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The impact of changes in influent load on the removal of endocrine disrupting chemicals (EDCs) by sewage treatment has not been fully characterised. This study assessed the efficacy of an advanced tertiary sewage treatment plant (STP) to remove EDCs during normal and peak flow events of sewage influent using trace chemical analysis of selected EDCs and four estrogenic in vitro bioassays. During the summer holiday season, influent volume increased by 68%, nutrient concentrations by at least 26% and hydraulic retention time was reduced by 40% compared with base flow conditions. Despite these pressures on the treatment system the concentrations and mass loading of estrone, 17β-estradiol, estriol, Bisphenol A, 4- t -octylphenol and technical nonylphenol were not significantly higher (p > 0.05) during the peak flow conditions compared with base flow conditions. Chemical analysis and in vitro bioassays showed that the efficacy of the STP in removing EDCs was not affected by the different loadings between baseline and peak flow regimes. This study demonstrates that large flow variations within the design capacity of advanced multi-stage STPs should not reduce the removal efficacy of EDCs. [ABSTRACT FROM AUTHOR]

Background: CYP450 polymorphisms result in variable rates of drug metabolism. CYP drug-drug interactions can contribute to altered drug effectiveness and safety.Study Objectives: The primary objective was to determine the percentage of emergency department (ED) patients with cytochrome 2C19 (CYP2C19) drug-drug interactions. The secondary objective was to determine the prevalence of CYP2C19 polymorphisms in a US ED population.Methods: We conducted a prospective observational study in an urban academic ED with 72,000 annual visits. Drug ingestion histories for the 48 hours preceding ED visit were obtained; each drug was coded as CYP2C19 substrate, inhibitor, inducer, or not CYP2C19 dependent. Ten percent of patients were randomized to undergo CYP2C19 genotyping using the Roche Amplichip.Results: A total of 502 patients were included; 61% were female, 65% were white, and median age was 39 years (interquartile range, 22-53). One hundred thirty-one (26.1%) patients had taken at least 1 CYP2C19-dependent home drug. Eighteen (13.7%) patients who were already taking a CYP2C19-dependent drug were given or prescribed a CYP2C19-dependent drug while in the ED. Among the 53 patients genotyped, 52 (98%) were extensive metabolizers and 1 was a poor metabolizer.Conclusions: In a population of ED patients, more than a quarter had taken a CYP2C19-dependent drug in the preceding 48 hours, but few were given or prescribed another CYP2C19-dependent drug in the ED. On genotyping analysis, CYP2C19 polymorphisms were uncommon in our cohort. We conclude that changing prescribing practice due to CYP2C19 drug-drug interaction or genotype is unlikely to be useful in most US ED populations. [ABSTRACT FROM AUTHOR]

Abstract: Peer victimization in the form of bullying is a chronic social stressor experienced by many humans during development. Exposure to bullying has been associated with a variety of mental disorders, such as anxiety and depression. Participants pre-selected for the presence or absence of a history of being bullied were brought into a laboratory and placed in a stressful situation. Blood pressure, heart rate, and salivary cortisol levels were measured before the introduction of the stressor (Time 1), at the end of the stressor (Time 2), and after its removal (Time 3). Men with a history of exposure to frequent bullying showed blunted blood pressure responses at Time 2 compared to control men. Bullied and Non-bullied women did not show any differences in any of the measures. Men and women in both groups showed an increase in heart rate in response to the stressor. There were no significant differences in salivary cortisol levels between Bullied and Non-bullied participants. However, salivary cortisol levels and systolic blood pressure were lower in Bullied male participants who reported having no feelings of anger about their experience compared to controls and those who did report anger. These data show altered sympathetic responses to stress in men with a history of victimization as well as suggesting long-term effects on the HPA axis in the most affected individuals. [Copyright &y& Elsevier]

Introduction: Normoglycemic patients undergoing pancreaticoduodenectomy (Whipple procedure) often inquire whether they will be diabetic postoperatively. There is limited information on this issue. We therefore looked at a more subtle measurement of long-term glycemic control, hemoglobin A1c (HgbA1c), as a prognostic tool in predicting progression to diabetes post Whipple. Patients and methods: A retrospective review over a 6-year period of all patients undergoing Whipple procedures at a single institution was conducted. In all, 27 patients had no prior history of diabetes, complete follow-up, and measured preoperative HgbA1c values. Postoperative diabetes was defined as the need for oral hypoglycemic agents or insulin. These charts were analyzed for progression to diabetes after Whipple. Results: Of the 27 patients, 10 were considered to have postoperative diabetes. The average preoperative HgbA1c value for these patients was 6.3±0.66. This was statistically different from the 17 patients without postoperative diabetes (average HgbA1c 5.2±0.39, p<0.001). The positive predictive value, negative predictive value, sensitivity, and specificity were 82%, 94%, 90%, and 88%, respectively. Conclusion: This study demonstrates that progression to diabetes is very unlikely after Whipple operation if the preoperative HgbA1c value is in the normal range. The apparent utility of HgbA1c in predicting postoperative diabetes in this small study suggests that this laboratory test may be very helpful in counseling patients for Whipple operation. [ABSTRACT FROM AUTHOR]

There is a documented substantial gap between the level of nutrition education for medical trainees and the need to provide nutrition counseling. Culinary medicine offers a solution, but there are multiple barriers and no guides to implementation. This article identifies core components and strategies to overcome barriers on the basis of experiences of multiple institutions. The outline forms a foundation to be built upon by future collaborators to empower more widespread implementation of culinary medicine education and improve medical nutrition education and ultimately, patient outcomes. [ABSTRACT FROM AUTHOR]

Assessing historical records of DOC concentrations (DOC) in drinking water sources is important for water utilities to understand long-term planning for infrastructure needs. This study investigates 15–20 years of historical data of the Woronora water supply catchment in Australia inclusive of the water filtration plant (WFP), the lake from where the water was drawn for WFP supply, and the two primary river inputs. The DOC at each site ranged from 0.8 mg L−1 to 13.9 mg L−1, with the highest and lowest concentrations observed in Waratah Rivulet. The DOC in the lake and WFP significantly (p < 0.001) increased at annual change rates of 0.192 and 0.180 mg L−1 yr−1. However, Woronora River showed a ∼50% lower rate of DOC increase at 0.096 mg L−1 yr−1 (p < 0.001), while Waratah Rivulet showed no trend (p > 0.05). UV 254 also showed increasing trends at Woronora River, Lake Woronora, and Woronora WFP, indicating an increase in aromatic DOC compounds in all three sites. Waratah Rivulet, however, transported more than 60% of the total DOC load into Lake Woronora due to high flow volumes (more than 65% of total annual system flow). Annual DOC load to the lake is positively correlated with annual rainfall (R2 > 0.92; p < 0.001). The higher percentage (>73%) of the samples had SUVA 254 greater than 2 L mg −1 m-1 in all four sites indicating a dominance of hydrophobic DOC. The terrestrial plant-derived DOC has increased in Lake Woronora, predominantly influenced by historical rainfall magnitude. The results underscore the importance of considering the impact of increased DOC at the treatment plant intake for the planning and operation of the Woronora water supply system. [Display omitted] • Significant increases in DOC and UV 254 observed in three of four sites over the last 15–20 years. • Strong correlation found between DOC load and rainfall events. • Predominantly terrestrial plant derived DOC found in the Woronora water system. • Waratah Rivulet identified as the primary contributor of DOC due to higher annual flow. • Study underscores the need for advanced treatment technologies to manage increasing DOC. [ABSTRACT FROM AUTHOR]