Cross-connections in drinking water distribution networks: Quantitative microbial risk assessment in combination with fault tree analysis and hydraulic modelling.

Deficiencies in drinking water distribution networks, such as cross-connections, may lead to contamination of the drinking water and pose a serious health risk to consumers. Cross-connections and backflows are considered among the most severe public health risks in distribution networks. The aim of this paper was to provide a framework for estimating the risk of infection from cross-connection and backflow events.

[Difficulties and shortcomings in decisions on treatment restrictions].

Using a questionnaire for doctors at the Central hospital in Kristianstad, Sweden, we have investigated how work on treatment restrictions is handled and documented, whether different circumstances affect the decisions taken, and what support and training the doctors consider is needed. Far from all patients/relatives are informed about decisions regarding life support treatment, and compliance with applicable laws and directives is low. The propensity to inform tend to be lower when the decision is that no life-sustaining measures will be taken.

Occurrence and removal efficiency of parasitic protozoa in Swedish wastewater treatment plants.

Giardia intestinalis, Cryptosporidium spp., Entamoeba histolytica and Dientamoeba fragilis are parasitic protozoa and causative agents of gastroenteritis in humans. G.

Norovirus Dynamics in Wastewater Discharges and in the Recipient Drinking Water Source: Long-Term Monitoring and Hydrodynamic Modeling.

Norovirus (NoV) that enters drinking water sources with wastewater discharges is a common cause of waterborne outbreaks. The impact of wastewater treatment plants (WWTPs) on the river Göta älv (Sweden) was studied using monitoring and hydrodynamic modeling. The concentrations of NoV genogroups (GG) I and II in samples collected at WWTPs and drinking water intakes (source water) during one year were quantified using duplex real-time reverse-transcription polymerase chain reaction.

Microbial risk assessment of drinking water based on hydrodynamic modelling of pathogen concentrations in source water.

Norovirus contamination of drinking water sources is an important cause of waterborne disease outbreaks. Knowledge on pathogen concentrations in source water is needed to assess the ability of a drinking water treatment plant (DWTP) to provide safe drinking water. However, pathogen enumeration in source water samples is often not sufficient to describe the source water quality.

Efficacy of a device to narrow the coronary sinus in refractory angina.

Background: Many patients with coronary artery disease who are not candidates for revascularization have refractory angina despite standard medical therapy. The balloon-expandable, stainless steel, hourglass-shaped, coronary-sinus reducing device creates a focal narrowing and increases pressure in the coronary sinus, thus redistributing blood into ischemic myocardium.

Methods: We randomly assigned 104 patients with Canadian Cardiovascular Society (CCS) class III or IV angina (on a scale from I to IV, with higher classes indicating greater limitations on physical activity owing to angina) and myocardial ischemia, who were not candidates for revascularization, to implantation of the device (treatment group) or to a sham procedure (control group).

Incorporating expert judgments in utility evaluation of bacteroidales qPCR assays for microbial source tracking in a drinking water source.

Several assays for the detection of host-specific genetic markers of the order Bacteroidales have been developed and used for microbial source tracking (MST) in environmental waters. It is recognized that the source-sensitivity and source-specificity are unknown and variable when introducing these assays in new geographic regions, which reduces their reliability and use. A Bayesian approach was developed to incorporate expert judgments with regional assay sensitivity and specificity assessments in a utility evaluation of a human and a ruminant-specific qPCR assay for MST in a drinking water source.

Evaluation of a passive sampler for the speciation of metals in urban runoff water.

Metals in urban runoff water need to be monitored in order to estimate fluxes and assess their impact on the aquatic environment. Passive sampling is a useful and reliable emerging tool for measuring time averaged concentrations of metals in water bodies. This paper describes the deployment of a passive sampler to measure Cu, Ni and Zn in an urban runoff water treatment facility.

Short-term microbial release during rain events from on-site sewers and cattle in a surface water source.

The protection of drinking water from pathogens such as Cryptosporidium and Giardia requires an understanding of the short-term microbial release from faecal contamination sources in the catchment. Flow-weighted samples were collected during two rainfall events in a stream draining an area with on-site sewers and during two rainfall events in surface runoff from a bovine cattle pasture. Samples were analysed for human (BacH) and ruminant (BacR) Bacteroidales genetic markers through quantitative polymerase chain reaction (qPCR) and for sorbitol-fermenting bifidobacteria through culturing as a complement to traditional faecal indicator bacteria, somatic coliphages and the parasitic protozoa Cryptosporidium spp.

The association of drinking water treatment and distribution network disturbances with Health Call Centre contacts for gastrointestinal illness symptoms.

There are relatively few studies on the association between disturbances in drinking water services and symptoms of gastrointestinal (GI) illness. Health Call Centres data concerning GI illness may be a useful source of information. This study investigates if there is an increased frequency of contacts with the Health Call Centre (HCC) concerning gastrointestinal symptoms at times when there is a risk of impaired water quality due to disturbances at water works or the distribution network.

Estimation of pathogen concentrations in a drinking water source using hydrodynamic modelling and microbial source tracking.

The faecal contamination of drinking water sources can lead to waterborne disease outbreaks. To estimate a potential risk for waterborne infections caused by faecal contamination of drinking water sources, knowledge of the pathogen concentrations in raw water is required. We suggest a novel approach to estimate pathogen concentrations in a drinking water source by using microbial source tracking data and fate and transport modelling.

Reduced peripheral vascular reactivity in refractory angina pectoris: Effect of enhanced external counterpulsation.

Aims: To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation (EECP) in patients with chronic refractory angina.

Methods: Twenty patients diagnosed with refractory angina were divided into EECP (n = 10) or no EECP (n = 10) groups. The data were compared to matched healthy subjects (n = 20).

Replacement predictions for drinking water networks through historical data.

Lifetime distribution functions and current network age data can be combined to provide an assessment of the future replacement needs for drinking water distribution networks. Reliable lifetime predictions are limited by a lack of understanding of deterioration processes for different pipe materials under varied conditions. An alternative approach is the use of real historical data for replacement over an extended time series.

Decay of Bacteroidales genetic markers in relation to traditional fecal indicators for water quality modeling of drinking water sources.

The implementation of microbial fecal source tracking (MST) methods in drinking water management is limited by the lack of knowledge on the transport and decay of host-specific genetic markers in water sources. To address these limitations, the decay and transport of human (BacH) and ruminant (BacR) fecal Bacteroidales 16S rRNA genetic markers in a drinking water source (Lake Rådasjön in Sweden) were simulated using a microbiological model coupled to a three-dimensional hydrodynamic model. The microbiological model was calibrated using data from outdoor microcosm trials performed in March, August, and November 2010 to determine the decay of BacH and BacR markers in relation to traditional fecal indicators.

Cost-effectiveness analysis of risk-reduction measures to reach water safety targets.

Identifying the most suitable risk-reduction measures in drinking water systems requires a thorough analysis of possible alternatives. In addition to the effects on the risk level, also the economic aspects of the risk-reduction alternatives are commonly considered important. Drinking water supplies are complex systems and to avoid sub-optimisation of risk-reduction measures, the entire system from source to tap needs to be considered.

Effects on blood pressure in patients with refractory angina pectoris after enhanced external counterpulsation.

Objective: Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to reduce the frequency and severity of angina pectoris. Little is known how EECP affects the blood pressure.

Methods: 153 patients with refractory angina were treated with either EECP or retained on their pharmacological treatment (reference group).

Periodontitis: a future risk of acute coronary syndrome? A follow-up study over 3 years.

Background: Periodontitis has been associated with cardiovascular disease. We assess if the recurrence of acute coronary syndrome (ACS) could be predicted by preceding medical and periodontal conditions.

Methods: A total of 165 consecutive subjects with ACS and 159 medically healthy, matched control subjects were examined and followed for 3 years.

Enhanced external counter pulsation in treatment of refractory angina pectoris: two year outcome and baseline factors associated with treatment failure.

Background: Enhanced external counter pulsation (EECP) is a non-invasive treatment option for patients with refractory angina pectoris ineligible to further traditional treatment. The aim of this study was to evaluate the effect of EECP on patients at a Scandinavian medical centre and to investigate if outcome can be predicted by analysing baseline factors.

Methods: 86 consecutive patients (70 male, 16 female) were treated with EECP and followed for two years post treatment.

Comparison of patients undergoing enhanced external counterpulsation and spinal cord stimulation for refractory angina pectoris.

Introduction: As more patients survive coronary events, the prevalence of patients with refractory angina pectoris is increasing. The aim was to evaluate the effects of enhanced external counterpulsation (EECP) and spinal cord stimulation (SCS) and compare with optimal medically treated patients with refractory angina.

Methods: 153 patients with refractory angina were treated with either EECP, SCS, or were retained on their pharmacological treatment (control).

Bacterial profile and burden of periodontal infection in subjects with a diagnosis of acute coronary syndrome.

Background: Periodontitis has been identified as a potential risk factor in cardiovascular diseases. It is possible that the stimulation of host responses to oral infections may result in vascular damage and the inducement of blood clotting. The aim of this study was to assess the role of periodontal infection and bacterial burden as an explanatory variable to the activation of the inflammatory process leading to acute coronary syndrome (ACS).

One year follow-up of patients with refractory angina pectoris treated with enhanced external counterpulsation.

Background: Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to be effective in reducing both angina and myocardial ischemia in patients not responding to medical therapy and without revascularization alternatives. The aim of the present study was to assess the long-term outcome of EECP treatment at a Scandinavian centre, in relieving angina in patients with chronic refractory angina pectoris.

Methods: 55 patients were treated with EECP.

High-sensitivity serum C-reactive protein levels in subjects with or without myocardial infarction or periodontitis.

Background: Serum high-sensitivity C-reactive protein (hsC-rp) is a non-specific marker of inflammation. Elevated hsC-rp levels are found in subjects with cardiovascular diseases (CVDs). Periodontitis may influence hsC-rp levels.

Chronic periodontitis, a significant relationship with acute myocardial infarction.

Background: Chronic periodontitis (CP) has been associated with cardiovascular diseases. The study purposes were to identify the odds of acute myocardial infarction (AMI) and CP defined at different thresholds.

Methods And Results: We studied 80 subjects with clinically confirmed AMI and 80 matched control subjects with no evidence of cardiovascular disease all receiving a comprehensive periodontal examination.

Performance of an in situ passive sampling system for metals in stormwater.

A passive sampler has been developed and is demonstrated in situ for urban runoff. The passive sampler is compared to conventional composite (time-dependent and flow-weighted) bottle sampling during and between storm events. The sampling was carried out at established stormwater stations; before and after a stormwater detention pond.