High-Resolution Depth-Discrete Analysis of PFAS Distribution and Leaching for a Vadose-Zone Source at an AFFF-Impacted Site.

The long-term leaching of polyfluoroalkyl substances (PFAS) within the vadose zone of an AFFF application site for which the depth to groundwater is approximately 100 m was investigated by characterizing the vertical distribution of PFAS in a high spatial resolution. The great majority (99%) of PFAS mass resides in the upper 3 m of the vadose zone. The depths to which each PFAS migrated, quantified by moment analysis, is an inverse function of molar volume, demonstrating chromatographic separation. The PFAS were operationally categorized into three chain-length groups based on the three general patterns of retention observed. The longest-chain (>∼335 cm3/mol molar volume) PFAS remained within the uppermost section of the core, exhibiting minimal leaching. Conversely, the shortest-chain (<∼220 cm3/mol) PFAS accumulated at the bottom of the interval, which coincides with the onset of a calcic horizon. PFAS with intermediate-chain lengths were distributed along the length of the core, exhibiting differential magnitudes of leaching. The minimal or differential leaching observed for the longest- and intermediate-chain-length PFAS, respectively, demonstrates that retention processes significantly impacted migration. The accumulation of shorter-chain PFAS at the bottom of the core is hypothesized to result from limited deep infiltration and potential-enhanced retention associated with the calcic horizon.

Role Distinctions and Role Overlap Among Behavioral Health Providers.

Integrated behavioral health care (IBHC) models are a growing trend for health care delivery, particularly in the primary setting. Clinicians working within IBHC contexts provide a spectrum of behavioral health services, including screening, prevention and health promotion, assessment, and treatment services. Integration of behavioral health providers into primary and specialty medical settings addresses the significant need for behavioral health services, improves care quality, improves patient experience, and reduces costs of care, access issues, and delays in service provision. While benefits are clear, what type of model to implement and which behavioral health care providers to include in that model remain elusive. This is partly due to the failure of IBHC models to include all behavioral health providers in their design, a lack of clarity of the expertise of each provider, and how providers work together. IBHC models are also complicated by contextual issues such as the relative availability of each profession, population health needs in different clinic populations, and financial factors. The purpose of this manuscript is to the clarify roles and responsibilities of different behavioral health professions including similarities and differences in their training, areas of unique expertise (role distinctions), shared responsibilities (role overlap), and relative cost and availability in the United States.

Reassurance from second trimester sonographic placental scan for pregnancies complicated by abnormal first trimester biomarkers.

OBJECTIVE: Enhanced first trimester aneuploidy screening (eFTS) combines serum biomarkers and ultrasound. Abnormal biomarkers are associated with placental complications, such as fetal growth restriction (FGR). We aimed to evaluate whether a Midtrimester placental scan can provide reassurance regarding FGR in women with abnormal eFTS biomarkers. METHODS: We conducted a retrospective cohort study of women who had eFTS and delivered at a single referral center. Women with abnormal biomarkers had a mid-trimester scan of the placenta (morphologic assessment, fetal biometry and uterine artery pulsatility index). We compared pregnancies with abnormal eFTS biomarkers and normal placental scans (study group) with those who had normal eFTS biomarkers (control group). RESULTS: A total of 6,514 women were included, of whom 343 (5.3%) comprised the study group. Women in the study group had an increased risk of hypertensive disorders of pregnancy [(aOR)1.96(95%CI 1.21-3.16)], and preterm birth <37 weeks [aOR1.98(95%CI 1.33-2.95)] compared to the control group. Yet, their neonates were not at higher risk for FGR <3rd, 5th, or 10th percentile [aOR1.16(95%CI 0.83-1.63), 1.14(95%CI 0.70-1.87), and 0.47(95%CI 0.17-1.27), respectively]. CONCLUSION: A normal second trimester placental scan provided reassurance regarding the risk of FGR in women at high risk based on abnormal eFTS biomarkers.

Formation and control of disinfection by-products from iodinated contrast media attenuation through sequential treatment processes of ozone-low pressure ultraviolet light followed by chlorination.

Different groups of disinfection by-products (DBPs) were studied through the degradation of iopamidol by the sequential oxidation process of ozone-low pressure ultraviolet light (O3-LPUV) followed by chlorination. This paper investigates the attenuation of iopamidol under this sequential treatment and the effect of chlorine contact time (30 min versus 3 days) to control the formation potential of DBPs: trihalomethanes (THMs), haloacetonitriles (HANs) and haloacetamides (HAMs). Thirty target DBPs among the 9 iodinated-DBPs (I-DBPs), were monitored throughout the sequential treatment. Results showed that O3-LPUV removed up to 99% of iopamidol, while ozone and LPUV alone removed only 90% and 76% respectively. After chlorine addition, O3-LPUV yielded 56% lower I-DBPs than LPUV. Increasing chlorine contact time resulted in higher concentrations of all DBP groups (THMs, HANs, and HAMs), with the exception of I-DBPs. One new iodinated-haloacetamide, namely chloroiodoacetamide (CIACM) and one iodoacetonitrile (IACN) were detected. These results suggest the iodine incorporated in iopamidol may be a precursor for iodinated-nitrogenous-DBPs, which are currently not well studied.

Uterine artery Doppler to predict growth restriction in cases of abnormal first trimester analytes.

We retrospectively included women with abnormal FTS analytes and compared outcomes between those with elevated and normal UtA-PI. Out of 582 women with abnormal FTS analytes, 65 (11.2%) had elevated UtA-PI. Neonates of women in this group had higher rates of birth weight <3rd, 5th, and 10th percentile. The area under the ROC curve for predicting FGR <10th percentile by UtA-PI was 0.584, for FGR<5th percentile 0.593, and for FGR<3rd percentile 0.720. In women with abnormal FTS, elevated UtA-PI is associated with higher rates of FGR, but its predictability is moderate-to-poor.

TeleMental Health: Standards, Reimbursement, and Interstate Practice [Formula: see text].

BACKGROUND: TeleMental Health (TMH) is gaining widespread acceptance in the United States. OBJECTIVE: Summarize current evidence regarding TMH risks and benefits, standards of care, practice guidelines, reimbursement, and interstate practice issues pertinent to psychiatric nurses and consumers. DESIGN: A targeted review of literature, current practice, and TMH websites was generated using the following key search words: clinical outcomes, practice guidelines, regulations, interstate practice, and reimbursement for TMH. A search of government and professional organization websites and a literature review of PubMed and PsychINFO databases was limited to the past 15 years. RESULTS: Studies demonstrate TMH services are equal in efficacy to that provided in face-to-face encounters and preferred by some populations. Current TMH practice guidelines, reimbursement, and regulatory issues are reviewed. CONCLUSIONS: Providers, including psychiatric advanced practice registered nurses, can use TMH to effectively address the growing need for mental health services, although regulatory, licensure, and clinical issues must be addressed prior to offering TMH services.

Mapping educational opportunities for healthcare workers on antimicrobial resistance and stewardship around the world.

BACKGROUND: Antimicrobial resistance is an important global issue facing society. Healthcare workers need to be engaged in solving this problem, as advocates for rational antimicrobial use, stewards of sustainable effectiveness, and educators of their patients. To fulfill this role, healthcare workers need access to training and educational resources on antimicrobial resistance. METHODS: To better understand the resources available to healthcare workers, we undertook a global environmental scan of educational programs and resources targeting healthcare workers on the topic of antimicrobial resistance and antimicrobial stewardship. Programs were identified through contact with key experts, web searching, and academic literature searching. We summarized programs in tabular form, including participating organizations, region, and intended audience. We developed a coding system to classify programs by program type and participating organization type, assigning multiple codes as necessary and creating summary charts for program types, organization types, and intended audience to illustrate the breadth of available resources. RESULTS: We identified 94 educational initiatives related to antimicrobial resistance and antimicrobial stewardship, which represent a diverse array of programs including courses, workshops, conferences, guidelines, public outreach materials, and online-resource websites. These resources were developed by a combination of government bodies, professional societies, universities, non-profit and community organizations, hospitals and healthcare centers, and insurance companies and industry. Most programs either targeted healthcare workers collectively or specifically targeted physicians. A smaller number of programs were aimed at other healthcare worker groups including pharmacists, nurses, midwives, and healthcare students. CONCLUSIONS: Our environmental scan shows that there are many organizations working to develop and share educational resources for healthcare workers on antimicrobial resistance and antimicrobial stewardship. Governments, hospitals, and professional societies appear to be driving action on this front, sometimes working with other types of organizations. A broad range of resources have been made freely available; however, we have noted several opportunities for action, including increased engagement with students, improvements to pre-service education, recognition of antimicrobial resistance courses as continuing medical education, and better platforms for resource-sharing online.

Performance evaluation of Puritan® universal transport system (UniTranz-RT™) for preservation and transport of clinical viruses.

The ability of a non-propagating microbial transport medium to maintain the viability of clinically relevant viruses was compared to a similar commercial medium to establish performance equivalence. Two dilutions of stock of test viruses, namely adenovirus (AdV), cytomegalovirus (CMV), echovirus Type 30 (EV), herpes simplex virus (HSV) types 1 and 2, influenza A, parainfluenza 3 (PIV), respiratory syncytial virus (RSV), and varicella zoster virus (VZV), were spiked into Puritan® Medical Products Company Universal Transport System (UniTranz-RT™) and BD(TM) Universal Viral Transport System (UVT) and incubated at 4 °C and room temperature (RT) for up to 72 hr. Post incubation assessment of recovery of AdV, EV, HSV-2, PIV, and VZV from UniTranz-RT™ and UVT using shell vial assays followed by immunofluorescence staining demonstrated statistically significant differences between both transport media. In general, significantly higher recoveries of AdV, EV, and VZV were found from UniTranz-RT™ than UVT whereas HSV-2 and PIV were recovered better from UVT than UniTranz-RT™, under specific test conditions. The recovery of HSV-1, influenza A, PIV, and RSV showed no significant differences between transport media. Sulforhodamine B-based assay analysis of UniTranz-RT™ lots prior to and at expiration exhibited no cytotoxicity. The overall results of the study validate the full performance of UniTranz-RT™ as a viral transport medium and establish its effectiveness on par with the UVT.

Performance evaluation of two microbial transport media designed for preservation and transport of Chlamydiae, Mycoplasma and Ureaplasma.

The ability of a non-propagating transport device (test device) to maintain the viability of clinically relevant bacteria was compared with a similar commercial device (predicate device) to establish performance equivalence. Test bacteria, namely Chlamydia trachomatis, Chlamydia pneumoniae, Mycoplasma hominis, Mycoplasma pneumoniae and Ureaplasma urealyticum, were inoculated into the test [Puritan Medical Products Universal Transport System (UniTranz-RT(TM))] and predicate (BD Universal Viral Transport System) devices, and incubated at 4 °C and room temperature for up to 72 h. Bacterial viability was assessed at selected time points post-incubation using shell vial assays followed by immunofluorescence staining (for Chlamydia) or by standard culture techniques (for Mycoplasma and Ureaplasma). Results indicated that the Chlamydia strains were equally stable in both test and predicate devices through 72 h storage, at both test temperatures. Quantifiable levels of Mycoplasma and Ureaplasma were recovered from the test and predicate devices throughout the storage period. Low-temperature storage improved bacterial viability when compared with room temperature storage. In addition, the predicate device demonstrated slightly improved performance versus the test device in the context of Mycoplasma and Ureaplasma following 72 h storage. The overall results of the study confirmed the full performance of UniTranz-RT(TM) as a microbial transport medium and established equal performance with the predicate device.

Psychosocial effects of disaster in children and adolescents: significance and management.

This article provides a synthesis of the literature addressing the psychological and social effects on children and adolescents after disasters, and the factors that contribute to protecting this population from experiencing related symptoms. Clinical implications are presented for health care providers to reduce the possibility of long-term psychopathologies based on the National Commission on Children and Disasters 2010 Report.