Return to Running for Postpartum Elite and Subelite Athletes.

CONTEXT: There is little evidence to guide elite athletes who desire returning to competition after giving birth to a child. Ultimately, this can result in decreased performance and increased risk of injury. This paper addresses aspects that must be considered when building and monitoring a return to running program for a postpartum elite or subelite athlete, including pelvic floor and core stability, progressive reloading of the musculoskeletal system, monitoring of nutritional parameters, and considerations for lactation. EVIDENCE ACQUISITION: PubMed and CINAHL (Cumulative Index for Nursing and Allied Health Literature) were searched with the following search strategy: (extreme sports OR elite athletes OR running OR exercise) AND (breastfeeding OR lactation OR bone density OR fetal weight OR gestational weight gain OR postpartum or post-partum OR postnatal OR post-natal OR pregnancy OR childbirth). The following information is based on best available evidence and clinical experience. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Due to the interplay between cardiovascular fitness, postpartum nutrition, lactation, and progressive reloading of the muscular and skeletal system, we propose a multimodal, multidisciplinary approach to safely and successfully allow an athlete to return to an elite level of competition. CONCLUSION: Return to running in the postpartum period is a highly individualized process that benefits from multidisciplinary, individualized care. This includes monitoring of nutrition, core and pelvic floor function, bone reloading, muscle and tendon reloading, and breastfeeding care when applicable. STRENGH OF RECOMMENDATION TAXONOMY (SORT): C.

Translation of patients' advance directives in intensive care units: are we there yet?

OBJECTIVES: This review examined studies regarding the implementation and translation of patients' advance directives (AD) in intensive care units (ICUs), focusing on practical difficulties and obstacles. METHODS: The digital PubMed and Medline databases were screened using predefined keywords to identify relevant prospective and retrospective studies published until 2022. RESULTS: Seventeen studies from the United States, Europe, and South Africa (including 149,413 patients and 1210 healthcare professionals) were identified. The highest prevalence of ADs was described in a prospective study in North America (49%), followed by Central Europe (13%), Asia (4%), Australia and New Zealand (4%), Latin America (3%), and Northern and Southern Europe (2.6%). While four retrospective studies reported limited effects of ADs, four retrospective studies, one survey and one systematic review indicated significant effects on provision of intensive care, higher rates of do-not-resuscitate orders, and care withholding in patients with ADs. Four of these studies showed shorter ICU stays, and lower treatment costs in patients with ADs. One prospective and two retrospective studies reported issues with loss, delayed or no transmission of ADs. One survey revealed that 91% of healthcare workers did not regularly check for ADs. Two retrospective studies and two survey revealed that the implementation of directives is further challenged by issues with their applicability, phrasing, and compliance by the critical care team and family members. CONCLUSIONS: Although ADs may improve intensive- and end-of-life care, insufficient knowledge, lack of awareness, poor communication between healthcare providers and patients or surrogates, lack of standardization of directives, as well as ethical and legal concerns challenge their implementation.

Predicting mayfly recovery in acid mine-impaired streams using logistic regression models of in-stream habitat and water chemistry.

Mayflies (Order Ephemeroptera) require high quality water and habitat in streams to thrive, so their appearance after restoration is an indicator of ecological recovery. To better understand the importance of restoring in-stream habitat versus water chemistry for macroinvertebrate communities, we developed taxon-specific models of occurrence for five mayfly genera (Caenis, Isonychia, Stenonema, Stenacron, and Baetis) inhabiting streams in the Appalachian Mountains, USA. Presence/absence records from past decades were used to develop single and multiple logistic predictive models based on catchment characteristics (drainage area, gradient), in-stream habitat variables (e.g., substrate, channel morphology, pool and riffle quality), and water chemistry. Model performance was evaluated using (a) classification rates and Hosmer-Lemeshow values for test sets of data withheld from the original model-building dataset and (b) a field comparison of predicted versus observed mayfly occurrences at 53 sites in acid mine drainage-impaired watersheds in 2012. The classification accuracies of final models for Caenis, Stenacron, and Baetis ranged from 50 to 75%. In-stream habitat features were not significant predictor variables for these three taxa, only water chemistry. Models for Isonychia and Stenonema had higher classification rates (81%) and included both habitat and chemical variables. However, actual occurrences of Isonychia and Stenonema at study sites in 2012 were low, consistent with the calculated probability of occurrence (Po) < 0.60. Caenis occurred at test sites 35% of the time when the model predicted a Po > 0.40. Stenacron showed the greatest consistency of actual versus predicted occurrences, occurring at 56% of sites when the Po (based on pH and conductivity) was > 0.50 and only at 1 site when Po < 0.5. The results demonstrate how predictive models of individual indicator taxa could be valuable for evaluating the relative impacts of restoring physical habitat versus water chemistry during stream remediation.

Field Analysis of Polychlorinated Biphenyls (PCBs) in Soil Using Solid-Phase Microextraction (SPME) and a Portable Gas Chromatography-Mass Spectrometry System.

An expedited field analysis method was developed for the determination of polychlorinated biphenyls (PCBs) in soil matrices using a portable gas chromatography-mass spectrometry (GC-MS) instrument. Soil samples of approximately 0.5 g were measured with a portable scale and PCBs were extracted by headspace solid-phase microextraction (SPME) with a 100 µm polydimethylsiloxane (PDMS) fiber. Two milliliters of 0.2 M potassium permanganate and 0.5 mL of 6 M sulfuric acid solution were added to the soil matrices to facilitate the extraction of PCBs. The extraction was performed for 30 min at 100 ℃ in a portable heating block that was powered by a portable generator. The portable GC-MS instrument took less than 6 min per analysis and ran off an internal battery and helium cylinder. Six commercial PCB mixtures, Aroclor 1016, 1221, 1232, 1242, 1248, 1254, and 1260, could be classified based on the GC chromatograms and mass spectra. The detection limit of this method for Aroclor 1260 in soil matrices is approximately 10 ppm, which is sufficient for guiding remediation efforts in contaminated sites. This method was applicable to the on-site analysis of PCBs with a total analysis time of 37 min per sample. However, the total analysis time could be improved to less than 7 min per sample by conducting the rate-limiting extraction step for different samples in parallel.

Characterization and fate of polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans in soils and sediments at the Portsmouth Gaseous Diffusion Plant, Ohio.

The U.S. Department of Energy Portsmouth Gaseous Diffusion Plant is in the early stages of decommissioning and decontamination. During operations, the site drew a large amount of electric power and had multiple large switchyards on site. These are a source of polychlorinated biphenyls (PCB) contamination to both on-site and off-site streams. Some soil remediation has been completed in the main switchyard. During 2011 and 2012, fifteen sites were sampled at the surface (<10 cm) and subsurface (20-30 cm) to characterize the extent of PCB contamination, to identify weathering and migration of PCB contamination and to explore potential polychlorinated dibenzo-p-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF) contamination due to transformer fires and explosions in the 1950s and 1960s. Stagnant sites tended to exhibit more migration of contamination to deeper sediments than sites with fast-moving waters, and the highest concentrations were found at the bottom of a settling pond. A signature set of five dioxin-like PCBs were consistently found across the site with higher concentrations in carbon rich surface sediments. PCB concentrations had a significant inverse correlation with clay content, suggesting that PCBs did not bind to clays at this site. Remediation has reduced PCB concentrations throughout the site compared to levels found in previous studies and long-term upkeep of sediment lagoons is necessary to retain PCB and dioxin-rich sediments. The flow regimen, organic carbon and clay content play a very important role in the fate of PCBs in the environment at the surface as well as downward migration.

Long-term chemical and biological improvement in an acid mine drainage-impacted watershed.

Acid mine drainage (AMD) is a common result of coal and metal mining worldwide caused by weathering of metal sulfides exposed during mining. AMD typically results in low-pH, high-metal, high-conductivity water that does not support aquatic life. Chemical water quality improvement does not necessarily lead to rapid biological recovery. Little Raccoon Creek, a major tributary to Raccoon Creek in the Western Allegheny Plateau of Ohio, drains 401 km(2), has a legacy of AMD that stems from mining activities over more than a century. Since 1999, seven major passive treatments systems have been installed in the watershed to a total of over $6.5 million. This study analyzes the hourly water quality data collected at a United States Geological Survey gage station alongside trends in fish and macroinvertebrate communities. Both fish and macroinvertebrate communities have shown a statistically significant improvement in the lower reaches of Little Raccoon Creek since treatment began. Long-term chemical monitoring shows a significant increase in pH, but no significant change in conductivity. The conductivity data is well correlated with sulfate concentrations and discharge, while the pH is well correlated with net  alkalinity data, but not with discharge. Significant investment in passive treatment systems and land reclamation has decreased the percent occurrence of pH measurements below the target of 6.5 and has led to recovery of both fish and macroinvertebrate communities in the downstream reaches of Little Raccoon Creek. Long-term monitoring has proven to be a valuable tool to assess success of a high-cost remediation program.

Determination of Aroclor 1260 in soil samples by gas chromatography with mass spectrometry and solid-phase microextraction.

A novel fast screening method was developed for the determination of polychlorinated biphenyls that are constituents of the commercial mixture, Aroclor 1260, in soil matrices by gas chromatography with mass spectrometry combined with solid-phase microextraction. Nonequilibrium headspace solid-phase microextraction with a 100 µm polydimethylsiloxane fiber was used to extract polychlorinated biphenyls from 0.5 g of soil matrix. The use of 2 mL of saturated potassium dichromate in 6 M sulfuric acid solution improved the reproducibility of the extractions and the mass transfer of the polychlorinated biphenyls from the soil matrix to the microextraction fiber via the headspace. The extraction time was 30 min at 100°C. The percent recoveries, which were evaluated using an Aroclor 1260 standard and liquid injection, were within the range of 54.9-65.7%. Two-way extracted ion chromatogram data were used to construct calibration curves. The relative error was <±15% and the relative standard deviation was <15%, which are respective measures of the accuracy and precision. The method was validated with certified soil samples and the predicted concentrations for Aroclor 1260 agreed with the certified values. The method was demonstrated to be linear from 10 to 1000 ng/g for Aroclor 1260 in dry soil.

The role of remediation, natural alkalinity sources and physical stream parameters in stream recovery.

Acid mine drainage (AMD) negatively impacts not only stream chemistry, but also aquatic biology. The ultimate goal of AMD treatment is restoration of the biological community, but that goal is rarely explicit in treatment system design. Hewett Fork in Raccoon Creek Watershed, Ohio, has been impacted by historic coal mining and has been treated with a calcium oxide doser in the headwaters of the watershed since 2004. All of the acidic inputs are isolated to a 1.5 km stretch of stream in the headwaters of the Hewett Fork watershed. The macroinvertebrate and fish communities have begun to recover and it is possible to distinguish three zones downstream of the doser: an impaired zone, a transition zone and a recovered zone. Alkalinity from both the doser and natural sources and physical stream parameters play a role in stream restoration. In Hewett Fork, natural alkaline additions downstream are higher than those from the doser. Both, alkaline additions and stream velocity drive sediment and metal deposition. Metal deposition occurs in several patterns; aluminum tends to deposit in regions of low stream velocity, while iron tends to deposit once sufficient alkalinity is added to the system downstream of mining inputs. The majority of metal deposition occurs upstream of the recovered zone. Both the physical stream parameters and natural alkalinity sources influence biological recovery in treated AMD streams and should be considered in remediation plans.

Participatory mapping of sex trade and enumeration of sex workers using capture-recapture methodology in Diego-Suarez, Madagascar.

BACKGROUND: Capture-recapture methodology has been employed to estimate the size of hidden or difficult-to-reach human populations such as sex workers, homeless persons, and intravenous drug users. This study took place in the context of efforts to improve the quality of curative and preventive services for sexually transmitted infections offered to sex workers in Diego-Suarez, Madagascar in partnership with sex workers. GOAL: The goal of this study was to better understand sex-trading practices, map out sex work sites, and estimate the size of a mobile sex-worker population in Diego-Suarez, Madagascar using methods that can be reproduced in other resource-poor settings. STUDY DESIGN: Forty sex workers were trained to function as field researchers. Key informants in designated neighborhoods were identified and interviewed. Basic maps of sex-trade sites were designed by hand. The number of sex workers in Diego-Suarez was estimated using capture-recapture methodology. An educational brochure was used to "capture" sex workers during a first phase, and "recapture" 2 weeks later. RESULTS: Most sex trade was street based and mobile. Capture-recapture methods estimated a total of 2684 sex workers (95% CI: 2588-2780) in Diego-Suarez, or approximately 12% of the 15- to 49-year-old female population in the city. CONCLUSION: Geographic mapping and capture-recapture proved to be low-cost and relatively easy to use techniques for counting a hard-to-reach population, such as female street-based sex workers. Sex workers can be capable fieldworkers, and their active participation in research concerning sex work should be considered whenever possible. A high proportion of women of reproductive age were found to engage in sex work, indicating that there is an urgent need to scale up sexually transmitted infection and HIV prevention activities targeting sex workers, their sexual partners, and the general population.