Assessing background levels of specific conductivity using weight of evidence.

There are many ways to estimate background levels, and many types of evidence may contribute to determining whether a water, air, or soil is at background. As a result, it is important to define background in each case and to weigh the available evidence to determine the best estimate of background. A weight-of-evidence approach is demonstrated that assesses whether the background SC is sufficiently similar in streams of Ecoregion 70 in West Virginia and Ohio. During planning, five relevant considerations were identified to assess background SC: physical properties, measured SC, spatial distribution of low SC sites, biological properties, and data relevance and reliability. For each consideration, diverse types of evidence were generated, evaluated, and synthesized using weight of evidence. In the example, evidence was weighed for the hypothesis that background SC is similar in two areas in Ecoregion 70, the Western Allegheny Plateau in the eastern United States. Where, as in this case, background is not well characterized by measurements, because data sets are small or sampling designs or anthropogenic inputs may influence estimates of background, it is suggested that information about regional properties, related to and affected by SC, may be used to determine whether SC in the less characterized area is sufficiently similar to a well characterized area.

Palliative Care Screening: Appraisal of a Tool to Identify Patients' Symptom Management and Advance Care Planning Needs.

BACKGROUND: The palliative care needs of hospitalized patients often go unmet, resulting in unrelieved symptoms and a lack of understanding about advance care planning. OBJECTIVES: This article analyzes the 10-item Palliative Assessment Screening Tool (PAST) to determine if the PAST aids in the identification of hospitalized patients with palliative care needs and facilitates completion of advance directives. METHODS: A systematic review of studies published from 2012-2016, as well as a retrospective chart review, were used to analyze the PAST. For this 12-week pilot study, all adult patients either admitted or transferred to a 24-bed medical-surgical oncology/orthopedic unit were assessed by the bedside nurse for their potential palliative needs. FINDINGS: Using the PAST seems to improve the identification of patients with palliative needs, leading to better management of symptoms. The PAST is also likely useful in facilitating the completion of advance directives, but this requires further study.

A field-based characterization of conductivity in areas of minimal alteration: A case example in the Cascades of northwestern United States.

The concentration of salts in streams is increasing world-wide making freshwater a declining resource. Developing thresholds for freshwater with low specific conductivity (SC), a measure of dissolved ions in water, may protect high quality resources that are refugia for aquatic life and that dilute downstream waters. In this case example, methods are illustrated for estimating protective levels for streams with low SC. The Cascades in the Pacific Northwest of the United States of America was selected for the case study because a geophysical model indicated that the SC of freshwater streams was likely to be very low. Also, there was an insufficient range in the SC data to accurately derive a criterion using the 2011, US Environmental Protection Agency field-based extirpation concentration distribution method. Instead, background and a regression model was used to estimate chronic and acute SC levels that could extirpate 5% of benthic invertebrate genera. Background SC was estimated at the 25th centile (33µS/cm) of the measured data and used as the independent variable in a least squares empirical background-to-criteria (B-C) model. Because no comparison could be made with effect levels estimated from a paired SC and biological data set from the Cascades, the lower 50% prediction limit (PL) was identified as an example chronic water quality criterion (97µS/cm). The maximum exposure threshold was estimated at the 90th centile SC of streams meeting the chronic SC level. The example acute SC level was 190µS/cm. Because paired aquatic life and SC data are often sparse, the B-C method is useful for developing SC criteria for other systems with limited data.

A field-based model of the relationship between extirpation of salt-intolerant benthic invertebrates and background conductivity.

Field-collected measures of dissolved salts and occurrences of aquatic invertebrates have been used to develop protective levels. However, sufficiently large field data sets of exposures and biota are often not available. Therefore, a model was developed to predict the exposure extirpating 5% of benthic invertebrate genera using only measures of specific conductivity (SC) as the independent variable. The model is based on 3 assumptions: (1) a genus will rarely occur where the background exceeds its upper physiological limit; (2) the lowest possible tolerance limit of a genus in a region is defined by the natural background; and (3) as a result, there will be a regular association between natural background SC and the SC at which salt-intolerant genera are present. Three steps were used to develop the model. First, background SC was characterized as the 25th centile of sampled sites for each of 24 areas in the United States with streams dominated by bicarbonate and sulfate ions. Second, the extirpation concentration (XC95), an estimate of the upper tolerance limit with respect to SC, was calculated for genera in 24 data sets. Next, the lower 5th centile of each set of XC95 values (XCD05) was identified for the most salt-intolerant members in each data set. Finally, the relationship between the 24 background SC and the 24 XCD05 values was empirically modeled to develop a background-to-criterion model. The least squares regression of XCD05 values on log background SC (log Y = 0.658logX + 1.071) yields a strong linear relationship (r = 0.93). The regression model makes it possible to use SC background to predict the SC likely to extirpate the most salt-intolerant genera in an area. The results also suggest that species distribute along natural background gradients of SC and that this relationship can be used to develop criteria for ionic concentration.

Field-based method for evaluating the annual maximum specific conductivity tolerated by freshwater invertebrates.

Most water quality criteria are based on laboratory toxicity tests and usually include chronic and acute magnitudes. Field-based criteria are typically based on long-term or continuous exposures, so they are chronic. Biological responses of quantified, short-term aqueous exposures are seldom documented in the field. However, acute values may be derived by estimating an upper limit using temporal variance and chronic values. This method estimates an upper limit from the variance of pollutant measurements from stream locations that attain the chronic criterion. The formula for deriving a 90th centile of a standard normal distribution is used to identify the upper limit, a criterion maximum exposure concentration (CMEC). The calculated CMEC is interpreted as a maximum exposure that 95% of organisms may tolerate if the chronic exposure is not exceeded. The methods of deriving chronic and acute criteria are illustrated with specific conductivity in a mountainous area in the eastern United States. The biological relevance of the CMEC was assessed using the maximum annual exposure during the life cycle of the most salt-intolerant genera. The method using the chronic criterion and the variance of water chemistry data is practical, whereas frequently collecting and analyzing paired biological and chemical samples at numerous sites is impractical and may give misleading results due to lags in biological response. This method can be used anywhere with sufficient data to estimate the temporal variability and may be applicable for field-based criteria other than the specific conductivity criteria illustrated here.

A flow-chart for developing water quality criteria from two field-based methods.

Field-based methods increase relevance and realism when setting water quality criteria. They also pose challenges. To enable a consistent process, a flow chart was developed for choosing between two field-based methods and then selecting among candidate results. The two field-based methods estimated specific conductivity (SC) levels likely to extirpate 5% of benthic invertebrate genera: an extirpation concentration distribution (XCD) method and a background-to-criterion (B-C) model developed by the U.S. Environmental Protection Agency. The B-C model is a least squares regression of the 5th centile of XCD (XCD05) values against estimates of background SC. Selection of an XCD05 from the flowchart is determined by characteristics of the paired chemical and biological data sets and method for estimating the XCD05 values. Confidence in these example SC XCD05 values is based on the size of the data sets and ecoregional SC disturbance. The level of ecoregional SC disturbance was judged by comparing the background SC (the 25th centile of the data set used to calculate a XCD05) and an estimate of natural base-flow SC modeled from geophysical attributes in the region. The B-C approach appears to be a viable option for estimating a SC benchmark with inexpensive estimates of SC background while the XCD method is used when the data are abundant. To illustrate the use of the flow chart, example SC XCD05 values were calculated for 63 of 86 Level III ecoregions in the conterminous United States of America.

Effects of pharmaceuticals on Daphnia survival, growth, and reproduction.

Pharmaceuticals have been globally detected in surface waters, and the ecological impacts of these biologically-active, ubiquitous chemicals are largely unknown. To evaluate the aquatic toxicity of individual pharmaceuticals and mixtures, we performed single species laboratory toxicity tests with Daphnia magna, a common freshwater zooplankton. We conducted acute (6-day) and chronic (30-day) exposure pharmaceutical bioassays and evaluated survivorship and morphology of adults and neonates, adult length, resting egg production, brood size (fecundity), and the proportion of male broods produced (sex ratio). In general, exposure to a single pharmaceutical in the 1-100 microg/l range yielded no apparent effects on the normal life processes of Daphnia. However, chronic fluoxetine exposure (36 microg/l) significantly increased Daphnia fecundity, and acute clofibric acid exposure (10 microg/l) significantly increased sex ratio. A mixture of fluoxetine (36 microg/l) and clofibric acid (100 microg/l) caused significant mortality; the same fluoxetine concentration mixed with 10 microg/l clofibric acid resulted in significant deformities, including malformed carapaces and swimming setae. Mixtures of three to five antibiotics (total antibiotic concentration 30-500 microg/l) elicited changes in Daphnia sex ratio. We conclude: (1) individual and mixtures of pharmaceuticals affect normal development and reproduction of Daphnia magna, (2) aquatic toxicity of pharmaceutical mixtures can be unpredictable and complex compared to individual pharmaceutical effects, and (3) timing and duration of pharmaceutical exposure influence aquatic toxicity.

Human mercury toxicity and ice angler fish consumption: are people eating enough to cause health problems?

Mercury contamination of aquatic ecosystems is a global environmental concern. Bioaccumulation of mercury in fish exposes consumers to risk. We interviewed ice anglers on Monona Bay, Wisconsin during the 2001-2002 ice fishing season to determine risk associated with fish consumption and methyl mercury (MeHg) intake. The majority of anglers (95%) were not at risk of mercury toxicity because they ate less fish than would be required to create health problems. The remaining 5% of ice anglers barely exceeded the mercury toxicity threshold, with the exception of one angler who exceeded the threshold by 0.926 ppm. Anglers encountered were all male and predominantly Caucasian. Fish consumption by ice anglers was independent of awareness of consumption advisories, education, income, and age. This suggests that future awareness efforts should (1) identify groups of anglers most at risk and (2) create policies to effectively reach these audiences.

Effects of exercise on canine skeletal muscle proteolysis: an investigation of the ubiquitin-proteasome pathway and other metabolic markers.

The effects of long-term athletic training are associated with excessive skeletal muscle turnover attributable to increased rates of myofibrillar protein synthesis and proteolysis, which are mechanisms poorly understood in the athletic dog. A physiologic field study using 44 English pointers and Labrador retrievers that had been purposely bred for bird hunting and retrieving was conducted to examine changes in the ubiquitin-proteasome (UP) pathway, which has been implicated in exercise-induced proteolysis. Muscle biopsy samples were collected from all dogs in September (preseason, pretraining) and February (peak season, peak activity). Western blot analysis was used to assess changes in expression of various components of the UP pathway in the biopsy samples. Citrate synthase and glycogen levels were also measured in a subset of these samples. Results across the population indicated pronounced up-regulation of ubiquitinated conjugates and the p31 regulatory capping subunit during the peak hunting period compared with the preseason period. In contrast, the catalytic core of the proteasome (beta-subunits) showed no apparent up-regulation in response to increased physical activity. Increased physical activity during the hunting season was associated with increased muscle glycogen levels and citrate synthase activity in these dogs. Overall, up-regulation of specific components of the UP pathway was an indication that it plays a role in the proteolytic process associated with skeletal muscle turnover during long-term athletic training, as previously believed.