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Perkins RG, Slavin EI, Andrade TMC, Blenkinsopp C, Pearson P, Froggatt T, Godwin G, Parslow J, Hurley S, Luckwell R, Wain DJ. Managing taste and odour metabolite production in drinking water reservoirs: The importance of ammonium as a key nutrient trigger. J Environ Manage 2019; 244:276-284. [PMID: 31128332 DOI: 10.1016/j.jenvman.2019.04.123] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/18/2019] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
Taste and odour (T&O) compounds (most commonly 2-MIB and Geosmin) in drinking water are becoming an increasingly global problem for water management. Here, the trigger(s) for 2-MIB and Geosmin production were investigated in Plas Uchaf reservoir (North Wales, UK) with detailed water sample analysis between 2015 and 2016. Historical abstraction data from this reservoir and 4 reservoirs in Somerset (England, UK) were compared statistically using Self-Organising Map (SOM) analysis. In-reservoir measurements (2015-2016) revealed an 85% reduction in ammonium from the primary external loading source led to lower 2-MIB and Geosmin concentrations, with peak concentrations of 2-MIB declining from 60 to 21 ng l-1 and Geosmin declining from 140 to 18 ng l-1. No other measured water chemistry parameter showed a significant difference between years. The SOM results support the in-reservoir findings, revealing 2-MIB and Geosmin to be associated with high ammonium relative to nitrate for all 5 reservoirs. We conclude that ammonium is key for stimulating cyanobacterial productivity and production of T&O compounds. Whilst it is well understood that adequate availability of phosphorus is required for rapid growth in cyanobacteria, and hence should still be considered in management decisions, we suggest that monitoring sources and concentrations of ammonium is key for managing T&O outbreaks in drinking water reservoirs.
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Affiliation(s)
- R G Perkins
- School of Earth and Ocean Sciences, Cardiff University, Park Place, Cardiff, Wales, CF10 3AT, UK; Catchment Team, Dŵr Cymru Welsh Water, Pentwyn Road, Nelson, Treharris, Wales, CF46 6LY, UK
| | - E I Slavin
- Department of Architecture and Civil Engineering, University of Bath, Claverton, Bath, England, BA2 7AY, UK.
| | - T M C Andrade
- Catchment Team, Dŵr Cymru Welsh Water, Pentwyn Road, Nelson, Treharris, Wales, CF46 6LY, UK
| | - C Blenkinsopp
- Department of Architecture and Civil Engineering, University of Bath, Claverton, Bath, England, BA2 7AY, UK
| | - P Pearson
- Head of Water Services Science, Dŵr Cymru Welsh Water, Pentwyn Road, Nelson, Treharris, Wales, CF46 6LY, UK
| | - T Froggatt
- Catchment Team, Dŵr Cymru Welsh Water, Pentwyn Road, Nelson, Treharris, Wales, CF46 6LY, UK
| | - G Godwin
- Catchment Team, Dŵr Cymru Welsh Water, Pentwyn Road, Nelson, Treharris, Wales, CF46 6LY, UK
| | - J Parslow
- Catchment Team, Dŵr Cymru Welsh Water, Pentwyn Road, Nelson, Treharris, Wales, CF46 6LY, UK
| | - S Hurley
- Wessex Water, Operations Centre, Claverton Down Road, Claverton, Bath, BA2 7WW, UK
| | - R Luckwell
- Bristol Water Plc., Bridgwater Road, Bristol, BS13 7AT, UK
| | - D J Wain
- Department of Architecture and Civil Engineering, University of Bath, Claverton, Bath, England, BA2 7AY, UK
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Mathioudakis N, Jeun R, Godwin G, Perschke A, Yalamanchi S, Everett E, Greene P, Knight A, Yuan C, Hill Golden S. Development and Implementation of a Subcutaneous Insulin Clinical Decision Support Tool for Hospitalized Patients. J Diabetes Sci Technol 2019; 13:522-532. [PMID: 30198324 PMCID: PMC6501530 DOI: 10.1177/1932296818798036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Insulin is one of the highest risk medications used in hospitalized patients. Multiple complex factors must be considered in determining a safe and effective insulin regimen. We sought to develop a computerized clinical decision support (CDS) tool to assist hospital-based clinicians in insulin management. METHODS Adapting existing clinical practice guidelines for inpatient glucose management, a design team selected, configured, and implemented a CDS tool to guide subcutaneous insulin dosing in non-critically ill hospitalized patients at two academic medical centers that use the EpicCare® electronic medical record (EMR). The Agency for Healthcare Research and Quality (AHRQ) best practices in CDS design and implementation were followed. RESULTS A CDS tool was developed in the form of an EpicCare SmartForm, which generates an insulin regimen by integrating information about the patient's body weight, diabetes type, home and hospital insulin requirements, and nutritional status. Total daily recommended insulin doses are distributed into respective basal and nutritional doses with a tailored correctional insulin scale. Preimplementation, several approaches were used to communicate this new tool to clinicians, including emails, lectures, and videos. Postimplementation, a support team was available to address user technical issues. Feedback from stakeholders has been used to continuously refine the tool. Inclusion of the programming in the EMR vendor's community library has allowed dissemination of the tool outside our institution. CONCLUSIONS We have developed an EMR-based tool to guide SQ insulin dosing in non-critically ill hospitalized patients. Further studies are needed to evaluate adoption and clinical effectiveness of this intervention.
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Affiliation(s)
- Nestoras Mathioudakis
- Division of Endocrinology, Diabetes
& Metabolism, Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Nestoras Mathioudakis, MD MHS, Division of
Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of
Medicine, 1830 E Monument St, Ste 333, Baltimore, MD 21287, USA.
| | - Rebecca Jeun
- Division of Endocrinology, Diabetes
& Metabolism, Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Gerald Godwin
- Epic Information Technology Team, Johns
Hopkins Health System, Baltimore, MD, USA
| | - Annette Perschke
- Nursing Administration, Clinical
Informatics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Swaytha Yalamanchi
- Division of Endocrinology, Diabetes
& Metabolism, Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Estelle Everett
- Division of Endocrinology, Diabetes
& Metabolism, Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | | | - Amy Knight
- Johns Hopkins Bayview Medical Center,
Baltimore, MD, USA
| | - Christina Yuan
- Armstrong Institute for Patient Safety
and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sherita Hill Golden
- Division of Endocrinology, Diabetes
& Metabolism, Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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Caravani K, Jarema T, Kazi A, Murry R, Godwin G. EP-1684 Radiation isocontour levels for shielding considerations of the Varian Halcyon linear accelerator. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Simpson J, Loria D, Kazi A, Godwin G, Sasso G. 1561 poster MR SPECTROSCOPY IMAGING IN RADIOTHERAPY TREATMENT PLANNING OF THE PROSTATE: DOSE PAINTING THE DOMINANT LESION. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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