Potable Re-use of Treated Reclaimed Wastewater

Many water systems in New Mexico have been severely impacted by the 10-year drought currently occurring in the arid southwest. One of those, Cloudcroft NM, experiences large demand increases on the weekends. Because available water in their fracture formation aquifer has steadily declined, it is often difficult to fill available storage above the 25% level. In addition many of the homes surrounding Cloudcroft now have dry private wells because of the dropping water table. This has forced some citizens on private supplies to rely on the public water system to provide for their needs. In response to the severe drought, the community has instituted severe water rationing, conservation measures, and installed a small surface water treatment plant to treat water that collects in a 1 million gallon firefighting pond

The Complex Management of Mechanical Prosthetic Valve Thrombosis

Mechanical prosthetic valve thrombosis (PVT) is a serious condition that is associated with various life-threatening complications. The utilization of multimodality imaging techniques is critical in identifying this etiology. Its management is complex and often requires repeat surgical valve replacements. Our report describes the case of a 48-year-old female who presented with mechanical mitral valve thrombosis in the setting of subtherapeutic anticoagulation. Due to her complex surgical history, nonsurgical therapeutic options were initially pursued for management. Through shared decision-making and after exhaustion of other alternatives, she was maintained on optimized medical therapy and was scheduled for repeat elective surgery. After compliance with medical therapy and close monitoring, she improved significantly, and her underlying pathology completely resolved, eliminating the need for surgery. This report indicates that the management of mechanical prosthetic valve thrombosis should be individualized and emphasizes the importance of involving a multidisciplinary team of medical and surgical professionals to achieve the best clinical outcomes

A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021

IMPORTANCE While much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID. OBJECTIVE To estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery. DESIGN We jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study. RESULTS Analyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8-312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38-7.96) of all infections. The fatigue, respiratory, and cognitive clusters occurred in 51.0% (16.9-92.4), 60.4% (18.9-89.1), and 35.4% (9.4-75.1) of long COVID cases, respectively. Those with milder acute COVID-19 cases had a quicker estimated recovery (median duration 3.99 months [IQR 3.84-4.20]) than those admitted for the acute infection (median duration 8.84 months [IQR 8.10-9.78]). At twelve months, 15.1% (10.3-21.1) continued to experience long COVID symptoms. CONCLUSIONS AND RELEVANCE The occurrence of debilitating ongoing symptoms of COVID-19 is common. Knowing how many people are affected, and for how long, is important to plan for rehabilitative services and support to return to social activities, places of learning, and the workplace when symptoms start to wane. KEY POINTS Question: What are the extent and nature of the most common long COVID symptoms by country in 2020 and 2021?Findings: Globally, 144.7 million people experienced one or more of three symptom clusters (fatigue; cognitive problems; and ongoing respiratory problems) of long COVID three months after infection, in 2020 and 2021. Most cases arose from milder infections. At 12 months after infection, 15.1% of these cases had not yet recovered.Meaning: The substantial number of people with long COVID are in need of rehabilitative care and support to transition back into the workplace or education when symptoms start to wane

Status, Trends, and Conservation of Eelgrass in Atlantic Canada and the Northeastern United States: Workshop Report

Eelgrass (Zostera marina L) is the dominant seagrass occurring in eastern Canada and the northeastern United States, where it often forms extensive meadows in coastal and estuarine areas. Eelgrass beds are extremely productive and provide many valuable ecological functions and ecosystem services. They serve as critical feeding and nursery habitat for a wide variety of commercially and recreationally important fish and shellfish and as feeding areas for waterfowl and other waterbirds. Eelgrass detritus is also transported considerable distances to fuel offshore food webs. In addition, eelgrass beds stabilize bottom sediments, dampen wave energy, absorb nutrients from surrounding waters, and retain carbon through burial

Investigating the prevalence, predictors, and prognosis of suboptimal statin use early after a non-ST elevation acute coronary syndrome

BACKGROUND:High-potency statin therapy is recommended in the secondary prevention of car-diovascular disease but discontinuation, dose reduction, statin switching, and/or nonadherence occurin practice.OBJECTIVES:To determine the prevalence and predictors of deviation from high-potency statin useearly after a non-ST elevation acute coronary syndrome (NSTE-ACS) and its association with subse-quent major adverse cardiovascular events (MACE) and all-cause mortality (ACM).METHODS:A total of 1005 patients from a UK-based prospective NSTE-ACS cohort study dis-charged on high-potency statin therapy (atorvastatin 80 mg, rosuvastatin 20 mg, or 40 mg daily)were included. At 1 month, patients were divided into constant high-potency statin users, and subop-timal users incorporating statin discontinuation, dose reduction, switching statin to a lower equivalentpotency, and/or statin nonadherence. Follow-up was a median of 16 months.RESULTS:There were 156 suboptimal (w15.5%) and 849 constant statin users. Factors associatedin multivariable analysis with suboptimal statin occurrence included female sex (odds ratio 1.75, 95%confidence interval [CI] 1.14–2.68) and muscular symptoms (odds ratio 4.28, 95% CI 1.30–14.08).Suboptimal statin use was associated with increased adjusted risks of time to MACE (hazard ratio2.10, 95% CI 1.25–3.53,P5.005) and ACM (hazard ratio 2.46, 95% CI 1.38–4.39,P5.003). Sub-group analysis confirmed that the increased MACE/ACM risks were principally attributable to statindiscontinuation or nonadherence.CONCLUSIONS:Conversion to suboptimal statin use is common early after NSTE-ACS and ispartly related to muscular symptoms. Statin discontinuation or non-adherence carries an adverse prog-nosis. Interventions that preserve and enhance statin utilization could improve post NSTE-ACSoutcomes

Understanding maternity care providers’ use of data in Southern Tanzania

Introduction: Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers’ perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use. Methods: We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards to understand maternity providers’ interaction with data in two rural hospitals in Southern Tanzania. Constant comparative data analysis was applied to develop initial and focused codes, subcategories and categories were continuously validated through peer and member checks. Results: Maternity care providers found routine health information data of little use to reconcile demands from managers, the community and their challenging working environment within their daily work. They thus added informal narrative documentation sources. They created alternative narratives through data of a maternity care where mothers and babies were safeguarded. The resulting documentation system, however, led to duplication and increased systemic complexity. Conclusions: Current health information systems may not meet all data demands of maternity care providers, or other healthcare workers. Policy makers and health information system specialists need to acknowledge different ways of data use beyond health service planning, with an emphasis on healthcare providers’ data needs for clinical documentatio

Vitamin A deficiency retinopathy related to medical interventions in a Swiss cohort: a case series

AIMS OF THE STUDY: Vitamin A deficiency retinopathy is a potentially blinding disease. In developed countries, vitamin A deficiency due to malnutrition is rare. However, vitamin A deficiency can be caused by malabsorption resulting from bowel resection or medication. In this retrospective study, we present five cases of vitamin A deficiency retinopathy related to malabsorption secondary to medical interventions. METHODS: Electronic charts over a ten-year period (2012–2022) were screened for vitamin A deficiency retinopathy. Only patients with vitamin A deficiency confirmed by laboratory tests were included. Symptoms, medical history, visual acuity, optical coherence tomography, fundus autofluorescence, electrophysiological examination, and vitamin A levels were reviewed. RESULTS: Five eligible cases were identified. Median age was 44.7 years (range 22.2–88.9), median duration of ocular symptoms prior to diagnosis was 14 months, and median visual acuity was 1.0 (range 0.5–1.0, Snellen, decimal). Three patients had a history of bariatric surgery, one patient had a small bowel resection and was on octreotide treatment, and one patient suffered from cystic fibrosis and had a history of small bowel resection and severe hepatopathy. Optical coherence tomography showed various abnormalities, including a reduced interdigitation zone, subretinal drusenoid deposits, and a thinned outer nuclear layer. Electroretinogram findings ranged from abnormal oscillatory potentials to non-recordable rod responses. CONCLUSIONS: Vitamin A deficiency retinopathy can occur following medical interventions associated with malabsorption. In cases of night blindness, vitamin A levels should be measured

Water splitting with polyoxometalate-treated photoanodes: Enhancing performance through sensitizer design

Visible light driven water oxidation has been demonstrated at near-neutral pH using photoanodes based on nanoporous films of TiO2, polyoxometalate (POM) water oxidation catalyst [{Ru4O4(OH)2(H2O)4}(γ-SiW10O36)2]10- (1), and both known photosensitizer [Ru(bpy)2(H4dpbpy)]2+ (P2) and the novel crown ether functionalized dye [Ru(5-crownphen)2(H2dpbpy)] (H22). Both triads, containing catalyst 1, and catalyst-free dyads, produce O2 with high faradaic efficiencies (80 to 94%), but presence of catalyst enhances quantum yield by up to 190% (maximum 0.39%). New sensitizer H22 absorbs light more strongly than P2, and increases O2 quantum yields by up to 270%. TiO2-2 based photoelectrodes are also more stable to desorption of active species than TiO2-P2: losses of catalyst 1 are halved when pH > TiO2 point-of-zero charge (pzc), and losses of sensitizer reduced below the pzc (no catalyst is lost when pH < pzc). For the triads, quantum yields of O2 are higher at pH 5.8 than at pH 7.2, opposing the trend observed for 1 under homogeneous conditions. This is ascribed to lower stability of the dye oxidized states at higher pH, and less efficient electron transfer to TiO2, and is also consistent with the 4th 1-to-dye electron transfer limiting performance rather than catalyst TOFmax. Transient absorption reveals that TiO2-2-1 has similar 1st electron transfer dynamics to TiO2-P2-1, with rapid (ps timescale) formation of long-lived TiO2(e-)-2-1(h+) charge separated states, and demonstrates that metallation of the crown ether groups (Na+/Mg2+) has little or no effect on electron transfer from 1 to 2. The most widely relevant findings of this study are therefore: (i) increased dye extinction coefficients and binding stability significantly improve performance in dye-sensitized water splitting systems; (ii) binding of POMs to electrode surfaces can be stabilized through use of recognition groups; (iii) the optimal homogeneous and TiO2-bound operating pHs of a catalyst may not be the same; and (iv) dye-sensitized TiO2 can oxidize water without a catalyst