Increased suicide risk among workers following toxic metal exposure at the Paducah gaseous diffusion plant from 1952 to 2003: a cohort study.

BACKGROUND: Suicide is a problem worldwide and occupation is an important risk factor. In the last decade, 55 200 deaths in the US were attributed to occupational risk factors. OBJECTIVE: To determine if toxic metal exposure was associated with suicide risk among Paducah gaseous diffusion plant (PGDP) workers. METHODS: We assembled a cohort of 6820 nuclear industry workers employed from 1952 to 2003. A job-specific exposure matrix (JEM) was used to determine metal exposure likelihood. Uranium exposure was also assessed by urinalysis. All suicide/self-injury International Classification for Disease (ICD) codes were used to identify suicides. Standardized mortality ratios (SMR), odds ratios (OR), and hazard ratios (HR) were used to estimate suicide risk. RESULTS: PGDP suicide victims typically were younger white men. Within exposure likelihood categories, several suicide SMRs were typically elevated for several metals. Only beryllium exposure likelihood was associated with an increased HR. Uranium urine concentration was associated with an elevated suicide risk after stratification by urinalysis frequency. CONCLUSION: Suicide risk is associated with uranium exposure.

Multivariate logistic regression for predicting total culturable virus presence at the intake of a potable-water treatment plant: novel application of the atypical coliform/total coliform ratio.

Predicting the presence of enteric viruses in surface waters is a complex modeling problem. Multiple water quality parameters that indicate the presence of human fecal material, the load of fecal material, and the amount of time fecal material has been in the environment are needed. This paper presents the results of a multiyear study of raw-water quality at the inlet of a potable-water plant that related 17 physical, chemical, and biological indices to the presence of enteric viruses as indicated by cytopathic changes in cell cultures. It was found that several simple, multivariate logistic regression models that could reliably identify observations of the presence or absence of total culturable virus could be fitted. The best models developed combined a fecal age indicator (the atypical coliform [AC]/total coliform [TC] ratio), the detectable presence of a human-associated sterol (epicoprostanol) to indicate the fecal source, and one of several fecal load indicators (the levels of Giardia species cysts, coliform bacteria, and coprostanol). The best fit to the data was found when the AC/TC ratio, the presence of epicoprostanol, and the density of fecal coliform bacteria were input into a simple, multivariate logistic regression equation, resulting in 84.5% and 78.6% accuracies for the identification of the presence and absence of total culturable virus, respectively. The AC/TC ratio was the most influential input variable in all of the models generated, but producing the best prediction required additional input related to the fecal source and the fecal load. The potential for replacing microbial indicators of fecal load with levels of coprostanol was proposed and evaluated by multivariate logistic regression modeling for the presence and absence of virus.

Predictive input parameters for enteric virus presence at the inlet of a potable water supply.

Kentucky river water samples were collected at the input of a potable water supply weekly, for a period of two years. Eighteen parameters were analysed and/or recorded for each weekly observation. The variables were of a physical, chemical and biological nature. Enteric virus presence was detected by cell culture analysis from approximately 200 L samples of river water. A database of 108 observations was assembled. Of these only 100 complete observations were used for the modelling analysis. Model input parameters were selected solely based on their statistical significance in forward, backward and stepwise selection procedures. Multivariate logistic regression (MLR) was used to determine the relative significance of the input parameters for predicting the presence or absence of enteric virus. The final, best-fit MLR model that used log-transformed values for enterococci, the AC/TC ratio, faecal coliforms (FC) and temperature demonstrated 82.5 and 81.4% sensitivity and specificity, respectively.

Probing Norwalk-like virus presence in shellfish, using artificial neural networks.

A database was examined using artificial neural network (ANN) models to investigate the efficacy of predicting PCR-identified Norwalk-like virus presence and absence in shellfish. The relative importance of variables in the model and the predictive power obtained by application of ANN modelling methods were compared with previously developed logistic regression models. In addition, two country-specific datasets were analysed separately with ANN models to determine if the relative importance of the input variables was similar for geographically diverse regions. The results of this analysis found that ANN models predicted Norwalk-like virus presence and absence in shellfish with equivalent, and better, precision than logistic regression models. For overall classification performance, ANN modelling had a rate of 93%, vs 75% for the logistic regression. ANN models were able to illuminate the site-specific relationships between indicators and pathogens.

The utility of the AC/TC ratio for watershed management: a case study.

A human-impacted watershed was monitored during the dry summer seasons in 2002 and 2003 to investigate the impact of providing access to sewer mains to local village residences. Faecal coliform concentrations were monitored at select sites along the 30-mile stretch of creek, together with faecal streptococci, enterococci and total coliforms. Analysis of the results found that levels of faecal coliforms were inadequate at identifying significant known influxes of human and animal sewage established by sanitary survey. However, the bacterial ratio of atypical colonies to total coliform colonies (AC/TC), obtained from the total coliform membrane filter assay on m-Endo media, correctly indexed human faecal impact of inadequately sewered villages located along the creek. In addition, the AC/TC ratio correctly classified the predominant source of faecal runoff in the creek headwaters as agricultural, and indicated when aged agricultural faecal material was introduced by tributaries. An approach for watershed management that uses the AC/TC ratio in addition to levels of bacteria is proposed.

Novel bacterial ratio for predicting faecal age.

This study presents an extension of ongoing research into the utility of the ratio of colonies isolated on membrane filters during the total coliform test using m-Endo broth media. Investigations into the relative shifts in concentrations of indicator bacterial populations over time, in laboratory-based survival studies conducted with filtered river water, were undertaken. Also, analysis of Kentucky River water quality data collected from the inlet of a local water treatment plant was carried out. Survival studies found that the ratio between the raw concentrations of atypical colonies (AC) and total coliform colonies (TC) was directly related to the amount of time coliform spiked river water had been held in open jars in the laboratory. The AC/TC ratio in the jars would rise from < 1 at the time of coliform spiking to > 200 within 4d. The rise in AC/TC ratio with time in river water was confirmed in the analysis of two years of Kentucky River water quality data where the average AC/TC ratio during months with high river flow (rain) was 3.37 and rose to an average of 27.58 during months with low flow. The average AC/TC ratio during high flow months compared to that of raw human sewage (3.9) and the ratio increased to values associated with animal impacted urban runoff (18.9) during low flow months.

Artificial neural network modelling: a summary of successful applications relative to microbial water quality.

Artificial neural networks (ANN) are modelling tools that can be of great utility in studies of microbial water quality. The ability of ANNs to work with complex, inter-related multiparameter databases and provide superior predictive power in non-linear relationships suits their application to microbial water quality studies. To date ANNs have been successfully applied (a) for the prediction of peak microbial concentrations, (b) to sort land use associated faecal pollution sources and relative ages of runoff and (c) towards the selection and study of surrogate parameters. Predictions of peak microbial contamination or faecal pollution sources have been greater than 90% accurate. The importance of a subgroup of organisms that are isolated by the total coliform membrane filter test on m-Endo media in defining faecal sources was revealed through parameter selection exercises. The result is the definition of a new bacterial ratio that can be directly related to the age of faecal contamination in animal impacted runoff.

F-specific RNA coliphages: occurrence, types, and survival in natural waters.

A small, well-defined watershed was investigated over a 2-year period to determine the prevalence of F-specific RNA coliphage (F + RNA) serotypes as indicators of animal fecal contamination. Sampling sites collected runoff from areas of urban and agricultural land use patterns. F-specific coliphages were concentrated from 2-L freshwater samples by polyethylene glycol precipitation, isolated using the double agar layer (DAL) method, confirmed as F + RNA by RNAse suppression, and serotyped. A subset of serotyped F + RNA were confirmed by genotyping. To determine relative survival, 10 confirmed F + RNA field isolates and 5 prototypic F + RNA were spiked into surface water and incubated at 25 degrees C for 36 days. F-specific coliphage isolation was strongly associated with rainfall events and was infrequent from primarily animal impacted surface waters. Field isolates were predoffiinantly Type I F + RNA (81%) and raw sewage isolates were predominantly Type III F + RNA (57%). Genotyping from either the watershed or raw sewage samples never positively identified Type IV F + RNA. Results from laboratory studies showed that F + RNA differ in their survival in water and that Type IV strains were the least persistent. Type III F + RNA were found to be reliably related to the release of uncontrolled human fecal material in the watershed, but the results of this study suggest that further study is required before utilizing for fecal source identification in natural waters.

Selecting a sensitive bacteriophage assay for evaluation of a prototype water recycling system.

A rapid, simple, and direct (RSD) assay of eluate from filter concentration was developed to enumerate low numbers of MS2 bacteriophage, used as a surrogate for enteric viruses, from samples collected from a prototype-sized water recycling system. The RSD assay utilized a 50-ml eluate volume in a modified single-layer assay, neutralizing eluate pH by buffered, double-strength agar. The RSD assay developed was simpler and minimized sample-handling steps compared with another published method. The RSD assay method showed greater sensitivity than the other published method for recovering phage from filter eluate while avoiding pH shifts, which can inactivate phage. Grant numbers: NAGW 2356.

Neural network modelling of Cryptosporidium and Giardia concentrations in the Delaware River, USA.

Artificial neural networks are brain-like structures used in mathematical modelling that excel in pattern recognition. In this research, a simple feed-forward artificial neural network, trained by error back-propagation algorithm, was used as a tool to relate peak Cryptosporidium and Giardia concentrations with other biological, chemical and physical parameters in surface water. Multiple water quality parameters at a water treatment plant intake on the Delaware River, New Jersey, USA, collected in 1996, were provided to the authors for recognition analysis. Water samples were classified as "background" and "above background" based on the concentration of full and empty oocysts and cysts of Cryptosporidium and Giardia. The results of this preliminary effort were encouraging. Parameters significant to the identification of each protozoa were identified, eight for Cryptosporidium and seven for Giardia by a stepwise elimination technique. Data withheld from the model training was used to validate the trained models and evaluate the most effective internal architecture. In both cases, the best prediction performance was found when the number of internal nodes was twice that of the input parameters in single hidden-layer architecture. Predictions for the classification of the verification data set resulted in no false-negatives (mis-prediction of above background protozoa concentrations) when the models were optimally trained.

Effect of microgravity on Escherichia coli and MS-2 bacteriophage disinfection by iodinated resins.

Experiments on chemical disinfection by iodinated resins were conducted on STS 50 (USML-1), which flew a 13 day mission during 1992. Fluid processing apparatus containing microorganisms and iodinated resins was assembled in either Manhattan, Kansas, or Boulder, Colorado, and loaded on-board the Space Shuttle for the mission. Pentaiodide resin was more effective than the triiodide resin against Escherichia coli. Both resins were more effective bactericides at unit gravity than microgravity because of cosedimentation of bacteria and iodinated resin beads. In bacteriophage experiments, the triiodide resin reduced the viable titer of MS-2 by nine logs. The few viable phage surviving chemical disinfection were associated with precipitant formation in the fluid processing apparatus.

Remission of autoimmune hemolytic anemia associated with chronic lymphocytic leukemia following splenic irradiation.

A 56-year old woman with chronic lymphocytic leukemia associated with corticosteroid-resistant autoimmune hemolytic anemia was successfully treated with splenic irradiation. Cobalt 60 in the dose of 8 Gy was delivered to the spleen, considered sufficient for therapy of B lymphocyte CALLA-phenotype. There has been no recurrence of autoimmune hemolytic anemia over a follow-up period of 28 months. The mechanism of action of splenic irradiation is discussed. This treatment might offer a simple and effective alternative to splenectomy in patients with steroid-resistant hemolytic anemia when surgical operation is contraindicated or refused.