, indicating that virulent strains of E. faecalis and E. faecium may not be widely disseminated at beaches. A higher frequency of asa1 and esp among E. faecalis from dogs and of asa1 among birds (mostly seagull) suggests that further studies on the distribution and virulence potential of strains carrying these genes may be warranted

Water quality criteria for an acidifying ocean: Challenges and opportunities for improvement

This is PMEL Contribution 4396. Acidification has sparked discussion about whether regulatory agencies should place coastal waters on the Clean Water Act 303(d) impaired water bodies list. Here we describe scientific challenges in assessing impairment with existing data, exploring use of both pH and biological criteria. Application of pH criteria is challenging because present coastal pH levels fall within the allowable criteria range, but the existing criteria allow for pH levels that are known to cause extensive biological damage. Moreover, some states express their water quality criteria as change from natural conditions, but the spatio-temporal distribution and quality of existing coastal pH data are insufficient to define natural condition. Biological criteria require that waters be of sufficient quality to support resident biological communities and are relevant because a number of biological communities have declined over the last several decades. However, the scientific challenge is differentiating those declines from natural population cycles and positively associating them with acidification-related water quality stress. We present two case studies, one for pteropods and one for oysters, which illustrate the opportunities, challenges and uncertainties associated with implementing biological criteria. The biggest challenge associated with these biological assessments is lack of co-location between long-term biological and chemical monitoring, which inhibits the ability to connect biological response with an acidification stressor. Developing new, ecologically relevant water quality criteria for acidification and augmenting coastal water monitoring at spatio-temporal scales appropriate to those criteria would enhance opportunities for effective use of water quality regulations.This is the publisher’s final pdf. The published article is copyrighted by Elsevier and can be found at: http://www.journals.elsevier.com/ocean-and-coastal-managementKeywords: Water quality criteria, 303(d), Acidification, Pteropod

The History and Prehistory of Natural-Language Semantics

Contemporary natural-language semantics began with the assumption that the meaning of a sentence could be modeled by a single truth condition, or by an entity with a truth-condition. But with the recent explosion of dynamic semantics and pragmatics and of work on non- truth-conditional dimensions of linguistic meaning, we are now in the midst of a shift away from a truth-condition-centric view and toward the idea that a sentence’s meaning must be spelled out in terms of its various roles in conversation. This communicative turn in semantics raises historical questions: Why was truth-conditional semantics dominant in the first place, and why were the phenomena now driving the communicative turn initially ignored or misunderstood by truth-conditional semanticists? I offer a historical answer to both questions. The history of natural-language semantics—springing from the work of Donald Davidson and Richard Montague—began with a methodological toolkit that Frege, Tarski, Carnap, and others had created to better understand artificial languages. For them, the study of linguistic meaning was subservient to other explanatory goals in logic, philosophy, and the foundations of mathematics, and this subservience was reflected in the fact that they idealized away from all aspects of meaning that get in the way of a one-to-one correspondence between sentences and truth-conditions. The truth-conditional beginnings of natural- language semantics are best explained by the fact that, upon turning their attention to the empirical study of natural language, Davidson and Montague adopted the methodological toolkit assembled by Frege, Tarski, and Carnap and, along with it, their idealization away from non-truth-conditional semantic phenomena. But this pivot in explana- tory priorities toward natural language itself rendered the adoption of the truth-conditional idealization inappropriate. Lifting the truth-conditional idealization has forced semanticists to upend the conception of linguistic meaning that was originally embodied in their methodology

Impacts of Coastal Acidification on the Pacific Northwest Shellfish Industry and Adaptation Strategies Implemented in Response

In 2007, the US west coast shellfish industry began to feel the effects of unprecedented levels of larval mortality in commercial hatcheries producing the Pacific oyster Crassostrea gigas. Subsequently, researchers at Whiskey Creek Shellfish Hatchery, working with academic and government scientists, showed a high correlation between aragonite saturation state (Ω[subscript]arag) of inflowing seawater and survival of larval groups, clearly linking increased CO₂ to hatchery failures. This work led the Pacific Coast Shellfish Growers Association (PCSGA) to instrument shellfish hatcheries and coastal waters, establishing a monitoring network in collaboration with university researchers and the US Integrated Ocean Observing System. Analytical developments, such as the ability to monitor Ω[subscript]arag in real time, have greatly improved the industry’s understanding of carbonate chemistry and its variability and informed the development of commercial-scale water treatment systems. These treatment systems have generally proven effective, resulting in billions of additional oyster larvae supplied to Pacific Northwest oyster growers. However, significant challenges remain, and a multifaceted approach, including selective breeding of oyster stocks, expansion of hatchery capacity, continued monitoring of coastal water chemistry, and improved understanding of biological responses will all be essential to the survival of the US west coast shellfish industry