Onsite wastewater treatment systems (OWTS) are a major source of excess nutrients and co-pollutants in watersheds across the United States. In Barnstable County (Cape Cod), Massachusetts, effluent from septic systems and cesspools contributes approximately 80% of the controllable reactive nitrogen (N) load to numerous impaired estuaries and degrades water quality in the region's sole source aquifer, streams and ponds. In unsewered areas, wastewater N loads could be reduced substantially by Innovative/Alternative (I/A) septic systems designed for enhanced removal. Use, however, has been partly limited by the availability of high performing, cost effective options, while conventional septic systems continue to be installed in watersheds with well documented N impairments. This paper describes the strategic replacement of residential OWTS with two I/A models that incorporate woodchip bioreactors to enhance N removal. Systems were installed at 14 neighboring homes in Barnstable, MA, and monitored for field performance. Influent and effluent were sampled monthly and analyzed for N and phosphorus (P), among other water quality indicators. Flow to each system was continuously metered to estimate nutrient loads. Results from the first 25 months of monitoring for 13 systems with at least a full year of data are presented in terms of 1) reductions in nutrient concentrations and mass loads and 2) reliability of the systems for meeting a performance goal of total N (TN) < 10 mg/L. Discussion supports consideration of where and how these technologies may be successfully used to manage excess N in sensitive watersheds.
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http://dx.doi.org/10.1016/j.jenvman.2024.122737 | DOI Listing |
J Clin Monit Comput
January 2025
Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands.
Purpose: This study provides an economic evaluation of bedside, data-driven, and model-informed precision dosing of antibiotics in comparison with usual care among critically ill patients with sepsis or septic shock.
Methods: This economic evaluation was conducted alongside an AutoKinetics randomized controlled trial. Effect measures included quality-adjusted life years (QALYs), mortality and pharmacokinetic target attainment.
Innovations (Phila)
January 2025
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Objective: Percutaneous vegetation debulking has been reported to treat tricuspid valve infective endocarditis (TVIE), but data on feasibility compared with conventional surgical strategies are limited. We aimed to compare short-term outcomes of suction debulking with partial venovenous bypass to conventional open surgery in this population.
Methods: This was a single-center, retrospective study that included all patients with isolated TVIE who underwent suction debulking with partial venovenous bypass or tricuspid valve surgery between January 2010 and December 2022.
Pediatr Rheumatol Online J
January 2025
Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Background: An accurate diagnosis of septic versus reactive or autoimmune arthritis remains clinically challenging. A multi-omics strategy comprising metagenomic and proteomic technologies were undertaken for children diagnosed with presumed septic arthritis to advance clinical diagnoses and care for affected individuals.
Methods: Twelve children with suspected septic arthritis were prospectively enrolled to compare standard of care tests with a rapid multi-omics approach.
J Control Release
January 2025
Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry and Sichuan Province, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610041, China.. Electronic address:
Sepsis is a life-threatening disease characterized by excessive systemic inflammation and coagulopathy. Platelets and neutrophils form a "dangerous alliance" through crosstalk, promoting the inflammatory cytokine storm and coagulation disorders during sepsis. Platelet-neutrophil crosstalk leads to the formation of platelet-neutrophil complexes (PNCs), which are the central "protagonists" of this "dangerous alliance.
View Article and Find Full Text PDFCrit Care
January 2025
Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Background: Rapid, adequate treatment is crucial to reduce mortality in sepsis. Risk stratification scores used at emergency departments (ED) are limited in detecting all septic patients with increased mortality risk. We assessed whether the addition of prehospital lactate analysis to clinical risk stratification tools improves detection of patients with increased risk for rapid deterioration and death in sepsis.
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