Evaluation of distribution system water quality during a free chlorine conversion.

Chloraminated drinking water systems commonly use free chlorine conversions (FCCs) to prevent or control nitrification, but unintended water quality changes may occur, including increased disinfection by-product and metal concentrations. This study evaluated water quality in a chloraminated drinking water system and residential locations before, during, and after their annual, planned FCC. Water quality alternated between relatively consistent and variable periods when switching disinfectants.

Reconsider the burn: The transient effect of a chlorine burn on controlling opportunistic pathogens in a full-scale chloraminated engineered water system.

Nitrification is a serious water-quality issue in chloraminated engineered water systems (EWSs). Nitrification is often remediated by a chlorine burn (i.e.

Building size and disinfectant type influence the detection and concentration of Mycobacterium spp. in hot water plumbing.

The number of nontuberculous mycobacteria (NTM) lung disease cases is increasing in the United States (US). This respiratory disease is primarily caused by three NTM species: Mycobacterium avium, M. intracellulare, and M.

Investigation of Chloramines, Disinfection Byproducts, and Nitrification in Chloraminated Drinking Water Distribution Systems.

Four chloraminated drinking water distribution systems (CDWDSs) required to maintain numeric versus "detectable" residuals were spatially and temporally sampled for water quality and associated trihalomethane (THM) and haloacetic acid (HAA) formation. Monochloramine decreased from entry point (EP) to maximum residence time (MRT) samples while THMs and HAAs initially increased and then stabilized or slightly decreased. Subsequently, EP and MRT samples were used in laboratory-held studies to further evaluate disinfectant residual stability, chloramine speciation, and nitrification occurrence.

Water quality influences Legionella pneumophila determination.

Legionellosis is a respiratory disease of public health concern. The bacterium Legionella pneumophila is the etiologic agent responsible for >90% of legionellosis cases in the United States. Legionellosis transmission primarily occurs through the inhalation or aspiration of contaminated water aerosols or droplets.

Hot water plumbing in residences and office buildings have distinctive risk of Legionella pneumophila contamination.

Aim: To observe how Legionella pneumophila, the causative agent for legionellosis, can transmit through the hot water plumbing of residences and office buildings.

Method And Results: Using qPCR, L. pneumophila and L.

Occurrence revisited: Mycobacterium avium and Mycobacterium intracellulare in potable water in the USA.

Nontuberculous mycobacterium (NTM) infections are increasing in the USA and have a high cost burden associated with treatment. Thus, it is necessary to understand what changes could be contributing to this increase in NTM disease rate. Water samples from 40 sites were collected from around the USA.

Inequality of access to advanced therapies for patients with inflammatory arthritis: a postcode lottery?

Objectives: Advanced therapies (AT), including biologics, biosimilars and Janus kinase inhibitors, have dramatically improved the quality of life of patients with RA, PsA and axial spondyloarthritis (axSpA). Evidence-based criteria for prescribing these drugs in England and Wales is formulated by the National Institute for Health and Care Excellence (NICE) through health technology appraisals and guidelines, with the aim of providing equitable access to AT for patients with severe or resistant disease. Similar bodies exist in some, but not all European countries, with disparities in AT access between countries for RA.

Understanding Microbial Loads in Wastewater Treatment Works as Source Water for Water Reuse.

Facing challenges in water demands and population size, particularly in the water-scarce regions in the United States, the reuse of treated municipal wastewater has become a viable potential to relieve the ever-increasing demands of providing water for (non-)potable use. The objectives of this study were to assess microbial quality of reclaimed water and to investigate treatability of microorganisms during different treatment processes. Raw and final treated effluent samples from three participating utilities were collected monthly for 16 months and analyzed for various microbial pathogens and fecal indicator organisms.

Legionella and other opportunistic pathogens in full-scale chloraminated municipal drinking water distribution systems.

Water-based opportunistic pathogens (OPs) are a leading cause of drinking-water-related disease outbreaks, especially in developed countries such as the United States (US). Physicochemical water quality parameters, especially disinfectant residuals, control the (re)growth, presence, colonization, and concentrations of OPs in drinking water distribution systems (DWDSs), while the relationship between OPs and those parameters remain unclear. This study aimed to quantify how physicochemical parameters, mainly monochloramine residual concentration, hydraulic residence time (HRT), and seasonality, affected the occurrence and concentrations of four common OPs (Legionella, Mycobacterium, Pseudomonas, and Vermamoeba vermiformis) in four full-scale DWDSs in the US.

Chloramine Concentrations within Distribution Systems and Their Effect on Heterotrophic Bacteria, Mycobacterial Species, and Disinfection Byproducts.

Chloramine is a secondary disinfectant used to maintain microbial control throughout public water distribution systems. This study investigated the relationship between chloramine concentration, heterotrophic bacteria, and specific Mycobacterium species. Sixty-four water samples were collected at four locations within the utility's distribution network on four occasions.

Twelve tips for being an effective clinical skills peer teacher.

The vast majority of clinical skills teaching at our medical school in London is delivered through a peer teaching programme, with research demonstrating that medical students unequivocally prefer being taught clinical skills by peer teachers (students) over-qualified physicians. Peer teaching holds a plethora of benefits for both the learner and the teacher; encouraging academic and professional growth for teachers while instilling confidence in tutees through an improved learning atmosphere. Teaching is an essential skill for all physicians, and peer teaching is an invaluable method to cultivate these teaching skills throughout medical education.

Etoposide and olaparib polymer-coated nanoparticles within a bioadhesive sprayable hydrogel for post-surgical localised delivery to brain tumours.

Glioblastoma is a malignant brain tumour with a median survival of 14.6 months from diagnosis. Despite maximal surgical resection and concurrent chemoradiotherapy, reoccurrence is inevitable.

Use of rheumatoid arthritis impact of disease (RAID) in routine care; identification of DAS28 remission and unmet patient-reported outcomes.

Objective: The aim was to assess how the patient-reported outcome RA impact of disease (RAID) relates to DAS28 categories in routine care, its utility in identifying patients in DAS28 remission (RDAS) or low disease activity (LDAS) and the burden of unmet patient-reported needs in those achieving RDAS/LDAS.

Methods: DAS28 and RAID scores were collected from patients with established RA attending for routine review. The relationship between RAID and DAS28 was assessed with univariate pairwise correlation and mixed-effects linear regression analyses.

Impact of Chlorine and Chloramine on the Detection and Quantification of Legionella pneumophila and Species.

Potable water can be a source of transmission for legionellosis and nontuberculous mycobacterium (NTM) infections and diseases. Legionellosis is caused largely by , specifically serogroup 1 (Sg1). , , and are three leading species associated with pulmonary NTM disease.

The effectiveness of disinfection and flushing procedures to prevent coliform persistence in aircraft water systems.

A full-scale reproduction of an aircraft drinking water system was conditioned using municipal tap water with a mixture of free chlorine and chloramines, and subsequently contaminated with coliforms. Disinfection was undertaken using chlorine dioxide, ozone and a mixed oxidant solution followed by flushing until no disinfectant residual remained. Results showed that coliforms were not persistent on the aircraft plumbing surfaces, and coliforms were not detected after disinfection and flushing with any disinfectant.

Dietary fats and pharmaceutical lipid excipients increase systemic exposure to orally administered cannabis and cannabis-based medicines.

There has been an escalating interest in the medicinal use of Cannabis sativa in recent years. Cannabis is often administered orally with fat-containing foods, or in lipid-based pharmaceutical preparations. However, the impact of lipids on the exposure of patients to cannabis components has not been explored.

Increased Frequency of Nontuberculous Mycobacteria Detection at Potable Water Taps within the United States.

Nontuberculous mycobacteria (NTMs) are environmental microorganisms that can cause infections in humans, primarily in the lung and soft tissue. The prevalence of NTM-associated diseases is increasing in the United States. Exposure to NTMs occurs primarily through human interactions with water (especially aerosolized).

Widespread molecular detection of Legionella pneumophila Serogroup 1 in cold water taps across the United States.

In the United States, 6,868 cases of legionellosis were reported to the Center for Disease Control and Prevention in 2009-2010. Of these reports, it is estimated that 84% are caused by the microorganism Legionella pneumophila Serogroup (Sg) 1. Legionella spp.

Detection of Mycobacterium avium subsp. paratuberculosis in drinking water and biofilms by quantitative PCR.

It has been suggested that Mycobacterium avium subspecies paratuberculosis has a role in Crohn's disease. The organism may be acquired but is difficult to culture from the environment. We describe a quantitative PCR (qPCR) method to detect M.

Maternal residential proximity to waste sites and industrial facilities and conotruncal heart defects in offspring.

Most studies of the relationship between maternal residential proximity to sources of environmental pollution and congenital cardiovascular malformations have combined heart defects into one group or broad subgroups. The current case-control study examined whether risk of conotruncal heart defects, including subsets of specific defects, was associated with maternal residential proximity to hazardous waste sites and industrial facilities with recorded air emissions. Texas Birth Defects Registry cases were linked to their birth or fetal death certificate.