Less frequent dosing of erythropoiesis stimulating agents in patients undergoing dialysis: a European multicentre cost study.

OBJECTIVE: To calculate the variable costs involved with the process of delivering erythropoiesis stimulating agents (ESA) in European dialysis practices. METHODS: A conceptual model was developed to classify the processes and sub-processes followed in the pharmacy (ordering from supplier, receiving/storing/delivering ESA to the dialysis unit), dialysis unit (dose determination, ordering, receipt, registration, storage, administration, registration) and waste disposal unit. Time and material costs were recorded. Labour costs were derived from actual local wages while material costs came from the facilities' accounting records. Activities associated with ESA administration were listed and each activity evaluated to determine if dosing frequency affected the amount of resources required. RESULTS: A total of 21 centres in 8 European countries supplied data for 142 patients (mean) per hospital (range 42-648). Patients received various ESA regimens (thrice-weekly, twice-weekly, once-weekly, once every 2 weeks and once-monthly). Administering ESA every 2 weeks, the mean costs per patient per year for each process and the estimates of the percentage reduction in costs obtainable, respectively, were: pharmacy labour (10.1 euro, 39%); dialysis unit labour (66.0 euro, 65%); dialysis unit materials (4.11 euro, 61%) and waste unit materials (0.43 euro, 49%). LIMITATION: Impact on financial costs was not measured. CONCLUSION: ESA administration has quantifiable labour and material costs which are affected by dosing frequency.

High occurrence of hepatitis E virus in samples from wastewater treatment plants in Switzerland and comparison with other enteric viruses.

Hepatitis E virus (HEV) is responsible for many enterically transmitted viral hepatitides around the world. It is currently one of the waterborne diseases of global concern. In industrialized countries, HEV appears to be more common than previously thought, even if it is rarely virulent. In Switzerland, seroprevalence studies revealed that HEV is endemic, but no information was available on its environmental spread. The aim of this study was to investigate -using qPCR- the occurrence and concentration of HEV and three other viruses (norovirus genogroup II, human adenovirus-40 and porcine adenovirus) in influents and effluents of 31 wastewater treatment plants (WWTPs) in Switzerland. Low concentrations of HEV were detected in 40 out of 124 WWTP influent samples, showing that HEV is commonly present in this region. The frequency of HEV occurrence was higher in summer than in winter. No HEV was detected in WWTP effluent samples, which indicates a low risk of environmental contamination. HEV occurrence and concentrations were lower than those of norovirus and adenovirus. The autochthonous HEV genotype 3 was found in all positive samples, but a strain of the non-endemic and highly pathogenic HEV genotype I was isolated in one sample, highlighting the possibility of environmental circulation of this genotype. A porcine fecal marker (porcine adenovirus) was not detected in HEV positive samples, indicating that swine are not the direct source of HEV present in wastewater. Further investigations will be necessary to determine the reservoirs and the routes of dissemination of HEV.

Improving anemia management with less frequently dosed erythropoiesis stimulating agents

Introduction and Aims: The process of delivering erythropoiesis stimulating agents (ESAs) to hemodialysis patients (HD) is complex. Many European countries are requiring centers to document this process. To date, there has not been any comprehensive description of the operational aspects of ESA delivery in Europe. The objective of the Mercurius study was to describe the entire process of ESA delivery in dialysis centers. In addition, we explored the benefits of less frequent dosing. Methods: A conceptual model was developed to classify the sub-processes in the pharmacy, dialysis unit, waste unit, and back office. Within each dialysis unit activities associated with dose determination, ordering procedures, receipt and storage of ESAs, and ESA administration were measured. Within the pharmacy, ordering from supplier, receiving and storing, and delivering ESA to the dialysis unit were measured. The amount of time and materials associated with waste disposal and back office activities were also observed. We also evaluated the impact of less frequent dosing on the resources required to perform anemia management for HD patients. Structured interviews with staff were used to develop a comprehensive list of processes, sub-processes, and activities that are routinely followed to order, register, administer, and dispose of waste associated with ESAs. Each activity was evaluated to determine if less frequent dosing influenced the amount of resources required. A model was developed to estimate the change in resources consumed using less frequent dosing regimens. Results: Eight centers from 5 European countries (Belgium, France, Italy, Sweden, and Switzerland) participated in the study. The number of HD patients in each center ranged from 42 to 707 (mean=175). Across all of the centers, patients received a variety of dosing regimens (eg, TIW, BIW, QW and Q2W). The mean (±SD) time spent for the pharmacy to order an ESA from the supplier was 6.1 (±8.7) minutes; time spent in the dialysis unit and pharmacy for receiving and storing ESPs was 5.3 (±5.3) and 10.0 (±10.9) minutes, respectively; and time spent administering each injection was 6.4 (±6.5) minutes. Switching from current dosing practices to Q2W could decrease the mean number of syringes used from 12,420 to 5,085 per year. We estimate a reduction in the number of disinfective tissues and liquids of 58% and 71%, respectively by switching from current practice to dosing ESAs Q2W. Conclusions: There was significant variation in the time that it takes to perform routine ESA activities. We estimate that a reduction in resources required to manage anemia can be obtained by reducing the frequency of administration from the current mix of ESAs. These resources could be redeployed for patient care.

Projecte de construcció d'una plataforma especial per al desgel i neteja d'aeronaus a l'aeroport de Girona-Costa Brava

L’objecte d’aquest projecte és definir totes les instal·lacions que caldria construir per tal de dotar l’Aeroport de Girona-Costa Brava d’una plataforma (àrea pavimentada) especial d’estacionament que servís per al desgel i la neteja d’aeronaus, minimitzant al màxim l’impacte sobre el medi ambient i garantint el manteniment de l’operativitat a l’aeroport. El disseny d’aquesta plataforma hauria de permetre recollir l’aigua amb etilenglicol procedent de les operacions de desgel i conduir-la a un dipòsit per al seu posterior tractament i reutilització, a fi de no contaminar el subsòl i les aigües subterrànies. En cas de no utilitzar-se, l’aigua recollida en aquesta plataforma es conduiria a la xarxa d’aigües pluvials

Field testing of arsenic in groundwater samples of Bangladesh using a test kit based on lyophilized bioreporter bacteria.

A test kit based on living, lyophilized bacterial bioreporters emitting bioluminescence as a response to arsenite and arsenate was applied during a field campaign in six villages across Bangladesh. Bioreporter field measurements of arsenic in groundwater from tube wells were in satisfying agreement with the results of spectroscopic analyses of the same samples conducted in the lab. The practicability of the bioreporter test in terms of logistics and material requirements, suitability for high sample throughput, and waste disposal was much better than that of two commercial chemical test kits that were included as references. The campaigns furthermore demonstrated large local heterogeneity of arsenic in groundwater, underscoring the use of well switching as an effective remedy to avoid high arsenic exposure.

Exposition à des particules virales aéroportées potentiellement pathogènes dans des abattoirs et dans la filière du tri des déchets

La caractérisation de l'exposition à des bioaérosols dans différents secteurs de travail a, durant de nombreuses années, été documentée principalement pour les icroorganismes cultivables tels que les bactéries et les champignons. Puis, le développement des méthodes moléculaires d'analyse de l'ADN par amplification de séquences spécifiques ou universelles par PCR(1) a permis une caractérisation beaucoup plus réaliste des expositions en tenant compte, non seulement des bactéries et champignons cultivables, mais aussi des non-cultivables qui représentent l'immense majorité des icroorganismes totaux présents dans l'air. Ainsi, depuis une dizaine d'années, nos connaissances sur les communautés bactériennes et fongiques aéroportées se sont élargies (1). Aujourd'hui, une nouvelle avancée est faite, grâce à la métagénomique(2) qui permet d'identifier (après ou non amplification de l'ADN total) une grande part des séquences d'ADN présentes dans un environnement (2). L'utilisation de la PCR(1) et/ou de la métagénomique(2), dans le domaine de la santé au travail, s'est jusqu'à présent limitée à la caractérisation de l'exposition aux bactéries et champignons laissant de côté les virus. Cependant, il s'avère que beaucoup de virus pathogènes se transmettent par voie aérienne et qu'un grand nombre de travailleurs manipulent des matières pouvant être contaminées. C'est le cas des employés des abattoirs, potentiellement exposés à des virus zoonotiques(3) et des employés d'usines de tri des déchets ménagers solides. Cette note décrit deux études qui ont évalué, pour la première fois dans ces secteurs de travail, l'exposition professionnelle à des particules virales, la première en utilisant la métagénomique(2) et la seconde en utilisant les méthodes PCR(1) classique.

Evaluating Properties of Blended Cements for Concrete Pavements, December 2003

The addition of supplementary cementitious materials (SCMs), such as fly ash (FA) and slag, generally improves concrete workability, durability, and long-term strength. New trends in sustainable development of concrete infrastructure and in environmental regulations on waste disposal are spurring use of SCMs in concrete. However, use of SCM concrete is sometimes limited due to a lack of understanding about material behaviors and lack of proper specifications for its construction practice. It is believed that SCM concrete performance varies significantly with the source and proportion of the cementitious materials. SCM concrete often displays slower hydration, accompanied by slower setting and lower early-age strength, especially under cold weather conditions. The present research was conducted to have a better understanding of SCM concrete behaviors under different weather conditions. In addition to the study of the effect of SCM content on concrete set time using cementitious materials from different sources/manufacturers, further research may be needed to investigate the effects of SCM combinations on concrete flowability, air stability, cracking resistance, and durability.

Iowa Brownfield Reuse Guide, September 15, 2008

Brownfield sites come in all shapes and sizes, from vacated industrial sites to a single building plagued with asbestos materials. Brownfield sites are found in both urban and rural settings and present challenges that make the cleanup and redevelopment of these sites unique as compared with other real estate projects.

Fact Sheet: Hazardous Martials Accidents, 2011

A hazardous materials accident can occur anywhere. Communities located near chemical manufacturing plants are particularly at risk. However, hazardous materials are transported on our roadways, railways and waterways daily, so any area is considered vulnerable to an accident.

Surfactant protein A, exposure to endotoxin, and asthma in garbage collectors and in wastewater workers.

Endotoxin causes an inflammation at the bronchial and alveolar level. The inflammation-induced increase in permeability of the bronchoalveolar epithelial barrier is supposed to cause a leakage of pneumoproteins. Therefore, their concentrations are expected to increase in the bloodstream.This study aimed at examining the association between occupational exposure to endotoxin and a serum pneumoprotein, surfactant protein A, to look for nonoccupational factors capable of confounding this association, and examine the relation between surfactant protein A and spirometry. There were 369 control subjects, 325 wastewater workers, and 84 garbage collectors in the study. Exposure to endotoxin was assessed through personal sampling and the Limulus amebocytes lysate assay. Surfactant protein A was determined by an in house sandwich enzyme-linked immunosorbent assay (ELISA) in 697 subjects. Clinical and smoking history were ascertained and spirometry carried out according to American Thoracic Society criteria. Multiple linear regression was used for statistical analysis. Exposure was fairly high during some tasks in wastewater workers but did not influence surfactant protein A. Surfactant protein A was lower in asthmatics. Interindividual variability was large. No correlation with spirometry was found. Endotoxin has no effect on surfactant protein A at these endotoxin levels and serum surfactant protein A does not correlate with spirometry. The decreased surfactant protein A secretion in asthmatics requires further study.

Annual Report Of the State Geologist, March 2012

What we do: Since 1892, the Iowa Geological and Water Survey (IGWS) has provided earth, water, and mapping science to all Iowans. We collect and interpret information on subsurface geologic conditions, groundwater and surface water quantity and quality, and the natural and built features of our landscape. This information is critical for: Predicting the future availability of economic water supplies and mineral resources. Assuring proper function of waste disposal facilities. Delineation of geologic hazards that may jeopardize property and public safety. Assessing trends and providing protection of water quality and soil resources. Applied technical assistance for economic development and environmental stewardship. Our goal: Providing the tools for good decision making to assure the long-term vitality of Iowa’s communities, businesses, and quality of life. Information and technical assistance are provided through web-based databases, comprehensive Geographic Information System (GIS) tools, predictive groundwater models, and watershed assessments and improvement grants. The key service we provide is direct assistance from our technical staff, working with Iowans to overcome real-world challenges. This report describes the basic functions of IGWS program areas and highlights major activities and accomplishments during calendar year 2011. More information on IGWS is available at http://www.igsb.uiowa.edu/.

Antibiotiques et bactéries antibiorésistantes dans les effluents d'hôpitaux : état des lieux en Europe (revue de la littérature)

L'utilisation massive d'antibiotiques dans les établissements de santé participe à la sélection des souches bactériennes résistantes aux antibiotiques. Ces bactéries ainsi que les résidus d'antibiotiques se retrouvent dans les effluents des hôpitaux et atteignent les stations d'épuration communales, où elles ne sont pas systématiquement éliminées par le processus de traitement des eaux. La dissémination d'antibiotiques et de souches résistantes dans l'environnement naturel peut avoir des conséquences non négligeables en termes de santé publique et de perturbations écologiques. En Europe, il semble qu'actuellement très peu d'hôpitaux traitent leurs effluents, mais ceci devrait se généraliser à l'avenir. Le but de cette revue est de faire un état des lieux et une synthèse des études ayant mesuré la présence d'antibiotiques et de bactéries résistantes aux antibiotiques dans les eaux de sorties des hôpitaux et d'évaluer les risques potentiels liés à la dissémination aéroportée (bioaérosols) de ces bactéries dans l'environnement direct de l'hôpital. [Auteure]

Jätteen rinnakkaispolton rooli ja rajaehdot Suomen jätestrategiassa

Suomen jätehuolto on kokemassa murrosta kuluvina aikoina. Pienimuotoinen jätteen rinnakkaispoltto, joka on ollut Suomen jätehuollolle ominaista, uhkaa koitua kannattamattomaksi ja loppua kokonaan. Tässä työssä pyritään selvittämään jätteen rinnakkaispolton rooli ja rajaehdot Suomen jätestrategiassa nytkun jätehuolto on muuttunut uusien direktiivien voimaan astumisen myötä. Työssäkäsitellään rinnakkaispolttoa koskevaa lainsäädäntöä ja sen vaikutusta polton tulevaisuuteen. Rajaehtoja on tarkasteltu savukaasupäästöjen, päästörajojen ja tuhkan ominaisuuksien muuttumisen avulla polttosuhteen muuttuessa. Lisäksi työssä on arvioitu jätteenpolttoasetuksen aiheuttamat lisäkustannukset jätettä polttaville voimalaitoksille ja pohdittu, miten kustannukset on kompensoitavissa. Työn perusteella vaikuttaa siltä, että jätteen rinnakkaispoltolla voi tulevaisuudessakin olla merkittävä rooli Suomen jätehuollossa. Jätteen energiahyödyntämistä joudutaan lisäämään tulevaisuudessa rutkasti, jotta saavutettaisiin vaadittu jätteen hyötykäyttötaso. Rinnakkaispolton alalta on Suomessa huippuosaamista ja laitospotentiaalia on valmiina, joten rinnakkaispoltto tarjoaa helpon mahdollisuuden jätteen hyödyntämisasteen parantamiseen. Kriittiseksi tekijäksimuodostuu se, voiko yhdyskuntajätteistä valmistettua polttoainetta polttaa sähkön ja lämmön yhteistuotantoon tarkoitetuilla laitoksilla. Mikäli se olisi mahdollista, voisi tämän työn perusteella rinnakkaispoltolla olla suuri rooli suomalaisessa jätehuollossa ja sen tulevaisuudessa.