Meeting the Water and Sanitation Challenges of Underbounded Communities in the U.S.

Water and sanitation (wastewater) infrastructure in the United States is aging and deteriorating, with massive underinvestment over the past several decades. For many years, lack of attention to water and sanitation infrastructure has combined with racial segregation and discrimination to produce uneven access to water and wastewater services resulting in growing threats to human and environmental health. In many metropolitan areas in the U.S., those that often suffer disproportionately are residents of low-income, minority communities located in urban disadvantaged unincorporated areas on the margins of major cities. Through the process of underbounding (the selective expansion of city boundaries to exclude certain neighborhoods often based on racial demographics or economics), residents of these communities are disallowed municipal citizenship and live without piped water, sewage lines, and adequate drainage or flood control. This Perspective identifies the range of water and sanitation challenges faced by residents in these communities. We argue that future investment in water and sanitation should prioritize these communities and that interventions need to be culturally context sensitive. As such, approaches to address these problems must not only be technical but also social and give attention to the unique geographic and political setting of local infrastructures.

Evaluation of a personal protective equipment support programme for staff during the COVID-19 pandemic in London.

BACKGROUND: The coronavirus disease 2019 pandemic has presented an enormous challenge to healthcare providers worldwide. The appropriate use of personal protective equipment (PPE) has been essential to ensure staff and patient safety. The 'PPE Helper Programme' was developed at a large London hospital group to counteract suboptimal PPE practice. Based on a behaviour change model of capability, opportunity and motivation (COM-B), the programme provided PPE support, advice and education to ward staff. AIM: Evaluation of the PPE Helper Programme. METHODS: Clinical and non-clinical ward staff completed a questionnaire informed by the Theoretical Domains Framework and COM-B model. The questionnaire was available in paper and electronic versions. Quantitative responses were analysed using descriptive and non-parametric statistics, and free-text responses were analysed thematically. FINDINGS: Over a 6-week period, PPE helpers made 268 ward visits. Overall, 261 questionnaires were available for analysis. Across the Trust, 68% of respondents reported having had contact with a PPE helper. Staff who had encountered a PPE helper responded significantly more positively to a range of statements about using PPE than staff who had not encountered a PPE helper. Black and minority ethnic staff were significantly more anxious regarding the adequacy of PPE. Non-clinical and redeployed staff (e.g. domestic staff) were most positive about the impact of PPE helpers. Free-text comments showed that staff found the PPE Helper Programme supportive and would have liked it earlier in the pandemic. CONCLUSION: The PPE Helper Programme is a feasible and beneficial intervention for providing support, advice and education to ward staff during infectious disease outbreaks.

Moving up the Sanitation Ladder while Considering Function: An Assessment of Indigenous Communities, Pit Latrine Users, and Their Perceptions of Resource Recovery Sanitation Technology in Panama.

As households move up the sanitation ladder, health risks presumably decline but the corresponding technologies may require increasing operation and maintenance costs. One critique of the ladder is that it prioritizes technology and could be improved if it included a functional approach to monitoring, such as including aspects of environmental sustainability that consider resource recovery. Using analyses of data obtained from semi-structured interviews, surveys, and field observations, this study examines the functional transition toward improved sanitation technology as a household moves up the sanitation ladder with the added function of resource recovery (from pit latrines to composting latrines). The study took place in six indigenous Ngäbe communities in Panama. The results reveal that of 103 pit latrines studied, 88% were completed and in use, but only 35% were operated appropriately. Approximately 60% of pit latrine owners reported that they would use composting latrines, with compost as the primary perceived benefit. Barriers to adoption include lack of prior experience, user disgust of working with excrement, and the perceived amount of work required for operation. Overall, these findings indicate the importance of establishing demonstration projects and culturally aligned training for more complex sanitation technologies that enable resource recovery. The results have broad implications for understanding sanitation technology transitions in rural and indigenous settlements in other world regions.

Evidence-Informed strategies for promoting equitability in brownfields redevelopment.

Brownfields redevelopment creates opportunities for enhanced environmental conditions, improved physical and mental health, community cohesion, and economic prosperity. However, brownfields cleanup and recycling projects sometimes fail due to a lack of community engagement. Recent research suggests that such failures can stem from a lack of equitability in the planning process, especially when it comes to decision making. This paper examines issues of equitability in a recent brownfields redevelopment project in Tampa, Florida funded by the U.S. Environmental Protection Agency. The project focused on an underserved and under-resourced community with long-term environmental burdens and health disparities. Our ethnographic research shows that, while the project engaged in multiple and intersecting efforts to include a diversity of community voices in the decision-making process, ultimately structural and organizational power imbalances in sustainability transitions influenced participation in redevelopment initiatives. This study suggests that attending to issues of power articulated through expressions of local and authoritative knowledge about environmental cleanup and redevelopment can lead to deeper levels of community engagement.

Strong-field control of H3 + production from methanol dications: Selecting between local and extended formation mechanisms.

Using the CD3OH isotopologue of methanol, the ratio of D2H+ to D3 + formation is manipulated by changing the characteristics of the intense femtosecond laser pulse. Detection of D2H+ indicates a formation process involving two hydrogen atoms from the methyl side of the molecule and a proton from the hydroxyl side, while detection of D3 + indicates local formation involving only the methyl group. Both mechanisms are thought to involve a neutral D2 moiety. An adaptive control strategy that employs image-based feedback to guide the learning algorithm results in an enhancement of the D2H+/D3 + ratio by a factor of approximately two. The optimized pulses have secondary structures 110-210 fs after the main pulse and result in photofragments that have different kinetic energy release distributions than those produced from near transform limited pulses. Systematic changes to the linear chirp and higher order dispersion terms of the laser pulse are compared to the results obtained with the optimized pulse shapes.

Hypofractionated Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Tumours in Children and Young Adults.

AIMS: Cancer remains a leading cause of death in children and adolescents in the developed world. Despite advances in oncological management, rates of primary treatment failure remain significant. Radiation of recurrent or metastatic disease improves survival in adults but there is little data to support clinical decision making in the paediatric/teenage and young adult population. MATERIALS AND METHODS: We present a retrospective case series of 14 patients treated with stereotactic ablative body radiotherapy or stereotactic radiosurgery at The Royal Marsden Hospital from September 2011 to December 2015. Eligible patients were aged <25 years, with Lansky/Karnofsky performance status ≥60 with confirmed relapsed or metastatic tumour in fewer than three sites. Follow-up was in accordance with standard clinical care and included regular outpatient review and radiological surveillance. Local control, progression-free survival and overall survival are presented. RESULTS: Data for 14 patients with 18 treated lesions were included. The median patient age was 15 years (range 5-20 years). Nine patients were treated for local recurrence and five for metastatic lesions. All patients had already undergone multiple previous treatments. Eleven patients had undergone previous radiotherapy. The median interval between the completion of initial radiotherapy and reirradiation was 29.0 months (range 0.2-49.5 months). The median follow-up was 3.4 years (range 0.28-6.4 years). The 1-year local control rate was 78.6% and the 2-year local control rate was 57.1%. Overall median survival was 58.4 months (95% confidence interval 33.8-82.9 months). Cumulative biologically effective doses (BED) over 200 Gy were associated with late toxicity (P = 0.04). CONCLUSION: Radical doses of short-course hypofractionated radiotherapy can achieve excellent local control and may contribute to the prolongation of overall survival. There is a need for prospective trials exploring the use of ablative radiotherapy in metastatic disease in paediatric/teenage and young adult patients in order to establish safe and effective treatment schedules.

Adaptive strong-field control of vibrational population in NO2.

An adaptive closed-loop system employing coincidence time-of-flight feedback is used to determine the optimal pulse shapes for manipulating the branching ratio of NO dications following double ionization by an intense laser pulse. Selection between the long-lived NO2+ and the dissociative N+ + O+ final states requires control of the vibrational population distribution in the transient NO2+. The ability to both suppress and enhance NO2+ relative to N+ + O+ is observed, with the effectiveness of shaped pulses surpassing near Fourier transform-limited pulses by about an order of magnitude in each direction, depending on the pulse energy. The control is subsequently investigated using velocity map imaging, identifying plausible dissociation pathways leading to N+ + O+. Combining the information about the N+ + O+ dissociation with a well-defined control objective supports the conclusion that the primary control mechanism involves selectively populating long-lived NO2+ vibrational states.

Dependence on the Initial Configuration of Strong Field-Driven Isomerization of C2H2 Cations and Anions.

We have investigated the femtosecond laser-induced fragmentation of C2H2 q ion beam targets in various initial configurations, including acetylene (linear HCCH), vinylidene (H2CC), and cis/ trans. The initial configuration is shown to have a tremendous impact on the branching ratio of acetylene-like (CH q1 + CH q2) and vinylidene-like (C q1' + CH2 q2') dissociation of a specific C2H2 q molecular ion. In particular, whereas C2H2+ generated from C2H2, a linear HCCH target, exhibits comparable levels of acetylene-like and vinylidene-like fragmentation, vinylidene or cis/ trans configuration ion beams preferably undergo vinylidene-like fragmentation, with an acetylene branching ratio ranging from 13.9% to zero.

Drink wise, age well; reducing alcohol related harm among people over 50: a study protocol.

BACKGROUND: Evidence suggests that the use of alcohol among older adults (defined as those aged 50+) has increased in recent years, with people aged 55-64 now more likely to exceed the recommended weekly guidelines than any other age group. METHODS/ DESIGN: This is a quasi-experimental study with a before-after design. A postal questionnaire will be sent to 76,000 people aged 50 and over registered with a general practice in five different 'demonstration' (intervention) and control areas in the UK. Multiple interventions will then be delivered in demonstration areas across the UK. At the end of the programme, a postal questionnaire will be sent to the same individuals who completed it pre-programme to establish if there has been a reduction in alcohol use, at-risk drinking and alcohol related problems. Qualitative interviews with clients and staff will explore how the interventions were experienced; how they may work to bring about change and to identify areas for practice improvements. DISCUSSION: This study protocol describes a multi-level, multi-intervention prevention-to-treatment programme which aims to reduce alcohol-related harm in people aged 50 and over.

The importance of Rydberg orbitals in dissociative ionization of small hydrocarbon molecules in intense laser fields.

Much of our intuition about strong-field processes is built upon studies of diatomic molecules, which typically have electronic states that are relatively well separated in energy. In polyatomic molecules, however, the electronic states are closer together, leading to more complex interactions. A combined experimental and theoretical investigation of strong-field ionization followed by hydrogen elimination in the hydrocarbon series C2D2, C2D4 and C2D6 reveals that the photofragment angular distributions can only be understood when the field-dressed orbitals rather than the field-free orbitals are considered. Our measured angular distributions and intensity dependence show that these field-dressed orbitals can have strong Rydberg character for certain orientations of the molecule relative to the laser polarization and that they may contribute significantly to the hydrogen elimination dissociative ionization yield. These findings suggest that Rydberg contributions to field-dressed orbitals should be routinely considered when studying polyatomic molecules in intense laser fields.

Syndromic surveillance for influenza in Tianjin, China: 2013-14.

Background: Diverse sources of syndromic surveillance including over-the-counter (OTC) drug sales, hospital and school-based influenza-like illness (ILI) and Baidu search queries estimate influenza activity in Tianjin, China. The purpose of this study was to determine which syndromic surveillance systems had the strongest correlation with laboratory-confirmed influenza activity. Methods: Data were obtained from sentinel hospitals and laboratories; sentinel hospitals also reported percentage of ILI. OTC sales and school-based ILI absentee data were provided by public pharmacies and schools. Baidu search queries for influenza surveillance were analyzed. Spearman correlation analysis examined correlations of syndromic systems with laboratory-confirmed data. Results: Syndromic data for hospital ILI%, OTC sales and school-based ILI correlated well with laboratory data (r = 0.732, 0.490 and 0.693, respectively; P < 0.05). Baidu, the predominant Chinese Internet service, searches for 'influenza', 'cough' and 'fever' correlated best with laboratory-confirmed activity; queries for 'fever' were strongest (r = 0.924, P < 0.001). Correlations between school-based ILI and laboratory-confirmed influenza increased from 0.693 to 0.795 after a 1-week lag (P < 0.05). Conclusions: A Baidu query of 'fever' provided the strongest correlation to laboratory surveillance. School-based ILI absence reporting detected influenza virus activity 1 week earlier than laboratory confirmation. Use of diverse syndromic surveillance systems in conjunction with traditional surveillance systems can improve influenza surveillance.

Stereotactic radiosurgery planning of vestibular schwannomas: Is MRI at 3 Tesla geometrically accurate?

PURPOSE: MRI is a mandatory requirement to accurately plan Stereotactic Radiosurgery (SRS) for Vestibular Schwannomas. However, MRI may be distorted due not only to inhomogeneity of the static magnetic field and gradients but also due to susceptibility-induced effects, which are more prominent at higher magnetic fields. We assess geometrical distortions around air spaces and consider MRI protocol requirements for SRS planning at 3 T. METHODS: Hardware-related distortion and the effect of incorrect shimming were investigated with structured test objects. The magnetic field was mapped over the head on five volunteers to assess susceptibility-related distortion in the naso-oro-pharyngeal cavities (NOPC) and around the internal ear canal (IAC). RESULTS: Hardware-related geometric displacements were found to be less than 0.45 mm within the head volume, after distortion correction. Shimming errors can lead to displacements of up to 4 mm, but errors of this magnitude are unlikely to arise in practice. Susceptibility-related field inhomogeneity was under 3.4 ppm, 2.8 ppm, and 2.7 ppm for the head, NOPC region and IAC region, respectively. For the SRS planning protocol (890 Hz/pixel, approximately 1 mm3 isotropic), susceptibility-related displacements were less than 0.5 mm (head), and 0.4 mm (IAC and NOPC). Large displacements are possible in MRI examinations undertaken with lower receiver bandwidth values, commonly used in clinical MRI. Higher receiver bandwidth makes the protocol less vulnerable to sub-optimal shimming. The shimming volume and the CT-MR co-registration must be considered jointly. CONCLUSION: Geometric displacements can be kept under 1 mm in the vicinity of air spaces within the head at 3 T with appropriate setting of the receiver bandwidth, correct shimming and employing distortion correction.

Treatment of pediatric cerebral radiation necrosis: a systematic review.

Cerebral radiation necrosis (CRN) is a toxicity of radiation therapy that can result in significant, potentially life-threatening neurologic deficits. Treatment for CRN has included surgical resection, corticosteroids, hyperbaric oxygen therapy (HBOT), and bevacizumab, but no consensus approach has been identified. We reviewed the available literature to evaluate efficacy of treatment approaches. Using methods specified in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines when possible, we conducted searches of Ovid MEDLINE, Embase and Pubmed to identify studies reporting on outcomes for children (≤21 years old) with CRN. Eligible studies from 1990 to 2014 describing central nervous system (CNS) radiation necrosis with details of both treatment and outcomes were included. Eleven studies meeting criteria were identified. Of the nine studies with total patient denominators, 37 of 806 patients developed CRN (incidence = 4.6 %). Patients received treatment courses of steroids alone (n = 13), steroids with bevacizumab (n = 11) or HBOT (n = 12). Patients who failed to respond to steroids were more likely to be older than steroid-responsive patients (p = 0.009). With the exception of steroid-related adverse events, there was only one report of an adverse event (brainstem stroke) potentially attributable to intervention (bevacizumab). Those who received proton beam RT were both younger (p = 0.001) and had a shorter time to development of CRN (p = 0.079). The most common treatment following steroid initiation was addition of bevacizumab or HBOT, with good success and minimal toxicity. However, randomized controlled trials are needed to establish a definitive treatment algorithm that can be applied to children affected by CRN.

Incorporating real time velocity map image reconstruction into closed-loop coherent control.

We report techniques developed to utilize three-dimensional momentum information as feedback in adaptive femtosecond control of molecular dynamics. Velocity map imaging is used to obtain the three-dimensional momentum map of the dissociating ions following interaction with a shaped intense ultrafast laser pulse. In order to recover robust feedback information, however, the two-dimensional momentum projection from the detector must be inverted to reconstruct the full three-dimensional momentum of the photofragments. These methods are typically slow or require manual inputs and are therefore accomplished offline after the images have been obtained. Using an algorithm based upon an "onion-peeling" (also known as "back projection") method, we are able to invert 1040 × 1054 pixel images in under 1 s. This rapid inversion allows the full photofragment momentum to be used as feedback in a closed-loop adaptive control scheme, in which a genetic algorithm tailors an ultrafast laser pulse to optimize a specific outcome. Examples of three-dimensional velocity map image based control applied to strong-field dissociation of CO and O2 are presented.

Prostate stereotactic body radiotherapy­first UK experience.

AIMS: Stereotactic body radiotherapy (SBRT) combines image-guided radiotherapy with hypofractionation, both of which will probably result in improvements in patient outcomes in prostate cancer. Most clinical experience with this technique resides in North America. Here we present the first UK cohort to receive SBRT for prostate cancer. MATERIALS AND METHODS: Fifty-one prostate cancer patients (10 low risk, 35 intermediate risk and 6 high risk) were treated with 36.25 Gy in five fractions over 1-2 weeks and gold seed image guidance. All patients had toxicity International Prostate Symptom score (IPSS) and Radiation Therapy Oncology Group recorded prospectively and prostate-specific antigen was measured 3-6 monthly during follow-up. RESULTS: The median IPSS was 6, 11, 8 and 5 at baseline, 1-3 weeks, 4-6 weeks and 7-12 weeks after treatment. Radiation Therapy Oncology Group genitourinary and gastrointestinal toxicity of grade 2 was seen in 22% and 14%, respectively, at 1-3 weeks after treatment; no patient had grade 3+ toxicity at this time point, although two patients had grade 3 urinary frequency recorded during treatment. The median follow-up for the 42 patients who did not receive androgen deprivation was 14.5 months. Prostate-specific antigen at 13-18 months after treatment was 1.3 ng/ml. CONCLUSION: Prostate SBRT is a promising treatment for organ-confined prostate cancer and is currently being investigated in a UK-led phase III trial.

Association of selenium and copper with lipids in umbilical cord blood.

Altered levels of selenium and copper have been linked with altered cardiovascular disease risk factors including changes in blood triglyceride and cholesterol levels. However, it is unclear whether this can be observed prenatally. This cross-sectional study includes 274 singleton births from 2004 to 2005 in Baltimore, Maryland. We measured umbilical cord serum selenium and copper using inductively coupled plasma mass spectrometry. We evaluated exposure levels vis-à-vis umbilical cord serum triglyceride and total cholesterol concentrations in multivariable regression models adjusted for gestational age, birth weight, maternal age, race, parity, smoking, prepregnancy body mass index, n-3 fatty acids and methyl mercury. The percent difference in triglycerides comparing those in the highest v. lowest quartile of selenium was 22.3% (95% confidence interval (CI): 7.1, 39.7). For copper this was 43.8% (95% CI: 25.9, 64.3). In multivariable models including both copper and selenium as covariates, copper, but not selenium, maintained a statistically significant association with increased triglycerides (percent difference: 40.7%, 95% CI: 22.1, 62.1). There was limited evidence of a relationship of increasing selenium with increasing total cholesterol. Our findings provide evidence that higher serum copper levels are associated with higher serum triglycerides in newborns, but should be confirmed in larger studies.

Adaptive strong-field control of chemical dynamics guided by three-dimensional momentum imaging.

Shaping ultrafast laser pulses using adaptive feedback can manipulate dynamics in molecular systems, but extracting information from the optimized pulse remains difficult. Experimental time constraints often limit feedback to a single observable, complicating efforts to decipher the underlying mechanisms and parameterize the search process. Here we show, using two strong-field examples, that by rapidly inverting velocity map images of ions to recover the three-dimensional photofragment momentum distribution and incorporating that feedback into the control loop, the specificity of the control objective is markedly increased. First, the complex angular distribution of fragment ions from the nω+C2D4→C2D3++D interaction is manipulated. Second, isomerization of acetylene (nω+C2H2→C2H2(2+)→CH2++C+) is controlled via a barrier-suppression mechanism, a result that is validated by model calculations. Collectively, these experiments comprise a significant advance towards the fundamental goal of actively guiding population to a specified quantum state of a molecule.

Human rabies in Tianjin, China.

BACKGROUND: Human rabies has recently re-emerged as a significant public health threat in Tianjin, China. METHODS: Using surveillance data compiled by the Tianjin Centers for Disease Control and Prevention, we describe 60 cases of human rabies reported from 2005 to 2011 in the municipality of Tianjin, China. RESULTS: All 60 cases of human rabies resulted in death. Cases were primarily male (80%), middle aged (mean 40.6 years), and exposed to rabies in a rural setting (82%). Most exposures were associated with dog bites (93%) and no animal had a history of rabies vaccination; no cases were laboratory confirmed. Fifteen percent of patients sought medical attention for their wound, and none received a complete regimen of WHO-recommended post-exposure prophylaxis (PEP). CONCLUSIONS: These findings suggest the need for China's public health authority to improve animal rabies surveillance and control strategies through laboratory case confirmation, more rapid response to potential exposures with provision of appropriate PEP, and education to the public and to health care providers on identifying and reducing rabies risk.

Using direct payments to fund short breaks for families with a disabled child.

BACKGROUND: A clear policy trend exists towards promoting the use of direct payments (DPs), including those for families with disabled children who use short breaks. However, uptake has been slow and use of DPs has been socially patterned. Recent programmes in England have dramatically increased investment in short break provision including breaks funded through DPs. This research examines the characteristics, circumstances and experiences of families who use DPs to fund short breaks with those who use short breaks funded in other ways. METHOD: The paper draws on surveys totalling 348 parents and carers in families with disabled children using short breaks. We investigate associations between the use of DPs and a range of demographic, socio-economic, well-being, service use and satisfaction indicators. Logistic regression identifies which variables are most strongly associated with use of DPs. We also draw on open-ended survey responses which highlight important aspects of families' experience of using DPs. RESULTS: Characteristics significantly associated with increased use of DPs include the presence of main carers who are female, more highly educated and from White British backgrounds, younger children, lower levels of area deprivation, greater access to service and social networks and use of more hours of short breaks. Characteristics not found to be significantly associated with use of DPs include various health and well-being indicators, impairment characteristics of children and service satisfaction. A range of benefits of DPs are described along with problems accessing and using them. CONCLUSIONS: Direct payments can have a number of benefits for families using short breaks, but access to them is currently problematic and socially patterned. If the uptake of DPs is to be increased and made more equitable, more attention must be paid to promoting and supporting their use in ways which meet the needs of individual families.

The organization of thanatology.

This article explores, using Wilensky's Model of Professionalization, the emergence of professional organizations within the thanatology. The authors review the history of four organizations--The Foundation of Thanatology, Ars Moriendi, The Forum for Death Education and Counseling (now the Association for Death Education and Counseling: A Thanatology Organization [ADEC]), and The International Work Group on Death, Dying, and Bereavement (IWG). The authors speculate on some of the reasons that the first two failed while IWG and ADEC remain viable-while noting challenges that these remaining thanatological organizations will experience as they seek to continue to stay relevant.