Climate change and waterborne disease risk in the Great Lakes region of the U.S

Advances in crop proteomics: PTMs of proteins under abiotic stress

Under natural conditions, crop plants are frequently subjected to various abiotic environmental stresses such as drought and heat wave, which may become more prevalent in the coming decades. Plant acclimation and tolerance to an abiotic stress are always associated with significant changes in PTMs of specific proteins. PTMs are important for regulating protein function, subcellular localization and protein activity and stability. Studies of plant responses to abiotic stress at the PTMs level are essential to the process of plant phenotyping for crop improvement. The ability to identify and quantify PTMs on a large-scale will contribute to a detailed protein functional characterization that will improve our understanding of the processes of crop plant stress acclimation and stress tolerance acquisition. Hundreds of PTMs have been reported, but it is impossible to review all of the possible protein modifications. In this review, we briefly summarize several main types of PTMs regarding their characteristics and detection methods, review the advances in PTMs research of crop proteomics, and highlight the importance of specific PTMs in crop response to abiotic stress.

The emerging threats of climate change on tropical coastal ecosystem services, public health, local economies and livelihood sustainability of small islands: Cumulative impacts and synergies

Climate change has significantly impacted tropical ecosystems critical for sustaining local economies and community livelihoods at global scales. Coastal ecosystems have largely declined, threatening the principal source of protein, building materials, tourism-based revenue, and the first line of defense against storm swells and sea level rise (SLR) for small tropical islands. Climate change has also impacted public health (i.e., altered distribution and increased prevalence of allergies, water-borne, and vector-borne diseases). Rapid human population growth has exacerbated pressure over coupled social-ecological systems, with concomitant non-sustainable impacts on natural resources, water availability, food security and sovereignty, public health, and quality of life, which should increase vulnerability and erode adaptation and mitigation capacity. This paper examines cumulative and synergistic impacts of climate change in the challenging context of highly vulnerable small tropical islands. Multiple adaptive strategies of coupled social-ecological ecosystems are discussed. Multi-level, multi-sectorial responses are necessary for adaptation to be successful.

Analysis of Risk and Burden of Dysentery Associated with Floods from 2004 to 2010 in Nanning, China

This study aimed to examine the association between floods and the morbidity of dysentery and to quantify the burden of dysentery due to floods in Nanning, China. A generalized additive mixed model was conducted to assess the relationship between monthly morbidity of dysentery and floods from 2004 to 2010. The years lived with disability (YLDs) of dysentery attributable to floods were then estimated based on the WHO framework of the burden of disease study for calculating the potential impact fraction. The relative risk (RR) of floods on the morbidity of dysentery was 1.44 (95% confidence interval [CI] = 1.18-1.75). The models suggest that a potential 1-day rise in flood duration may lead to 8% (RR = 1.08, 95% CI = 1.04-1.12) increase in the morbidity of dysentery. The average attributable YLD per 1,000 of dysentery caused by floods were 0.013 in males, 0.005 in females, and 0.009 in persons. Our study confirms that floods have significantly increased the risk and the burden of dysentery in the study area. Public health action should be taken to prevent and control the potential risk of dysentery after floods. Vulnerable groups such as males and children should be paid more attention.

Extreme Precipitation and Emergency Room Visits for Gastrointestinal Illness in Areas with and without Combined Sewer Systems: An Analysis of Massachusetts Data, 2003-2007

BACKGROUND

Combined sewer overflows (CSOs) occur in combined sewer systems when sewage and stormwater runoff are released into water bodies, potentially contaminating water sources. CSOs are often caused by heavy precipitation and are expected to increase with increasing extreme precipitation associated with climate change.

OBJECTIVES

The aim of this study was to assess whether the association between heavy rainfall and rate of emergency room (ER) visits for gastrointestinal (GI) illness differed in the presence of CSOs.

METHODS

For the study period 2003-2007, time series of daily rate of ER visits for GI illness and meteorological data were organized for three exposure regions: a) CSOs impacting drinking water sources, b) CSOs impacting recreational waters, c) no CSOs. A distributed lag Poisson regression assessed cumulative effects for an 8-day lag period following heavy (≥ 90th and ≥ 95th percentile) and extreme (≥ 99th percentile) precipitation events, controlling for temperature and long-term time trends.

RESULTS

The association between extreme rainfall and rate of ER visits for GI illness differed among regions. Only the region with drinking water exposed to CSOs demonstrated a significant increased cumulative risk for rate (CRR) of ER visits for GI for all ages in the 8-day period following extreme rainfall: CRR: 1.13 (95% CI: 1.00, 1.28) compared with no rainfall.

CONCLUSIONS

The rate of ER visits for GI illness was associated with extreme precipitation in the area with CSO discharges to a drinking water source. Our findings suggest an increased risk for GI illness among consumers whose drinking water source may be impacted by CSOs after extreme precipitation.

CITATION

Jagai JS, Li Q, Wang S, Messier KP, Wade TJ, Hilborn ED. 2015. Extreme precipitation and emergency room visits for gastrointestinal illness in areas with and without combined sewer systems: an analysis of Massachusetts data, 2003-2007. Environ Health Perspect 123:873-879; http://dx.doi.org/10.1289/ehp.1408971.

Stormwater runoff to an impaired lake: impacts and solutions

Stormwater runoff can represent a significant source of pollutants to downstream water bodies. An integrated assessment was conducted for the Spring Lake watershed in western Michigan because of concerns that increased impervious land cover in the watershed, especially in sub-basins adjacent to Spring Lake, would result in greater stormwater runoff and pollutant loads. Spring Lake has a history of high total phosphorus (TP) concentrations and cyanobacterial blooms. An alum treatment, paid for by an assessment, was applied to Spring Lake in 2005 to control internal phosphorus loading; hence, there was an economic incentive for stakeholders to limit new phosphorus from entering the lake, which otherwise would reduce the long-term efficacy of the alum treatment. This study provides a novel six-step process that identifies priority areas and optimally reduces nonpoint sources of pollution. We identified a suite of best management practices to be placed in the watershed, assessed their optimal locations based on pollutant sources, and modeled the degree to which their implementation would reduce TP and total suspended solids. Application of the modeled best management practices (BMPs) resulted in a 15 % reduction in TP load and a 17 % reduction in total suspended solid load. Reductions were not uniform throughout the watershed, with the greatest reductions closest to Spring Lake. We also developed a flow chart for BMP selection, which may be transferable to other watersheds with similar issues.

Variation in rocky shore assemblages and abundances of key taxa along gradients of stormwater input

Stormwater brings freshwater and terrestrially derived contaminants into coastal systems and is predicted to increase with climate change. This study aimed to characterise variation in rocky shore assemblages in relation to stormwater pollution. Intertidal assemblages were sampled in similar habitats at a range of distances (0 m, 10 m, 20 m, 60 m, and 100 m) from stormwater outfalls on three rocky shores north of Dublin. In general, taxon richness and algal cover increased after 20 m from a stormwater outfall. Limpet population structure and condition index showed no consistent patterns among shores. Assemblage structure at or near stormwater sites differed from that at sites 100 m away. These findings, ideally supplemented by experimental research, may be used to inform stormwater management and remediation approaches.

Impacts of global change on the concentrations and dilution of combined sewer overflows in a drinking water source

This study presents an analysis of climate change impacts on a large river located in Québec (Canada) used as a drinking water source. Combined sewer overflow (CSO) effluents are the primary source of fecal contamination of the river. An analysis of river flowrates was conducted using historical data and predicted flows from a future climate scenario. A spatio-temporal analysis of water quality trends with regard to fecal contamination was performed and the effects of changing flowrates on the dilution of fecal contaminants were analyzed. Along the river, there was a significant spatial trend for increasing fecal pollution downstream of CSO outfalls. Escherichia coli concentrations (upper 95th percentile) increased linearly from 2002 to 2012 at one drinking water treatment plant intake. Two critical periods in the current climate were identified for the drinking water intakes considering both potential contaminant loads and flowrates: local spring snowmelt that precedes river peak flow and extra-tropical storm events that occur during low flows. Regionally, climate change is expected to increase the intensity of the impacts of hydrological conditions on water quality in the studied basin. Based on climate projections, it is expected that spring snowmelt will occur earlier and extreme spring flowrates will increase and low flows will generally decrease. High and low flows are major factors related to the potential degradation of water quality of the river. However, the observed degradation of water quality over the past 10 years suggests that urban development and population growth may have played a greater role than climate. However, climate change impacts will likely be observed over a longer period. Source water protection plans should consider climate change impacts on the dilution of contaminants in addition to local land uses changes in order to maintain or improve water quality.

Phosphoproteomics reveals the effect of ethylene in soybean root under flooding stress

Flooding has severe negative effects on soybean growth. To explore the flooding-responsive mechanisms in early-stage soybean, a phosphoproteomic approach was used. Two-day-old soybean plants were treated without or with flooding for 3, 6, 12, and 24 h, and root tip proteins were then extracted and analyzed at each time point. After 3 h of flooding exposure, the fresh weight of soybeans increased, whereas the ATP content of soybean root tips decreased. Using a gel-free proteomic technique, a total of 114 phosphoproteins were identified in the root tip samples, and 34 of the phosphoproteins were significantly changed with respect to phosphorylation status after 3 h of flooding stress. Among these phosphoproteins, eukaryotic translation initiation factors were dephosphorylated, whereas several protein synthesis-related proteins were phosphorylated. The mRNA expression levels of sucrose phosphate synthase 1F and eukaryotic translation initiation factor 4 G were down-regulated, whereas UDP-glucose 6-dehydrogenase mRNA expression was up-regulated during growth but down-regulated under flooding stress. Furthermore, bioinformatic protein interaction analysis of flooding-responsive proteins based on temporal phosphorylation patterns indicated that eukaryotic translation initiation factor 4 G was located in the center of the network during flooding. Soybean eukaryotic translation initiation factor 4 G has homology to programmed cell death 4 protein and is implicated in ethylene signaling. The weight of soybeans was increased with treatment by an ethylene-releasing agent under flooding condition, but it was decreased when plants were exposed to an ethylene receptor antagonist. These results suggest that the ethylene signaling pathway plays an important role, via the protein phosphorylation, in mechanisms of plant tolerance to the initial stages of flooding stress in soybean root tips.

Evaluating rain gardens as a method to reduce the impact of sewer overflows in sources of drinking water

The implications of climate change and changing precipitation patterns need to be investigated to evaluate mitigation measures for source water protection. Potential solutions need first to be evaluated under present climate conditions to determine their utility as climate change adaptation strategies. An urban drainage network receiving both stormwater and wastewater was studied to evaluate potential solutions to reduce the impact of combined sewer overflows (CSOs) in a drinking water source. A detailed hydraulic model was applied to the drainage basin to model the implementation of best management practices at a drainage basin scale. The model was calibrated and validated with field data of CSO flows for seven events from a survey conducted in 2009 and 2010. Rain gardens were evaluated for their reduction of volumes of water entering the drainage network and of CSOs. Scenarios with different levels of implementation were considered and evaluated. Of the total impervious area within the basin directly connected to the sewer system, a maximum of 21% could be alternately directed towards rain gardens. The runoff reductions for the entire catchment ranged from 12.7% to 19.4% depending on the event considered. The maximum discharged volume reduction ranged from 13% to 62% and the maximum peak flow rate reduction ranged from 7% to 56%. Of concern is that in-sewer sediment resuspension is an important process to consider with regard to the efficacy of best management practices aimed at reducing extreme loads and concentrations. Rain gardens were less effective for large events, which are of greater importance for drinking water sources. These practices could increase peak instantaneous loads as a result of greater in-sewer resuspension during large events. Multiple interventions would be required to achieve the objectives of reducing the number, total volumes and peak contaminant loads of overflows upstream of drinking water intakes.

Climate change: challenges and opportunities for global health

IMPORTANCE

Health is inextricably linked to climate change. It is important for clinicians to understand this relationship in order to discuss associated health risks with their patients and to inform public policy.

OBJECTIVES

To provide new US-based temperature projections from downscaled climate modeling and to review recent studies on health risks related to climate change and the cobenefits of efforts to mitigate greenhouse gas emissions.

DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS

We searched PubMed and Google Scholar from 2009 to 2014 for articles related to climate change and health, focused on governmental reports, predictive models, and empirical epidemiological studies. Of the more than 250 abstracts reviewed, 56 articles were selected. In addition, we analyzed climate data averaged over 13 climate models and based future projections on downscaled probability distributions of the daily maximum temperature for 2046-2065. We also compared maximum daily 8-hour average ozone with air temperature data taken from the National Oceanic and Atmospheric Administration, National Climate Data Center.

RESULTS

By 2050, many US cities may experience more frequent extreme heat days. For example, New York and Milwaukee may have 3 times their current average number of days hotter than 32°C (90°F). High temperatures are also strongly associated with ozone exceedance days, for example, in Chicago, Illinois. The adverse health aspects related to climate change may include heat-related disorders, such as heat stress and economic consequences of reduced work capacity; respiratory disorders, including those exacerbated by air pollution and aeroallergens, such as asthma; infectious diseases, including vectorborne diseases and waterborne diseases, such as childhood gastrointestinal diseases; food insecurity, including reduced crop yields and an increase in plant diseases; and mental health disorders, such as posttraumatic stress disorder and depression, that are associated with natural disasters. Substantial health and economic cobenefits could be associated with reductions in fossil fuel combustion. For example, greenhouse gas emission policies may yield net economic benefit, with health benefits from air quality improvements potentially offsetting the cost of US and international carbon policies.

CONCLUSIONS AND RELEVANCE

Evidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health care professionals have an important role in understanding and communicating the related potential health concerns and the cobenefits from policies to reduce greenhouse gas emissions.

Impacts of floods on dysentery in Xinxiang city, China, during 2004-2010: a time-series Poisson analysis

Background

Xinxiang, a city in Henan Province, suffered from frequent floods due to persistent and heavy precipitation from 2004 to 2010. In the same period, dysentery was a common public health problem in Xinxiang, with the proportion of reported cases being the third highest among all the notified infectious diseases.

Objectives

We focused on dysentery disease consequences of different degrees of floods and examined the association between floods and the morbidity of dysentery on the basis of longitudinal data during the study period.

Design

A time-series Poisson regression model was conducted to examine the relationship between 10 times different degrees of floods and the monthly morbidity of dysentery from 2004 to 2010 in Xinxiang. Relative risks (RRs) of moderate and severe floods on the morbidity of dysentery were calculated in this paper. In addition, we estimated the attributable contributions of moderate and severe floods to the morbidity of dysentery.

Results

A total of 7591 cases of dysentery were notified in Xinxiang during the study period. The effect of floods on dysentery was shown with a 0-month lag. Regression analysis showed that the risk of moderate and severe floods on the morbidity of dysentery was 1.55 (95% CI: 1.42–1.670) and 1.74 (95% CI: 1.56–1.94), respectively. The attributable risk proportions (ARPs) of moderate and severe floods to the morbidity of dysentery were 35.53 and 42.48%, respectively.

Conclusions

This study confirms that floods have significantly increased the risk of dysentery in the study area. In addition, severe floods have a higher proportional contribution to the morbidity of dysentery than moderate floods. Public health action should be taken to avoid and control a potential risk of dysentery epidemics after floods.

When it rains, it pours: future climate extremes and health

BACKGROUND

The accelerating accumulation of greenhouse gases in the Earth's atmosphere is changing global environmental conditions in unprecedented and potentially irreversible ways. Climate change poses a host of challenges to the health of populations through complex direct and indirect mechanisms. The direct effects include an increased frequency of heat waves, rising sea levels that threaten low-lying communities, anticipated extremes in the global hydrologic cycle (droughts, floods, and intense storms), and adverse effects on agricultural production and fisheries due to environmental stressors and changes in land use. Indirectly, climate change is anticipated to threaten health by worsening urban air pollution and increasing rates of infectious (particularly waterborne and vector-borne) disease transmission.

OBJECTIVE

To provide a state-of-the-science review on the health consequences of a changing climate.

FINDINGS

Environmental public health researchers have concluded that, on balance, adverse health outcomes will dominate under these changed climatic conditions. The number of pathways through which climate change can affect the health of populations makes this environmental health threat one of the largest and most formidable of the new century. Geographic location plays an influential role the potential for adverse health effects caused by climate change, and certain regions and populations are more vulnerable than others to expected health effects. Two kinds of strategies are available for responding to climate change: mitigation policies (which aim to reduce greenhouse gas emissions) and adaptation measures (relating to preparedness for anticipated impacts).

CONCLUSIONS

To better understand and address the complex nature of health risks posed by climate change, interdisciplinary collaboration is critical. Efforts to move beyond our current reliance on fossil fuels to cleaner, more sustainable energy sources may offer some of the greatest health opportunities in more than a century and cobenefits beyond the health sector. Because the nations least responsible for climate change are most vulnerable to its effects, the challenge to reduce greenhouse gas emissions is not merely technical, but also moral.

Is enough attention given to climate change in health service planning? An Australian perspective

BACKGROUND

Within an Australian context, the medium to long-term health impacts of climate change are likely to be wide, varied and amplify many existing disorders and health inequities. How the health system responds to these challenges will be best considered in the context of existing health facilities and services. This paper provides a snapshot of the understanding that Australian health planners have of the potential health impacts of climate change.

METHODS

The first author interviewed (n=16) health service planners from five Australian states and territories using an interpretivist paradigm. All interviews were digitally recorded, key components transcribed and thematically analysed.

RESULTS

Results indicate that the majority of participants were aware of climate change but not of its potential health impacts. Despite this, most planners were of the opinion that they would need to plan for the health impacts of climate change on the community.

CONCLUSION

With the best available evidence pointing towards there being significant health impacts as a result of climate change, now is the time to undertake proactive service planning that address market failures within the health system. If considered planning is not undertaken then Australian health system can only deal with climate change in an expensive ad hoc, crisis management manner. Without meeting the challenges of climate change to the health system head on, Australia will remain unprepared for the health impacts of climate change with negative consequences for the health of the Australian population.

Associations between extreme precipitation and gastrointestinal-related hospital admissions in Chennai, India

BACKGROUND

Understanding the potential links between extreme weather events and human health in India is important in the context of vulnerability and adaptation to climate change. Research exploring such linkages in India is sparse.

OBJECTIVES

We evaluated the association between extreme precipitation and gastrointestinal (GI) illness-related hospital admissions in Chennai, India, from 2004 to 2007.

METHODS

Daily hospital admissions were extracted from two government hospitals in Chennai, India, and meteorological data were retrieved from the Chennai International Airport. We evaluated the association between extreme precipitation (≥ 90th percentile) and hospital admissions using generalized additive models. Both single-day and distributed lag models were explored over a 15-day period, controlling for apparent temperature, day of week, and long-term time trends. We used a stratified analysis to explore the association across age and season.

RESULTS

Extreme precipitation was consistently associated with GI-related hospital admissions. The cumulative summary of risk ratios estimated for a 15-day period corresponding to an extreme event (relative to no precipitation) was 1.60 (95% CI: 1.29, 1.98) among all ages, 2.72 (95% CI: 1.25, 5.92) among the young (≤ 5 years of age), and 1.62 (95% CI: 0.97, 2.70) among the old (≥ 65 years of age). The association was stronger during the pre-monsoon season (March-May), with a cumulative risk ratio of 6.50 (95% CI: 2.22, 19.04) for all ages combined compared with other seasons.

CONCLUSIONS

Hospital admissions related to GI illness were positively associated with extreme precipitation in Chennai, India, with positive cumulative risk ratios for a 15-day period following an extreme event in all age groups. Projected changes in precipitation and extreme weather events suggest that climate change will have important implications for human health in India, where health disparities already exist.

CITATION

Bush KF, O'Neill MS, Li S, Mukherjee B, Hu H, Ghosh S, Balakrishnan K. 2014. Associations between extreme precipitation and gastrointestinal-related hospital admissions in Chennai, India. Environ Health Perspect 122:249-254; http://dx.doi.org/10.1289/ehp.1306807.

Assessing combined sewer overflows with long lead time for better surface water management

During high-intensity rainfall events, the capacity of combined sewer overflows (CSOs) can exceed resulting in discharge of untreated stormwater and wastewater directly into receiving rivers. These discharges can result in high concentrations of microbial pathogens, biochemical oxygen demand, suspended solids, and other pollutants in the receiving waters. The frequency and severity of the CSO discharge are strongly influenced by climatic factors governing the occurrence of urban stormwater runoff, particularly the amount and intensity of the rainfall. This study attempts to assess the impact of climate change (change in rainfall amount and frequency) on CSO under the high (A1FI) and low (B1) Special Report on Emissions Scenarios of the greenhouse concentration derived from three global circulation models in the north west of England at the end of the twenty-first century.

Influence of seasonal and inter-annual hydro-meteorological variability on surface water fecal coliform concentration under varying land-use composition

Quantifying the influence of hydro-meteorological variability on surface source water fecal contamination is critical to the maintenance of safe drinking water. Historically, this has not been possible due to the scarcity of data on fecal indicator bacteria (FIB). We examined the relationship between hydro-meteorological variability and the most commonly measured FIB, fecal coliform (FC), concentration for 43 surface water sites within the hydro-climatologically complex region of British Columbia. The strength of relationship was highly variable among sites, but tended to be stronger in catchments with nival (snowmelt-dominated) hydro-meteorological regimes and greater land-use impacts. We observed positive relationships between inter-annual FC concentration and hydro-meteorological variability for around 50% of the 19 sites examined. These sites are likely to experience increased fecal contamination due to the projected intensification of the hydrological cycle. Seasonal FC concentration variability appeared to be driven by snowmelt and rainfall-induced runoff for around 30% of the 43 sites examined. Earlier snowmelt in nival catchments may advance the timing of peak contamination, and the projected decrease in annual snow-to-precipitation ratio is likely to increase fecal contamination levels during summer, fall, and winter among these sites. Safeguarding drinking water quality in the face of such impacts will require increased monitoring of FIB and waterborne pathogens, especially during periods of high hydro-meteorological variability. This data can then be used to develop predictive models, inform source water protection measures, and improve drinking water treatment.

Label-free quantitative proteomic analysis of abscisic acid effect in early-stage soybean under flooding

Flooding is a serious problem for soybean cultivation because it markedly reduces growth. To investigate the role of phytohormones in soybean under flooding stress, gel-free proteomic technique was used. When 2-day-old soybeans were flooded, the content of abscisic acid (ABA) did not decrease in the root, though its content decreased in untreated plant. When ABA was added during flooding treatment, survival ratio was improved compared with that of soybeans flooded without ABA. When 2-day-old soybeans were flooded with ABA, the abundance of proteins related to cell organization, vesicle transport and glycolysis decreased compared with those in root of soybeans flooded without ABA. Furthermore, the nuclear proteins were analyzed to identify the transcriptional regulation. The abundance of 34 nuclear proteins such as histone deacetylase and U2 small nuclear ribonucleoprotein increased by ABA supplementation under flooding; however, 35 nuclear proteins such as importin alpha, chromatin remodeling factor, zinc finger protein, transducin, and cell division 5 protein decreased. Of them, the mRNA expression levels of cell division cycle 5 protein, C2H2 zinc finger protein SERRATE, CCCH type zinc finger family protein, and transducin were significantly down-regulated under the ABA treatment. These results suggest that ABA might be involved in the enhancement of flooding tolerance of soybean through the control of energy conservation via glycolytic system and the regulation on zinc finger proteins, cell division cycle 5 protein and transducin.

Roadside ditches as conduits of fecal indicator organisms and sediment: implications for water quality management

Roadside ditches are ubiquitous, yet their role in water pollution conveyance has largely been ignored, especially for bacteria and sediment. The goal of this study was to determine if roadside ditches are conduits for fecal indicator organisms and sediment, and if land use, specifically manure amendment, affects the concentrations and loadings. Seven roadside ditches in central New York, adjacent to either manure amended fields or predominately forested land, were monitored for one year for Escherichia coli (E. coli), total suspended solids (TSS) and flow. E. coli concentrations in water samples following storms averaged 4616 MPN of E. coli/100 mL. Concentrations reached as high as >241,960 MPN of E. coli/100 mL and frequently exceeded New York State and US EPA recommendations. Concentrations peaked in both summers following manure spreading, with declining levels thereafter. However, viable organisms were detected throughout the year. The concentrations were also high in the forested sites, with possible sources including wildlife, pets, septic wastes and livestock. E. coli concentrations and loadings were related to TSS concentrations and loadings, whether manure had been spread in the last 30 days and for concentrations only, antecedent rainfall. Viable E. coli were also present in ditch sediment between storm events and were available for resuspension and transport. Total suspended solids concentrations averaged 0.51 g/L and reached as high as 52.2 g/L. Loads were similarly high, at an average of 631.6 kg/day. Both concentrations and loads tended to be associated with discharge and rainfall parameters. The cumulative pollutant contribution from the ditch network was estimated to be large enough to produce detectable and sometimes high concentrations in a receiving stream in a small, rural watershed. Roadside drainage networks need to be actively managed for water quality improvements, because they capture and rapidly shunt stormwater and associated contaminants to streams.

Stakeholder analysis combined with social network analysis provides fine-grained insights into water infrastructure planning processes

Environmental policy and decision-making are characterized by complex interactions between different actors and sectors. As a rule, a stakeholder analysis is performed to understand those involved, but it has been criticized for lacking quality and consistency. This lack is remedied here by a formal social network analysis that investigates collaborative and multi-level governance settings in a rigorous way. We examine the added value of combining both elements. Our case study examines infrastructure planning in the Swiss water sector. Water supply and wastewater infrastructures are planned far into the future, usually on the basis of projections of past boundary conditions. They affect many actors, including the population, and are expensive. In view of increasing future dynamics and climate change, a more participatory and long-term planning approach is required. Our specific aims are to investigate fragmentation in water infrastructure planning, to understand how actors from different decision levels and sectors are represented, and which interests they follow. We conducted 27 semi-structured interviews with local stakeholders, but also cantonal and national actors. The network analysis confirmed our hypothesis of strong fragmentation: we found little collaboration between the water supply and wastewater sector (confirming horizontal fragmentation), and few ties between local, cantonal, and national actors (confirming vertical fragmentation). Infrastructure planning is clearly dominated by engineers and local authorities. Little importance is placed on longer-term strategic objectives and integrated catchment planning, but this was perceived as more important in a second analysis going beyond typical questions of stakeholder analysis. We conclude that linking a stakeholder analysis, comprising rarely asked questions, with a rigorous social network analysis is very fruitful and generates complementary results. This combination gave us deeper insight into the socio-political-engineering world of water infrastructure planning that is of vital importance to our well-being.

Occurrence of waterborne pathogens and Escherichia coli at offshore drinking water intakes in lake Ontario

The occurrence of waterborne pathogens was investigated at three drinking water intakes located about 2 km offshore in Lake Ontario. Water sampling was conducted over 3 years for Campylobacter spp., Cryptosporidium spp., Giardia spp., cultivable enteric viruses, and water quality parameters. All pathogens were detected in the offshore source water for each water treatment plant (WTP1 to WTP3), although at relatively low frequencies and concentrations. Giardia was the most common pathogen, occurring in 36% of water samples from the influent of WTP1 (n = 46), and with a maximum concentration of 0.70 cysts/liter in this influent. Cryptosporidium occurred as frequently as 15% in the WTP2 influent (n = 35), with a maximum concentration of 0.40 oocysts/liter in the WTP1 influent. The human Bacteroidales HF183 DNA marker was most common in the WTP1 influent (19%), and this was the only WTP where the Cryptosporidium hominis genotype was detected. No water quality parameter was predictive of pathogen occurrence across all three WTP influents. Escherichia coli was often below detection when pathogens were detected, and spikes in E. coli concentrations often did not coincide with pathogen occurrence. After summer rain events, river plumes had E. coli concentrations as high as 222 CFU/100 ml in surface waters 2 km offshore, without impacting drinking water intakes below the thermocline on the lake bottom. At times, prechlorination to control mussels at offshore intake cribs compromised the use of E. coli for "raw" water quality assessment, particularly for chlorine-resistant Cryptosporidium. E. coli measured by standard methods did not reliably predict pathogen occurrence at drinking water intakes in offshore ecosystems.

Assessing seasonal variations and age patterns in mortality during the first year of life in Tanzania

Lack of birth and death registries in most of developing countries, particularly those in sub-Saharan Africa led to the establishment of Demographic Surveillance Systems (DSS) sites which monitor large population cohorts within defined geographical areas. DSS collects longitudinal data on migration, births, deaths and their causes via verbal autopsies. DSS data provide an opportunity to monitor many health indicators including mortality trends. Mortality rates in Sub-Sahara Africa show seasonal patterns due to high infant and child malaria-related mortality which is influenced by seasonal features present in environmental and climatic factors. However, it is unclear whether seasonal patterns differ by age in the first few months of life. This study provides an overview of approaches to assess, capture and detect seasonality peaks and patterns in mortality using the infant mortality data from the Rufiji DSS, Tanzania. Seasonality was best captured using Bayesian negative binomial models with time and cycle dependent seasonal parameters and autoregressive temporal error terms. Seasonal patterns are similar among different age groups during infancy and timing of their mortality peaks do not differ. Seasonality in mortality rates with two peaks per year is pronounced which corresponds to rainy seasons. Understanding of these trends is important for public health preparedness.

Geographic setting influences Great Lakes beach microbiological water quality

Understanding of factors that influence Escherichia coli (EC) and enterococci (ENT) concentrations, pathogen occurrence, and microbial sources at Great Lakes beaches comes largely from individual beach studies. Using 12 representative beaches, we tested enrichment cultures from 273 beach water and 22 tributary samples for EC, ENT, and genes indicating the bacterial pathogens Shiga-toxin producing E. coli (STEC), Shigella spp. , Salmonella spp , Campylobacter jejuni/coli , and methicillin-resistant Staphylococcus aureus , and 108-145 samples for Bacteroides human, ruminant, and gull source-marker genes. EC/ENT temporal patterns, general Bacteroides concentration, and pathogen types and occurrence were regionally consistent (up to 40 km), but beach catchment variables (drains/creeks, impervious surface, urban land cover) influenced exceedances of EC/ENT standards and detections of Salmonella and STEC. Pathogen detections were more numerous when the EC/ENT Beach Action Value (but not when the Geometric Mean and Statistical Threshold Value) was exceeded. EC, ENT, and pathogens were not necessarily influenced by the same variables. Multiple Bacteroides sources, varying by date, occurred at every beach. Study of multiple beaches in different geographic settings provided new insights on the contrasting influences of regional and local variables, and a broader-scale perspective, on significance of EC/ENT exceedances, bacterial sources, and pathogen occurrence.

Climate change and temperature rise: implications on food- and water-borne diseases

This study attempts to quantify climate-induced increases in morbidity rates associated with food- and water-borne illnesses in the context of an urban coastal city, taking Beirut-Lebanon as a study area. A Poisson generalized linear model was developed to assess the impacts of temperature on the morbidity rate. The model was used with four climatic scenarios to simulate a broad spectrum of driving forces and potential social, economic and technologic evolutions. The correlation established in this study exhibits a decrease in the number of illnesses with increasing temperature until reaching a threshold of 19.2 °C, beyond which the number of morbidity cases increases with temperature. By 2050, the results show a substantial increase in food- and water-borne related morbidity of 16 to 28% that can reach up to 42% by the end of the century under A1FI (fossil fuel intensive development) or can be reversed to ~0% under B1 (lowest emissions trajectory), highlighting the need for early mitigation and adaptation measures.

Effects of extreme precipitation to the distribution of infectious diseases in Taiwan, 1994-2008

The incidence of extreme precipitation has increased with the exacerbation of worldwide climate disruption. We hypothesize an association between precipitation and the distribution patterns that would affect the endemic burden of 8 infectious diseases in Taiwan, including water- and vector-borne infectious diseases. A database integrating daily precipitation and temperature, along with the infectious disease case registry for all 352 townships in the main island of Taiwan was analysed for the period from 1994 to 2008. Four precipitation levels, <130 mm, 130–200 mm, 200–350 mm and >350 mm, were categorized to represent quantitative differences, and their associations with each specific disease was investigated using the Generalized Additive Mixed Model and afterwards mapped on to the Geographical Information System. Daily precipitation levels were significantly correlated with all 8 mandatory-notified infectious diseases in Taiwan. For water-borne infections, extreme torrential precipitation (>350 mm/day) was found to result in the highest relative risk for bacillary dysentery and enterovirus infections when compared to ordinary rain (<130 mm/day). Yet, for vector-borne diseases, the relative risk of dengue fever and Japanese encephalitis increased with greater precipitation only up to 350 mm. Differential lag effects following precipitation were statistically associated with increased risk for contracting individual infectious diseases. This study’s findings can help health resource sector management better allocate medical resources and be better prepared to deal with infectious disease outbreaks following future extreme precipitation events.

Influence of variable precipitation on coastal water quality in southern California

OBJECTIVES

To examine the consequences of changing precipitation levels on southern California's recreational coastal water quality, and compare the responses of watersheds with differing levels of urban development.

METHODS

The geo-temporal relationship for six years (2000-2005) of precipitation levels, discharge rates for the ten primary waterways, and coastal water bacteria concentrations at seventy-eight southern California beaches were examined.

RESULTS

Precipitation levels, river-creek discharge rates, and coastal water bacteria concentrations were significantly correlated (p < 0.01) for all ten watersheds investigated. Water bacteria concentrations significantly increased with higher levels of precipitation across 95% of the seventy-eight beaches investigated. A heavily developed watershed had significantly higher median bacteria concentrations (186 cfu) in the adjoining coastal waters compared to an undeveloped watershed (10 cfu) of similar size.

CONCLUSIONS

Precipitation and ensuing runoff strongly control the rate of polluted water delivered to most beaches in southern California. Variable precipitation generates a greater response in coastal water bacteria concentrations in developed watersheds compared to undeveloped areas. Projected declines in regional precipitation as a consequence of climate change may result in less contaminated water delivered to coastal waters, thus decreasing risk of water associated illnesses during winter months.

Climate change and health risks: assessing and responding to them through 'adaptive management'

Climate change and associated changing weather patterns, including severe weather events, are expected to increase the prevalence of a wide range of health risks. Yet there is uncertainty about the timing, location, and severity of these changes. Adaptive management, a structured process of decision making in the face of imperfect information, is an approach that can help the public health field effectively anticipate, plan for, and respond to the health risks of climate change. In this article I describe adaptive management and how it could increase the effectiveness of local and national strategies, policies, and programs to manage climate-sensitive health outcomes.

Arsenic and Mn levels in Isaza (Gymnogobius isaza) during the mass mortality event in Lake Biwa, Japan

The present study measured the concentrations of 25 elements (Li, Mg, V, Cr, Mn, Co, Ni, Cu, Zn, As, Se, Rb, Sr, Mo, Ag, Cd, In, Sn, Sb, Cs, Ba, Hg, Tl, Pb and Bi) in the whole body of Isaza which is an endemic fish species to Lake Biwa, Japan, and compared the values in the specimens from the mass mortality Isaza (MMI) and normal fresh Isaza (NFI). The mean levels of Mn and total As (T-As) were relatively higher in MMI than in NFI. In the T-As, highly toxic inorganic As was detected in MMI. Moreover we found Mn and As concentrations in surface sediment were extremely high and temporally increased. From all these results, we could infer that the dissolution of Mn and As from surface sediment of Lake Biwa might have been one of the cause for the mass mortality of Isaza.

Non-heat related impacts of climate change on working populations

Environmental and social changes associated with climate change are likely to have impacts on the well-being, health, and productivity of many working populations across the globe. The ramifications of climate change for working populations are not restricted to increases in heat exposure. Other significant risks to worker health (including physical hazards from extreme weather events, infectious diseases, under-nutrition, and mental stresses) may be amplified by future climate change, and these may have substantial impacts at all scales of economic activity. Some of these risks are difficult to quantify, but pose a substantial threat to the viability and sustainability of some working populations. These impacts may occur in both developed and developing countries, although the latter category is likely to bear the heaviest burden.This paper explores some of the likely, non-heat-related health issues that climate change will have on working populations around the globe, now and in the future. These include exposures to various infectious diseases (vector-borne, zoonotic, and person-to-person), extreme weather events, stress and mental health issues, and malnutrition.

Association between rainfall and pediatric emergency department visits for acute gastrointestinal illness

BACKGROUND

Microbial water contamination after periods of heavy rainfall is well described, but its link to acute gastrointestinal illness (AGI) in children is not well known.

OBJECTIVES

We hypothesize an association between rainfall and pediatric emergency department (ED) visits for AGI that may represent an unrecognized, endemic burden of pediatric disease in a major U.S. metropolitan area served by municipal drinking water systems.

METHODS

We conducted a retrospective time series analysis of visits to the Children's Hospital of Wisconsin ED in Wauwatosa, Wisconsin. Daily visit totals of discharge International Classification of Diseases, 9th Revision codes of gastroenteritis or diarrhea were collected along with daily rainfall totals during the study period from 2002 to 2007. We used an autoregressive moving average model, adjusting for confounding variables such as sewage release events and season, to look for an association between daily visits and rainfall after a lag of 1-7 days.

RESULTS

A total of 17,357 AGI visits were identified (mean daily total, 7.9; range, 0-56). Any rainfall 4 days prior was significantly associated with an 11% increase in AGI visits. Expected seasonal effects were also seen, with increased AGI visits in winter months.

CONCLUSIONS

We observed a significant association between rainfall and pediatric ED visits for AGI, suggesting a waterborne component of disease transmission in this population. The observed increase in ED visits for AGI occurred in the absence of any disease outbreaks reported to public health officials in our region, suggesting that rainfall-associated illness may be underestimated. Further study is warranted to better address this association.

Sporadic gastroenteritis and recreational swimming in a longitudinal community cohort study in Melbourne, Australia

The relation between sporadic gastroenteritis and recreational swimming was examined in a cohort of 2,811 people in Melbourne, Australia, over a 15-month period (September 1997-February 1999). Data from a prospective community-based study of gastroenteritis were used for a Poisson analysis of temporality between reported swimming (in public or private pools/spas and in marine or freshwater settings) and a highly credible gastroenteritis (HCG) event. Overall, HCG events were more likely in participants who had swum in a public pool/spa (incidence rate ratio (IRR) = 1.25, 95% confidence interval (CI): 1.10, 1.42; P = 0.001) or river/lake/dam (IRR = 1.77, 95% CI: 1.13, 2.79; P = 0.014) during the previous week or had swum in a public pool/spa (IRR = 1.29, 95% CI: 1.13, 1.46; P < 0.001) during the previous 2 weeks. Subanalysis by age showed that HCG episodes were also more likely in adults who had swum in a private pool/spa (IRR = 1.56, 95% CI: 1.02, 2.39; P = 0.042) during the previous week or swum at an ocean/beach (IRR = 1.78, 95% CI: 1.12, 2.81; P = 0.014) during the previous 2 weeks, demonstrating significant associations between all swimming locations and gastrointestinal symptoms. This study showed that although the incremental risk of recreational swimming is significant, it is relatively small.

The future of epidemiology

In this article, the authors discuss current challenges and opportunities in epidemiology that will affect the field's future. Epidemiology is commonly considered the methodologic backbone for the fields of public health and outcomes research because its practitioners describe patterns of disease occurrence, identify risk factors and etiologic determinants, and demonstrate the usefulness of interventions. Like most aspects of science, epidemiology is in rapid flux. Several factors that are influencing and will continue to influence epidemiology and the health of the public include factors fundamental to framing the discipline of epidemiology (i.e., its means of communication, its methodologies, its access to data, its values, its population perspective), factors relating to scientific advances (e.g., genomics, comparative effectiveness in therapeutics), and factors shaping human health (e.g., increasing globalism, the environment, disease and lifestyle, demographics, infectious disease).

Climate change and emergency medicine: impacts and opportunities

There is scientific consensus that the climate is changing, that human activity plays a major role, and that the changes will continue through this century. Expert consensus holds that significant health effects are very likely. Public health and health care systems must understand these impacts to properly pursue preparedness and prevention activities. All of medicine will very likely be affected, and certain medical specialties are likely to be more significantly burdened based on their clinical activity, ease of public access, public health roles, and energy use profiles. These specialties have been called on to consider the likely impacts on their patients and practice and to prepare their practitioners. Emergency medicine (EM), with its focus on urgent and emergent ambulatory care, role as a safety-net provider, urban concentration, and broad-based clinical mission, will very likely experience a significant rise in demand for its services over and above current annual increases. Clinically, EM will see amplification of weather-related disease patterns and shifts in disease distribution. In EM's prehospital care and disaster response activities, both emergency medical services (EMS) activity and disaster medical assistance team (DMAT) deployment activities will likely increase. EM's public health roles, including disaster preparedness, emergency department (ED)-based surveillance, and safety-net care, are likely to face increasing demands, along with pressures to improve fuel efficiency and reduce greenhouse gas emissions. Finally, EM's roles in ED and hospital management, particularly related to building and purchasing, are likely to be impacted by efforts to reduce greenhouse gas emissions and enhance energy efficiency. Climate change thus presents multiple clinical and public health challenges to EM, but also creates numerous opportunities for research, education, and leadership on an emerging health issue of global scope.