To promote the environmental sustainability of rural sanitation, a soil moisture controlled wastewater subsurface drip irrigation (SDI) dispersal system was field tested in the Black Belt Prairie of Alabama, USA. The soil moisture control strategy was designed to regulate wastewater disposal timing according to drain field conditions to prevent hydraulic overloading and corresponding environmental hazard. CW2D/HYDRUS simulation modeling was utilized to explore difficult-to-measure aspects of system performance. While the control system successfully adapted hydraulic loading rate to changing drain field conditions, saturated field conditions during the dormant season presented practical application challenges. The paired field experiment and simulation model demonstrate that soil biofilm growth was stimulated in the vicinity of drip emitters. Although biofilm growth is critical in maintaining adequate COD and NH4+-N removal efficiencies, the efficient removal of biodegradable COD itself by soil biofilm limits denitrification of formed NO3--N . Furthermore, stimulated soil biofilm growth can create soil clogging around drip emitters, which was discerned in the field experiment along with salt accumulation, both of which were verified by simulation. Comparable modeling of system performance in sand and clay media demonstrate that the placement of soil moisture sensors within the drain field can have pronounced impacts on system hydraulic performance, depending on the soil permeability. Overall, the soil moisture control strategy tested is shown as a viable supplemental technology to promote the environmental sustainability of rural sanitation systems.
- MeSH
- Waste Disposal, Fluid MeSH
- Wastewater * MeSH
- Grassland MeSH
- Soil * MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Alabama MeSH
OBJECTIVE: To estimate the long-run mortality effects of Hurricanes Katrina and Rita on seniors with diabetes. RESEARCH DESIGN AND METHODS: We performed a retrospective cohort analysis of Medicare enrollment and claims data covering four states and ∼10 years. Affected individuals were identified by whether they lived in a county that suffered a high impact and were stratified by whether they moved to a different county following the storms. Propensity scores matched affected and comparison subjects based on demographic and socioeconomic characteristics and the presence of chronic conditions. Our sample consisted of 170,328 matched affected subjects. RESULTS: The affected subjects had a nearly 40% higher all-cause mortality risk in the 1st month after the storms, but the difference fell to <6% by the end of the full observation period. The mortality risks of heart disease and nephritis also exhibited the largest differences immediately following the storms. Among the affected subjects, the all-cause mortality risk was higher for those who moved to a different county, with an especially large difference among those who moved to an affected county. CONCLUSIONS: The propensity matching procedure resulted in the comparison and affected groups having similar observable characteristics. However, we only examined the extreme outcome of mortality, our definition of affected was somewhat crude, and our sample did not include individuals enrolled in Medicare Advantage. Our findings highlight the importance of the immediate response to disasters, yet also demonstrate the long-lasting impact disasters can have.
- MeSH
- Cyclonic Storms history mortality MeSH
- History, 21st Century MeSH
- Diabetes Mellitus mortality MeSH
- Disasters history statistics & numerical data MeSH
- Humans MeSH
- Medicare MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Propensity Score MeSH
- Check Tag
- History, 21st Century MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Historical Article MeSH
- Research Support, N.I.H., Extramural MeSH
- Geographicals
- Alabama MeSH
- Louisiana MeSH
- Mississippi MeSH
- United States MeSH
- Texas MeSH
BACKGROUND: Neoadjuvant chemotherapy for potentially resectable metastatic colorectal cancer (MCC) is becoming a more common treatment algorithm. The aim of the present study was to evaluate the efficacy of precision hepatic arterial Irinotecan therapy in unresectable MCC. METHODS: An open-label, multi-centre, multi-national single arm study of MCC patients, who received hepatic arterial irinotecan. Primary endpoints were safety, tolerance and metastatic tumour resection. RESULTS: Fifty-five patients with metastatic colorectal to the liver underwent a total of 90 hepatic arterial irinotecan treatments. The extent of liver involvement was < 25% in 75% of the patients (n= 41), between 26 and 50% in 15% of the patients (n= 11) and >50% in 10% of the patients (n= 24). The median number of hepatic lesions was four (range 1-20), with a median total size of all target lesions of 9 cm (range 5.5-28 cm) with 50% of patients having bilobar tumour distribution. The median number of irinotecan treatments was two (range 1-5). The median treatment dose was 100 mg (range 100-200) with a median total hepatic treatment of 200 mg (range 200-650). The majority of treatments (86%) were performed as lobar infusion treatments, and 30% of patients were treated with concurrent simultaneous chemotherapy. Eleven (20%) patients demonstrated significant response and downstage of their disease or demonstrated stable disease without extra-hepatic disease progression allowing resection, ablation or resection and ablation. There were no post-operative deaths. Post-operative complications morbidity occurred in 18% of patients, with none of them hepatic related. Non-tumorous liver resected demonstrated no evidence of steatohepatitis from the irinotecan arterial infusion. CONCLUSIONS: Hepatic arterial infusion irinotecan drug-eluting beads is safe and effective in pre-surgical therapy and helpful in evaluating the biology of metastatic colorectal cancer to the liver prior to planned hepatic resection.
- MeSH
- Chemotherapy, Adjuvant MeSH
- Hepatic Artery MeSH
- Chemoembolization, Therapeutic * adverse effects MeSH
- Adult MeSH
- Antineoplastic Agents, Phytogenic administration & dosage adverse effects MeSH
- Hepatectomy * adverse effects MeSH
- Infusions, Intra-Arterial MeSH
- Irinotecan MeSH
- Camptothecin administration & dosage adverse effects analogs & derivatives MeSH
- Carcinoma diagnosis secondary surgery therapy MeSH
- Catheter Ablation * adverse effects MeSH
- Colorectal Neoplasms pathology therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Microspheres * MeSH
- Liver Neoplasms diagnosis secondary surgery therapy MeSH
- Neoadjuvant Therapy MeSH
- Tomography, X-Ray Computed MeSH
- Positron-Emission Tomography MeSH
- Proportional Hazards Models MeSH
- Prospective Studies MeSH
- Registries MeSH
- Chi-Square Distribution MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Alabama MeSH
- Czech Republic MeSH
- Kentucky MeSH
