Incidence and geographical distribution of sudden infant death syndrome in relation to content of nitrate in drinking water and groundwater levels

The position of geochemical variables as causal co-factors of diseases of unknown aetiology

Abstract

The term diseases of unknown aetiology (DUA) or idiopathic diseases is used to describe diseases that are of uncertain or unknown cause or origin. Among plausible geoenvironmental co-factors in causation of DUA, this article focusses on the entry of trace elements, including metals and metalloids into humans, and their involvement in humoral and cellular immune responses, representing potentially toxic agents with implications as co-factors for certain DUA. Several trace elements/metals/metalloids (micronutrients) play vital roles as co-factors for essential enzymes and antioxidant molecules, thus, conferring protection against disease. However, inborn errors of trace element/metal/metalloid metabolisms can occur to produce toxicity, such as when there are basic defects in the element transport mechanism. Ultimately, it is the amount of trace element, metal or metalloid that is taken up, its mode of accumulation in human tissues, and related geomedical attributes such as the chemical form and bioavailability that decisively determine whether the exerted effects are toxic or beneficial. Several case descriptions of DUA that are common worldwide are given to illustrate our knowledge so far of how trace element/metal/metalloid interactions in the immune system may engender its dysregulation and be implicated as causal co-factors of DUA.

Article highlights

The importance of a proper understanding of geochemical perturbations in human metabolisms is emphasisedIt is proferred that such an understanding would aid greatly in the decipherment of diseases of unknown aetiology (DUA)The thesis presented may pave the way towards better diagnosis and therapy of DUA.

Nano-enabling of strong-base ion-exchange media via a room-temperature aluminum (hydr)oxide synthesis method to simultaneously remove nitrate and fluoride

This study demonstrated a new room-temperature method for synthesizing aluminum (hydr)oxide material inside the pores of strong-base ion-exchange resin to fabricate a novel class of hybrid media capable of simultaneously removing nitrate and fluoride as model groundwater contaminants. The aluminum (hydr)oxide hybrid media was fabricated by reducing aluminum ion precursors with borohydride within ion-exchange resin at room temperature, followed by exposure to environmental oxygen. The hybrid media was characterized, and its performance to simultaneously remove nitrate and fluoride was determined in simple and complex water matrices using short-bed column tests operated under conditions realistic for point-of-use systems. Results revealed that, although not optimized, aluminum (hydr)oxide hybrid media was able to simultaneously remove nitrate and fluoride, which was not possible with neither unmodified strong-base ion-exchange resin nor conventional granular activated alumina alone. Future modifications and optimizations of this relatively simple and inexpensive fabrication process have the potential to yield an entire class of hybrid media suitable for point-of-use/point-of-entry water treatment systems.

Electrochemically-induced reduction of nitrate in aqueous solution

In this study, we evaluated the removal of nitrate from synthetic groundwater by a cathode followed by an anode electrode sequence in the electrochemical flow-through reactor. We also tested the feasibility of the used electrode sequence to minimize the production of ammonia during the nitrate reduction. The performance of monometallic Fe, Cu, Ni and carbon foam cathodes was tested under different current intensities, flow rates/regimes and the presence of Pd and Ag catalyst coating. With the use of monometallic Fe and an increase in current intensity from 60 mA to 120 mA, the nitrate removal rate increased from 7.6% to 25.0%, but values above 120 mA caused a decrease in removal due to excessive gas formation at the electrodes. Among tested materials, monometallic Fe foam cathode showed the highest nitrates removal rate and increased significantly in the presence of Pd catalyst: from 25.0% to 39.8%. Further, the circulation under 3 mL min^-1 elevated the nitrate removal by 33% and the final nitrate concentration fell below the maximum contaminant level of 10 mg L^-1 nitrate-nitrogen (NO₃-N). During the treatment, the yield of ammonia production after the cathode was 92±4% while after the anode (Ti/IrO₂/Ta₂O₅), the amount of ammonia significantly declined to 50%. The results proved that flow-through, undivided electrochemical systems can be used to remove nitrate from groundwater with the possibility of simultaneously controlling the generation of ammonia.

Does the groundwater nitrate pollution in China pose a risk to human health? A critical review of published data

Nitrate pollution has pervaded many parts of the world, especially in developing countries such as China. Based on the available groundwater nitrate data sets in China (2000-2015), the groundwater pollution levels at the provincial scale are evaluated which contains 33 provinces (units) except for Macau because of lacking data. Then, the potential risks posed to human health in national scale are quantified. In order to make the results more precise and systematical, both drinking and dermal contact exposure pathways are considered, and the influenced crowd are more finely divided into four groups to study the impacts of age and gender on the outcome, which include infants (0-6 months), children (7 months-17 years old), adult males (18 years old-), and adult females (18 years old-). Results indicate that there are seven units whose groundwater nitrate concentrations exceed the standard value with Shaanxi being a seriously poor condition. Facing the same level of nitrate, the health risk level changes in the order of infants > children > adult males > adult females. That is to say, minors and males are more vulnerable compared with adults and females, respectively. There is no adverse effect on adult females of the whole country, while gender really impacts on the health risk assessment result. Adult males, children, and infants face various degrees of health risk respectively in Shaanxi and Shandong, which are needed to pay more attention to.

SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment

Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.

Advances in nanomaterial based approaches for enhanced fluoride and nitrate removal from contaminated water

Various nanomaterials for fluoride and nitrate removal from contaminated water.

Simultaneous removal of selected oxidized contaminants in groundwater using a continuously stirred hydrogen-based membrane biofilm reactor

A laboratory trial was conducted for evaluating the capability of a continuously stirred hydrogen-based membrane biofilm reactor to simultaneously reduce nitrate (NO(3-)-N), sulfate (SO4(2-)), bromate (BrO3-), hexavalent chromium (Cr(VI)) and parachloronitrobenzene (p-CNB). The reactor contained two bundles of hollow fiber membranes functioning as an autotrophic biofilm carrier and hydrogen pipe as well. On the condition that hydrogen was supplied as electron donor and diffused into water through membrane pores, autohydrogenotrophic bacteria were capable of reducing contaminants to forms with lower toxicity. Reduction occurred within 1 day and removal fluxes for NO(3-)-N, SO4(2-), BrO3-, Cr(VI), and p-CNB reached 0.641, 2.396, 0.008, 0.016 and 0.031 g/(day x m2), respectively after 112 days of continuous operation. Except for the fact that sulfate was 37% removed under high surface loading, the other four contaminants were reduced by over 95%. The removal flux comparison between phases varying in surface loading and H2 pressure showed that decreasing surface loading or increasing H2 pressure would promote removal flux. Competition for electrons occurred among the five contaminants. Electron-equivalent flux analysis showed that the amount of utilized hydrogen was mainly controlled by NO(3-)-N and SO4(2-) reduction, which accounted for over 99% of the electron flux altogether. It also indicated the electron acceptor order, showing that nitrate was the most prior electron acceptor while suIfate was the second of the five contaminants.

SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment

Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying "Policy Statement--Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).

Development of a novel nitrate-selective composite sensor based on doped polypyrrole

The manufacture and evaluation of a novel sensor built with a composite material, highly selective to nitrate ions using doped polypyrrole as a recognition agent, are presented. When the ratio of recognition agent to graphite was optimized at 1:1, and the sensitivities found closely approached nernstian behavior. The stability times attained were less than 14 min with response times also below 20 s. Batch characterization of the sensor displayed a sensitivity of 57.1 mV/decade of nitrate ion activity (alphaNO3-) and a detection limit of 5.37 x 10(-5) M, which are comparable to those reported for commercial sensors. Evaluation of the selectivity coefficients showed high affinity to nitrate ion, superior to that of commercial sensors and others reported in the literature. The composite material gives the sensor a prolonged service life with the added capability of allowing the regeneration of its active surface. Coupling the sensor and a solid state, composite-type, reference electrode to a flow injection analysis system (FIA) permitted to achieve an effective overall assessment of the system. A nitrate determination test was conducted on real samples. A comparison of the results obtained, either with stationary measurements or with FIA, indicated that there were no significant differences from the values from manufacturer's specifications.