20 CFR 654.406 - Excreta and liquid waste disposal.

Code of Federal Regulations, 2011 CFR

2011-04-01

... subsurface septic tank-seepage system or other type of liquid waste treatment and disposal system, privies or... RESPONSIBILITIES OF THE EMPLOYMENT SERVICE SYSTEM Housing for Agricultural Workers Housing Standards § 654.406... accumulate on the ground surface. (b) Where public sewer systems are available, all facilities for disposal...

20 CFR 654.406 - Excreta and liquid waste disposal.

Code of Federal Regulations, 2012 CFR

2012-04-01

... subsurface septic tank-seepage system or other type of liquid waste treatment and disposal system, privies or... RESPONSIBILITIES OF THE EMPLOYMENT SERVICE SYSTEM Housing for Agricultural Workers Housing Standards § 654.406... accumulate on the ground surface. (b) Where public sewer systems are available, all facilities for disposal...

20 CFR 654.406 - Excreta and liquid waste disposal.

Code of Federal Regulations, 2013 CFR

2013-04-01

... subsurface septic tank-seepage system or other type of liquid waste treatment and disposal system, privies or... RESPONSIBILITIES OF THE EMPLOYMENT SERVICE SYSTEM Housing for Agricultural Workers Housing Standards § 654.406... accumulate on the ground surface. (b) Where public sewer systems are available, all facilities for disposal...

Closure Report for Corrective Action Unit 516: Septic Systems and Discharge Points

DOE Office of Scientific and Technical Information (OSTI.GOV)

NSTec Environmental Restoration

Corrective Action Unit (CAU) 516 is located in Areas 3, 6, and 22 of the Nevada Test Site. CAU 516 is listed in the Federal Facility Agreement and Consent Order of 1996 as Septic Systems and Discharge Points, and is comprised of six Corrective Action Sites (CASs): {sm_bullet} CAS 03-59-01, Bldg 3C-36 Septic System {sm_bullet} CAS 03-59-02, Bldg 3C-45 Septic System {sm_bullet} CAS 06-51-01, Sump and Piping {sm_bullet} CAS 06-51-02, Clay Pipe and Debris {sm_bullet} CAS 06-51-03, Clean Out Box and Piping {sm_bullet} CAS 22-19-04, Vehicle Decontamination Area The Nevada Division of Environmental Protection (NDEP)-approved corrective action alternative for CASsmore » 06-51-02 and 22-19-04 is no further action. The NDEP-approved corrective action alternative for CASs 03-59-01, 03-59-02, 06-51-01, and 06-51-03 is clean closure. Closure activities included removing and disposing of total petroleum hydrocarbon (TPH)-impacted septic tank contents, septic tanks, distribution/clean out boxes, and piping. CAU 516 was closed in accordance with the NDEP-approved CAU 516 Corrective Action Plan (CAP). The closure activities specified in the CAP were based on the recommendations presented in the CAU 516 Corrective Action Decision Document (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2004). This Closure Report documents CAU 516 closure activities. During closure activities, approximately 186 tons of hydrocarbon waste in the form of TPH-impacted soil and debris, as well as 89 tons of construction debris, were generated and managed and disposed of appropriately. Waste minimization techniques, such as field screening of soil samples and the utilization of laboratory analysis to characterize and classify waste streams, were employed during the performance of closure work.« less

Water quality impacts from on-site waste disposal systems to coastal areas through groundwater discharge

NASA Astrophysics Data System (ADS)

Harris, P. J.

1995-12-01

This report summarizes research studies linking on-site waste disposal systems (OSDS) to pathogen and nutrient concentrations in groundwater with the potential to impact coastal embayments. Few studies connect OSDS to coastal water quality. Most studies examined pathogen and nutrient impacts to groundwater and omitted estimations of contaminants discharged to surface water. The majority of studies focused on nitrogen, with little information on pathogens and even less on phosphorus. Nitrogen discharged from OSDS poses the greatest threat to water quality. Vertical distance of septic tank infiltration system from the water table, septic system design, and siting remain the key components in minimizing potential impacts from OSDS for control of both pathogens and nutrients. The most comprehensive information connecting nutrient contributions from OSDS to surface water quality was the study conducted on Buttermilk Bay in Massachusetts where 74% of nitrogen to the bay was attributed to onsite disposal systems. In conclusion, further studies on the viability and transport of pathogens and nutrients through the groundwater aquifer and across the groundwater/surface-water interface are needed. Additional research on the importance of septic system design on the availability of contaminants to groundwater as well as the minimum distance between the septic system and water table necessary to protect groundwater are also indicated.

Pharmaceuticals in on-site sewage effluent and ground water, Western Montana

USGS Publications Warehouse

Godfrey, E.; Woessner, W.W.; Benotti, M.J.

2007-01-01

Human use of pharmaceuticals results in the excretion and disposal of compounds that become part of municipal and domestic waste streams. On-site waste water disposal and leaking city sewer systems can provide avenues for the migration of effluent to the underlying aquifers. This research assessed the occurrence and persistence of 22 target pharmaceuticals in septic tank effluent and two shallow, coarse-grained aquifers in western Montana. Twelve compounds (acetaminophen, caffeine, codeine, carbamazepine, cotinine, erythromycin-18, nicotine, paraxanthine, ranitidine, sulfamethoxazole, trimethoprim, and warfarin) were detected in a high school septic tank effluent. Three of the 12 compounds, carbamazepine, sulfamethoxazole, and nicotine, were detected in the underlying sand and gravel aquifer after effluent percolation through a 2.0-m thick sand vadose zone. Sampling of a second sand, gravel, and cobble dominated unconfined aquifer, partially overlain by septic systems and a city sewer system, revealed the presence of caffeine, carbamazepine, cotinine, nicotine, and trimethoprim. The presence of carbamazepine and sulfamethoxazole in these aquifers appears to correlate with local usage based on a reported monthly prescription volume. This work highlights the need for expanding geochemical investigations of sewage waste impacted ground water systems to include sampling for selected pharmaceuticals. ?? 2007 National Ground Water Association.

Pharmaceuticals in on-site sewage effluent and ground water, Western Montana.

PubMed

Godfrey, Emily; Woessner, William W; Benotti, Mark J

2007-01-01

Human use of pharmaceuticals results in the excretion and disposal of compounds that become part of municipal and domestic waste streams. On-site waste water disposal and leaking city sewer systems can provide avenues for the migration of effluent to the underlying aquifers. This research assessed the occurrence and persistence of 22 target pharmaceuticals in septic tank effluent and two shallow, coarse-grained aquifers in western Montana. Twelve compounds (acetaminophen, caffeine, codeine, carbamazepine, cotinine, erythromycin-18, nicotine, paraxanthine, ranitidine, sulfamethoxazole, trimethoprim, and warfarin) were detected in a high school septic tank effluent. Three of the 12 compounds, carbamazepine, sulfamethoxazole, and nicotine, were detected in the underlying sand and gravel aquifer after effluent percolation through a 2.0-m thick sand vadose zone. Sampling of a second sand, gravel, and cobble dominated unconfined aquifer, partially overlain by septic systems and a city sewer system, revealed the presence of caffeine, carbamazepine, cotinine, nicotine, and trimethoprim. The presence of carbamazepine and sulfamethoxazole in these aquifers appears to correlate with local usage based on a reported monthly prescription volume. This work highlights the need for expanding geochemical investigations of sewage waste impacted ground water systems to include sampling for selected pharmaceuticals.

Corrective Action Plan for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point, Nevada Test Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

K. B. Campbell

This Corrective Action Plan (CAP) provides selected corrective action alternatives and proposes the closure methodology for Corrective Action Unit (CAU) 262, Area 25 Septic Systems and Underground Discharge Point. CAU 262 is identified in the Federal Facility Agreement and Consent Order (FFACO) of 1996. Remediation of CAU 262 is required under the FFACO. CAU 262 is located in Area 25 of the Nevada Test Site (NTS), approximately 100 kilometers (km) (62 miles [mi]) northwest of Las Vegas, Nevada. The nine Corrective Action Sites (CASs) within CAU 262 are located in the Nuclear Rocket Development Station complex. Individual CASs are locatedmore » in the vicinity of the Reactor Maintenance, Assembly, and Disassembly (R-MAD); Engine Maintenance, Assembly, and Disassembly (E-MAD); and Test Cell C compounds. CAU 262 includes the following CASs as provided in the FFACO (1996); CAS 25-02-06, Underground Storage Tank; CAS 25-04-06, Septic Systems A and B; CAS 25-04-07, Septic System; CAS 25-05-03, Leachfield; CAS 25-05-05, Leachfield; CAS 25-05-06, Leachfield; CAS 25-05-08, Radioactive Leachfield; CAS 25-05-12, Leachfield; and CAS 25-51-01, Dry Well. Figures 2, 3, and 4 show the locations of the R-MAD, the E-MAD, and the Test Cell C CASs, respectively. The facilities within CAU 262 supported nuclear rocket reactor engine testing. Activities associated with the program were performed between 1958 and 1973. However, several other projects used the facilities after 1973. A significant quantity of radioactive and sanitary waste was produced during routine operations. Most of the radioactive waste was managed by disposal in the posted leachfields. Sanitary wastes were disposed in sanitary leachfields. Septic tanks, present at sanitary leachfields (i.e., CAS 25-02-06,2504-06 [Septic Systems A and B], 25-04-07, 25-05-05,25-05-12) allowed solids to settle out of suspension prior to entering the leachfield. Posted leachfields do not contain septic tanks. All CASs located in CAU 262 are inactive or abandoned. However, some leachfields may still receive liquids from runoff during storm events. Results from the 2000-2001 site characterization activities conducted by International Technology (IT) Corporation, Las Vegas Office are documented in the Corrective Action Investigation Report for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point, Nevada Test Site, Nevada. This document is located in Appendix A of the Corrective Action Decision Document for CAU 262. Area 25 Septic Systems and Underground Discharge Point, Nevada Test Site, Nevada. (DOE/NV, 2001).« less

Remaining Sites Verification Package for the 1607-B2 Septic System and 100-B-14:2 Sanitary Sewer System, Waste Site Reclassification Form 2006-055

DOE Office of Scientific and Technical Information (OSTI.GOV)

L. M. Dittmer

The 1607-B2 waste site is a former septic system associated with various 100-B facilities, including the 105-B, 108-B, 115-B/C, and 185/190-B buildings. The site was evaluated based on confirmatory results for feeder lines within the 100-B-14:2 subsite and determined to require remediation. The 1607-B2 waste site has been remediated to achieve the remedial action objectives specified in the Remaining Sites ROD. The results of verification sampling show that residual contaminant concentrations do not preclude any future uses and allow for unrestricted use of shallow zone soils. The results also demonstrate that residual contaminant concentrations are protective of groundwater and themore » Columbia River.« less

40 CFR 258.28 - Liquids restrictions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... septic waste; (2) The waste is leachate or gas condensate derived from the MSWLF unit and the MSWLF unit... leachate collection system as described in § 258.40(a)(2) of this part. The owner or operator must place...

40 CFR 258.28 - Liquids restrictions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... septic waste; (2) The waste is leachate or gas condensate derived from the MSWLF unit and the MSWLF unit... leachate collection system as described in § 258.40(a)(2) of this part. The owner or operator must place...

40 CFR 258.28 - Liquids restrictions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... septic waste; (2) The waste is leachate or gas condensate derived from the MSWLF unit and the MSWLF unit... leachate collection system as described in § 258.40(a)(2) of this part. The owner or operator must place...

Greenhouse gas emissions from septic systems in New York State

NASA Astrophysics Data System (ADS)

Truhlar, A. M.; Rahm, B. G.; Brooks, R. A.; Nadeau, S. A.; Walter, M. T.

2015-12-01

Onsite septic systems are a practical way to treat wastewater in rural or less-densely populated areas. Septic systems utilize microbial processes to eliminate organic wastes and nutrients such as nitrogen; these processes can contribute to air pollution through the release of greenhouse gases (GHGs). At each of nine septic systems, we measured fluxes of CH4, CO2, and N2O from the soil over the leach field and sand filter, and from the roof outlet vent. These are the most likely locations for gas emissions during normal operation of the septic system. The majority of all septic system gas emissions were released from the roof vent. However, our comparisons of the gas fluxes from these locations suggest that biological processes in the soil, especially the soil over the leach field, can influence the type and quantity of gas that is released from the system. The total vent, sand filter, and leach field GHG emissions were 0.12, 0.045, and 0.046 tonne CO2e capita-1 year-1, respectively. In total, this represents about 1.5% of the annual carbon footprint of an individual living in the US.

Closure Report for Corrective Action Unit 224: Decon Pad and Septic Systems, Nevada Test Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

NSTec Environmental Restoration

Corrective Action Unit (CAU) 224 is located in Areas 02, 03, 05, 06, 11, and 23 of the Nevada Test Site, which is situated approximately 65 miles northwest of Las Vegas, Nevada. CAU 224 is listed in the Federal Facility Agreement and Consent Order (FFACO) of 1996 as Decon Pad and Septic Systems and is comprised of the following nine Corrective Action Sites (CASs): CAS 02-04-01, Septic Tank (Buried); CAS 03-05-01, Leachfield; CAS 05-04-01, Septic Tanks (4)/Discharge Area; CAS 06-03-01, Sewage Lagoons (3); CAS 06-05-01, Leachfield; CAS 06-17-04, Decon Pad and Wastewater Catch; CAS 06-23-01, Decon Pad Discharge Piping; CASmore » 11-04-01, Sewage Lagoon; and CAS 23-05-02, Leachfield. The Nevada Division of Environmental Protection (NDEP)-approved corrective action alternative for CASs 02-04-01, 03-05-01, 06-03-01, 11-04-01, and 23-05-02 is no further action. As a best management practice, the septic tanks and distribution box were removed from CASs 02-04-01 and 11-04-01 and disposed of as hydrocarbon waste. The NDEP-approved correction action alternative for CASs 05-04-01, 06-05-01, 06-17-04, and 06-23-01 is clean closure. Closure activities for these CASs included removing and disposing of radiologically and pesticide-impacted soil and debris. CAU 224 was closed in accordance with the NDEP-approved CAU 224 Corrective Action Plan (CAP). The closure activities specified in the CAP were based on the recommendations presented in the CAU 224 Corrective Action Decision Document (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, 2005). This Closure Report documents CAU 224 closure activities. During closure activities, approximately 60 cubic yards (yd3) of mixed waste in the form of soil and debris; approximately 70 yd{sup 3} of sanitary waste in the form of soil, liquid from septic tanks, and concrete debris; approximately 10 yd{sup 3} of hazardous waste in the form of pesticide-impacted soil; approximately 0.5 yd{sup 3} of universal waste in the form of fluorescent light bulbs; and approximately 0.5 yd{sup 3} of low-level waste in the form of a radiologically impacted fire hose rack were generated, managed, and disposed of appropriately. Waste minimization techniques, such as the utilization of laboratory analysis and field screening to guide the extent of excavations, were employed during the performance of closure work.« less

Use of an Artificial Sweetener to Identify Sources of Groundwater Nitrate Contamination.

PubMed

Robertson, W D; Van Stempvoort, D R; Roy, J W; Brown, S J; Spoelstra, J; Schiff, S L; Rudolph, D R; Danielescu, S; Graham, G

2016-07-01

The artificial sweetener acesulfame (ACE) is a potentially useful tracer of waste water contamination in groundwater. In this study, ACE concentrations were measured in waste water and impacted groundwater at 12 septic system sites in Ontario, Canada. All samples of septic tank effluent (n = 37) had ACE >6 µg/L, all samples of groundwater from the proximal plume zones (n = 93) had ACE >1 µg/L and, almost all samples from the distal plume zones had ACE >2 µg/L. Mean mass ratios of total inorganic nitrogen/ACE at the 12 sites ranged from 680 to 3500 for the tank and proximal plume samples. At five sites, decreasing ratio values in the distal zones indicated nitrogen attenuation. These ratios were applied to three aquifers in Canada that are nitrate-stressed and an urban stream where septic systems are present nearby to estimate the amount of waste water nitrate contamination. At the three aquifer locations that are agricultural, low ACE values (<0.02-0.15 µg/L) indicated that waste water contributed <15% of the nitrate in most samples. In groundwater discharging to the urban stream, much higher ACE values (0.2-11 µg/L) indicated that waste water was the likely source of >50% of the nitrate in most samples. This study confirms that ACE is a powerful tracer and demonstrates its use as a diagnostic tool for establishing whether waste water is a significant contributor to groundwater contamination or not. © 2016, National Ground Water Association.

Effects of copper particles on a model septic system's function and microbial community.

PubMed

Taylor, Alicia A; Walker, Sharon L

2016-03-15

There is concern surrounding the addition of nanoparticles into consumer products due to toxicity potential and the increased risk of human and environmental exposures to these particles. Copper nanoparticles are found in many common consumer goods; therefore, the disposal and subsequent interactions between potentially toxic Cu-based nanoparticles and microbial communities may have detrimental impacts on wastewater treatment processes. This study investigates the effects of three copper particles (micron- and nano-scale Cu particles, and a nano-scale Cu(OH)2-based fungicide) on the function and operation of a model septic tank. Septic system analyses included water quality evaluations and microbial community characterizations to detect changes in and relationships between the septic tank function and microbial community phenotype/genotype. As would be expected for optimal wastewater treatment, biological oxygen demand (BOD5) was reduced by at least 63% during nano-scale Cu exposure, indicating normal function. pH was reduced to below the optimum anaerobic fermentation range during the micro Cu exposure, suggesting incomplete degradation of organic waste may have occurred. The copper fungicide, Cu(OH)2, caused a 57% increase in total organic carbon (TOC), which is well above the typical range for septic systems and also corresponded to increased BOD5 during the majority of the Cu(OH)2 exposure. The changes in TOC and BOD5 demonstrate that the system was improperly treating waste. Overall, results imply individual exposures to the three Cu particles caused distinct disruptions in septic tank function. However, it was observed that the system was able to recover to typical operating conditions after three weeks post-exposure. These results imply that during periods of Cu introduction, there are likely pulses of improper removal of total organic carbon and significant changes in pH not in the optimal range for the system. Copyright © 2016 Elsevier Ltd. All rights reserved.

75 FR 29757 - New York State Prohibition of Discharges of Vessel Sewage; Final Affirmative Determination

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-27

..., 4 dispose of wastes to an on-site septic system, 21 dispose to a holding tank and 62 dispose to a... and regulated septic tanks or holding tanks for transport to a sewage treatment plant. Online maps are... are in a No Discharge Zone. A Type III marine sanitation device (holding tank) is the only type that...

Corrective Action Investigation Plan for Corrective Action Unit 405: Area 3 Septic Systems, Tonopah Test Range, Nevada(April 2001, Rev. 0) with Record of Technical Change No. 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

DOE /NV

2001-04-26

This Corrective Action Investigation Plan contains the U.S. Department of Energy, Nevada Operations Office's (DOE/NV's) approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 405, Area 3 Septic Systems, Tonopah Test Range (TTR), under the Federal Facility Agreement and Consent Order. Corrective Action Unit 405 consists of Corrective Action Sites 03-05-002-SW03, 03-05-002-SW04, and 03-05-002-SW07 (also collectively known as: Septic Waste Systems [SWSs] 3, 4, and 7). Located in Area 3 in the northwest section of the TTR, approximately 140 miles northwest of Las Vegas, this location was historically (betweenmore » 1960 and 1990) used as a research facility with the mission to perform defense-related projects, and whose operations generated sanitary and industrial wastewaters potentially contaminated with COPCs and disposed of in septic tanks and leachfields. Though Septic Waste Systems 3, 4, and 7 were origin ally constructed to receive sanitary sewage, they may have inadvertently received effluent containing potentially hazardous and radiological constituents containing acetone, benzene, ethylbenzene, 4-methyl-2-pentanone, toluene, xylenes, volatile organic compound constituents, phenols, arsenic, barium, lead, mercury, hydrocarbons of oil and grease, and uranium-234, -235, and -238. The Area 3 septic systems were documented in a DOE/NV 1996 report as being included in the septic tank abandonment program conducted by Sandia National Laboratories in 1993; however, this program was not completed and the possibility exists that some of the Area 3 septic tanks may not have been abandoned. Even though all of the SWSs addressed in this CAIP are inactive, geophysical surveys conducted in 1993 were generally inconclusive and did not provide useful data for the purposes of this investigation. The scope of this current investigation, therefore, will be to determine the existence of the identified CO PCs and excavation will be the primary investigation method employed for these leachfield systems, but this effort may be limited by existing facilities and utilities. The results of this field investigation will support a defensible evaluation of corrective action alternatives in the subsequent corrective action decision document.« less

Greenhouse Gas Emissions from Septic Systems in New York State.

PubMed

Truhlar, Allison M; Rahm, Brian G; Brooks, Rachael A; Nadeau, Sarah A; Makarsky, Erin T; Walter, M Todd

2016-07-01

Onsite septic systems use microbial processes to eliminate organic wastes and nutrients such as nitrogen; these processes can contribute to air pollution through the release of greenhouse gases (GHGs). Current USEPA estimates for septic system GHG emissions are based on one study conducted in north-central California and are limited to methane; therefore, the contribution of these systems to the overall GHG emission budget is unclear. This study quantified and compared septic system GHG emissions from the soil over leach fields and the roof vent, which are the most likely locations for gas emissions during normal septic system operation. At each of eight septic systems, we measured fluxes of CH, CO, and NO using a static chamber method. The roof vent released the majority of septic system gas emissions. In addition, the leach field was a significant source of NO fluxes. Comparisons between leach field and vent emissions suggest that biological processes in the leach field soil may influence the type and quantity of gas released. Overall, our results suggest that (i) revisions are needed in USEPA guidance (e.g., septic systems are not currently listed as a source of NO emissions) and (ii) similar studies representing a wider range of climatic and geographic settings are needed. The total vent, sand filter, and leach field GHG emissions were 0.17, 0.045, and 0.050 t CO-equivalents capita yr, respectively. In total, this represents about 1.5% of the annual carbon footprint of an individual living in the United States. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Pluggable microbial fuel cell stacks for septic wastewater treatment and electricity production.

PubMed

Yazdi, Hadi; Alzate-Gaviria, Liliana; Ren, Zhiyong Jason

2015-03-01

Septic tanks and other decentralized wastewater treatment systems play an important role in protecting public health and water resource for remote or developing communities. Current septic systems do not have energy production capability, yet such feature can be very valuable for areas lack access to electricity. Here we present an easy-to-operate microbial fuel cell (MFC) stack that consists a common base and multiple pluggable units, which can be connected in either series or parallel for electricity generation during waste treatment in septic tanks. Lab studies showed such easy configuration obtained a power density of 142±6.71mWm(-2) when 3 units are connected in parallel, and preliminary calculation indicates that a system that costs approximately US $25 can power a 6-watt LED light for 4h per day with great improvement potential. Detailed electrochemical characterizations provide insights on system internal loss and technology advancement needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

USEPA Waste Disposal Shareware: Purdue University and USEPA (1988-1989).

ERIC Educational Resources Information Center

Rubleske, Joseph B.; Lindsey, Greg

1997-01-01

Describes and evaluates two USEPA shareware programs called Principles of On-Site Wastewater Treatment (ONSITE) and Residential Waste Treatment Evaluation (RWASTE). ONSITE, a tutorial, provides an overview of septic systems and their relationship to soils. RWASTE builds on ONSITE. Both are effective tools for persons interested in acquiring…

Remaining Sites Verification Package for the 1607-B2 Septic System and 100-B-14:2 Sanitary Sewer System, Waste Site Reclassification Form 2004-006

DOE Office of Scientific and Technical Information (OSTI.GOV)

L. M. Dittmer

The 100-B-14:2 subsite encompasses the former sanitary sewer feeder lines associated with the 1607-B2 and 1607-B7 septic systems. Feeder lines associated with the 185/190-B building have also been identified as the 100-B-14:8 subsite, and feeder lines associated with the 1607-B7 septic system have also been identified as the 100-B-14:9 subsite. These two subsites have been administratively cancelled to resolve the redundancy. The results of verification sampling show that residual contaminant concentrations do not preclude any future uses and allow for unrestricted use of shallow zone soils. The results also demonstrate that residual contaminant concentrations are protective of groundwater and themore » Columbia River.« less

Falluja Waste Water Treatment System, Falluja, Iraq

DTIC Science & Technology

2008-10-27

NAME(S) AND ADDRESS(ES) Office of the Special Inspector General for Iraq Reconstruction,400 Army Navy Drive,Arlington,VA,22202 8. PERFORMING...waterways. In addition, another problem was the illegal discharge of septic sewage collected from homes into rivers or on land. The nonoperational...and the storm water collection system, which resulted in the disposal of sanitary waste directly into the Euphrates River. The discharge of raw

Influence of septic system wastewater treatment on titanium dioxide nanoparticle subsurface transport mechanisms.

PubMed

Waller, Travis; Marcus, Ian M; Walker, Sharon L

2018-06-04

Engineered nanomaterials (ENMs) are commonly incorporated into food and consumer applications to enhance a specific product aspect (i.e., optical properties). Life cycle analyses revealed ENMs can be released from products during usage and reach wastewater treatment plants (WWTPs), with titanium dioxide (TiO 2 ) accounting for a large fraction. As such, food grade (FG) TiO 2 , a more common form of TiO 2 in wastewater, was used in this study. Nanomaterials in WWTPs have been well characterized, although the problematic septic system has been neglected. Elution and bioaccumulation of TiO 2 ENMs from WTTPs in downriver sediments and microorganisms has been observed; however, little is known about mechanisms governing the elution of FG TiO 2 from the septic drainage system. This study characterized the transport behavior and mechanisms of FG TiO 2 particles in porous media conditions after septic waste treatment. FG and industrial grade (IG) TiO 2 (more commonly studied) were introduced to septic tank effluent and low-ionic strength electrolyte solutions prior to column transport experiments. Results indicate that FG TiO 2 aggregate size (200-400 nm) remained consistent across solutions. Additionally, elution of FG and IG TiO 2 was greatest in septic effluent at the higher nanoparticle concentration (100 ppm). FG TiO 2 was well retained at the low (2 ppm) concentration in septic effluent, suggesting that particles that escape the septic system may still be retained in drainage field before reaching the groundwater system, although eluted particles are highly stabilized. Findings provide valuable insight into the significance of the solution environment at mediating differences observed between uniquely engineered nanomaterials. Graphical abstract.

78 FR 17224 - Environmental Impact Statement; Proposed South Puget Sound Prairie Habitat Conservation Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-20

... operation of solid waste facilities; permitting and monitoring of wells, septic systems, and decommissioning of home oil tanks; maintenance and monitoring of water resources and associated facilities...

Effects of drain wells on the ground-water quality of the western Snake Plain Aquifer, Idaho

USGS Publications Warehouse

Moreland, Joe A.; Seitz, Harold R.; LaSala, Albert Mario

1976-01-01

Approximately 3,100 drain wells injects irrigation waste water, urban runoff, septic-tank effluent, and industrial waste water into the Snake Plain aquifer in Minidoka, Gooding, Jerome, and Lincoln Counties, Idaho. About 29,000 acre-feet of irrigation waste water, 100 acre-feet of urban runoff, 400 acre-feet of septic-tank effluent, and 1,000 acre-feet of industrial waste water are injected annually. The quality of irrigation waste water is highly variable, depending upon its source, method and rate of application, amount of fertilizer added, and other factors. The quality of urban runoff water is generally much better than irrigation waste water. Septic-tank effluent is relatively high in nutrient concentrations. Chloride concentrations also are high, and bacterial concentrations are exceedingly high. The only industrial waste water sampled during this study had been used for cooling. No chemical changes were noted, but temperature was significantly increased. The data indicate that drain-well inflow does move appreciable distances through the aquifer and can be detected in downgradient wells. (Woodard-USGS)

Enzyme pretreatment of fats, oil and grease from restaurant waste to prolong septic soil treatment system effectiveness.

PubMed

Dong, Younsuk; Safferman, Steven I; Ostahowski, Jeff; Herold, Tom; Panter, Ronald

2017-01-02

When a fast-food restaurant's wastewater containing fats, oil and grease (FOG) is discharged into a collection system, it builds up over time and clogs pipes. Similarly, when such wastewater flows into a septic soil treatment system, it adheres to the surface of inlet pipes, gravel/distribution media and soil, restricting the flow and eventually clogging the septic soil treatment system. In this study, an enzymatic pretreatment system was tested on wastewater from a fast-food restaurant to determine its effectiveness in preventing septic soil treatment system clogging. This system used aeration equipment, baffles and a one-time inoculum that excretes enzymes to reduce the molecular weight and number of double bonds associated with FOG. FOG containing triglycerides having lower molecular weights and fewer double bonds are less sticky. The enzymatic pretreatment system was found to cause these changes as verified by measuring the types of triglycerides (compounds in FOG) using liquid chromatography/mass spectrometry. A unique bench-scale septic soil treatment system (soil trench) was also used. Each contained six soil moisture sensors to enable the determination of moisture saturation trends among the five tested conditions: sanitary wastewater only, a combination of sanitary and kitchen wastewater, enzymatically pretreated sanitary and kitchen wastewater, kitchen wastewater, and enzymatically pretreated kitchen wastewater. For all influent types, a significant amount of FOG and other pollutants were removed, regardless of the initial concentrations. Moisture sensor readings showed differences among the tested conditions, indicating that septic soil treatment system clogging was delayed. Inspection of the influent pipe and gravel at the end of testing verified these differences as did the measurements of volatile solids.

7 CFR 1777.21 - Use of funds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... reasonable costs for closing abandoned septic tanks and water wells when necessary to protect the health and...) Construct, enlarge, extend, or otherwise improve community water and/or waste disposal systems. Otherwise improve would include extending service lines to and/or connecting residence's plumbing to the system. (2...

7 CFR 1777.21 - Use of funds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... reasonable costs for closing abandoned septic tanks and water wells when necessary to protect the health and...) Construct, enlarge, extend, or otherwise improve community water and/or waste disposal systems. Otherwise improve would include extending service lines to and/or connecting residence's plumbing to the system. (2...

7 CFR 1777.21 - Use of funds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... reasonable costs for closing abandoned septic tanks and water wells when necessary to protect the health and...) Construct, enlarge, extend, or otherwise improve community water and/or waste disposal systems. Otherwise improve would include extending service lines to and/or connecting residence's plumbing to the system. (2...

7 CFR 1777.21 - Use of funds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... reasonable costs for closing abandoned septic tanks and water wells when necessary to protect the health and...) Construct, enlarge, extend, or otherwise improve community water and/or waste disposal systems. Otherwise improve would include extending service lines to and/or connecting residence's plumbing to the system. (2...

Sludge accumulation and conversion to methane in a septic tank treating domestic wastewater or black water.

PubMed

Elmitwalli, Tarek

2013-01-01

Although the septic tank is the most applied on-site system for wastewater pre-treatment, limited research has been performed to determine sludge accumulation and biogas production in the tank. Therefore a dynamic mathematical model based on the Anaerobic Digestion Model No. 1 (ADM1) was developed for anaerobic digestion of the accumulated sludge in a septic tank treating domestic wastewater or black water. The results showed that influent chemical oxygen demand (COD) concentration and hydraulic retention time (HRT) of the tank mainly control the filling time with sludge, while operational temperature governs characteristics of the accumulated sludge and conversion to methane. For obtaining stable sludge and high conversion, the tank needs to be operated for a period more than a year without sludge wasting. Maximum conversion to methane in the tank is about 50 and 60% for domestic wastewater and black water, respectively. The required period for sludge wasting depends on the influent COD concentration and the HRT, while characteristics of the wasted sludge are affected by operational temperature followed by the influent COD concentration and the HRT. Sludge production from the tank ranges between 0.19 to 0.22 and 0.13 to 0.15 L/(person.d), for the domestic wastewater and black water, respectively.

CONTAMINATION OF PUBLIC GROUND WATER SUPPLIES BY SUPERFUND SITES

EPA Science Inventory

Multiple sources of contamination can affect ground water supplies, including municipal landfills, industrial operations, leaking underground storage tanks, septic tank systems, and prioritized uncontrolled hazardous waste sites known as “Superfund” sites. A review of Superfund R...

Remaining Sites Verification Package for the 1607-F7, 141-M Building Septic Tank, Waste Site Reclassification Form 2006-040

DOE Office of Scientific and Technical Information (OSTI.GOV)

L. M. Dittmer

2006-10-19

The 1607-F7, 141-M Building Septic Tank waste site was a septic tank and drain field that received sanitary sewage from the former 141-M Building. Remedial action was performed in August and November 2005. The results of verification sampling demonstrate that residual contaminant concentrations support future unrestricted land uses that can be represented by a rural-residential scenario. These results also show that residual concentrations support unrestricted future use of shallow zone soil and that contaminant levels remaining in the soil are protective of groundwater and the Columbia River.

The distribution and modeling of nitrate transport in the Carson Valley alluvial aquifer, Douglas County, Nevada

USGS Publications Warehouse

Naranjo, Ramon C.; Welborn, Toby L.; Rosen, Michael R.

2013-01-01

The distribution of nitrate as nitrogen (referred to herein as nitrate-N) concentrations in groundwater was determined by collecting more than 200 samples from 8 land-use categories: single family residential, multifamily residential, rural (including land use for agriculture), vacant land, commercial, industrial, utilities, and unclassified. Nitrate-N concentrations ranged from below detection (less than 0.05 milligrams per liter) to 18 milligrams per liter. The results of nitrate-N concentrations that were sampled from three wells equalled or exceeded the maximum contaminant level of 10 milligrams per liter set by the U.S. Environmental Protection Agency. Nitrate-N concentrations in sampled wells showed a positive correlation between elevated nitrate-N concentrations and the percentage of single-family land use and septic-system density. Wells sampled in other land-use categories did not have any correlation to nitrate-N concentrations. In areas with greater than 50-percent single-family land use, nitrate-N concentrations were two times greater than in areas with less than 50 percent single-family land use. Nitrate-N concentrations in groundwater near septic systems that had been used more than 20 years were more than two times greater than in areas where septic systems had been used less than 20 years. Lower nitrate-N concentrations in the areas where septic systems were less than 20 years old probably result from temporary storage of nitrogen leaching from septic systems into the unsaturated zone. In areas where septic systems are abundant, nitrate-N concentrations were predicted to 2059 by using numerical models within the Ruhenstroth and Johnson Lane subdivisions in the Carson Valley. Model results indicated that nitrate-N concentrations will continue to increase and could exceed the maximum contaminant level over extended areas inside and outside the subdivisions. Two modeling scenarios were used to simulate future transport as a result of removal of septic systems (source of nitrate-N contamination) and the termination of domestic pumping of groundwater. The models showed the largest decrease in nitrate-N concentrations when septic systems were removed and wells continued to pump. Nitrate-N concentrations probably will continue to increase in areas that are dependent on septic systems for waste disposal either under current land-use conditions in the valley or with continued growth and change in land use in the valley.

Enhanced attenuation of septic system phosphate in noncalcareous sediments.

PubMed

Robertson, W D

2003-01-01

Review of phosphate behavior in four mature septic system plumes on similar textured sand has revealed a strong correlation between carbonate mineral content and phosphate concentrations. A plume on calcareous sand (Cambridge site, 27 wt % CaCO3 equiv.) has proximal zone PO4 concentrations (4.8 mg/L P average) that are about 75% of the septic tank effluent value, whereas three plumes on noncalcareous sand (Muskoka, L. Joseph, and Nobel sites, <1 wt % CaCO3 equiv.) have proximal zone phosphate concentrations (<0.1 mg/L P) that are consistently less than 2% of the effluent values. Phosphate attenuation at the noncalcareous sites appears to be an indirect result of the development of acidic conditions (site average pH 3.5 to 5.9) and elevated Al concentrations (up to 24 mg/L), which subsequently causes the precipitation of Al-P minerals such as variscite (AlPO4 x 2H2O). This is supported by scanning electron microscope analyses, which show the widespread occurrence of (Al+P)--rich secondary mineral coatings on sand grains below the infiltration beds. All of these septic systems are more than 10 years old, indicating that these attenuation reactions have substantial longevity. A field lysimeter experiment demonstrated that this reaction sequence can be readily incorporated into engineered waste water treatment systems. We feel this important P removal mechanism has not been adequately recognized, particularly for its potential significance in reducing P loading from septic systems in lakeshore environments.

Overview of Microbial Source Tracking Methods Targeting Human Fecal Pollution Sources

EPA Science Inventory

Exposure to human fecal waste can be a public health risk dueto the presence of human pathogens. Human fecal pollutioncan be introduced into water resources from damagedsewer lines, faulty septic systems, combined sewer overflows,illicit dumping activities, and even recreational ...

PERFORMANCE EVALUATION OF A CARBON-BASED REACTIVE BARRIER FOR NITRATE REMEDIATION

EPA Science Inventory

Nitrate (NO3-) is a common ground water contaminant related to agricultural activity, waste water disposal, leachate from landfills, septic systems, and industrial processes. This study reports on the performance of a carbon-based permeable reactive barrier (PRB) that was constr...

CARBON-BASED REACTIVE BARRIER FOR NITRATE REMEDIATION AT A FORMER SWINE CAFO

EPA Science Inventory

Nitrate (NO3-) is a common ground water contaminant related to agricultural activity, waste water disposal, leachate from landfills, septic systems, and industrial processes. This study reports on the performance of a carbon-based permeable reactive barrier (PRB) that was constr...

Addendum to the Closure Report for Corrective Action Unit 427: Area 3 Septic Waste Systems 2, 6, Tonopah Test Range, Nevada, Revision 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lynn Kidman

This document constitutes an addendum to the April 1999, Closure Report for Corrective Action Unit 427: Area 3 Septic Waste Systems 2, 6, Tonopah Test Range, Nevada as described in the document Recommendations and Justifications for Modifications for Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office Federal Facility Agreement and Consent Order (UR Modification document) dated February 2008. The UR Modification document was approved by NDEP on February 26, 2008. The approval of the UR Modification document constituted approval of each of the recommended UR modifications. In conformance with the UR Modificationmore » document, this addendum consists of: • This cover page that refers the reader to the UR Modification document for additional information • The cover and signature pages of the UR Modification document • The NDEP approval letter • The corresponding section of the UR Modification document This addendum provides the documentation justifying the cancellation of the URs for: • CAS 03-05-002-SW02, Septic Waste System • CAS 03-05-002-SW06, Septic Waste System These URs were established as part of Federal Facility Agreement and Consent Order (FFACO) corrective actions and were based on the presence of contaminants at concentrations greater than the action levels established at the time of the initial investigation (FFACO, 1996; as amended August 2006). Since these URs were established, practices and procedures relating to the implementation of risk-based corrective actions (RBCA) have changed. Therefore, these URs were re-evaluated against the current RBCA criteria as defined in the Industrial Sites Project Establishment of Final Action Levels (NNSA/NSO, 2006c). This re-evaluation consisted of comparing the original data (used to define the need for the URs) to risk-based final action levels (FALs) developed using the current Industrial Sites RBCA process. The re-evaluation resulted in a recommendation to remove these URs because contamination is not present at these sites above the risk-based FALs. Requirements for inspecting and maintaining these URs will be canceled, and the postings and signage at each site will be removed. Fencing and posting may be present at these sites that are unrelated to the FFACO URs such as for radiological control purposes as required by the NV/YMP Radiological Control Manual (NNSA/NSO, 2004f). This modification will not affect or modify any non-FFACO requirements for fencing, posting, or monitoring at these sites.« less

Comparative human health risk analysis of coastal community water and waste service options.

PubMed

Schoen, Mary E; Xue, Xiaobo; Hawkins, Troy R; Ashbolt, Nicholas J

2014-08-19

As a pilot approach to describe adverse human health effects from alternative decentralized community water systems compared to conventional centralized services (business-as-usual [BAU]), selected chemical and microbial hazards were assessed using disability adjusted life years (DALYs) as the common metric. The alternatives included: (1) composting toilets with septic system, (2) urine-diverting toilets with septic system, (3) low flush toilets with blackwater pressure sewer and on-site greywater collection and treatment for nonpotable reuse, and (4) alternative 3 with on-site rainwater treatment and use. Various pathogens (viral, bacterial, and protozoan) and chemicals (disinfection byproducts [DBPs]) were used as reference hazards. The exposure pathways for BAU included accidental ingestion of contaminated recreational water, ingestion of cross-connected sewage to drinking water, and shower exposures to DBPs. The alternative systems included ingestion of treated greywater from garden irrigation, toilet flushing, and crop consumption; and ingestion of treated rainwater while showering. The pathways with the highest health impact included the ingestion of cross-connected drinking water and ingestion of recreational water contaminated by septic seepage. These were also among the most uncertain when characterizing input parameters, particularly the scale of the cross-connection event, and the removal of pathogens during groundwater transport of septic seepage. A comparison of the health burdens indicated potential health benefits by switching from BAU to decentralized water and wastewater systems.

Corrective Action Investigation Plan for Corrective Action Unit 224: Decon Pad and Septic Systems Nevada Test Site, Nevada, Rev. No.: 0, with ROTC 1 and 2

DOE Office of Scientific and Technical Information (OSTI.GOV)

David A. Strand

This Corrective Action Investigation Plan (CAIP) contains project-specific information including facility descriptions, environmental sample collection objectives, and criteria for conducting site investigation activities at Corrective Action Unit (CAU) 224: Decon Pad and Septic Systems, Nevada Test Site (NTS), Nevada. This CAIP has been developed in accordance with the ''Federal Facility Agreement and Consent Order'' (FFACO) (1996) that was agreed to by the State of Nevada, the U.S. Department of Energy (DOE), and the U.S. Department of Defense (DoD). The NTS is approximately 65 miles (mi) northwest of Las Vegas, Nevada (Figure 1-1). Corrective Action Unit 224 is comprised of themore » nine Corrective Action Sites (CASs) listed below: 02-04-01, Septic Tank (Buried); 03-05-01, Leachfield; 05-04-01, Septic Tanks (4)/Discharge Area; 06-03-01, Sewage Lagoons (3); 06-05-01, Leachfield; 06-17-04, Decon Pad and Wastewater Catch; 06-23-01, Decon Pad Discharge Piping; 11-04-01, Sewage Lagoon; and 23-05-02, Leachfield. Corrective Action Sites 06-05-01, 06-23-01, and 23-05-02 were identified in the 1991 Reynolds Electrical & Engineering Co., Inc. (REECo) inventory (1991). The remaining sites were identified during review of various historical documents. Additional information will be obtained by conducting a corrective action investigation (CAI) prior to evaluating and selecting a corrective action alternative for each CAS. The CAI will include field inspections, radiological and geological surveys, and sample collection. Data will also be obtained to support investigation-derived waste (IDW) disposal and potential future waste management decisions.« less

What Is the Problem to Which the Answer was Public Law 83-280: How is it Working Out and What Should We Do Next?

DTIC Science & Technology

2013-09-01

Improvement Program to rehabilitate senior’s homes to acceptable standards including; roofing, handicap accessibility, and septic systems. The...buildings, highways, hospitals, waste management sites, shelters, reservoirs/water tanks , historical sites, emergency operations centers, casinos

DEVELOPMENT OF HOST-SPECIFIC METAGENOMIC MARKERS FOR MICROBIAL SOURCE TRACKING USING A NOVEL METAGENOMIC APPROACH

EPA Science Inventory

Fecal contamination of source water has always been an important issue to the drinking water industry. Improper disposal of animal waste, leaky septic tanks, storm runoff, and the abundance of wildlife in natural water systems can all be responsible for the spread of enteric path...

Bayesian nitrate source apportionment to individual groundwater wells in the Central Valley by use of elemental and isotopic tracers

USGS Publications Warehouse

Ransom, Katherine M; Grote, Mark N.; Deinhart, Amanda; Eppich, Gary; Kendall, Carol; Sanborn, Matthew E.; Sounders, A. Kate; Wimpenny, Joshua; Yin, Qing-zhu; Young, Megan B.; Harter, Thomas

2016-01-01

Groundwater quality is a concern in alluvial aquifers that underlie agricultural areas, such as in the San Joaquin Valley of California. Shallow domestic wells (less than 150 m deep) in agricultural areas are often contaminated by nitrate. Agricultural and rural nitrate sources include dairy manure, synthetic fertilizers, and septic waste. Knowledge of the relative proportion that each of these sources contributes to nitrate concentration in individual wells can aid future regulatory and land management decisions. We show that nitrogen and oxygen isotopes of nitrate, boron isotopes, and iodine concentrations are a useful, novel combination of groundwater tracers to differentiate between manure, fertilizers, septic waste, and natural sources of nitrate. Furthermore, in this work, we develop a new Bayesian mixing model in which these isotopic and elemental tracers were used to estimate the probability distribution of the fractional contributions of manure, fertilizers, septic waste, and natural sources to the nitrate concentration found in an individual well. The approach was applied to 56 nitrate-impacted private domestic wells located in the San Joaquin Valley. Model analysis found that some domestic wells were clearly dominated by the manure source and suggests evidence for majority contributions from either the septic or fertilizer source for other wells. But, predictions of fractional contributions for septic and fertilizer sources were often of similar magnitude, perhaps because modeled uncertainty about the fraction of each was large. For validation of the Bayesian model, fractional estimates were compared to surrounding land use and estimated source contributions were broadly consistent with nearby land use types.

Potential Impacts of Organic Wastes on Small Stream Water Quality

NASA Astrophysics Data System (ADS)

Kaushal, S. S.; Groffman, P. M.; Findlay, S. E.; Fischer, D. T.; Burke, R. A.; Molinero, J.

2005-05-01

We monitored concentrations of dissolved organic carbon (DOC), dissolved oxygen (DO) and other parameters in 17 small streams of the South Fork Broad River (SFBR) watershed on a monthly basis for 15 months. The subwatersheds were chosen to reflect a range of land uses including forested, pasture, mixed, and developed. The SFBR watershed is heavily impacted by organic wastes, primarily from its large poultry industry, but also from its rapidly growing human population. The poultry litter is primarily disposed of by application to pastures. Our monthly monitoring results showed a strong inverse relationship between mean DOC and mean DO and suggested that concentrations of total nitrogen (TN), DOC, and the trace gases nitrous oxide, methane and carbon dioxide are impacted by organic wastes and/or nutrients from animal manure applied to the land and/or human wastes from wastewater treatment plants or septic tanks in these watersheds. Here we estimate the organic waste loads of these watersheds and evaluate the impact of organic wastes on stream DOC and alkalinity concentrations, electrical conductivity, sediment potential denitrification rate and plant stable nitrogen isotope ratios. All of these water quality parameters are significantly correlated with watershed waste loading. DOC is most strongly correlated with total watershed waste loading whereas conductivity, alkalinity, potential denitrification rate and plant stable nitrogen isotope ratio are most strongly correlated with watershed human waste loading. These results suggest that more direct inputs (e.g., wastewater treatment plant effluents, near-stream septic tanks) have a greater relative impact on stream water quality than more dispersed inputs (land applied poultry litter, septic tanks far from streams) in the SFBR watershed. Conductivity, which is generally elevated in organic wastes, is also significantly correlated with total watershed waste loading suggesting it may be a useful indicator of overall watershed waste loading. Although this work was reviewed by EPA and approved for publication, it may not necessarily reflect official Agency policy.

Inhalation dose due to presence of 131I in air above septic tank system of an endocrinology hospital.

PubMed

Mietelski, J W; Grabowska, S; Nowak, T; Bogacz, J; Gaca, P; Bartyzel, M; Budzanowski, M

2005-01-01

We present here measurements of the 131I concentration for both: gaseous and aerosol fraction of 131I in the air above the septic tank containing wastes from medical application of this isotope. Aerosols were collected using air filters, whereas gaseous forms of iodine were trapped in KI impregnated charcoal double layer cartridge. Besides an active method (pumping of the air through system of filters) an attempt for using a passive method (charcoal traps) for monitoring of radio-iodine is described. For better characterisation of a site the external kerma was determined by means of G-M and TLD techniques as well as the activity kept in the septic tank was measured by gamma spectrometry. Results show that the activity of the aerosol fraction can be neglected compared to that of the gaseous fraction. He measured activity of air is low, on the level of 1 Bq m(-3), even during simulated failure of the ventilation system. Estimated inhalation dose for the serviceman of septic tanks is low ( approximately 10%) compared with external dose obtained by such person due to gamma radiation from the tank (on the level approximately 500 nSv h(-1)). Therefore, the concept of passive monitoring of the iodine in air was abandoned. Also estimated is the efficiency of 131I reduction by a charcoal filter of the ventilation system and 131I input to the environment by the ventilation chimney.

Suspended sediment in selected streams of southeastern Montana

USGS Publications Warehouse

Litke, D.W.

1982-01-01

The relatively flat Badger Road area near Fairbanks occupies part of the alluvial plain of the Chena and Tanana Rivers and is underlain by scattered areas of permafrost. The water table of the high-transmissivity aquifer that underlies the area is generally shallower than 15 feet, fluctuates seasonally about 2 feet, and slopes northwesterly, the direction of ground-water flow. Private domestic-supply wells obtain water from the upper part of the aquifer. Septic systems used to dispose of waste water are installed at or only slightly above the water table in the same aquifer. Analyses of samples from 16 observation wells in undeveloped parts of the study area and from 33 domestic wells indicated that water quality has not been significantly degraded by on-site waste disposal. Three samples had detectable but minor contamination by fecal coliform bacteria. Anomalous values of chloride and ammonia in one third of the domestic wells may indicate incipient degradation of ground-water quality by septic-tank effluent. (USGS)

Alternative treatment for septic tank sludge: co-digestion with municipal solid waste in bioreactor landfill simulators.

PubMed

Valencia, R; den Hamer, D; Komboi, J; Lubberding, H J; Gijzen, H J

2009-02-01

Co-disposal of septic tank sludge had a positive effect on the municipal solid waste (MSW) stabilisation process in Bioreactor Landfill simulators. Co-disposal experiments were carried out using the Bioreactor Landfill approach aiming to solve the environmental problems caused by indiscriminate and inadequate disposal of MSW and especially of septic tank sludge. The simulator receiving septic tank sludge exhibited a 200 days shorter lag-phase as compared to the 350 days required by the control simulator to start the exponential biogas production. Additionally, the simulator with septic sludge apparently retained more moisture (>60% w/w), which enhanced the overall conversion of organic matter hence increasing the biogas production (0.60 m3 biogas kg(-1)VS(converted)) and removal efficiency of 60% for VS from the simulator. Alkaline pH values (pH>8.5) did not inhibit the biogas production; moreover it contributed to reduce partially the negative effects of NH(4)(+) (>2 g L(-1)) due to NH(3) volatilisation thus reducing the nitrogen content of the residues. Associated risks and hazards with septage disposal were practically eliminated as total coliform and faecal coliform contents were reduced by 99% and 100%, respectively at the end of the experiment. These results indicate that co-disposal has two direct benefits, including the safe and environmentally sound disposal of septic tank sludge and an improvement of the overall performance of the Bioreactor Landfill by increasing moisture retention and supplying a more acclimatised bacterial population.

Exploration of Antecedents of Environmentally Responsible Behavior by Stakeholders in Grand Lake Watershed

ERIC Educational Resources Information Center

Holmes, Teri S.

2013-01-01

Grand Lake O' the Cherokees in Oklahoma is one of two lakes in the State of Oklahoma that allows private ownership and development of the shoreline. This has created water quality issues attributed to phosphorus levels in effluent waste water from septic systems and municipal water treatment facilities, as well as nutrient and sediment…

Corrective Action Investigation Plan for Corrective Action Unit 555: Septic Systems Nevada Test Site, Nevada, Rev. No.: 0 with Errata

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pastor, Laura

2005-12-01

This Corrective Action Investigation Plan (CAIP) contains project-specific information including facility descriptions, environmental sample collection objectives, and criteria for conducting site investigation activities at Corrective Action Unit (CAU) 555: Septic Systems, Nevada Test Site (NTS), Nevada. This CAIP has been developed in accordance with the ''Federal Facility Agreement and Consent Order'' (FFACO) (1996) that was agreed to by the State of Nevada, the U.S. Department of Energy (DOE), and the U.S. Department of Defense. Corrective Action Unit 555 is located in Areas 1, 3 and 6 of the NTS, which is approximately 65 miles (mi) northwest of Las Vegas, Nevada,more » and is comprised of the five corrective action sites (CASs) shown on Figure 1-1 and listed below: (1) CAS 01-59-01, Area 1 Camp Septic System; (2) CAS 03-59-03, Core Handling Building Septic System; (3) CAS 06-20-05, Birdwell Dry Well; (4) CAS 06-59-01, Birdwell Septic System; and (5) CAS 06-59-02, National Cementers Septic System. An FFACO modification was approved on December 14, 2005, to include CAS 06-20-05, Birdwell Dry Well, as part of the scope of CAU 555. The work scope was expanded in this document to include the investigation of CAS 06-20-05. The Corrective Action Investigation (CAI) will include field inspections, radiological surveys, geophysical surveys, sampling of environmental media, analysis of samples, and assessment of investigation results, where appropriate. Data will be obtained to support corrective action alternative evaluations and waste management decisions. The CASs in CAU 555 are being investigated because hazardous and/or radioactive constituents may be present in concentrations that could potentially pose a threat to human health and the environment. Existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives for the CASs. Additional information will be generated by conducting a CAI before the evaluation and selection of corrective action alternatives.« less

Marching Microbes

NASA Technical Reports Server (NTRS)

1999-01-01

Under an SBIR contract with Marshall Space Flight Center, Micro-Bac International developed a new system for the treatment of wastewater based on the metabolic activity of photorphic bacteria. These microorganisms are now being sold as a liquid product called Mega-Bac TF. It is currently used for septic systems and wastewater ponds, lakes and lagoons to degrade fat, oil, fecal matter and other biologically derived wastes. Potential applications include homes, agriculture, food processors and chemical manufacturing.

Salang Hospital: Lack of Water and Power Severely Limits Hospital Services, and Major Construction Deficiencies Raise Safety Concerns

DTIC Science & Technology

2014-01-01

November 27, 2013 SIGAR 14-31-IP/Salang Hospital Page 3 • Hospital staff stated they believe the hospital’s septic tank is leaking. The staff told...us that, to the best of their knowledge, no leach field2 was built for the septic tank . • The statement of work required the contractor to provide...2 A leach field is typically installed with a septic tank for subsurface disposal of liquid waste. Multiple perforated pipes buried under ground

Corrective Action Plan for Corrective Action Unit 271: Areas 25, 26, and 27 Septic Systems, Nevada Test Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

R. B. Jackson

2003-05-01

The Areas 25, 26 and 27 Septic Systems are in the Federal Facility Agreement and Consent Order (FFACO) of 1996 as Corrective Action Unit (CAU) 271. This Corrective Action Plan (CAP) provides selected corrective action alternatives and proposes the closure methodology for CAU 271. CAU 271 is located on the Nevada Test Site (NTS) approximately 105 kilometers (65 miles) northwest of Las Vegas, Nevada, and consists of the following 15 Corrective Action Sites (CAS): CAS 25-04-1, Septic System; CAS 25-04-03, Septic System; CAS25-04-04, Septic System; CAS 25-04-08, Septic System; CAS 25-04-09, Septic System; CAS 25-04-10, Septic System; CAS 25-04-11, Septicmore » System; CAS 26-03-01, Contaminated Water Reservoir; CAS 26-04-1, Septic System; CAS 26-04-02, Septic System; CAS 26-05-01, Radioactive Leachfield; CAS-26-05-03, Septic System; CAS 26-05-04, Septic System; CAS 26-05-05, Septic System; and CAS 27-05-02, Leachfield.« less

Enhanced primary treatment of concentrated black water and kitchen residues within DESAR concept using two types of anaerobic digesters.

PubMed

Kujawa-Roeleveld, K; Elmitwalli, T; Zeeman, G

2006-01-01

Anaerobic digestion of concentrated domestic wastewater streams--black or brown water, and solid fraction of kitchen waste is considered as a core technology in a source separation based sanitation concept (DESAR--decentralised sanitation and reuse). A simple anaerobic digester can be implemented for an enhanced primary treatment or, in some situations, as a main treatment. Two reactor configurations were extensively studied; accumulation system (AC) and UASB septic tank at 15, 20 and 25 degrees C. Due to long retention times in an AC reactor, far stabilisation of treated medium can be accomplished with methanisation up to 60%. The AC systems are the most suitable to apply when the volume of waste to be treated is minimal and when a direct reuse of a treated medium in agriculture is possible. Digested effluent contains both liquid and solids. In a UASB septic tank, efficient separation of solids and liquid is accomplished. The total COD removal was above 80% at 25 degrees C. The effluent contains COD and nutrients, mainly in a soluble form. The frequency of excess sludge removal is low and sludge is well stabilised due to a long accumulation time.

Corrective Action Investigation Plan for Corrective Action Unit 516: Septic Systems and Discharge Points, Nevada Test Site, Nevada, Rev. 0, Including Record of Technical Change No. 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

This Corrective Action Investigation Plan (CAIP) contains the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Sites Office's (NNSA/NSO's) approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 516, Septic Systems and Discharge Points, Nevada Test Site (NTS), Nevada, under the Federal Facility Agreement and Consent Order. CAU 516 consists of six Corrective Action Sites: 03-59-01, Building 3C-36 Septic System; 03-59-02, Building 3C-45 Septic System; 06-51-01, Sump Piping, 06-51-02, Clay Pipe and Debris; 06-51-03, Clean Out Box and Piping; and 22-19-04, Vehicle Decontamination Area. Located in Areasmore » 3, 6, and 22 of the NTS, CAU 516 is being investigated because disposed waste may be present without appropriate controls, and hazardous and/or radioactive constituents may be present or migrating at concentrations and locations that could potentially pose a threat to human health and the environment. Existing information and process knowledge on the expected nature and extent of contamination of CAU 516 are insufficient to select preferred corrective action alternatives; therefore, additional information will be obtained by conducting a corrective action investigation. The results of this field investigation will support a defensible evaluation of corrective action alternatives in the corrective action decision document. Record of Technical Change No. 1 is dated 3/2004.« less

Trends in nitrate and dissolved-solids concentrations in ground water, Carson Valley, Douglas County, Nevada, 1985-2001

USGS Publications Warehouse

Rosen, Michael R.

2003-01-01

Analysis of trends in nitrate and total dissolved-solids concentrations over time in Carson Valley, Nevada, indicates that 56 percent of 27 monitoring wells that have long-term records of nitrate concentrations show increasing trends, 11 percent show decreasing trends, and 33 percent have not changed. Total dissolved-solids concentrations have increased in 52 percent of these wells and are stable in 48 percent. None of these wells show decreasing trends in total dissolved-solids concentrations. The wells showing increasing trends in nitrate and total dissolved-solids concentrations were always in areas that use septic waste-disposal systems. Therefore, the primary cause of these increases is likely the increase in septic-tank usage over the past 40 years.

Evidence of norovirus (NV)in a major produce production region watershed and a low density microarray strategy for detecting NV(Abstract)

USDA-ARS?s Scientific Manuscript database

The presence of Norovirus (NV) in watersheds in the vicinity of raw produce production is a concern. This could occur due to leaking septic systems, improper RV waste removal, improperly treated recycled wastewater, or other unknown factors. We used a qRT-PCR method to test for NV in rinsates from M...

Skeletal Muscle and Lymphocyte Mitochondrial Dysfunctions in Septic Shock Trigger ICU-Acquired Weakness and Sepsis-Induced Immunoparalysis.

PubMed

Maestraggi, Quentin; Lebas, Benjamin; Clere-Jehl, Raphaël; Ludes, Pierre-Olivier; Chamaraux-Tran, Thiên-Nga; Schneider, Francis; Diemunsch, Pierre; Geny, Bernard; Pottecher, Julien

2017-01-01

Fundamental events driving the pathological processes of septic shock-induced multiorgan failure (MOF) at the cellular and subcellular levels remain debated. Emerging data implicate mitochondrial dysfunction as a critical factor in the pathogenesis of sepsis-associated MOF. If macrocirculatory and microcirculatory dysfunctions undoubtedly participate in organ dysfunction at the early stage of septic shock, an intrinsic bioenergetic failure, sometimes called "cytopathic hypoxia," perpetuates cellular dysfunction. Short-term failure of vital organs immediately threatens patient survival but long-term recovery is also severely hindered by persistent dysfunction of organs traditionally described as nonvital, such as skeletal muscle and peripheral blood mononuclear cells (PBMCs). In this review, we will stress how and why a persistent mitochondrial dysfunction in skeletal muscles and PBMC could impair survival in patients who overcome the first acute phase of their septic episode. First, muscle wasting protracts weaning from mechanical ventilation, increases the risk of mechanical ventilator-associated pneumonia, and creates a state of ICU-acquired muscle weakness, compelling the patient to bed. Second, failure of the immune system ("immunoparalysis") translates into its inability to clear infectious foci and predisposes the patient to recurrent nosocomial infections. We will finally emphasize how mitochondrial-targeted therapies could represent a realistic strategy to promote long-term recovery after sepsis.

Combining land use information and small stream sampling with PCR-based methods for better characterization of diffuse sources of human fecal pollution.

PubMed

Peed, Lindsay A; Nietch, Christopher T; Kelty, Catherine A; Meckes, Mark; Mooney, Thomas; Sivaganesan, Mano; Shanks, Orin C

2011-07-01

Diffuse sources of human fecal pollution allow for the direct discharge of waste into receiving waters with minimal or no treatment. Traditional culture-based methods are commonly used to characterize fecal pollution in ambient waters, however these methods do not discern between human and other animal sources of fecal pollution making it difficult to identify diffuse pollution sources. Human-associated quantitative real-time PCR (qPCR) methods in combination with low-order headwatershed sampling, precipitation information, and high-resolution geographic information system land use data can be useful for identifying diffuse source of human fecal pollution in receiving waters. To test this assertion, this study monitored nine headwatersheds over a two-year period potentially impacted by faulty septic systems and leaky sanitary sewer lines. Human fecal pollution was measured using three different human-associated qPCR methods and a positive significant correlation was seen between abundance of human-associated genetic markers and septic systems following wet weather events. In contrast, a negative correlation was observed with sanitary sewer line densities suggesting septic systems are the predominant diffuse source of human fecal pollution in the study area. These results demonstrate the advantages of combining water sampling, climate information, land-use computer-based modeling, and molecular biology disciplines to better characterize diffuse sources of human fecal pollution in environmental waters.

Assessing Protection Afforded to the Microbiological Quality of Bedrock Groundwater from the Impacts of Septic Tank Effluent by Irish Glacial Till: A Field Study

NASA Astrophysics Data System (ADS)

Orr, Alison; McCarthy, Valerie; Meehan, Robert; Flynn, Raymond

2010-05-01

The rural population of Ireland relies almost exclusively on on-site treatment systems for disposal of waste water. Septic tank systems, which discharge effluent to ground, constitute the dominant means of waste water disposal. Many of the areas that employ this technology rely on private or small group groundwater supplies, often located in close proximity of septic tanks. Since many of these water supplies provide raw groundwater to consumers, septic tank effluent (STE) can pose a significant hazard to the microbiological quality of drinking water. T-tests (infiltration testing) carried out prior to tank installation aim to assess the capacity of subsoils to receive STE. Tests completed across Ireland indicate that many existing septic tank systems are located in low permeability subsoils. These subsoils are assumed to afford significant protection to the microbiological quality of groundwater in the underlying bedrock units. A two year investigation in the Lough Muckno Catchment in Co. Monaghan, investigating the impact of STE on water quality, involved carrying out T-tests at three sites where effluent discharged to a dense, silty, ‘fractured' glacial till derived from the underlying bedrock and containing clasts of low grade metamorphic Ordovician and Silurian sandstone and shale. Analysis of groundwater samples collected from 28 piezometers straddling the water table within the till, down-gradient of septic tank systems at two sites, permitted faecal indicator microorganism (FIO) levels in near-surface groundwater to be established. Associated hydraulic conductivity tests (slug tests) at all three sites permitted an evaluation of the levels of horizontal hydraulic conductivity heterogeneity present in the till. Slug test results suggest that till median hydraulic conductivities range from 1.1x10-4 cm/s to 1.1x10-5 cm/s, with variability of up to 2 orders of magnitude across each site. On the other hand no significant differences in properties existed between sites. T-test results ranged from 37.96 min/25mm to 98.26 min/25mm, suggesting hydraulic conductivities of the order of 1.1x10-3 cm/s to 4.24x10-4 cm/s. The contrast in hydraulic conductivity between T-test and slug test results may reflect slight anisotropy within the till, with water flowing vertically a little more easily than horizontally, under equivalent gradients. Despite the low hydraulic conductivities and the low hydraulic gradients observed at each site, analyses of water samples collected from up to 115 metres from septic tank discharge points consistently detected FIOs. The results of the study highlight the possibility of viable pathogenic microorganisms being transported considerable distances from septic tanks through fine-grained glacial tills. Given limited survival times of FIOs outside of their host organisms, study findings suggest that travel times in the till separating septic tanks from monitoring points are of the order of 10s of days, despite similarly low hydraulic conductivities determined independently by the T-test and slug test methods. The microbiological results, coupled to hydraulic measurements, point to very low effective porosities in the till that may possibly relate to fracturing. Moreover, hydraulic conductivity anisotropy suggests that contaminants may flow equally easily to depth. However, the exact levels of protection provided by the till will be a function of effective porosity variation with depth; the role played by fractures remains to be investigated but could prove to be potentially significant. Overall, the results of the study suggest that the levels of protection afforded by fine-grained Irish tills to bedrock aquifers may be considerably lower than originally assumed.

Bayesian Nitrate Source Apportionment to Individual Groundwater Wells in the Central Valley by use of Nitrogen, Oxygen, and Boron Isotopic Tracers

NASA Astrophysics Data System (ADS)

Lockhart, K.; Harter, T.; Grote, M.; Young, M. B.; Eppich, G.; Deinhart, A.; Wimpenny, J.; Yin, Q. Z.

2014-12-01

Groundwater quality is a concern in alluvial aquifers underlying agricultural areas worldwide, an example of which is the San Joaquin Valley, California. Nitrate from land applied fertilizers or from animal waste can leach to groundwater and contaminate drinking water resources. Dairy manure and synthetic fertilizers are the major sources of nitrate in groundwater in the San Joaquin Valley, however, septic waste can be a major source in some areas. As in other such regions around the world, the rural population in the San Joaquin Valley relies almost exclusively on shallow domestic wells (≤150 m deep), of which many have been affected by nitrate. Consumption of water containing nitrate above the drinking water limit has been linked to major health effects including low blood oxygen in infants and certain cancers. Knowledge of the proportion of each of the three main nitrate sources (manure, synthetic fertilizer, and septic waste) contributing to individual well nitrate can aid future regulatory decisions. Nitrogen, oxygen, and boron isotopes can be used as tracers to differentiate between the three main nitrate sources. Mixing models quantify the proportional contributions of sources to a mixture by using the concentration of conservative tracers within each source as a source signature. Deterministic mixing models are common, but do not allow for variability in the tracer source concentration or overlap of tracer concentrations between sources. Bayesian statistics used in conjunction with mixing models can incorporate variability in the source signature. We developed a Bayesian mixing model on a pilot network of 32 private domestic wells in the San Joaquin Valley for which nitrate as well as nitrogen, oxygen, and boron isotopes were measured. Probability distributions for nitrogen, oxygen, and boron isotope source signatures for manure, fertilizer, and septic waste were compiled from the literature and from a previous groundwater monitoring project on several dairies in the San Joaquin Valley. Median percent contribution of nitrate to wells from fertilizer, manure, and septic waste generally match the expected source based on land use patterns, with some exceptions.

Domestic wells have high probability of pumping septic tank leachate

NASA Astrophysics Data System (ADS)

Horn, J. E.; Harter, T.

2011-06-01

Onsite wastewater treatment systems such as septic systems are common in rural and semi-rural areas around the world; in the US, about 25-30 % of households are served by a septic system and a private drinking water well. Site-specific conditions and local groundwater flow are often ignored when installing septic systems and wells. Particularly in areas with small lots, thus a high septic system density, these typically shallow wells are prone to contamination by septic system leachate. Typically, mass balance approaches are used to determine a maximum septic system density that would prevent contamination of the aquifer. In this study, we estimate the probability of a well pumping partially septic system leachate. A detailed groundwater and transport model is used to calculate the capture zone of a typical drinking water well. A spatial probability analysis is performed to assess the probability that a capture zone overlaps with a septic system drainfield depending on aquifer properties, lot and drainfield size. We show that a high septic system density poses a high probability of pumping septic system leachate. The hydraulic conductivity of the aquifer has a strong influence on the intersection probability. We conclude that mass balances calculations applied on a regional scale underestimate the contamination risk of individual drinking water wells by septic systems. This is particularly relevant for contaminants released at high concentrations, for substances which experience limited attenuation, and those being harmful even in low concentrations.

Domestic wells have high probability of pumping septic tank leachate

NASA Astrophysics Data System (ADS)

Bremer, J. E.; Harter, T.

2012-08-01

Onsite wastewater treatment systems are common in rural and semi-rural areas around the world; in the US, about 25-30% of households are served by a septic (onsite) wastewater treatment system, and many property owners also operate their own domestic well nearby. Site-specific conditions and local groundwater flow are often ignored when installing septic systems and wells. In areas with small lots (thus high spatial septic system densities), shallow domestic wells are prone to contamination by septic system leachate. Mass balance approaches have been used to determine a maximum septic system density that would prevent contamination of groundwater resources. In this study, a source area model based on detailed groundwater flow and transport modeling is applied for a stochastic analysis of domestic well contamination by septic leachate. Specifically, we determine the probability that a source area overlaps with a septic system drainfield as a function of aquifer properties, septic system density and drainfield size. We show that high spatial septic system density poses a high probability of pumping septic system leachate. The hydraulic conductivity of the aquifer has a strong influence on the intersection probability. We find that mass balance calculations applied on a regional scale underestimate the contamination risk of individual drinking water wells by septic systems. This is particularly relevant for contaminants released at high concentrations, for substances that experience limited attenuation, and those that are harmful even at low concentrations (e.g., pathogens).

Pre-treatment of domestic wastewater with pre-composting tanks: evaluation of existing systems.

PubMed

Gajurel, D R; Benn, O; Li, Z; Behrendt, J; Otterpohl, R

2003-01-01

A relatively new technology called pre-composting tank or Rottebehaelter, retaining solid material and draining water to a certain extent, has been found to be an interesting component of decentralised systems to replace the usual septic tank. Results of the investigation revealed that solid material which has been retained in the pre-composting tanks still contained a high percentage of water. However, there was no odour problem at and near the tanks. The pre-composted materials have to be further composted together with household and garden wastes for a year prior to their use as soil conditioner. The filtrate is further treated in a constructed wetland. One of the major advantages of this system compared to other systems, such as septic tanks, is that it does not deprive agriculture of the valuable nutrients and soil conditioner from human excreta and does not require an expensive tanker truck. It can be the most appropriate system for application in regions where there is a demand for local reuse of the end product. It has to be stated that maintenance is a crucial factor.

Geohydrology of, and nitrogen and chloride in, the glacial aquifer, Milford-Matamoras area, Pike County, Pennsylvania

USGS Publications Warehouse

Senior, L.A.

1994-01-01

The glacial aquifer that underlies the Routes 209 and 6 corridor between Milford and Matamoras, Pa., is one of the most productive in Pike County. The aquifer is comprised of unconsolidated glacial outwash and kame-terrace deposits that lie within a glacially carved valley now occupied by the Delaware River. Most businesses and residences along this narrow, 7-mile-long corridor rely on individual wells for water supply and septic systems for waste-water disposal. A study of nutrients and chloride in ground water in the glacial aquifer was conducted to determine the effect of these constituents contributed from septic systems and road runoff on ground-water quality. Sources of nutrients and chloride in the recharge zone upgradient of the aquifer include road and parking-lot runoff, septic systems, and precipitation. Nitrate and chloride from these sources can infiltrate and move in the direction of ground-water flow in the saturated zone of the aquifer. A water-table map based on 29 water levels measured in August 1991 indicates that the direction of ground-water flow is from the edges of the valley toward t he Delaware River but is nearly parallel to the Delaware River in the central area of the valley. The average concentrations of nitrogen and chloride in recharge and total annual loads of nitrogen and chloride to ground water were estimated for six areas with different population densities. These estimates assumed a recharge rate to the glacial aquifer of 20 inches per year and a 15 percent loss of chloride and nitrogen in the atmospheric precipitation to surface runoff. The estimated average concentration of nitrogen in recharge ranged from 2.5 to 10 mg/L (milligrams per liter), which corresponds to a total annual load of nitrogen as ammonium released from septic tanks and present in precipitation was oxidized to nitrate as the dominant nitrogen species in ground water. Contributions of nitrogen from septic tanks were greater than contributions from runoff. Observed concentrations of nitrate, which was the most abundant nitrogen species in ground water in t he glacial aquifer, ranged from less than 0.05 to 5.1 mg/L as nitrogen, with a median of 1.1 mg/L as nitrogen. Concentrations of nitrogen measured in ground water were lower than estimated concentrations for recharge suggesting that dissolved nitrogen species may not be conservative in ground water. Nitrate is unstable in anoxic ground water and can be removed by denitrification. Ammonium can be sorbed onto the aquifer materials. Evidence for reducing conditions included a positive correlation between low concentrations of dissolved oxygen and low concentrations of nitrate. The estimated concentration of chloride in recharge ranged from 6.7 to 21 mg/L, and total annual load of chloride to ground water ranged from 19.4 to 50.6 x 10(3) lb/mi2. Chloride is considered to be a chemically conservative ion in ground water. Contributions of chloride to ground water from road salting were greater than contributions from septic tanks. Observed concentrations of chloride in 18 ground-water samples from the glacial aquifer ranged from 2.1 to 32 mg/L, with a median of 17.5 mg/L. Local contamination is indicated by the elevated concentrations of chloride (up to 680 mg/L) detected in four wells located downgradient of an abandoned industry that may have released salts in processing waste. Chloride concentrations in ground water appeared to be greater near major roads and in areas of relatively greater septic-system density than in areas upgradient of roads, farther downgradient from roads, or with less densely spaced septic systems.

Environmental fate of Ra in cation-exchange regeneration brine waste disposed to septic tanks, New Jersey Coastal Plain, USA: migration to the water table.

PubMed

Szabo, Zoltan; Jacobsen, Eric; Kraemer, Thomas F; Parsa, Bahman

2010-01-01

Fate of radium (Ra) in liquid regeneration brine wastes from water softeners disposed to septic tanks in the New Jersey Coastal Plain was studied. Before treatment, combined Ra ((226)Ra plus (228)Ra) concentrations (maximum, 1.54 Bq L(-1)) exceeded the 0.185 Bq L(-1) Maximum Contaminant Level in 4 of 10 studied domestic-well waters (median pH, 4.90). At the water table downgradient from leachfields, combined Ra concentrations were low (commonly < or =0.019 Bq L(-1)) when pH was >5.3, indicating sequestration; when pH was < or =5.3 (acidic), concentrations were elevated (maximum, 0.985 Bq L(-1) - greater than concentrations in corresponding discharged septic-tank effluents (maximum, 0.243 Bq L(-1))), indicating Ra mobilization from leachfield sediments. Confidence in quantification of Ra mass balance was reduced by study design limitations, including synoptic sampling of effluents and ground waters, and large uncertainties associated with analytical methods. The trend of Ra mobilization in acidic environments does match observations from regional water-quality assessments.

Septic Systems - What to Do after the Flood

EPA Pesticide Factsheets

Where can I find information on my septic system? Do I pump my tank during flooded or saturated drainfield conditions? What if my septic system has been used to dispose wastewater from my business? What do I do with my septic system after the flood?

Technical, economic and environmental feasibility of recycling nutrients in waste in Southern Thailand.

PubMed

Schouw, Nanette Levanius; Bregnhøj, Henrik; Mosbaek, Hans; Tjell, Jens Christian

2003-06-01

Technical, economic and environmental criteria were used to evaluate the feasibility of recycling plant nutrients in kitchen waste, human excreta and sullage from households in Phattalung (urban), Kuan Lang (peri urban) and Prik (rural) in Southern Thailand. The difference in situation and context of the three areas called for individual solutions, and for each area three sanitation systems were evaluated. However, in all three areas recycling human excreta and kitchen waste via composting latrines was found to be more environmental feasible than human excreta managed in septic tanks or sub surface trickle irrigation and kitchen waste disposed of at landfill sites or treated at composting plants. Sullage should in Kuan Lang and Prik be used directly on garden crops, but in Phattalung be treated in waste stabilisation ponds before discharge, to be environmentally feasible. The economic feasibility results varied among the three areas and among the involved stakeholders: farmers and Kuan Lang administration benefited from recycling waste, at the expense of other private users, Phattalung municipality and Prik municipality. The main cause of these conflicting interests was lack of cost recovery and public participation, which should therefore serve as the fundament of any future environmental and economic feasible sanitation system.

Organic waste compounds as contaminants in Milwaukee-area streams

USGS Publications Warehouse

Baldwin, Austin K.; Corsi, Steven R.; Magruder, Christopher; Magruder, Matthew; Bruce, Jennifer L.

2015-09-22

Organic waste compounds (OWCs) are ingredients and by-products of common agricultural, industrial, and household substances that can contaminate our streams through sources like urban runoff, sewage overflows, and leaking septic systems. To better understand how OWCs are affecting Milwaukee-area streams, the U.S. Geological Survey, in cooperation with the Milwaukee Metropolitan Sewerage District, conducted a three-year study to investigate the presence and potential toxicity of 69 OWCs in base flow, stormflow, pore water, and sediment at 14 stream sites and 3 Milwaukee harbor locations. This fact sheet summarizes the major findings of this study, including detection frequencies and concentrations, potential toxicity, the prevalence of polycyclic aromatic hydrocarbons (PAHs), and the influence of urbanization.

Determining sources of elevated salinity in pre-hydraulic fracturing water quality data using a multivariate discriminant analysis model

NASA Astrophysics Data System (ADS)

Lautz, L. K.; Hoke, G. D.; Lu, Z.; Siegel, D. I.

2013-12-01

Hydraulic fracturing has the potential to introduce saline water into the environment due to migration of deep formation water to shallow aquifers and/or discharge of flowback water to the environment during transport and disposal. It is challenging to definitively identify whether elevated salinity is associated with hydraulic fracturing, in part, due to the real possibility of other anthropogenic sources of salinity in the human-impacted watersheds in which drilling is taking place and some formation water present naturally in shallow groundwater aquifers. We combined new and published chemistry data for private drinking water wells sampled across five southern New York (NY) counties overlying the Marcellus Shale (Broome, Chemung, Chenango, Steuben, and Tioga). Measurements include Cl, Na, Br, I, Ca, Mg, Ba, SO4, and Sr. We compared this baseline groundwater quality data in NY, now under a moratorium on hydraulic fracturing, with published chemistry data for 6 different potential sources of elevated salinity in shallow groundwater, including Appalachian Basin formation water, road salt runoff, septic effluent, landfill leachate, animal waste, and water softeners. A multivariate random number generator was used to create a synthetic, low salinity (< 20 mg/L Cl) groundwater data set (n=1000) based on the statistical properties of the observed low salinity groundwater. The synthetic, low salinity groundwater was then artificially mixed with variable proportions of different potential sources of salinity to explore chemical differences between groundwater impacted by formation water, road salt runoff, septic effluent, landfill leachate, animal waste, and water softeners. We then trained a multivariate, discriminant analysis model on the resulting data set to classify observed high salinity groundwater (> 20 mg/L Cl) as being affected by formation water, road salt, septic effluent, landfill leachate, animal waste, or water softeners. Single elements or pairs of elements (e.g. Cl and Br) were not effective at discriminating between sources of salinity, indicating multivariate methods are needed. The discriminant analysis model classified most accurately samples affected by formation water and landfill leachate, whereas those contaminated by road salt, animal waste, and water softeners were more likely to be discriminated as contaminated by a different source. Using this approach, no shallow groundwater samples from NY appear to be affected by formation water, suggesting the source of salinity pre-hydraulic fracturing is primarily a combination of road salt, septic effluent, landfill leachate, and animal waste.

SepticSmart Homeowners

EPA Pesticide Factsheets

EPA’s SepticSmart initiative is a nation-wide public education effort with resources for homeowners with septic systems, local organizations and government leaders to learn how septic systems work and simple, everyday tips on how to properly maintain them.

40 CFR 240.200-2 - Recommended procedures: Design.

Code of Federal Regulations, 2014 CFR

2014-07-01

... processing. These include: Certain bulky wastes (e.g., combustible demolition and construction debris, tree... treatment facilities, raw sewage sludges, and septic tank pumpings. (b) If the facility is designed to...

40 CFR 240.200-2 - Recommended procedures: Design.

Code of Federal Regulations, 2012 CFR

2012-07-01

... processing. These include: Certain bulky wastes (e.g., combustible demolition and construction debris, tree... treatment facilities, raw sewage sludges, and septic tank pumpings. (b) If the facility is designed to...

OPPENHEIMER FORMULA

EPA Pesticide Factsheets

Technical product bulletin: this biological additive is a bioremediation agent in oil spill cleanups. Especially valuable in grass flats, marshes, and the open sea. Also effective in fresh water, municipal waste treatment, septic tanks and grease traps.

Baseline water-quality sampling to infer nutrient and contaminant sources at Kaloko-Honokōhau National Historical Park, Island of Hawai‘i, 2009

USGS Publications Warehouse

Hunt, Charles D.

2015-01-01

Some fraction of septic leachate is expected in groundwater because there are unsewered suburban and commercial developments upslope from the Park that rely on cesspools and septic systems. However, stable isotopes of nitrate did not implicate septic-waste nitrogen (heavy δ15N values on the order of +10 per mil or greater). Instead, the heaviest δ15N values of +6 to +8 per mil were associated with the large fishponds, likely as a result of biotic cycling. Water samples with δ15N values of +3 to +5 per mil were still isotopically heavier than the upland groundwater value of +2 per mil and likely reflect addition of heavier nitrogen, possibly from septic sources, nitrogen-fixing vegetation, or vehicular exhaust. Pharmaceuticals, wastewater compounds, and volatile organic compounds indicated that if contamination is present, it appears to be at low, barely detectable, levels--at least as reflected by the results of this study. The most diagnostic indication of septic contamination was at monitoring well KAHO 2, closest to Kaloko Light Industrial Park, where three pharmaceuticals (carbamazepine, sulfamethoxazole, and thiobendazole) were detected at trace-level parts-per-trillion concentrations. A screening-level test for laundry fabric brighteners indicated positive detection at most sites; however, readings were quite low and if laundry graywater is present, it appears to be a small, dilute fraction. Because the weather was persistently dry throughout the study period, the USGS team was unable to conduct a wet-weather “storm” sampling. Wet-weather results are expected to differ from those reported here, though by how much remains unknown.

Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries

PubMed Central

Kookana, Rai S.; Williams, Mike; Boxall, Alistair B. A.; Larsson, D. G. Joakim; Gaw, Sally; Choi, Kyungho; Yamamoto, Hiroshi; Thatikonda, Shashidhar; Zhu, Yong-Guan; Carriquiriborde, Pedro

2014-01-01

Active pharmaceutical ingredients (APIs) can enter the natural environment during manufacture, use and/or disposal, and consequently public concern about their potential adverse impacts in the environment is growing. Despite the bulk of the human population living in Asia and Africa (mostly in low- or middle-income countries), limited work relating to research, development and regulations on APIs in the environment have so far been conducted in these regions. Also, the API manufacturing sector is gradually shifting to countries with lower production costs. This paper focuses mainly on APIs for human consumption and highlights key differences between the low-, middle- and high-income countries, covering factors such as population and demographics, manufacture, prescriptions, treatment, disposal and reuse of waste and wastewater. The striking differences in populations (both human and animal), urbanization, sewer connectivity and other factors have revealed that the environmental compartments receiving the bulk of API residues differ markedly between low- and high-income countries. High sewer connectivity in developed countries allows capture and treatment of the waste stream (point-source). However, in many low- or middle-income countries, sewerage connectivity is generally low and in some areas waste is collected predominantly in septic systems. Consequently, the diffuse-source impact, such as on groundwater from leaking septic systems or on land due to disposal of raw sewage or septage, may be of greater concern. A screening level assessment of potential burdens of APIs in urban and rural environments of countries representing low- and middle-income as well as high-income has been made. Implications for ecological risks of APIs used by humans in lower income countries are discussed. PMID:25405973

75 FR 35024 - North Carolina Waters Along the Entire Length of Brunswick and Pender Counties and the Saline...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-21

... and regulated septic tanks or State approved on site waste treatment plant, or the waste is collected into a large holding tank for transport to a sewage treatment plant. Thus all vessel sewage will be... New Hanover Counties for pumping out vessel holding tanks: (1) St. James Plantation Marina, 910-253...

75 FR 7590 - North Carolina Waters Along the Entire Length of New Hanover County; Final No Discharge Zone...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

... approved and regulated septic tanks or State approved on- site waste treatment plant, or the waste is collected into a large holding tank for transport to a sewage treatment plant. Thus all vessel sewage will... tanks: (1) Carolina Beach Municipal Marina, Carolina Beach, 910-458-2540, open 24 hours per day, 7 days...

The promise of precise borehole gravimetry in petroleum exploration and exploitation

USGS Publications Warehouse

McCulloh, Thane Hubert

1966-01-01

This report provides comprehensive information on the geology, geohydrology, and mineral resources of Boone and Winnebago Counties for use in resource-based land-use planning and development. Data on the composition, thickness, and regional distribution of glacial drift and bedrock materials were used to construct maps of: geologic materials to a depth of 20 ft; bedrock topography; drift thickness; major terrains; and glacial drift aquifers. Because contamination of aquifers is a serious concern in some areas of the two counties, a major focus of this study is on interpreting data critical to the selection of suitable areas for municipal waste disposal and prevention of contamination from existing municipal landfills and septic systems. Interpretive maps accompanying the text: (1) rate geological sequences on their capacity to protect aquifers and surface water from contamination by land burial of municipal wastes, septic system disposal, and surface spreading of wastes and agricultural chemicals; (2) geologic sequences on their suitability for general construction; and (3) delineate resources of sand, gravel, peat, and dolomite. Areas in which aquifer contamination from waste disposal and other land-use practices is most likely to occur are those in which sand and gravel and/or permeable creviced bedrock are at or near the surface. Areas having the lowest contamination potential are underlain by thick (20 ft or more) deposits of fine-grained glacial till. Areas most favorable for general construction are well-drained locations in major river valleys and terrace outwash plains; areas least favorable for construction are scattered throughout both counties on poorly drained land having low bearing capacities and on uplands and slopes in northwestern Winnebago County where the drift is thin over the bedrock. Extensive deposits of sand and gravel occur in the major bedrock valleys. Dolomite deposits underlie all the uplands of Winnebago County and most of Boone County, but extraction costs are prohibitive where overburden is thick. High-grade dolomite with relatively thin overburden is found in eastern Winnebago County and southwestern Boone County. (Author 's abstract)

Isolating the impact of septic systems on fecal pollution in streams of suburban watersheds in Georgia, United States.

PubMed

Sowah, Robert A; Habteselassie, Mussie Y; Radcliffe, David E; Bauske, Ellen; Risse, Mark

2017-01-01

The presence of multiple sources of fecal pollution at the watershed level presents challenges to efforts aimed at identifying the influence of septic systems. In this study multiple approaches including targeted sampling and monitoring of host-specific Bacteroidales markers were used to identify the impact of septic systems on microbial water quality. Twenty four watersheds with septic density ranging from 8 to 373 septic units/km 2 were monitored for water quality under baseflow conditions over a 3-year period. The levels of the human-associated HF183 marker, as well as total and ruminant Bacteroidales, were quantified using quantitative polymerase chain reaction. Human-associated Bacteroidales yield was significantly higher in high density watersheds compared to low density areas and was negatively correlated (r = -0.64) with the average distance of septic systems to streams in the spring season. The human marker was also positively correlated with the total Bacteroidales marker, suggesting that the human source input was a significant contributor to total fecal pollution in the study area. Multivariable regression analysis indicates that septic systems, along with forest cover, impervious area and specific conductance could explain up to 74% of the variation in human fecal pollution in the spring season. The results suggest septic system impact through contributions to groundwater recharge during baseflow or failing septic system input, especially in areas with >87 septic units/km 2 . This study supports the use of microbial source tracking approaches along with traditional fecal indicator bacteria monitoring and land use characterization in a tiered approach to isolate the influence of septic systems on water quality in mixed-use watersheds. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Use of Permeable Barriers to Inhibit Virus Migration in the Subsurface

NASA Astrophysics Data System (ADS)

Schulze-Makuch, D.; Guan, H.; Totten, J.; Couroux, E.; Endley, S.; Hielscher, F.; Emmert, S.; Pillai, S. D.

2001-12-01

Ground water is susceptible to fecal contamination due to leaking sewer lines, faulty septic tanks and careless disposal of septic wastes; a problem especially common in low-income areas with no public sewage system. Under these conditions, viral and bacterial infection rates have been shown to increase. However, potential for viral infections can be reduced if the viruses are prevented from reaching the drinking water wells. Laboratory and field studies were conducted to determine whether iron-coated sand (ICS), pure zeolite (PZ) and surfactant modified zeolites (SMZ) could be used to retard virus migration in soils. In the laboratory, using a model aquifer and MS2 bacteriophage (as an enteric virus indicator) we showed that ICS and especially SMZ was able to remove more than 90 % of the injected viruses under various conditions. The removal efficiency of viruses was also tested under field conditions using septic effluent and a constructed submerged wetland. The performance of the wetland was greatly enhanced when using SMZ as filter pack for a pumping well that withdrew water at a downstream location from the wetland. Our results suggest that submerged wetlands, particularly if combined with a pumping well that has a filter pack consisting of surfactant modified zeolite (rather than the usual sand and gravel pack), are efficient in removing viruses from septic effluent. The permeable barrier materials tested here are economical and could significantly reduce the potential for viral contamination of drinking water wells. >http://www.geo.utep.edu/pub/dirksm/geobiowater/geobiowater.htm

Evaluating the influence of septic systems and watershed characteristics on stream faecal pollution in suburban watersheds in Georgia, USA.

PubMed

Sowah, R; Zhang, H; Radcliffe, D; Bauske, E; Habteselassie, M Y

2014-11-01

To determine the impact of septic systems on water quality and in so doing identify watershed level characteristics that influence septic system impact. Water samples were collected from streams in 24 well-characterized watersheds during baseflow to analyse for the levels of faecal indicators Escherichia coli and enterococci. The watersheds represent a gradient of land-use conditions from low to high density of septic systems, as well as developed to undeveloped uses. Our findings indicate statistically significant interaction between septic density and season for enterococci count (P = 0·005) and stream yield (P = 0·04). Seasonal variations in bacterial count and stream yield were also observed, with significant differences between spring-winter and summer-winter. Results from multiple linear regression models suggest that watershed characteristics (septic system density, median distance of septic systems to stream, per cent developed area and forest cover) and water temperature could explain approximately half (R(2) = 0·50) of the variability in bacterial count and yield in spring and summer. There is a significant positive relationship between septic system density and faecal pollution levels. However, this relationship is season dependent and is influenced by watershed level characteristics such as median distance of septic systems from streams, per cent developed area and forest cover. This study confirms the significant impact of septic systems on faecal pollution during baseflow and provides the tools that will enable effective pollution monitoring at the watershed scale. © 2014 The Society for Applied Microbiology.

Waste management in primary healthcare centres of Iran.

PubMed

Mesdaghinia, Alireza; Naddafi, Kazem; Mahvi, Amir Hossein; Saeedi, Reza

2009-06-01

The waste management practices in primary healthcare centres of Iran were investigated in the present study. A total of 120 primary healthcare centres located across the country were selected using the cluster sampling method and the current situation of healthcare waste management was determined through field investigation. The quantities of solid waste and wastewater generation per outpatient were found to be 60 g outpatient(-1) day(-1) and 26 L outpatient(-1) day(-1), respectively. In all of the facilities, sharp objects were separated almost completely, but separation of other types of hazardous healthcare solid waste was only done in 25% of the centres. The separated hazardous solid waste materials were treated by incineration, temporary incineration and open burning methods in 32.5, 8.3 and 42.5% of the healthcare centres, respectively. In 16.7% of the centres the hazardous solid wastes were disposed of without any treatment. These results indicate that the management of waste materials in primary healthcare centres in Iran faced some problems. Staff training and awareness, separation of healthcare solid waste, establishment of the autoclave method for healthcare solid waste treatment and construction of septic tanks and disinfection units in the centres that were without access to a sewer system are the major measures that are suggested for improvement of the waste management practices.

Marine recreation and public health microbiology: Quest for the ideal indicator

USGS Publications Warehouse

Griffin, Dale W.; Lipp, Erin K.; McLaughlin, Molly R.; Rose, Joan B.

2001-01-01

Four-fifths of the population of the United States live in close proximity to the oceans or Great Lakes, and approximately 100 million Americans use the marine environment for recreation each year (Thurman 1994). Consequently, contamination of lakes, rivers, and coastal waters raises significant public health issues. Among the leading sources of chemical and biological contamination of these waters and associated beaches are sewer systems, septic tanks, stormwater runoff, industrial wastes, wastewater injection wells, cesspits, animal wastes, commercial and private boat wastes, and human recreation. In 1997, 649 beach closings or advisories were caused by sewage spills and overflows (NRDC 1998). In Florida alone, approximately 500 million gallons of sewage were released along the coast each year during the late 1980s (Neshyba 1987). Thus one of the primary concerns in public health is the risk that humans using the marine environment for recreational activities will encounter microbial pathogens.

Marine recreation and public health microbiology: quest for the ideal indicator

USGS Publications Warehouse

Griffin, Dale W.; Lipp, Erin K.; McLaughlin, Molly R.; Rose, Joan B.

2001-01-01

Four-fifths of the population of the United States live in close proximity to the oceans or Great Lakes, and approximately 100 million Americans use the marine environment for recreation each year (Thurman 1994). Consequently, contamination of lakes, rivers, and coastal waters raises significant public health issues. Among the leading sources of chemical and biological contamination of these waters and associated beaches are sewer systems, septic tanks, stormwater runoff, industrial wastes, wastewater injection wells, cesspits, animal wastes, commercial and private boat wastes, and human recreation. In 1997, 649 beach closings or advisories were caused by sewage spills and overflows (NRDC 1998). In Florida alone, approximately 500 million gallons of sewage were released along the coast each year during the late 1980s (Neshyba 1987). Thus one of the primary concerns in public health is the risk that humans using the marine environment for recreational activities will encounter microbial pathogens.

A Homeowner's Guide to Septic Systems.

ERIC Educational Resources Information Center

Sponenberg, Torsten D.; And Others

This booklet provides basic information on septic system use and maintenance. Written for current and prospective homeowners, it offers guidelines for proper operation of household septic systems. In addition, (1) components of individual systems are diagrammatically explained; (2) suggestions for maintenance are outlined; (3) problem areas and…

Corrective Action Investigation Plan for Corrective Action Unit 219: Septic Systems and Injection Wells, Nevada Test Site, Nevada, Rev. No.: 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

David A. Strand

The Corrective Action Investigation Plan for Corrective Action Unit 219, Septic Systems and Injection Wells, has been developed in accordance with the ''Federal Facility Agreement and Consent Order'' (1996) that was agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. The purpose of the investigation is to ensure that adequate data are collected to provide sufficient and reliable information to identify, evaluate, and select technically viable corrective actions. Corrective Action Unit 219 is located in Areas 3, 16, and 23 of the Nevada Test Site, which is 65 miles northwest ofmore » Las Vegas, Nevada. Corrective Action Unit 219 is comprised of the six Corrective Action Sites (CASs) listed below: (1) 03-11-01, Steam Pipes and Asbestos Tiles; (2) 16-04-01, Septic Tanks (3); (3) 16-04-02, Distribution Box; (4) 16-04-03, Sewer Pipes; (5) 23-20-01, DNA Motor Pool Sewage and Waste System; and (6) 23-20-02, Injection Well. These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective action investigation prior to evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document.« less

Septic thrombophlebitis of the portal venous system: clinical and imaging findings in thirty-three patients.

PubMed

Ames, Jennifer T; Federle, Michael P

2011-07-01

Our purpose was to review the clinical and imaging findings in a series of patients with septic thrombophlebitis of the portal venous system in order to define criteria that might allow more confident and timely diagnosis. This is a retrospective case series. The clinical and imaging features were analyzed in 33 subjects with septic thrombophlebitis of the portal venous system. All 33 patients with septic thrombophlebitis of the portal venous system had pre-disposing infectious or inflammatory processes. Contrast-enhanced CT studies of patients with septic thrombophlebitis typically demonstrate an infectious gastrointestinal source (82%), thrombosis (70%), and/or gas (21%) of the portal system or its branches, and intrahepatic abnormalities such as a transient hepatic attenuation difference (THAD) (42%) or abscess (61%). Septic thrombophlebitis of the portal system is often associated with an infectious source in the gastrointestinal tract and sepsis. Contrast-enhanced CT demonstrates an infectious gastrointestinal source, thrombosis or gas within the portal system or its branches, and intrahepatic abnormalities such as abscess in most cases. We report a THAD in several of our patients, an observation that was not made in prior reports of septic thrombophlebitis.

Maintenance of submersible pumps in the septic tanks: ergonomic and biological risks to the worker.

PubMed

Mariño, Suzi; Figueiredo, Alex

2012-01-01

In this study was observed the maintenance task of submersible pumps septic tanks installed in industrial bathrooms. This maintenance activity operators are exposed to various biological and ergonomic risks. This type of activity requires its great physical performers who are also subject to contact with human waste in the form of liquids, gases and solids. Besides the problems mentioned, are still exposed to high temperatures that can cause diseases such as hyperthermia or heatstroke. These aspects were observed using the ergonomic assessment methodology in order to suggest improvements that are reflected in productivity and employee satisfaction.

Do septic systems contribute micropollutants and their transformation products to shallow groundwater?

USDA-ARS?s Scientific Manuscript database

Septic systems may contribute micropollutants to shallow groundwater and surface water. We constructed two in situ conventional drainfields (drip dispersal and gravel trench) and an advanced drainfield of septic systems to investigate the fate and transport of micropollutants to shallow groundwater....

Effluent migration from septic tank systems in two different lithologies, Broward County, Florida

USGS Publications Warehouse

Waller, B.G.; Howie, Barbara; Causaras, C.R.

1987-01-01

Two septic tank test sites, one in sand and one in limestone, in Broward County, Florida, were analyzed for effluent migration. Groundwater from shallow wells, both in background areas and hydraulically down-gradient of the septic tank system, was sampled during a 16-month period from April 1983 through August 1984. Water quality indicators were used to determine the effluent affected zone near the septic tank systems. Specific conductance levels and concentrations of chloride, sulfate, ammonium, and nitrate indicated effluent movement primarily in a vertical direction with abrupt dilution as it moved down-gradient. Effluent was detected in the sand to a depth more than 20 ft below the septic tank outlet, but was diluted to near background conditions 50 ft down-gradient from the tank. Effluent in the limestone was detected in all three observation wells to depths exceeding 25 ft below the septic tank outlet and was diluted, but still detectable, 40 ft down-gradient. The primary controls on effluent movement from septic tank systems in Broward County are the lithology and layering of the geologic materials, hydraulic gradients, and the volume and type of use the system receives. (Author 's abstract)

Superfund Record of Decision (EPA Region 3): Tyson Dump Number 1, Upper Merion Township, Montgomery County, PA. (Third remedial action), September 1990

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1990-09-28

The 4-acre Tyson Dump No. 1 site is an abandoned septic and chemical waste disposal area in Upper Merion Township, Montgomery County, Pennsylvania. The site consists of a series of abandoned unlined lagoons in a former sandstone quarry, and is bordered by unnamed tributaries to the Schuylkill River on the east and west, and a railroad switching yard to the north. Beyond the railroad yard is a floodplain/wetlands area and the Schuylkill River, which flows southeast toward Philadelphia. The river is the main source of drinking water in the area. From 1960 until 1973, the privately owned site was usedmore » for the disposal of liquid septic tank wastes, sludges, and chemical wastes that were hauled onsite in bulk tank trucks. The third ROD addresses OU3, the further remediation of the contaminated ground water that has migrated under the Schuylkill River. Additional ground water investigations will be conducted on the north side of the river, and based on the results, a fourth operable unit may be identified. The primary contaminants of concern affecting the ground water are VOCs including toluene and xylenes.« less

Evaluation of Nitrate Sources and Nitrate Management Strategies in California Suburban Growth Areas

NASA Astrophysics Data System (ADS)

Singleton, M. J.; Moran, J. E.; Esser, B. K.; Leif, R. N.; McNab, W. W.; Carle, S. F.; Moore, K. B.

2005-12-01

Population growth in California has pushed the boundaries of suburban communities into formerly agricultural areas. As a result there is considerable uncertainty as to whether nitrate contamination in groundwater wells results from current sources or is a legacy of agriculture. Fertilizer application for historical agriculture is frequently assumed to be a major source, but septic system leachate, other animal waste, and residential fertilizer application may also contribute. Potential remediation strategies may include improved fertilizer management and/or conversion from septic tanks to sewer systems, but the sources of nitrate and pathways to groundwater must first be identified in order to develop a plan of action. We combine the detection of trace organic compounds that are specific to domestic waste with isotopic compositions of nitrogen and oxygen in nitrate in order to determine nitrate sources. Under anaerobic conditions and in the presence of an electron donor such as organic carbon, microbially mediated denitrification may transform nitrate to harmless nitrogen gas, and fractionate the isotopologues of any residual nitrate. The occurrence of saturated zone denitrification is detected by measuring excess dissolved nitrogen gas with a field-portable membrane inlet mass spectrometer system. Groundwater age dating using the 3H/3He method provides a means of tracking the history of nitrate inputs to groundwater, including changes in nitrate flux after implementation of a remediation program. Groundwater that pre-dates agricultural or suburban activity is used to define natural background levels of nitrate. Study areas in California include Chico, Livermore, and Gilroy. This work was performed under the auspices of the U.S. Department of Energy by University of California, Lawrence Livermore National Laboratory under Contract W-7405-Eng-48.

Decrease of oxidative phosphorylation system function in severe septic patients.

PubMed

Lorente, Leonardo; Martín, María M; López-Gallardo, Ester; Blanquer, José; Solé-Violán, Jordi; Labarta, Lorenzo; Díaz, César; Jiménez, Alejandro; Montoya, Julio; Ruiz-Pesini, Eduardo

2015-10-01

The comparison of oxidative phosphorylation system capacities between septic patients and control subjects has been scarcely analyzed and only in studies with small sample size (fewer than 40 septic patients and 40 controls). Thus, the objective of this study was to compare platelet respiratory complex IV (CIV) activity between severe septic patients and healthy individuals in a larger series (including 198 severe septic patients and 96 healthy controls). A prospective, multicenter, observational study was carried out in 6 Spanish intensive care units. We obtained blood samples from 198 severe septic patients at day 1, 4, and 8 of the severe sepsis diagnosis and 96 sex- and age-matched healthy control individuals and determined platelet CIV-specific activity. The end point of the study was 30-day mortality. Control individuals showed higher platelet CIV-specific activity (P < .001) than surviving (n = 130) or nonsurviving (n = 68) severe septic patients at day 1, 4, and 8 of severe sepsis diagnosis. The major finding of our work, involving the largest series to date of severe septic patients with data on oxidative phosphorylation system capacity, was that surviving and nonsurviving septic patients showed lower platelet CIV-specific activity during the first week of sepsis than healthy controls. Copyright © 2015 Elsevier Inc. All rights reserved.

Septic systems as hot-spots of pollutants in the environment: Fate and mass balance of micropollutants in septic drainfields

USDA-ARS?s Scientific Manuscript database

Effluent discharged from septic systems, also known as onsite wastewater treatment systems, can be an important source of micropollutants in the environment. We investigated the fate and transport of 17 micropollutants, including human excretion markers, hormones, pharmaceuticals and personal care p...

Micropollutants in groundwater from septic systems: Transformations, transport mechanisms, and human health risk assessment.

PubMed

Yang, Yun-Ya; Toor, Gurpal S; Wilson, P Chris; Williams, Clinton F

2017-10-15

Septic systems may contribute micropollutants to shallow groundwater and surface water. We constructed two in situ conventional drainfields (drip dispersal and gravel trench) and an advanced drainfield of septic systems to investigate the fate and transport of micropollutants to shallow groundwater. Unsaturated soil-water and groundwater samples were collected, over 32 sampling events (January 2013 to June 2014), from the drainfields (0.31-1.07 m deep) and piezometers (3.1-3.4 m deep). In addition to soil-water and groundwater, effluent samples collected from the septic tank were also analyzed for 20 selected micropollutants, including wastewater markers, hormones, pharmaceuticals and personal care products (PPCPs), a plasticizer, and their transformation products. The removal efficiencies of micropollutants from septic tank effluent to groundwater were similar among three septic systems and were 51-89% for sucralose and 53->99% for other micropollutants. Even with high removal rates within the drainfields, six PPCPs and sucralose with concentrations ranging from <0.3 to 154 ng/L and 121 to 32,000 ng/L reached shallow groundwater, respectively. The human health risk assessment showed that the risk to human health due to consumption of groundwater is negligible for the micropollutants monitored in the study. A better understanding of ecotoxicological effects of micropollutant mixtures from septic systems to ecosystem and human health is warranted for the long-term sustainability of septic systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

Anaerobic on-site black water and kitchen waste treatment using UASB-septic tanks at low temperatures.

PubMed

Luostarinen, S; Rintala, J

2006-01-01

Anaerobic on-site treatment of black water (BW) and a mixture of black water and kitchen waste (BWKW) was studied in a two-phased upflow anaerobic sludge blanket septic tank (UASBst) at 10-20 degrees C. The processes were fed either continuously or discontinuously (twice per weekday). Moreover, BWKW was post-treated for nitrogen removal in an intermittently aerated moving bed biofilm reactor (MBBR) at 20 degrees C. Removal of total chemical oxygen demand (COD1) was efficient at minimum 90% with all three UASBst at all temperatures. Removal of dissolved COD (CODdis) was also high at approx. 70% with continuously fed BW and discontinuously fed BWKW, while with discontinuous BW feeding it was 20%. Temperature decrease had little effect on COD removals, though the need for phase 2 increased with decreasing temperature, especially with BWKW. Post-treatment of BWKW in MBBR resulted in approx. 50% nitrogen removal, but suffered from lack of carbon for denitrification. With carbon addition, removal of ca. 83% was achieved.

Modeling the influence of septic systems on fecal bacteria load in a suburban watershed in Georgia (GWRC 2017)

EPA Science Inventory

Watershed scale models such as the soil and water assessment tool (SWAT) are promising tools for studying the impacts of septic systems on water quality and quantity. In this study, SWAT was used to assess the influence of septic systems on bacterial loads in a suburban watershed...

Septic wastewater treatment using recycled rubber particles as biofiltration media.

PubMed

Oh, Jin Hwan; Park, Jaeyoung; Ellis, Timothy G

2014-01-01

Performance of the laboratory-scale recycled rubber particles (RRP) biofilter was compared to a conventional gravel system and a peat biofilter for treatment of septic tank effluent. During the study, the RRP biofilter provided similar or better performance than other systems in terms of organic removal and hydraulic capacity. After the start-up period, RRP biofilter achieved removal efficiencies for BOD5, total suspended solids (TSS), ammonia nitrogen of 96%, 93%, and 90%, respectively, over the range of hydraulic loading rates of 57-204 L/m2/d. On the other hand, the peat biofilter failed hydraulically and the gravel system showed high TSS concentrations in the effluent. RRP provided high surface area and sufficient time for biological treatment. In addition, RRP was observed to provide ammonia adsorption capacity. The results showed that RRP has the potential to be used as substitutes for natural aggregate such as gravel in septic system drainfields. The RRP biofilter can be used as alternative septic systems for the sites where an existing septic system has failed or site conditions, such as high groundwater table or small lot size, are not suitable for the installation of conventional septic systems.

Design and development of decentralized water and wastewater technologies: a combination of safe wastewater disposal and fertilizer production.

PubMed

Fach, S; Fuchs, S

2010-01-01

Modern wastewater treatment plants are often inappropriate for communities in developing countries. Such communities lack the funding, resources and skilled labour required to implement, operate, and maintain these plants. This research was conducted to investigate and establish an appropriate wastewater treatment system for the district of Gunung Kidul, Indonesia. Due to its lack of water during the dry season, this district is considered one of the poorest areas in the nation. First, wastewater was stored in septic tank units for a retention time of 26 days. Anaerobic conditions occurred, resulting in an 80% reduction of initial COD. The retained sludge was well stabilized with great potential, if dewatered, for reuse as fertilizer. Consequently, supernatant was separated for experiments consisting of lab scale aerobic sand filtering unit. Through filtration, further removals of COD (about 30%) and pathogens were achieved. Rich in nitrogen, the resulting effluent could be used for irrigation and soil conditioning. With faecal sludge and also a mixture of septic sludge and food waste, the hydrolysis stage of anaerobic digestion was examined. This paper discusses the laboratory findings in Karlsruhe and the design and implementation of a treatment system in Glompong, Indonesia.

Insulin alleviates degradation of skeletal muscle protein by inhibiting the ubiquitin-proteasome system in septic rats.

PubMed

Chen, Qiyi; Li, Ning; Zhu, Weiming; Li, Weiqin; Tang, Shaoqiu; Yu, Wenkui; Gao, Tao; Zhang, Juanjuan; Li, Jieshou

2011-06-03

Hypercatabolism is common under septic conditions. Skeletal muscle is the main target organ for hypercatabolism, and this phenomenon is a vital factor in the deterioration of recovery in septic patients. In skeletal muscle, activation of the ubiquitin-proteasome system plays an important role in hypercatabolism under septic status. Insulin is a vital anticatabolic hormone and previous evidence suggests that insulin administration inhibits various steps in the ubiquitin-proteasome system. However, whether insulin can alleviate the degradation of skeletal muscle protein by inhibiting the ubiquitin-proteasome system under septic condition is unclear. This paper confirmed that mRNA and protein levels of the ubiquitin-proteasome system were upregulated and molecular markers of skeletal muscle proteolysis (tyrosine and 3-methylhistidine) simultaneously increased in the skeletal muscle of septic rats. Septic rats were infused with insulin at a constant rate of 2.4 mU.kg-1.min-1 for 8 hours. Concentrations of mRNA and proteins of the ubiquitin-proteasome system and molecular markers of skeletal muscle proteolysis were mildly affected. When the insulin infusion dose increased to 4.8 mU.kg-1.min-1, mRNA for ubiquitin, E2-14 KDa, and the C2 subunit were all sharply downregulated. At the same time, the levels of ubiquitinated proteins, E2-14KDa, and the C2 subunit protein were significantly reduced. Tyrosine and 3-methylhistidine decreased significantly. We concluded that the ubiquitin-proteasome system is important skeletal muscle hypercatabolism in septic rats. Infusion of insulin can reverse the detrimental metabolism of skeletal muscle by inhibiting the ubiquitin-proteasome system, and the effect is proportional to the insulin infusion dose.

Septic systems as hot-spots of pollutants in the environment: Fate and mass balance of micropollutants in septic drainfields.

PubMed

Yang, Yun-Ya; Toor, Gurpal S; Wilson, P Chris; Williams, Clinton F

2016-10-01

Septic systems, a common type of onsite wastewater treatment systems, can be an important source of micropollutants in the environment. We investigated the fate and mass balance of 17 micropollutants, including wastewater markers, hormones, pharmaceuticals and personal care products (PPCPs) in the drainfield of a septic system. Drainfields were replicated in lysimeters (1.5m length, 0.9m width, 0.9m height) and managed similar to the field practice. In each lysimeter, a drip line dispersed 9L of septic tank effluent (STE) per day (equivalent to 32.29L/m(2) per day). Fourteen micropollutants in the STE and 12 in the leachate from drainfields were detected over eight months. Concentrations of most micropollutants in the leachate were low (<200ng/L) when compared to STE because >85% of the added micropollutants except for sucralose were attenuated in the drainfield. We discovered that sorption was the key mechanism for retention of carbamazepine and partially for sulfamethoxazole, whereas microbial degradation likely attenuated acetaminophen in the drainfield. This data suggests that sorption and microbial degradation limited transport of micropollutants from the drainfields. However, the leaching of small amounts of micropollutants indicate that septic systems are hot-spots of micropollutants in the environment and a better understanding of micropollutants in septic systems is needed to protect groundwater quality. Copyright © 2016 Elsevier B.V. All rights reserved.

Vasopressin synthesis by the magnocellular neurons is different in the supraoptic nucleus and in the paraventricular nucleus in human and experimental septic shock.

PubMed

Sonneville, Romain; Guidoux, Céline; Barrett, Lucinda; Viltart, Odile; Mattot, Virginie; Polito, Andrea; Siami, Shidasp; de la Grandmaison, Geoffroy Lorin; Blanchard, Anne; Singer, Mervyn; Annane, Djillali; Gray, Françoise; Brouland, Jean-Philippe; Sharshar, Tarek

2010-05-01

Impaired arginine vasopressin (AVP) synthesis and release by the neurohypophyseal system, which includes the neurohypophysis and magnocellular neurons of the paraventricular and supraoptic nuclei, have been postulated in septic shock, but changes in this system have never been assessed in human septic shock, and only partially experimentally. We investigated AVP synthesis and release by the neurohypophyseal system in 9 patients who died from septic shock and 10 controls, and in 20 rats with fecal peritonitis-induced sepsis and 8 sham-operation controls. Ten rats died spontaneously from septic shock, and the others were sacrificed. In patients with septic shock, as in rats that died spontaneously following sepsis induction, AVP immunohistochemical expression was decreased in the neurohypophysis and supraoptic magnocellular neurons, whereas it was increased in the paraventricular magnocellular neurons. No significant change was observed in AVP messenger RiboNucleic Acid (mRNA) expression assessed by in situ hybridization in either paraventricular or supraoptic magnocellular cells. This study shows that both in human and experimental septic shock, AVP posttranscriptional synthesis and transport are differently modified in the magnocellular neurons of the supraoptic and paraventricular nuclei. This may account for the inappropriate AVP release in septic shock and suggests that distinct pathogenic mechanisms operate in these nuclei.

Septic system density and infectious diarrhea in a defined population of children.

PubMed

Borchardt, Mark A; Chyou, Po-Huang; DeVries, Edna O; Belongia, Edward A

2003-05-01

One-quarter of U.S. households use a septic system for wastewater disposal. In this study we investigated whether septic system density was associated with endemic diarrheal illness in children. Cases--children 1 to < 19 years old seeking medical care for acute diarrhea--and controls resided in the Marshfield Epidemiologic Study Area, a population-based cohort in central Wisconsin. Enrollment was from February 1997 through September 1998. Study participants completed a structured interview, and septic system density was determined from county sanitary permits. Household wells were sampled for bacterial pathogens and indicators of water sanitary quality. Risk factors were assessed for cases grouped by diarrhea etiology. In multivariate analyses, viral diarrhea was associated with the number of holding tank septic systems in the 640-acre section surrounding the case residence [adjusted odds ratio (AOR), 1.08; 95% confidence interval (CI), 1.02-1.15; p = 0.008], and bacterial diarrhea was associated with the number of holding tanks per 40-acre quarter-quarter section (AOR, 1.22; 95% CI, 1.02-1.46; p = 0.026). Diarrhea of unknown etiology was independently associated with drinking from a household well contaminated with fecal enterococci (AOR, 6.18; 95% CI, 1.22-31.46; p = 0.028). Septic system densities were associated with endemic diarrheal illness in central Wisconsin. The association should be investigated in other regions, and standards for septic systems should be evaluated to ensure that the public health is protected.

Septic system density and infectious diarrhea in a defined population of children.

PubMed Central

Borchardt, Mark A; Chyou, Po-Huang; DeVries, Edna O; Belongia, Edward A

2003-01-01

One-quarter of U.S. households use a septic system for wastewater disposal. In this study we investigated whether septic system density was associated with endemic diarrheal illness in children. Cases--children 1 to < 19 years old seeking medical care for acute diarrhea--and controls resided in the Marshfield Epidemiologic Study Area, a population-based cohort in central Wisconsin. Enrollment was from February 1997 through September 1998. Study participants completed a structured interview, and septic system density was determined from county sanitary permits. Household wells were sampled for bacterial pathogens and indicators of water sanitary quality. Risk factors were assessed for cases grouped by diarrhea etiology. In multivariate analyses, viral diarrhea was associated with the number of holding tank septic systems in the 640-acre section surrounding the case residence [adjusted odds ratio (AOR), 1.08; 95% confidence interval (CI), 1.02-1.15; p = 0.008], and bacterial diarrhea was associated with the number of holding tanks per 40-acre quarter-quarter section (AOR, 1.22; 95% CI, 1.02-1.46; p = 0.026). Diarrhea of unknown etiology was independently associated with drinking from a household well contaminated with fecal enterococci (AOR, 6.18; 95% CI, 1.22-31.46; p = 0.028). Septic system densities were associated with endemic diarrheal illness in central Wisconsin. The association should be investigated in other regions, and standards for septic systems should be evaluated to ensure that the public health is protected. PMID:12727604

Low flow water quality in rivers; septic tank systems and high-resolution phosphorus signals.

PubMed

Macintosh, K A; Jordan, P; Cassidy, R; Arnscheidt, J; Ward, C

2011-12-15

Rural point sources of phosphorus (P), including septic tank systems, provide a small part of the overall phosphorus budget to surface waters in agricultural catchments but can have a disproportionate impact on the low flow P concentration of receiving rivers. This has particular importance as the discharges are approximately constant into receiving waters and these have restricted dilution capacity during ecologically sensitive summer periods. In this study, a number of identified high impact septic systems were replaced with modern sequential batch reactors in three rural catchments during a monitoring period of 4 years. Sub-hourly P monitoring was conducted using bankside-analysers. Results show that strategic replacement of defective septic tank systems with modern systems and polishing filters decreased the low flow P concentration of one catchment stream by 0.032 mg TPL(-1) (0.018 mg TRPL(-1)) over the 4 years. However two of the catchment mitigation efforts were offset by continued new-builds that increased the density of septic systems from 3.4 km(-2) to 4.6 km(-2) and 13.8 km(-2) to 17.2 km(-2) and subsequently increased low flow P concentrations. Future considerations for septic system mitigation should include catchment carrying capacity as well as technology changes. Copyright © 2011 Elsevier B.V. All rights reserved.

DEVELOPMENT OF HOST-SPECIFIC METAGENOMIC MARKERS FOR MICROBIAL SOURCE TRACKING USING A NOVEL METAGENOMIC APPROACH

EPA Science Inventory

Fecal contamination of source waters is an important issue to the drinking water industry. Improper disposal of animal waste, leaky septic tanks, storm runoff, and wildlife can all be responsible for spreading enteric pathogens into source waters. As a result, methods that can pi...

Septic Systems Case Studies

EPA Pesticide Factsheets

A collection of septic systems case studies to help community planners, elected officials, health department staff, state officials, and interested citizens explore alternatives for managing their decentralized wastewater treatment systems.

Waste-water impacts on groundwater: Cl/Br ratios and implications for arsenic pollution of groundwater in the Bengal Basin and Red River Basin, Vietnam.

PubMed

McArthur, J M; Sikdar, P K; Hoque, M A; Ghosal, U

2012-10-15

Across West Bengal and Bangladesh, concentrations of Cl in much groundwater exceed the natural, upper limit of 10 mg/L. The Cl/Br mass ratios in groundwaters range up to 2500 and scatter along mixing lines between waste-water and dilute groundwater, with many falling near the mean end-member value for waste-water of 1561 at 126 mg/L Cl. Values of Cl/Br exceed the seawater ratio of 288 in uncommon NO(3)-bearing groundwaters, and in those containing measurable amounts of salt-corrected SO(4) (SO(4) corrected for marine salt). The data show that shallow groundwater tapped by tube-wells in the Bengal Basin has been widely contaminated by waste-water derived from pit latrines, septic tanks, and other methods of sanitary disposal, although reducing conditions in the aquifers have removed most evidence of NO(3) additions from these sources, and much evidence of their additions of SO(4). In groundwaters from wells in palaeo-channel settings, end-member modelling shows that >25% of wells yield water that comprises ≥10% of waste-water. In palaeo-interfluvial settings, only wells at the margins of the palaeo-interfluvial sequence contain detectable waste water. Settings are identifiable by well-colour survey, owner information, water composition, and drilling. Values of Cl/Br and faecal coliform counts are both inversely related to concentrations of pollutant As in groundwater, suggesting that waste-water contributions to groundwater in the near-field of septic-tanks and pit-latrines (within 30 m) suppress the mechanism of As-pollution and lessen the prevalence and severity of As pollution. In the far-field of such sources, organic matter in waste-water may increase groundwater pollution by As. Copyright © 2012. Published by Elsevier B.V.

Quantification of Shallow Groundwater Nutrient Dynamics in Septic Areas

Treesearch

Ying Ouyang; Jia-En Zhang

2012-01-01

Of all groundwater pollution sources, septic systems are the second largest source of groundwater nitrate contamination in USA. This study investigated shallow groundwater (SGW) nutrient dynamics in septic areas at the northern part of the Lower St. Johns River Basin, Florida, USA. Thirty-five SGW-monitoring wells, located at nine different urban areas served by septic...

Sepsis and septic shock

PubMed Central

Hotchkiss, Richard S.; Moldawer, Lyle L.; Opal, Steven M.; Reinhart, Konrad; Turnbull, Isaiah R.; Vincent, Jean-Louis

2017-01-01

For more than two decades, sepsis was defined as a microbial infection that produces fever (or hypothermia), tachycardia, tachypnoea and blood leukocyte changes. Sepsis is now increasingly being considered a dysregulated systemic inflammatory and immune response to microbial invasion that produces organ injury for which mortality rates are declining to 15–25%. Septic shock remains defined as sepsis with hyperlactataemia and concurrent hypotension requiring vasopressor therapy, with in-hospital mortality rates approaching 30–50%. With earlier recognition and more compliance to best practices, sepsis has become less of an immediate life-threatening disorder and more of a long-term chronic critical illness, often associated with prolonged inflammation, immune suppression, organ injury and lean tissue wasting. Furthermore, patients who survive sepsis have continuing risk of mortality after discharge, as well as long-term cognitive and functional deficits. Earlier recognition and improved implementation of best practices have reduced in-hospital mortality, but results from the use of immunomodulatory agents to date have been disappointing. Similarly, no biomarker can definitely diagnose sepsis or predict its clinical outcome. Because of its complexity, improvements in sepsis outcomes are likely to continue to be slow and incremental. PMID:28117397

A NOVEL SCORING SYSTEM: PREDICTING SEPTIC SHOCK AT DIAGNOSIS EASILY IN ACUTE COMPLICATED PYELONEPHRITIS PATIENTS.

PubMed

Kubota, Masashi; Kanno, Toru; Nishiyama, Ryuichi; Okada, Takashi; Higashi, Yoshihito; Yamada, Hitoshi

2016-01-01

(Objectives) Because acute complicated pyelonephritis can easily cause sepsis and concomitant shock status, it is a potentially lethal disease. However, the predictors for the severity of pyelonephritis is not well analyzed. In this study, we aimed at clarifying the clinical characteristic risk factors associated with septic shock in patients with acute complicated pyelonephritis. (Materials and methods) From May 2009 to March 2014, 267 patients with acute complicated pyelonephritis were treated at our institution. We investigated the characteristics of the patients associated with septic shock, and assessed risk factors in these patients. By using these risk factors, we established a novel scoring system to predict septic shock. (Results) 267 patients included 145 patients with ureteral calculi and 75 patients with stent-related pyelonephritis. Septic shock occurred in 35 patients (13%), and the mortality rate was 0.75%. Multivariate analysis revealed that (P): Performance Status ≥3 (p=0.0014), (U): Presence of Ureteral calculi (p=0.043), (S): Sex of female (p=0.023), and (H): the presence of Hydronephrosis (p=0.039) were independent risk factors for septic shock. P.U.S.H. scoring system (range 0-4), which consists of these 4 factors, were positively correlated with the rate of septic shock (score 0: 0%, 1: 5.3%, 2: 3.4%, 3: 25.0%, 4: 42.3%). Importantly, patients with 3-4 P.U.S.H. scores were statistically more likely to become septic shock than those with 0-2 score (p=0.00014). (Conclusions) These results suggest that P.U.S.H. scoring system using 4 clinical factors is useful to predict the status of septic shock in patients with acute complicated pyelonephritis.

The role of contact system in septic shock: the next target? An overview of the current evidence.

PubMed

Nicola, Henrique

2017-01-01

Septic shock remains challenging to intensive care units worldwide, despite recent documented improvement in mortality over the years. Multiple new therapies have been attempted without success in large clinical trials. Evidence concerning the role of the contact system and bradykinin on septic shock physiological manifestations is shown by this article. The objective of the study is to review the current evidence linking contact system activation and septic shock, as well as efficacy of available therapies targeting this pathophysiological pathway and to evaluate the potential of further researching the matter. Multiple animal studies are already available and suggestive of a meaningful role of contact system activation on septic shock. However, human trials are still scarce, and the ones available are not enough to establish such a strong connection. Furthermore, attempted therapies have been successful across multiple species, but not as much in humans. Therefore, contact system and septic shock relationship remains plentiful in questions to be answered in the coming years or decades. Whether the contact system is not as relevant in humans as it is in animals or there is only lack of evidence remains to be explained. The subject is an attractive open field for further research aiming to aid in tackling such a burdensome condition.

Artificial Sweeteners Reveal Septic System Effluent in Rural Groundwater.

PubMed

Spoelstra, John; Senger, Natalie D; Schiff, Sherry L

2017-11-01

It has been widely documented that municipal wastewater treatment plant effluents are a major source of artificial sweeteners to surface waters. However, in rural areas, the extent to which septic systems contribute these same compounds to groundwater aquifers is largely unknown. We examined the occurrence of four commonly used artificial sweeteners in an unconfined sand aquifer that serves as a water supply for rural residents, as a receptor of domestic wastewater from septic systems, and as a source of baseflow to the Nottawasaga River, ON, Canada. Groundwater from the Lake Algonquin Sand Aquifer in the southern Nottawasaga River Watershed was collected from private domestic wells and as groundwater seeps discharging along the banks of the Nottawasaga River. Approximately 30% of samples had detectable levels of one or more artificial sweeteners, indicating the presence of water derived from septic system effluent. Using acesulfame concentrations to estimate the fraction of septic effluent in groundwater samples, ∼3.4 to 13.6% of the domestic wells had 1% or more of their well water being derived from septic system effluent. Similarly, 2.0 to 4.7% of the groundwater seeps had a septic effluent contribution of 1% or more. No relationship was found between the concentration of acesulfame and the concentration of nitrate, ammonium, or soluble reactive phosphorus in the groundwater, indicating that septic effluent is not the dominant source of nutrients in the aquifer. It is expected that the occurrence of artificial sweeteners in shallow groundwater is widespread throughout rural areas in Canada. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Reduced nutrient pollution in a rural stream following septic tank upgrade and installation of runoff retention measures.

PubMed

Ockenden, M C; Quinton, J N; Favaretto, N; Deasy, C; Surridge, B

2014-07-01

Surface water quality in the UK and much of Western Europe has improved in recent decades, in response to better point source controls and the regulation of fertilizer, manure and slurry use. However, diffuse sources of pollution, such as leaching or runoff of nutrients from agricultural fields, and micro-point sources including farmyards, manure heaps and septic tank sewerage systems, particularly systems without soil adsorption beds, are now hypothesised to contribute a significant proportion of the nutrients delivered to surface watercourses. Tackling such sources in an integrated manner is vital, if improvements in freshwater quality are to continue. In this research, we consider the combined effect of constructing small field wetlands and improving a septic tank system on stream water quality within an agricultural catchment in Cumbria, UK. Water quality in the ditch-wetland system was monitored by manual sampling at fortnightly intervals (April-October 2011 and February-October 2012), with the septic tank improvement taking place in February 2012. Reductions in nutrient concentrations were observed through the catchment, by up to 60% when considering total phosphorus (TP) entering and leaving a wetland with a long residence time. Average fluxes of TP, soluble reactive phosphorus (SRP) and ammonium-N (NH4-N) at the head of the ditch system in 2011 (before septic tank improvement) compared to 2012 (after septic tank improvement) were reduced by 28%, 9% and 37% respectively. However, TP concentration data continue to show a clear dilution with increasing flow, indicating that the system remained point source dominated even after the septic tank improvement.

[Nutritional support in sepsis].

PubMed

Ortiz Leyba, C; López Martínez, J; Blesa Malpica, A L

2005-06-01

Although it is considered that metabolic and nutritional support must be part of the management of septic patients, it has not been conclusively shown that nutritional support will improve survival or complications from sepsis. Specific data on this issue are scarce since there are few studies that have investigated specialized nutritional support in septic patients. Thus, most of the recommendations are based on outcomes obtained in severely ill patients with different pathologies. It is assumed that nutritional support should be carried out through the enteral route whenever possible, as in other critically ill patients. The energetic waste in these patients is highly variable, although in general terms the hypermetabolic situation may be classified as moderate. An adjustment factor of 1.25-1.30 is recommended for the Harris-Benedict's equation to calculate the caloric intake. Septic patients should receive a hyperproteic intake. The amount of glucose administered should not exceed 70% of non-protein calories, and lipids intake should not exceed 40%. With regards to micronutrients, it is recommended to increase the supply of those with antioxidant properties (vitamin E, carotenes, vitamin C, selenium). There are data to consider that the use of diets enriched with pharmaco-nutrients (both with parenteral and enteral routes) may be beneficial in septic patients, although there is some controversy when interpreting the outcomes.

Performance of UASB septic tank for treatment of concentrated black water within DESAR concept.

PubMed

Kujawa-Roeleveld, K; Fernandes, T; Wiryawan, Y; Tawfik, A; Visser, M; Zeeman, G

2005-01-01

Separation of wastewater streams produced in households according to their origin, degree of pollution and affinity to a specific treatment constitutes a starting point in the DESAR concept (decentralised sanitation and reuse). Concentrated black water and kitchen waste carry the highest load of organic matter and nutrients from all waste(water)streams generated from different human activities. Anaerobic digestion of concentrated black water is a core technology in the DESAR concept. The applicability of the UASB septic tank for treatment of concentrated black water was investigated under two different temperatures, 15 and 25 degrees C. The removal of total COD was dependent on the operational temperature and attained 61 and 74% respectively. A high removal of the suspended COD of 88 and 94% respectively was measured. Effluent nutrients were mainly in the soluble form. Precipitation of phosphate was observed. Effective sludge/water separation, long HRT and higher operational temperature contributed to a reduction of E. coli. Based on standards there is little risk of contamination with heavy metals when treated effluent is to be applied in agriculture as fertiliser.

A multi-tracer approach to assess fingerprints of nitrate in an aquifer under agriculturally used land

NASA Astrophysics Data System (ADS)

Pasten-Zapata, Ernesto; Ledesma-Ruiz, Rogelio; Ramirez, Aldo; Harter, Thomas; Mahlknecht, Jürgen

2014-05-01

To effectively manage groundwater quality it is essential to understand sources of contamination and underground processes. The objective of the study was to identify sources and fate of nitrate pollution occurring in an aquifer underneath a sub-humid to humid region in NE Mexico which provides 10% of national citrus production. Nitrate isotopes and halide ratios were applied to understand nitrate sources and transformations in relation to land use/land cover. It was found that the study area is subject to diverse nitrate sources including organic waste and wastewater, synthetic fertilizers and soil processes. Animal manure and sewage from septic tanks were the causes of groundwater nitrate pollution within orchards and vegetable agriculture. Dairy activities within a radius of 1,000m from a sampling point increased nitrate pollution. Leachates from septic tanks incited nitrate pollution in residential areas. Soil nitrogen and animal waste were the sources of nitrate in groundwater under shrubland and grassland. Partial denitrification processes were evidenced. The denitrification process helped to attenuate nitrate concentration in the agricultural lands and grassland particularly during summer months.

Pre-operative labs: Wasted dollars or predictors of post-operative cardiac and septic events in orthopaedic trauma patients?

PubMed

Lakomkin, Nikita; Sathiyakumar, Vasanth; Dodd, Ashley C; Jahangir, A Alex; Whiting, Paul S; Obremskey, William T; Sethi, Manish K

2016-06-01

As US healthcare expenditures continue to rise, there is significant pressure to reduce the cost of inpatient medical services. Studies have estimated that over 70% of routine labs may not yield clinical benefits while adding over $300 in costs per day for every inpatient. Although orthopaedic trauma patients tend to have longer inpatient stays and hip fractures have been associated with significant morbidity, there is a dearth of data examining pre-operative labs in predicting post-operative adverse events in these populations. The purpose of this study was to assess whether pre-operative labs significantly predict post-operative cardiac and septic complications in orthopaedic trauma and hip fracture patients. Between 2006 and 2013, 56,336 (15.6%) orthopaedic trauma patients were identified and 27,441 patients (7.6%) were diagnosed with hip fractures. Pre-operative labs included sodium, BUN, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white count, hematocrit, platelet count, prothrombin time, INR, and partial thromboplastin time. For each of these labs, patients were deemed to have normal or abnormal values. Patients were noted to have developed cardiac or septic complications if they sustained (1) myocardial infarction (MI), (2) cardiac arrest, or (3) septic shock within 30 days after surgery. Separate regressions incorporating over 40 patient characteristics including age, gender, pre-operative comorbidities, and labs were performed for orthopaedic trauma patients in order to determine whether pre-operative labs predicted adverse cardiac or septic outcomes. 749 (1.3%) orthopaedic trauma patients developed cardiac complications and 311 (0.6%) developed septic shock. Multivariate regression demonstrated that abnormal pre-operative platelet values were significantly predictive of post-operative cardiac arrest (OR: 11.107, p=0.036), and abnormal bilirubin levels were predictive (OR: 8.487, p=0.008) of the development of septic shock in trauma patients. In the hip fracture cohort, abnormal partial thromboplastin time was significantly associated with post-operative myocardial infarction (OR: 15.083, p=0.046), and abnormal bilirubin (OR: 58.674, p=0.002) significantly predicted the onset of septic shock. This is the first study to demonstrate the utility of pre-operative labs in predicting perioperative cardiac and septic adverse events in orthopaedic trauma and hip fracture patients. Particular attention should be paid to haematologic/coagulation labs (platelets, PTT) and bilirubin values. Prognostic Level II. Copyright © 2016 Elsevier Ltd. All rights reserved.

Plasma levels of F-actin and F:G-actin ratio as potential new biomarkers in patients with septic shock.

PubMed

Belsky, Justin B; Morris, Daniel C; Bouchebl, Ralph; Filbin, Michael R; Bobbitt, Kevin R; Jaehne, Anja K; Rivers, Emanuel P

2016-01-01

To compare plasma levels of F-actin, G-actin and thymosin beta 4 (TB4) in humans with septic shock, noninfectious systemic inflammatory response syndrome (SIRS) and healthy controls. F-actin was significantly elevated in septic shock as compared with noninfectious SIRS and healthy controls. G-actin levels were greatest in the noninfectious SIRS group but significantly elevated in septic shock as compared with healthy controls. TB4 was not detectable in the septic shock or noninfectious SIRS group above the assay's lowest detection range (78 ng/ml). F-actin is significantly elevated in patients with septic shock as compared with noninfectious SIRS. F-actin and the F:G-actin ratio are potential biomarkers for the diagnosis of septic shock.

Drivers and barriers among householders to managing domestic wastewater treatment systems in the Republic of Ireland; implications for risk prevention behaviour

NASA Astrophysics Data System (ADS)

Devitt, Catherine; O'Neill, Eoin; Waldron, Richard

2016-04-01

Septic systems that are malfunctioning, improperly sited or designed, present a contamination risk to drinking water sources, and subsequently, to human health. However, the international literature identifies gaps in householder knowledge regarding the function and maintenance requirements of septic systems, and also the potential health and environmental risk implications. Allied with householder fears related to the financial cost of risk management, these factors tend to reduce concern to recognise a malfunctioning system. In the Republic of Ireland, three-quarters of households in rural areas utilise an individual domestic wastewater treatment system (or septic system). Consequently, a significant portion of rural households that rely on groundwater sources via private-well use are at risk. Ireland reports one of the highest crude incidence rates of Verotoxigenic Escherichia coli (VTEC) infection in the European Union, and waterborne transmission related to contact with untreated or poorly treated water from private water sources is a factor in its transmission. Following recent Irish legislative change that places a duty of care on individual householders to ensure a proper system functioning, this exploratory study examines perceptions towards the risk management of septic systems among Irish householders. Using qualitative research methods, four focus groups selected on the basis of geographical variation, and two semi-structured interviews were conducted. While most householders agreed that poorly maintained septic systems represented a threat to the environment and to public health, none reported to having a regular maintenance routine in place. Thematic analysis revealed the drivers and barriers to septic system maintenance, and preferences of householders pertaining to communication on septic systems. The Health Belief Model is employed to help understand results. Results suggest that householder capacity to engage in regular risk management is reduced by limited perceptions of risk susceptibility and severity, impeding cues to action and barrier concerns. Understanding societal perceptions is central to effectively engaging with the public, and informing an improved approach to future pro-environmental engagement and behaviour.

Detection of Septic System Performance via Remote Sensing Technologies

NASA Astrophysics Data System (ADS)

Patterson, A. H.; Kuszmaul, J. S.; Harvey, C.

2005-05-01

Failing and improperly managed septic systems can affect water quality in their environs and cause health problems for individuals or community residents. When unchecked, failing systems can allow disease-causing pathogens to enter groundwater aquifers and pollute surface waters, contaminating drinking water, recreational waterways, and fishing grounds. Early detection of septic system leakage and failure can limit the extent of these problems. External symptoms which occur over an improperly functioning septic system can include lush or greener growth of vegetation, distress of vegetation, excessive soil moisture levels, or pooling of surface effluent. The use of remote sensing technologies coupled with attainable permit records to successfully identify these features could enable the appropriate agencies to target problem areas without extensive field inspection. High-resolution, airborne imagery was identified as having the potential to detect relative changes in soil moisture, to delineate individual leach fields, and to locate effluent discharges into water bodies. In addition, vegetation patterns responding to nutrient-rich effluent and increased soil moisture could be examined using a vegetation index. Both thermal- and color-infrared imagery were acquired for a study area in Jackson County, Mississippi, adjacent to the Gulf of Mexico. Within this coastal neighborhood known to have significant septic system failures, over 50 volunteer residents supplied information regarding the function of their systems and access to their property. Following data collection, regression methods were used to nominate the major indicators of malfunctioning systems. A ranking system for the "level of function" was derived from these analyses. A model was created which inputs data from attainable records and imagery analysis and outputs a predicted level of septic system function. The end product of this research will permit evaluation of septic system performance to be estimated using only easily obtainable data, allowing for minimal effort in the prioritization of problem areas by regulatory agencies.

Septic arthritis associated with systemic sepsis.

PubMed

Jung, Sung-Weon; Kim, Dong-Hee; Shin, Sung-Jin; Kang, Byoung-Youl; Eho, Yil-Ju; Yang, Seong-Wook

2018-01-01

Septic arthritis presents with good joint function, but sometimes leads to poor outcomes. Concurrent systemic sepsis has been regarded as the poor outcome, and the exact cause remains unclear. This paper was performed to identify factors associated with concurrent systemic sepsis and to research results to predict poor outcomes in patients with septic arthritis. Laboratory and medical data were reviewed for 137 adults with acute septic arthritis who underwent open or arthroscopic surgical debridement at our institution between January 2005 and December 2014. The patients were divided according to whether they had septic arthritis alone (Group A) or in combination with systemic sepsis (Group B). Systemic sepsis was defined as two more systemic inflammatory signs in response to an infectious process. Patient characteristics, laboratory findings, synovial fluid findings and cultures, and surgical results were compared between two groups. Of the 137 patients, 41 (29.9%) had initial systemic sepsis at the diagnosis of septic arthritis. Independent t test revealed that duration of prodromal symptom (p = 0.012), serum neutrophil percent (p = 0.008), C-reactive protein (p = 0.001), Charlson comorbidity index (p = 0.001), positive culture in synovial fluid (p = 0.001), and methicillin-sensitive Staphylococcus aureus (MSSA) isolate in synovial fluid (p = 0.001) had significant correlations with the group B. Repeated debridement was performed for those who had recurrence of infection, and this procedure was more often in group B (23 versus 21 joints, 23.9 versus 51.2%, p = 0.012). Progression of arthritis occurred more often in group B (16 versus 17 joints, 16.7 versus 41.5%, p = 0.001). Septic arthritis combined with systemic sepsis was related to duration of prodromal symptom, serum neutrophil percent, C-reactive protein, Charlson comorbidity index, positive culture in synovial fluid, and a MSSA isolate in synovial fluid. Concurrent systemic sepsis led to poor outcomes in patients with septic arthritis in terms of recurrence of infection and progression of arthritis. III Case control study.

Septic Arthritis

MedlinePlus

... Weak immune system. People with a weak immune system are at greater risk of septic arthritis. This includes people with diabetes, kidney and liver problems, and those taking drugs that suppress their immune systems. Joint trauma. Animal bites, puncture woods or cuts ...

Methane, carbon dioxide, and nitrous oxide emissions from septic tank systems.

PubMed

Diaz-Valbuena, Libia R; Leverenz, Harold L; Cappa, Christopher D; Tchobanoglous, George; Horwath, William R; Darby, Jeannie L

2011-04-01

Emissions of CH4, CO2, and N2O from conventional septic tank systems are known to occur, but there is a dearth of information as to the extent. Mass emission rates of CH4, CO2, and N2O, as measured with a modified flux chamber approach in eight septic tank systems, were determined to be 11, 33.3, and 0.005 g capita(-1) day(-1), respectively, in this research. Existing greenhouse gas (GHG) emission models based on BOD (biochemical oxygen demand) loading have estimated methane emissions to be as high as 27.1 g CH4 capita(-1) day(-1), more than twice the value measured in our study, and concluded that septic tanks are potentially significant sources of GHGs due to the large number of systems currently in use. Based on the measured CH4 emission value, a revised CH4 conversion factor of 0.22 (compared to 0.5) for use in the emissions models is suggested. Emission rates of CH4, CO2, and N2O were also determined from measurements of gas concentrations and flow rates in the septic vent system and were found to be 10.7, 335, and 0.2 g capita(-1)day(-1), respectively. The excellent agreement in the CH4 emission rates between the flux chamber and the vent values indicates the dominant CH4 source is the septic tank.

Using artificial sweeteners to identify contamination sources and infiltration zones in a coupled river-aquifer system

NASA Astrophysics Data System (ADS)

Bichler, Andrea; Muellegger, Christian; Hofmann, Thilo

2014-05-01

In shallow or unconfined aquifers the infiltration of contaminated river water might be a major threat to groundwater quality. Thus, the identification of possible contamination sources in coupled surface- and groundwater systems is of paramount importance to ensure water quality. Micropollutants like artificial sweeteners are promising markers for domestic waste water in natural water bodies. Compounds, such as artificial sweeteners, might enter the aquatic environment via discharge of waste water treatment plants, leaky sewer systems or septic tanks and are ubiquitously found in waste water receiving waters. The hereby presented field study aims at the (1) identification of contamination sources and (2) delineation of infiltration zones in a connected river-aquifer system. River bank filtrate in the groundwater body was assessed qualitatively and quantitatively using a combined approach of hydrochemical analysis and artificial sweeteners (acesulfame ACE) as waste water markers. The investigated aquifer lies within a mesoscale alpine head water catchment and is used for drinking water production. It is hypothesized that a large proportion of the groundwater flux originates from bank filtrate of a nearby losing stream. Water sampling campaigns in March and July 2012 confirmed the occurrence of artificial sweeteners at the investigated site. The municipal waste water treatment plant was identified as point-source for ACE in the river network. In the aquifer ACE was present in more than 80% of the monitoring wells. In addition, water samples were classified according to their hydrochemical composition, identifying two predominant types of water in the aquifer: (1) groundwater influenced by bank filtrate and (2) groundwater originating from local recharge. In combination with ACE concentrations a third type of water could be discriminated: (3) groundwater influence by bank filtrate but infiltrated prior to the waste water treatment plant. Moreover, the presence of ACE at elevated concentrations in aquifer zones dominated by local recharge indicated another point-source of domestic waste water. The combined analysis of ACE and conventional hydrochemical data proved to be useful to identify different sources of waste water. It is shown that the combination of physicochemical parameters and artificial sweeteners allow for a clear delineation of infiltration areas in the investigated aquifer system.

Eutrophication study at the Panjiakou-Daheiting Reservoir system, northern Hebei Province, People's Republic of China: Chlorophyll-a model and sources of phosphorus and nitrogen

USGS Publications Warehouse

Domagalski, Joseph L.; Lin, Chao; Luo, Yang; Kang, Jie; Wang, Shaoming; Brown, Larry R.; Munn, Mark D.

2007-01-01

Concentrations, loads, and sources of nitrate and total phosphorus were investigated at the Panjiakou and Daheiting Reservoir system in northern Hebei Province, People's Republic of China. The Luan He River is the primary source of water to these reservoirs, and the upstream watershed has a mix of land uses including agriculture, forest, and one large urban center. The reservoirs have a primary use for storage of drinking water and partially supply Tianjin City with its annual needs. Secondary uses include flood control and aqua culture (fish cages). The response of the reservoir system from phosphorus input, with respect to chlorophyll-a production from algae, was fitted to a model of normalized phosphorus loading that regresses the average summer-time chlorophyll-a concentration to the average annual phosphorus concentration of the reservoir. Comparison of the normalized phosphorus loading and chlorophyll-a response of this system to other reservoirs throughout the world indicate a level of eutrophication that will require up to an approximate 5–10-fold decrease in annual phosphorus load to bring the system to a more acceptable level of algal productivity. Isotopes of nitrogen and oxygen in dissolved nitrate were measured from the headwater streams and at various locations along the major rivers that provide the majority of water to these reservoirs. Those isotopic measurements indicate that the sources of nitrate change from natural background in the rivers to animal manure and septic waste upstream of the reservoir. Although the isotopic measurements suggest that animal and septic wastes are a primary source of nutrients, measurements of the molar ratio of nitrogen to phosphorus are more indicative of row-cropping practices. Options for reduction of nutrient loads include changing the management practices of the aqua culture, installation of new sewage treatment systems in the large urbanized area of the upper watershed, and agricultural management practices that would reduce the loading of nutrients and soil erosion from that land use.

Pollutant impacts to Cape Hatteras National Seashore from urban runoff and septic leachate.

PubMed

Mallin, Michael A; McIver, Matthew R

2012-07-01

The sandy barrier islands of Cape Hatteras National Seashore, USA, attract large seasonal influxes of tourists, and are host to numerous motels, rentals and second homes. To investigate the impacts of nearby urbanization on public trust waters, sampling was conducted in nine brackish water bodies within this coastal national park. A large tidal urban ditch delivered runoff-driven fecal-contaminated water directly into public beach waters. At all sites except the control, ammonium, phosphorus and fecal bacteria concentrations were high, strongly seasonal and significantly correlated with community water usage, indicating that increased septic tank usage led to increased pollutant concentrations in area waterways. Nutrients from septic systems caused ecosystem-level problems from algal blooms, BOD, and hypoxia while fecal microbes created potential human health problems. Septic system usage is widespread in sensitive coastal areas with high water tables and sandy soils and alternatives to standard septic systems must be required to protect human health and the environment. Copyright © 2012 Elsevier Ltd. All rights reserved.

Ammonia in ground water from the Mississippi River alluvium, Fort Madison, Iowa

USGS Publications Warehouse

Linhart, S. Mike

2001-01-01

Water samples were collected from three municipal wells, two industrial wells, one watersupply well at the Iowa State Penitentiary, one domestic well, two creeks, and the Mississippi River. Tritium analytical results indicate that the time of recharge was after 1953 for water from the municipal wells (where tritium samples were collected). The ammonia concentration, 5.1 milligrams per liter, was considerably higher in ground water collected from well Fort Madison #4 compared to samples collected from other wells. The dissolved organic carbon concentration was also highest in ground water collected from well Fort Madison #4 (5.5 milligrams per liter) although samples from other wells were also relatively high, 2.6 to 5.3 milligrams per liter. The most likely process producing the high ammonia concentration in ground water in the vicinity of well Fort Madison #4 is decomposition of organic matter (ammonification). Nitrogen isotope values, when compared to nitrogen isotope values found in ground water in the vicinity of some of the other wells, indicate the possibility that a higher percentage of the ammonia found in ground water in the vicinity of well Fort Madison #4 may be from human and(or) other animal wastes. Higher concentrations of dissolved phosphorus, orthophosphate, and a higher chloride-to-sodium mole ratio found in ground water sampled from well Fort Madison #4 could be indicative of a sewage or septic source. Potential sources include existing or abandoned septic systems, leaking sanitary sewer lines, commercial or residential waste-disposal sites, and agricultural runoff upgradient from well Fort Madison #4, or possibly, bed sediments of the Mississippi River.

The role of complement system in septic shock.

PubMed

Charchaflieh, Jean; Wei, Jiandong; Labaze, Georges; Hou, Yunfang Joan; Babarsh, Benjamin; Stutz, Helen; Lee, Haekyung; Worah, Samrat; Zhang, Ming

2012-01-01

Septic shock is a critical clinical condition with a high mortality rate. A better understanding of the underlying mechanisms is important to develop effective therapies. Basic and clinical studies suggest that activation of complements in the common cascade, for example, complement component 3 (C3) and C5, is involved in the development of septic shock. The involvement of three upstream complement pathways in septic shock is more complicated. Both the classical and alternative pathways appear to be activated in septic shock, but the alternative pathway may be activated earlier than the classical pathway. Activation of these two pathways is essential to clear endotoxin. Recent investigations have shed light on the role of lectin complement pathway in septic shock. Published reports suggest a protective role of mannose-binding lectin (MBL) against sepsis. Our preliminary study of MBL-associated serine protease-2 (MASP-2) in septic shock patients indicated that acute decrease of MASP-2 in the early phase of septic shock might correlate with in-hospital mortality. It is unknown whether excessive activation of these three upstream complement pathways may contribute to the detrimental effects in septic shock. This paper also discusses additional complement-related pathogenic mechanisms and intervention strategies for septic shock.

Corrective Action Plan for Corrective Action Unit 562: Waste Systems, Nevada National Security Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

NSTec Environmental Restoration

2011-04-30

This Corrective Action Plan has been prepared for Corrective Action Unit (CAU) 562, Waste Systems, in accordance with the Federal Facility Agreement and Consent Order (1996; as amended March 2010). CAU 562 consists of 13 Corrective Action Sites (CASs) located in Areas 2, 23, and 25 of the Nevada National Security Site. Site characterization activities were performed in 2009 and 2010, and the results are presented in Appendix A of the Corrective Action Decision Document for CAU 562. The scope of work required to implement the recommended closure alternatives is summarized. (1) CAS 02-26-11, Lead Shot, will be clean closedmore » by removing shot. (2) CAS 02-44-02, Paint Spills and French Drain, will be clean closed by removing paint and contaminated soil. As a best management practice (BMP), asbestos tile will be removed. (3) CAS 02-59-01, Septic System, will be clean closed by removing septic tank contents. As a BMP, the septic tank will be removed. (4) CAS 02-60-01, Concrete Drain, contains no contaminants of concern (COCs) above action levels. No further action is required; however, as a BMP, the concrete drain will be removed. (5) CAS 02-60-02, French Drain, was clean closed. Corrective actions were completed during corrective action investigation activities. As a BMP, the drain grates and drain pipe will be removed. (6) CAS 02-60-03, Steam Cleaning Drain, will be clean closed by removing contaminated soil. As a BMP, the steam cleaning sump grate and outfall pipe will be removed. (7) CAS 02-60-04, French Drain, was clean closed. Corrective actions were completed during corrective action investigation activities. (8) CAS 02-60-05, French Drain, will be clean closed by removing contaminated soil. (9) CAS 02-60-06, French Drain, contains no COCs above action levels. No further action is required. (10) CAS 02-60-07, French Drain, requires no further action. The french drain identified in historical documentation was not located during corrective action investigation activities. (11) CAS 23-60-01, Mud Trap Drain and Outfall, will be clean closed by removing sediment from the mud trap. As a BMP, the mud trap and outfall pipe will be removed. (12) CAS 23-99-06, Grease Trap, will be clean closed by removing sediment from the grease trap and backfilling the grease trap with grout. (13) CAS 25-60-04, Building 3123 Outfalls, will be clean closed by removing contaminated soil and the sludge-containing outfall pipe.« less

Estimated Quantity of Water in Fractured Bedrock Units on Mt. Desert Island, and Estimated Ground-Water Use, Recharge, and Dilution of Nitrogen in Septic Waste in the Bar Harbor Area, Maine

USGS Publications Warehouse

Nielsen, Martha G.

2002-01-01

In 2002, the U.S. Geological Survey, in cooperation with the town of Bar Harbor, Maine, and the National Park Service, conducted a study to assess the quantity of water in the bedrock units underlying Mt. Desert Island, and to estimate water use, recharge, and dilution of nutrients from domestic septic systems overlying the bedrock units in several watersheds in rural Bar Harbor. Water quantity was calculated as the static volume of water in the top 600 feet of saturated thickness of the bedrock units. Volumes of water were estimated on the basis of effective fracture porosities for the five different rock types found on Mt. Desert Island. Values of porosities for the various bedrock units from the literature range more than five orders of magnitude, although the possible range in porosities for most individual rock types is on the order of three orders of magnitude. The static volume of water in the various units may range from a low of 4,000 gallons per acre for intrusive igneous rocks (primarily granites) to 20 million gallons per acre for the Cranberry Island Volcanics, but given the range in porosity estimates, these numbers can vary by orders of magnitude. Water-use data for the municipal water supply in the Town of Bar Harbor (1998-2000) indicate that residential usage averages 225 gallons per household per day. Recharge to the bedrock units in rural Bar Harbor was bracketed using low, medium, and high estimates, which were 3, 9, and 14 inches per year, respectively. Water use in 2001 was about 2.5 percent of the total estimated medium recharge (9 inches per year) in the study area. Dilution of nitrogen in septic effluent discharging to the bedrock aquifer was evaluated for the development density in 2001. On the basis of an assumed concentration of 47 mg/L of nitrogen in septic system discharge, dilution factors in populated rural Bar Harbor watersheds ranged from 4 to 151, for the housing density in 2001. Understanding that ground water in this fractured bedrock system mixes slowly, the fully mixed average nitrate-nitrogen concentrations in ground water estimated for the watersheds ranged from 0.1 to 11 mg/L.

Decentralised treatment of concentrated sewage at low temperature in a two-step anaerobic system: two upflow-hybrid septic tanks.

PubMed

Elmitwalli, T A; Sayed, S; Groendijk, L; van Lier, J; Zeeman, G; Lettinga, G

2003-01-01

The decentralised treatment of concentrated sewage (about 3,600 mgCOD/l) at low temperature was investigated in a two-step anaerobic system: two-anaerobic hybrid (AH) septic tanks (each 0.575 m3). The two reactors were placed in a temperature controlled-room and the HRT was 2.5 days for each reactor. The system was fed with concentrated domestic sewage, mainly black water from about 40 toilets flushed with only 4 litre of water and a limited amount of grey water. The system showed high removal efficiency for the different COD fractions. Mean removal efficiencies in the two-step AH-septic tank at 5 days HRT and 13 degrees C were 94, 98, 74 and 78% for total COD, suspended COD, colloidal COD and dissolved COD respectively. The results of short run experiments indicated that the presence of reticulated polyurethane foam (RPF) media in the AH-septic tank improved the removal of suspended COD by 22%. The first AH-septic tank was full of sludge after 4 months of operation due to the high removal of particulate COD and the limited hydrolysis at low temperature conditions. Therefore, a simple mathematical model was developed based on ADM1 (the IWA model in 2002). Based on the experimental results and the mathematical model, only a one-step AH septic tank is required. An HRT of 5.5-7.5 days is needed for that one-step AH septic tank to treat concentrated sewage at a low temperature of 13 degrees C. Such a system can provide a total COD removal as high as 87% and will be full of sludge after a period of more than a year.

ELECTROLYTIC REACTOR FOR N REMOVAL FROM EXISTING SEPTIC TANKS - PHASE I

EPA Science Inventory

Neuroendocrine Derangements in Early Septic Shock: Pharmacotherapy for Relative Adrenal and Vasopressin Insufficiency.

PubMed

Schurr, James W; Szumita, Paul M; DeGrado, Jeremy R

2017-09-01

Septic shock is a leading cause of mortality in intensive care units throughout the world. While this disease state represents a highly complex pathophysiology involving numerous organ systems, the early approach to care includes adequate hemodynamic support traditionally achieved via infusions of vasoactive medications after adequate fluid resuscitation. Relative adrenal and vasopressin deficiencies are a common feature of septic shock that contribute to impaired hemodynamics. Hydrocortisone and vasopressin are endocrine system hormone analogues that target the acute neuroendocrine imbalance associated with septic shock. This clinically focused annotated review describes the pathophysiological mechanisms behind their use and explores the potential clinical roles of early administration and synergy when combined.

Predictors of septic shock in obstructive acute pyelonephritis.

PubMed

Tambo, Mitsuhiro; Okegawa, Takatsugu; Shishido, Toshihide; Higashihara, Eiji; Nutahara, Kikuo

2014-06-01

Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi. We retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis. Overall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock. Patients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.

Enterocyte-specific epidermal growth factor prevents barrier dysfunction and improves mortality in murine peritonitis.

PubMed

Clark, Jessica A; Gan, Heng; Samocha, Alexandr J; Fox, Amy C; Buchman, Timothy G; Coopersmith, Craig M

2009-09-01

Systemic administration of epidermal growth factor (EGF) decreases mortality in a murine model of septic peritonitis. Although EGF can have direct healing effects on the intestinal mucosa, it is unknown whether the benefits of systemic EGF in peritonitis are mediated through the intestine. Here, we demonstrate that enterocyte-specific overexpression of EGF is sufficient to prevent intestinal barrier dysfunction and improve survival in peritonitis. Transgenic FVB/N mice that overexpress EGF exclusively in enterocytes (IFABP-EGF) and wild-type (WT) mice were subjected to either sham laparotomy or cecal ligation and puncture (CLP). Intestinal permeability, expression of the tight junction proteins claudins-1, -2, -3, -4, -5, -7, and -8, occludin, and zonula occludens-1; villus length; intestinal epithelial proliferation; and epithelial apoptosis were evaluated. A separate cohort of mice was followed for survival. Peritonitis induced a threefold increase in intestinal permeability in WT mice. This was associated with increased claudin-2 expression and a change in subcellular localization. Permeability decreased to basal levels in IFABP-EGF septic mice, and claudin-2 expression and localization were similar to those of sham animals. Claudin-4 expression was decreased following CLP but was not different between WT septic mice and IFABP-EGF septic mice. Peritonitis-induced decreases in villus length and proliferation and increases in apoptosis seen in WT septic mice did not occur in IFABP-EGF septic mice. IFABP-EGF mice had improved 7-day mortality compared with WT septic mice (6% vs. 64%). Since enterocyte-specific overexpression of EGF is sufficient to prevent peritonitis-induced intestinal barrier dysfunction and confers a survival advantage, the protective effects of systemic EGF in septic peritonitis appear to be mediated in an intestine-specific fashion.

Using Cl/Br ratios and other indicators to assess potential impacts on groundwater quality from septic systems: A review and examples from principal aquifers in the United States

NASA Astrophysics Data System (ADS)

Katz, Brian G.; Eberts, Sandra M.; Kauffman, Leon J.

2011-02-01

SummaryA detailed review was made of chemical indicators used to identify impacts from septic tanks on groundwater quality. Potential impacts from septic tank leachate on groundwater quality were assessed using the mass ratio of chloride-bromide (Cl/Br), concentrations of selected chemical constituents, and ancillary information (land use, census data, well depth, soil characteristics) for wells in principal aquifers of the United States. Chemical data were evaluated from 1848 domestic wells in 19 aquifers, 121 public-supply wells in 6 aquifers, and associated monitoring wells in four aquifers and their overlying hydrogeologic units. Based on previously reported Cl/Br ratios, statistical comparisons between targeted wells (where Cl/Br ratios range from 400 to 1100 and Cl concentrations range from 20 to 100 mg/L) and non-targeted wells indicated that shallow targeted monitoring and domestic wells (<20 m depth below land surface) had a significantly ( p < 0.05) higher median percentage of houses with septic tanks (1990 census data) than non-targeted wells. Higher ( p = 0.08) median nitrate-N concentration (3.1 mg/L) in oxic (dissolved oxygen concentrations >0.5 mg/L) shallow groundwater from target domestic wells, relative to non-target wells (1.5 mg/L), corresponded to significantly higher potassium, boron, chloride, dissolved organic carbon, and sulfate concentrations, which may also indicate the influence of septic-tank effluent. Impacts on groundwater quality from septic systems were most evident for the Eastern Glacial Deposits aquifer and the Northern High Plains aquifer that were associated with the number of housing units using septic tanks, high permeability of overlying sediments, mostly oxic conditions, and shallow wells. Overall, little or no influence from septic systems were found for water samples from the deeper public-supply wells. The Cl/Br ratio is a useful first-level screening tool for assessing possible septic tank influence in water from shallow wells (<20 m) with the range of 400-1100. The use of this ratio would be enhanced with information on other chloride sources, temporal variability of chloride and bromide concentrations in shallow groundwater, knowledge of septic-system age and maintenance, and the use of multiple tracers (combination of additional chemical and microbiological indicators).

Using Cl/Br ratios and other indicators to assess potential impacts on groundwater quality from septic systems: A review and examples from principal aquifers in the United States

USGS Publications Warehouse

Katz, B.G.; Eberts, S.M.; Kauffman, L.J.

2011-01-01

A detailed review was made of chemical indicators used to identify impacts from septic tanks on groundwater quality. Potential impacts from septic tank leachate on groundwater quality were assessed using the mass ratio of chloride-bromide (Cl/Br), concentrations of selected chemical constituents, and ancillary information (land use, census data, well depth, soil characteristics) for wells in principal aquifers of the United States. Chemical data were evaluated from 1848 domestic wells in 19 aquifers, 121 public-supply wells in 6 aquifers, and associated monitoring wells in four aquifers and their overlying hydrogeologic units. Based on previously reported Cl/Br ratios, statistical comparisons between targeted wells (where Cl/Br ratios range from 400 to 1100 and Cl concentrations range from 20 to 100 mg/L) and non-targeted wells indicated that shallow targeted monitoring and domestic wells (0.5. mg/L) shallow groundwater from target domestic wells, relative to non-target wells (1.5. mg/L), corresponded to significantly higher potassium, boron, chloride, dissolved organic carbon, and sulfate concentrations, which may also indicate the influence of septic-tank effluent. Impacts on groundwater quality from septic systems were most evident for the Eastern Glacial Deposits aquifer and the Northern High Plains aquifer that were associated with the number of housing units using septic tanks, high permeability of overlying sediments, mostly oxic conditions, and shallow wells. Overall, little or no influence from septic systems were found for water samples from the deeper public-supply wells.The Cl/Br ratio is a useful first-level screening tool for assessing possible septic tank influence in water from shallow wells (<20 m) with the range of 400-1100. The use of this ratio would be enhanced with information on other chloride sources, temporal variability of chloride and bromide concentrations in shallow groundwater, knowledge of septic-system age and maintenance, and the use of multiple tracers (combination of additional chemical and microbiological indicators). ?? 2010.

Identification, characterization and description of Arcobacter faecis sp. nov., isolated from a human waste septic tank.

PubMed

Whiteduck-Léveillée, Kerri; Whiteduck-Léveillée, Jenni; Cloutier, Michel; Tambong, James T; Xu, Renlin; Topp, Edward; Arts, Michael T; Chao, Jerry; Adam, Zaky; Lévesque, C André; Lapen, David R; Villemur, Richard; Khan, Izhar U H

2016-03-01

A study on the taxonomic classification of Arcobacter species was performed on the cultures isolated from various fecal sources where an Arcobacter strain AF1078(T) from human waste septic tank near Ottawa, Ontario, Canada was characterized using a polyphasic approach. Genetic investigations including 16S rRNA, atpA, cpn60, gyrA, gyrB and rpoB gene sequences of strain AF1078(T) are unique in comparison with other arcobacters. Phylogenetic analysis based on the 16S rRNA gene sequence revealed that the strain is most closely related to Arcobacter lanthieri and Arcobacter cibarius. Analyses of atpA, cpn60, gyrA, gyrB and rpoB gene sequences suggested that strain AF1078(T) formed a phylogenetic lineage independent of other species in the genus. Whole-genome sequence, DNA-DNA hybridization, fatty acid profile and phenotypic analysis further supported the conclusion that strain AF1078(T) represents a novel Arcobacter species, for which the name Arcobacter faecis sp. nov. is proposed, with type strain AF1078(T) (=LMG 28519(T); CCUG 66484(T)). Crown Copyright © 2015. Published by Elsevier GmbH. All rights reserved.

Technological aspects of the microbial treatment of sulfide-rich wastewaters: a case study.

PubMed

Sublette, K L; Kolhatkar, R; Raterman, K

1998-01-01

Thiobacillus denitrificans has been shown to be an effective biocatalyst for the treatment of a variety of sulfide-laden waste streams including sour water, sour gases, and refinery spent-sulfidic caustics. The term 'sour' originated in the petroleum industry to describe a waste contaminated with hydrogen sulfide or salts of sulfide and bisulfide. The microbial treatment of sour waste streams resulting from the production or refining of natural gas and crude oil have been investigated in this laboratory for many years. The application of this technology to the treatment of sour wastes on a commercially useful scale has presented several technical barriers including substrate inhibition (sulfide), product inhibition (sulfate), the need for septic operation, biomass recycle and recovery, mixed waste issues, and the need for large-scale cultivation of the organism for process startup. The removal of these barriers through process improvements are discussed in terms of a case study of the full-scale treatment of sulfide-rich wastewater. The ability of T. denitrificans to deodorize and detoxify an oil-field produced water containing sulfides was evaluated under full-scale field conditions at Amoco Production Co. Salt Creek Field in Midwest, WY. More than 800 m3/d of produced water containing 100 mg/L sulfide and total dissolved solids of 4800 mg/L were successfully biotreated in an earthen pit (3000 m3) over a six-month period. Complete removal of sulfides and elimination of associated odors were observed. The system could be upset by severe hydraulic disturbances; however, the system recovered rapidly when normal influent flow rates were restored.

Diagnostic accuracy of a screening electronic alert tool for severe sepsis and septic shock in the emergency department.

PubMed

Alsolamy, Sami; Al Salamah, Majid; Al Thagafi, Majed; Al-Dorzi, Hasan M; Marini, Abdellatif M; Aljerian, Nawfal; Al-Enezi, Farhan; Al-Hunaidi, Fatimah; Mahmoud, Ahmed M; Alamry, Ahmed; Arabi, Yaseen M

2014-12-05

Early recognition of severe sepsis and septic shock is challenging. The aim of this study was to determine the diagnostic accuracy of an electronic alert system in detecting severe sepsis or septic shock among emergency department (ED) patients. An electronic sepsis alert system was developed as a part of a quality-improvement project for severe sepsis and septic shock. The system screened all adult ED patients for a combination of systemic inflammatory response syndrome and organ dysfunction criteria (hypotension, hypoxemia or lactic acidosis). This study included all patients older than 14 years who presented to the ED of a tertiary care academic medical center from Oct. 1, 2012 to Jan. 31, 2013. As a comparator, emergency medicine physicians or the critical care physician identified the patients with severe sepsis or septic shock. In the ED, vital signs were manually entered into the hospital electronic heath record every hour in the critical care area and every two hours in other areas. We also calculated the time from the alert to the intensive care unit (ICU) referral. Of the 49,838 patients who presented to the ED, 222 (0.4%) were identified to have severe sepsis or septic shock. The electronic sepsis alert had a sensitivity of 93.18% (95% CI, 88.78% - 96.00%), specificity of 98.44 (95% CI, 98.33% - 98.55%), positive predictive value of 20.98% (95% CI, 18.50% - 23.70%) and negative predictive value of 99.97% (95% CI, 99.95% - 99.98%) for severe sepsis and septic shock. The alert preceded ICU referral by a median of 4.02 hours (Q1 - Q3: 1.25-8.55). Our study shows that electronic sepsis alert tool has high sensitivity and specificity in recognizing severe sepsis and septic shock, which may improve early recognition and management.

Long-term mortality of patients with septic ocular or central nervous system complications from pyogenic liver abscess: a population-based study.

PubMed

Lin, Yi-Tsung; Liu, Chia-Jen; Chen, Tzeng-Ji; Fung, Chang-Phone

2012-01-01

Taiwan is endemic for pyogenic liver abscess (PLA). Septic ocular or central nervous system (CNS) complications derived from PLA can result in catastrophic disability. We investigated the epidemiology and long-term prognosis of PLA patients with septic ocular or CNS complications over an 8-year period. We extracted 21,307 patients with newly diagnosed PLA from a nationwide health registry in Taiwan between 2000 and 2007. The frequency of and risk factors for PLA with septic ocular or CNS complications were determined. The 2-year survival of these patients was compared between those with and without septic ocular or CNS complications. Septic ocular or CNS complications accounted for 2.1% of all PLA patients. Age and the Charlson comorbidity index were significantly lower in PLA patients with ocular or CNS complications than those without. Diabetes and age <65 years were independent predictors of septic ocular or CNS complications. The 2-year mortality of patients with septic ocular or CNS complications was similar to those without complications (24.8% vs. 27.5%, p = 0.502). However, among patients <65 years old and a Charlson index ≤ 1, the 2-year mortality was significantly higher in those with than without complications (18.6% vs. 11.8%, p = 0.001). Physicians should recognize that catastrophic disability due to ocular or neurological complications from PLA could lead to a poor long-term prognosis, and should follow-up these patients more closely.

Linking fecal bacteria in rivers to landscape, geochemical, and hydrologic factors and sources at the basin scale

PubMed Central

Verhougstraete, Marc P.; Martin, Sherry L.; Kendall, Anthony D.; Hyndman, David W.; Rose, Joan B.

2015-01-01

Linking fecal indicator bacteria concentrations in large mixed-use watersheds back to diffuse human sources, such as septic systems, has met limited success. In this study, 64 rivers that drain 84% of Michigan’s Lower Peninsula were sampled under baseflow conditions for Escherichia coli, Bacteroides thetaiotaomicron (a human source-tracking marker), landscape characteristics, and geochemical and hydrologic variables. E. coli and B. thetaiotaomicron were routinely detected in sampled rivers and an E. coli reference level was defined (1.4 log10 most probable number⋅100 mL−1). Using classification and regression tree analysis and demographic estimates of wastewater treatments per watershed, septic systems seem to be the primary driver of fecal bacteria levels. In particular, watersheds with more than 1,621 septic systems exhibited significantly higher concentrations of B. thetaiotaomicron. This information is vital for evaluating water quality and health implications, determining the impacts of septic systems on watersheds, and improving management decisions for locating, constructing, and maintaining on-site wastewater treatment systems. PMID:26240328

Influence of detergent formulation on nutrient movement through sand columns simulating mound and conventional septic system drainfields

NASA Astrophysics Data System (ADS)

Alhajjar, Bashar J.; Linn Gould, C.; Chesters, Gordon; Harkin, John M.

1990-12-01

The effects of phosphate (P) and zeolite (Z) -built detergents on leaching of N and P through sand columns simulating septic system drainfields were examined in laboratory columns. To simulate mound septic system drainfields, paired sets of columns were dosed intermittently with septic tank effluent from households using P- or Z-built detergent. Two other paired sets of columns were flooded with P- or Z-effluent to simulate new conventional septic system drainfields; after clogging mats or "crusts" developed at infiltration surface, the subsurfaces of the columns were aerated to simulate mature (crusted) conventional septic system drainfields. NO 3 loading in leachate was 1.1 times higher and ortho-P loading was 4.3 times lower when columns were dosed with Z- than with P-effluent. Dosed columns removed P poorly; total phosphorus (TP) loading in leachate was 81 and 19 g m -2 yr -1 with P- and Z-effluent, respectively. In flooded columns 1.3, 2.0 and 1.8 times more NH 4, organic nitrogen (ON) and total nitrogen (TN) respectively, were leached with Z- than with P-effluent; NO 3 leaching was similar. Flooded columns removed P efficiently; TP leached through flooded systems was 2.5 and 1.4 g m -2 yr -1 with P- and Z effluent, respectively. Crusted columns fed Z-effluent leached 1.2, 2.6, 1.4 and 2.1 times more NH 4, NO 3, ON and TN, respectively, than those with P-effluent but 1.8 times less TP. Crusted columns removed P satisfactorily: 8.2 and 4.6 g m -2 yr -1 TP with P- and Z-effluent, respectively. The P-built detergent substantially improves the efficiency of N removal with satisfactory P removal in columns simulating conventional septic system drainfield. Simultaneous removal of N and P under flooded conditions might be explained by precipitation of struvite-type minerals. Dosed system drainfields were less efficient in removing N and P compared to flooded and crusted system drainfelds.

Sepsis and Septic Shock Strategies.

PubMed

Armstrong, Bracken A; Betzold, Richard D; May, Addison K

2017-12-01

Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: early, appropriate antimicrobial therapy; restoration of adequate cellular perfusion; timely source control. The new definitions of sepsis and septic shock reflect the inadequate sensitivity, specify, and lack of prognostication of systemic inflammatory response syndrome criteria. Sequential (sepsis-related) organ failure assessment more effectively prognosticates in sepsis and critical illness. Inadequate cellular perfusion accelerates injury and reestablishing perfusion limits injury. Multiple organ systems are affected by sepsis and septic shock and an evidence-based multipronged approach to systems-based therapy in critical illness results in improve outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Occurrence of herbicides and pharmaceutical and personal care products in surface water and groundwater around Liberty Bay, Puget Sound, Washington

USGS Publications Warehouse

Dougherty, Jennifer A.; Swarzenski, Peter W.; Dinicola, Richard S.; Reinhard, Martin

2010-01-01

Organic contaminants, such as pharmaceuticals and personal care products (PPCPs), pose a risk to water quality and the health of ecosystems. This study was designed to determine if a coastal community lacking point sources, such as waste water treatment plant effluent, could release PPCPs, herbicides, and plasticizers at detectable levels to their surface water and groundwater. Research was conducted in Liberty Bay, an embayment within Puget Sound, where 70% of the population (∼10,000) uses septic systems. Sampling included collection of groundwater and surface water with grab samples and the use of polar organic chemical integrative samplers (POCIS). We analyzed for a broad spectrum of 25 commonly used compounds, including PPCPs, herbicides, and a flame retardant. Twelve contaminants were detected at least once; only N,N-diethyl-meta-toluamide, caffeine, and mecoprop, a herbicide not attributed to septic systems, were detected in more than one grab sample. The use of POCIS was essential because contaminants were present at very low levels (nanograms), which is common for PPCPs in general, but particularly so in such a small community. The use of POCIS allowed the detection of five compounds that were not present in grab samples. Data suggest that the community is contaminating local water with PPCPs; this effect is likely to increase as the population and product usage increase. The results presented here are a first step toward assessing the transport of herbicides and PPCPs into this coastal system.

Occurrence of herbicides and pharmaceutical and personal care products in surface water and groundwater around Liberty Bay, Puget Sound, Washington.

PubMed

Dougherty, Jennifer A; Swarzenski, Peter W; Dinicola, Richard S; Reinhard, Martin

2010-01-01

Organic contaminants, such as pharmaceuticals and personal care products (PPCPs), pose a risk to water quality and the health of ecosystems. This study was designed to determine if a coastal community lacking point sources, such as waste water treatment plant effluent, could release PPCPs, herbicides, and plasticizers at detectable levels to their surface water and groundwater. Research was conducted in Liberty Bay, an embayment within Puget Sound, where 70% of the population (-10,000) uses septic systems. Sampling included collection of groundwater and surface water with grab samples and the use of polar organic chemical integrative samplers (POCIS). We analyzed for a broad spectrum of 25 commonly used compounds, including PPCPs, herbicides, and a flame retardant. Twelve contaminants were detected at least once; only N,N-diethyl-meta-toluamide, caffeine, and mecoprop, a herbicide not attributed to septic systems, were detected in more than one grab sample. The use of POCIS was essential because contaminants were present at very low levels (nanograms), which is common for PPCPs in general, but particularly so in such a small community. The use of POCIS allowed the detection of five compounds that were not present in grab samples. Data suggest that the community is contaminating local water with PPCPs; this effect is likely to increase as the population and product usage increase. The results presented here are a first step toward assessing the transport of herbicides and PPCPs into this coastal system.

Development of an efficient anaerobic co-digestion process for garbage, excreta, and septic tank sludge to create a resource recycling-oriented society.

PubMed

Sun, Zhao-Yong; Liu, Kai; Tan, Li; Tang, Yue-Qin; Kida, Kenji

2017-03-01

In order to develop a resource recycling-oriented society, an efficient anaerobic co-digestion process for garbage, excreta and septic tank sludge was studied based on the quantity of each biomass waste type discharged in Ooki machi, Japan. The anaerobic digestion characteristics of garbage, excreta and 5-fold condensed septic tank sludge (hereafter called condensed sludge) were determined separately. In single-stage mesophilic digestion, the excreta with lower C/N ratios yielded lower biogas volumes and accumulated higher volumes of volatile fatty acid (VFA). On the other hand, garbage allowed for a significantly larger volatile total solid (VTS) digestion efficiency as well as biogas yield by thermophilic digestion. Thus, a two-stage anaerobic co-digestion process consisting of thermophilic liquefaction and mesophilic digestion phases was proposed. In the thermophilic liquefaction of mixed condensed sludge and household garbage (wet mass ratio of 2.2:1), a maximum VTS loading rate of 24g/L/d was achieved. In the mesophilic digestion of mixed liquefied material and excreta (wet mass ratio of 1:1), biogas yield reached approximately 570ml/g-VTS fed with a methane content of 55% at a VTS loading rate of 1.0g/L/d. The performance of the two-stage process was evaluated by comparing it with a single-stage process in which biomass wastes were treated separately. Biogas production by the two-stage process was found to increase by approximately 22.9%. These results demonstrate the effectiveness of a two-stage anaerobic co-digestion process in enhancement of biogas production. Copyright © 2016 Elsevier Ltd. All rights reserved.

Corrective Action Investigation Plan for Corrective Action Unit 151: Septic Systems and Discharge Area, Nevada Test Site, Nevada, Rev. No.: 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

David A. Strand

2004-06-01

This Corrective Action Investigation Plan (CAIP) contains project-specific information for conducting site investigation activities at Corrective Action Unit (CAU) 151: Septic Systems and Discharge Area, Nevada Test Site, Nevada. Information presented in this CAIP includes facility descriptions, environmental sample collection objectives, and criteria for the selection and evaluation of environmental corrective action alternatives. Corrective Action Unit 151 is located in Areas 2, 12, 18, and 20 of the Nevada Test Site, which is 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 151 is comprised of the nine Corrective Action Sites (CAS) listed below: (1) 02-05-01, UE-2ce Pond; (2)more » 12-03-01, Sewage Lagoons (6); (3) 12-04-01, Septic Tanks; (4) 12-04-02, Septic Tanks; (5) 12-04-03, Septic Tank; (6) 12-47-01, Wastewater Pond; (7) 18-03-01, Sewage Lagoon; (8) 18-99-09, Sewer Line (Exposed); and (9) 20-19-02, Photochemical Drain. The CASs within CAU 151 are discharge and collection systems. Corrective Action Site 02-05-01 is located in Area 2 and is a well-water collection pond used as a part of the Nash test. Corrective Action Sites 12-03-01, 12-04-01, 12-04-02, 12-04-03, and 12-47-01 are located in Area 12 and are comprised of sewage lagoons, septic tanks, associated piping, and two sumps. The features are a part of the Area 12 Camp housing and administrative septic systems. Corrective Action Sites 18-03-01 and 18-99-09 are located in the Area 17 Camp in Area 18. These sites are sewage lagoons and associated piping. The origin and terminus of CAS 18-99-09 are unknown; however, the type and configuration of the pipe indicates that it may be a part of the septic systems in Area 18. Corrective Action Site 20-19-02 is located in the Area 20 Camp. This site is comprised of a surface discharge of photoprocessing chemicals.« less

Percolation Tests for Septic Systems: A Laboratory Exercise.

ERIC Educational Resources Information Center

Tinker, John R., Jr.

1978-01-01

Describes how the procedures by which a certificate soil tester evaluates a parcel of land for its suitability as a site for a private sewage system or septic tank can be used by college students as a laboratory exercise in environmental geology. (HM)

Short-term soil nutrient impact in a real-time drain field soil moisture controlled SDI wastewater disposal system

USDA-ARS?s Scientific Manuscript database

The Alabama Black Belt area is widespread of Vertisols that are generally unsuitable for conventional septic systems; nonetheless, systems of this type have been widely used in this region for decades. In order to explore alternatives for these conventional septic systems, a real-time soil moisture ...

Septic Systems Guidance, Policy, and Regulations

EPA Pesticide Factsheets

EPA has developed several documents outlining its mission, priorities and regulatory authorities as well as guidance and technical information to help communities establish comprehensive septic (onsite) management programs.

Beneficial effects of the heme oxygenase-1/carbon monoxide system in patients with severe sepsis/septic shock.

PubMed

Takaki, Shoji; Takeyama, Naoshi; Kajita, Yuka; Yabuki, Teru; Noguchi, Hiroki; Miki, Yasuo; Inoue, Yasusuke; Nakagawa, Takashi; Noguchi, Hiroshi

2010-01-01

We evaluated the relations among the arterial carbon monoxide (CO) concentration, heme oxygenase (HO)-1 expression by monocytes, oxidative stress, plasma levels of cytokines and bilirubin, and the outcome of patients with severe sepsis or septic shock. Thirty-six patients who fulfilled the criteria for severe sepsis or septic shock and 21 other patients without sepsis during their stay in the intensive care unit were studied. HO-1 protein expression by monocytes, arterial CO, oxidative stress, bilirubin, and cytokines were measured. Arterial blood CO, cytokine, and bilirubin levels, and monocyte HO-1 protein expression were higher in patients with severe sepsis/septic shock than in non-septic patients. Increased HO-1 expression was related to the arterial CO concentration and oxidative stress. There was a positive correlation between survival and increased HO-1 protein expression or a higher CO level. Arterial CO and monocyte HO-1 protein expression were increased in critically ill patients, particularly those with severe sepsis or septic shock, suggesting that oxidative stress is closely related to HO-1 expression. The HO-1/CO system may play an important role in sepsis.

Enrollment into a time sensitive clinical study in the critical care setting: results from computerized septic shock sniffer implementation.

PubMed

Herasevich, Vitaly; Pieper, Matthew S; Pulido, Juan; Gajic, Ognjen

2011-01-01

Recruitment of patients into time sensitive clinical trials in intensive care units (ICU) poses a significant challenge. Enrollment is limited by delayed recognition and late notification of research personnel. The objective of the present study was to evaluate the effectiveness of the implementation of electronic screening (septic shock sniffer) regarding enrollment into a time sensitive (24 h after onset) clinical study of echocardiography in severe sepsis and septic shock. We developed and tested a near-real time computerized alert system, the septic shock sniffer, based on established severe sepsis/septic shock diagnostic criteria. A sniffer scanned patients' data in the electronic medical records and notified the research coordinator on call through an institutional paging system of potentially eligible patients. The performance of the septic shock sniffer was assessed. The septic shock sniffer performed well with a positive predictive value of 34%. Electronic screening doubled enrollment, with 68 of 4460 ICU admissions enrolled during the 9 months after implementation versus 37 of 4149 ICU admissions before sniffer implementation (p<0.05). Efficiency was limited by study coordinator availability (not available at nights or weekends). Automated electronic medical records screening improves the efficiency of enrollment and should be a routine tool for the recruitment of patients into time sensitive clinical trials in the ICU setting.

Enrollment into a time sensitive clinical study in the critical care setting: results from computerized septic shock sniffer implementation

PubMed Central

Pieper, Matthew S; Pulido, Juan; Gajic, Ognjen

2011-01-01

Objective Recruitment of patients into time sensitive clinical trials in intensive care units (ICU) poses a significant challenge. Enrollment is limited by delayed recognition and late notification of research personnel. The objective of the present study was to evaluate the effectiveness of the implementation of electronic screening (septic shock sniffer) regarding enrollment into a time sensitive (24 h after onset) clinical study of echocardiography in severe sepsis and septic shock. Design We developed and tested a near-real time computerized alert system, the septic shock sniffer, based on established severe sepsis/septic shock diagnostic criteria. A sniffer scanned patients' data in the electronic medical records and notified the research coordinator on call through an institutional paging system of potentially eligible patients. Measurement The performance of the septic shock sniffer was assessed. Results The septic shock sniffer performed well with a positive predictive value of 34%. Electronic screening doubled enrollment, with 68 of 4460 ICU admissions enrolled during the 9 months after implementation versus 37 of 4149 ICU admissions before sniffer implementation (p<0.05). Efficiency was limited by study coordinator availability (not available at nights or weekends). Conclusions Automated electronic medical records screening improves the efficiency of enrollment and should be a routine tool for the recruitment of patients into time sensitive clinical trials in the ICU setting. PMID:21508415

Algorithm for the prophylaxis of septic complications in orthopedics and traumatology of locomotor system at the Department of Orthopedics at the Postgraduate Medical Education Center in Otwock.

PubMed

Białecki, Jerzy; Brychcy, Adrian; Marczyński, Wojciech Józef

2013-09-18

Current state of knowledge in a matter of septic complications after procedures with orthopaedic device implantation with particular consideration of THA and TKA is presented in the paper. Implant biocompatibility phenomenon as well as systemic reaction to its presence is also discussed. Algorithm for prophylactics of septic complications followed in Orthopaedic Department of PMEC in Otwock is introduced. Article is based on clinical observations of Orthopaedic Department's PMEC team.  

Intestine-specific deletion of microsomal triglyceride transfer protein increases mortality in aged mice.

PubMed

Liang, Zhe; Xie, Yan; Dominguez, Jessica A; Breed, Elise R; Yoseph, Benyam P; Burd, Eileen M; Farris, Alton B; Davidson, Nicholas O; Coopersmith, Craig M

2014-01-01

Mice with conditional, intestine-specific deletion of microsomal triglyceride transfer protein (Mttp-IKO) exhibit a complete block in chylomicron assembly together with lipid malabsorption. Young (8-10 week) Mttp-IKO mice have improved survival when subjected to a murine model of Pseudomonas aeruginosa-induced sepsis. However, 80% of deaths in sepsis occur in patients over age 65. The purpose of this study was to determine whether age impacts outcome in Mttp-IKO mice subjected to sepsis. Aged (20-24 months) Mttp-IKO mice and WT mice underwent intratracheal injection with P. aeruginosa. Mice were either sacrificed 24 hours post-operatively for mechanistic studies or followed seven days for survival. In contrast to young septic Mttp-IKO mice, aged septic Mttp-IKO mice had a significantly higher mortality than aged septic WT mice (80% vs. 39%, p = 0.005). Aged septic Mttp-IKO mice exhibited increased gut epithelial apoptosis, increased jejunal Bax/Bcl-2 and Bax/Bcl-XL ratios yet simultaneously demonstrated increased crypt proliferation and villus length. Aged septic Mttp-IKO mice also manifested increased pulmonary myeloperoxidase levels, suggesting increased neutrophil infiltration, as well as decreased systemic TNFα compared to aged septic WT mice. Blocking intestinal chylomicron secretion alters mortality following sepsis in an age-dependent manner. Increases in gut apoptosis and pulmonary neutrophil infiltration, and decreased systemic TNFα represent potential mechanisms for why intestine-specific Mttp deletion is beneficial in young septic mice but harmful in aged mice as each of these parameters are altered differently in young and aged septic WT and Mttp-IKO mice.

Influence of septic systems on stream base flow in the Apalachicola-Chattahoochee-Flint River Basin near Metropolitan Atlanta, Georgia, 2012

USGS Publications Warehouse

Clarke, John S.; Painter, Jaime A.

2014-01-01

Septic systems were identified at 241,733 locations in a 2,539-square-mile (mi2) study area that includes all or parts of 12 counties in the Metropolitan Atlanta, Georgia, area. Septic system percolation may locally be an important component of streamflow in small drainage basins where it augments natural groundwater recharge, especially during extreme low-flow conditions. The amount of groundwater reaching streams depends on how much is intercepted by plants or infiltrates to deeper parts of the groundwater system that flows beyond a basin divide and does not discharge into streams within a basin. The potential maximum percolation from septic systems in the study area is 62 cubic feet per second (ft3/s), of which 52 ft3/s is in the Chattahoochee River Basin and 10 ft3/s is in the Flint River Basin. These maximum percolation rates represent 0.4 to 5.7 percent of daily mean streamflow during the 2011–12 period at the farthest downstream gaging site (station 02338000) on the Chattahoochee River, and 0.5 to 179 percent of daily mean streamflow at the farthest downstream gaging site on the Flint River (02344350). To determine the difference in base flow between basins having different septic system densities, hydrograph separation analysis was completed using daily mean streamflow data at streamgaging stations at Level Creek (site 02334578), with a drainage basin having relatively high septic system density of 101 systems per square mile, and Woodall Creek (site 02336313), with a drainage basin having relatively low septic system density of 18 systems per square mile. Results indicated that base-flow yield during 2011–12 was higher at the Level Creek site, with a median of 0.47 cubic feet per second per square mile ([ft3/s]/mi2), compared to a median of 0.16 (ft3/s)/mi2, at the Woodall Creek site. At the less urbanized Level Creek site, there are 515 septic systems with a daily maximum percolation rate of 0.14 ft3/s, accounting for 11 percent of the base flow in September 2012. At the more urban Woodall Creek site, there are 50 septic systems with an average daily maximum percolation rate of 0.0097 ft3/s, accounting for 5 percent of base flow in September 2012. Streamflow measurements at 133 small drainage basins (less than 5 mi2 in area) during September 2012 indicated no statistically significant difference in streamflow or specific conductance between basins having high and low density of septic systems (HDS and LDS, respectively). The median base-flow yield was 0.04 (f3/s)/mi2 for HDS sites, ranging from 0 to 0.52 (ft3/s)/mi2, and 0.10 (ft3/s)/mi2 for LDS sites, ranging from 0 to 0.49 (ft3/s)/mi2. A Wilcoxon rank-sum test indicated the median base-flow yields for HDS and LDS sites were not statistically different, with a p-value of 0.345. Because of the large size of the study area and associated variations in basin characteristics, data collected in September 2012 were also evaluated on the basis of the basins physical characteristics in an attempt to reduce or eliminate other basin characteristics that might affect base flow. Basins were evaluated based on geologic area, four geographic subareas, and 45-meter (147.6 ft) buffer zone; there were no statistically significant differences between median base-flow yield for HDS and LDS basins. It is probable that detection of the contribution from septic system percolation in base flow at many of the sites visited in September 2012 was obscured by a combination of the limitations of measurement accuracy and evapotranspiration. Detection of septic system percolation may also have been complicated by leaky water and sewer mains, which may have resulted in higher streamflows in LDS basins relative to HDS basins.

[Surgical intensive care medicine. Current therapy concepts for septic diseases].

PubMed

Niederbichler, A D; Ipaktchi, K; Jokuszies, A; Hirsch, T; Altintas, M A; Handschin, A E; Busch, K H; Gellert, M; Steinau, H-U; Vogt, P M; Steinsträsser, L

2009-10-01

The clinical appearance of septic disorders is characterized by an enormous dynamic. The sepsis-induced dysbalance of the immune system necessitates immediate and aggressive therapeutic interventions to prevent further damage progression of the disease to septic shock and multiple organ failure. This includes supportive therapy to normalize and maintain organ and tissue perfusion as well as the identification of the infection focus. In cases where an infectious focus is identified, surgical source control frequently is a key element of the treatment strategy besides pharmacologic and supportive measures. The integrative approach of the management of septic patients requires rapid communication between the involved medical disciplines and the nursing personnel. Therefore, this article outlines current therapeutic concepts of septic diseases as well as central nursing aspects.

Concentrations of hormones, pharmaceuticals and other micropollutants in groundwater affected by septic systems in New England and New York.

PubMed

Phillips, P J; Schubert, C; Argue, D; Fisher, I; Furlong, E T; Foreman, W; Gray, J; Chalmers, A

2015-04-15

Septic-system discharges can be an important source of micropollutants (including pharmaceuticals and endocrine active compounds) to adjacent groundwater and surface water systems. Groundwater samples were collected from well networks tapping glacial till in New England (NE) and sandy surficial aquifer New York (NY) during one sampling round in 2011. The NE network assesses the effect of a single large septic system that receives discharge from an extended health care facility for the elderly. The NY network assesses the effect of many small septic systems used seasonally on a densely populated portion of Fire Island. The data collected from these two networks indicate that hydrogeologic and demographic factors affect micropollutant concentrations in these systems. The highest micropollutant concentrations from the NE network were present in samples collected from below the leach beds and in a well downgradient of the leach beds. Total concentrations for personal care/domestic use compounds, pharmaceutical compounds and plasticizer compounds generally ranged from 1 to over 20 μg/L in the NE network samples. High tris(2-butoxyethyl phosphate) plasticizer concentrations in wells beneath and downgradient of the leach beds (>20 μg/L) may reflect the presence of this compound in cleaning agents at the extended health-care facility. The highest micropollutant concentrations for the NY network were present in the shoreline wells and reflect groundwater that is most affected by septic system discharges. One of the shoreline wells had personal care/domestic use, pharmaceutical, and plasticizer concentrations ranging from 0.4 to 5.7 μg/L. Estradiol equivalency quotient concentrations were also highest in a shoreline well sample (3.1 ng/L). Most micropollutant concentrations increase with increasing specific conductance and total nitrogen concentrations for shoreline well samples. These findings suggest that septic systems serving institutional settings and densely populated areas in coastal settings may be locally important sources of micropollutants to adjacent aquifer and marine systems. Published by Elsevier B.V.

Ground-water flow and quality in Wisconsin's shallow aquifer system

USGS Publications Warehouse

Kammerer, P.A.

1995-01-01

In terms of chemical quality, the water is suitable for potable supply and most other uses, but objectionable hardness in large areas and concen- trations of iron and manganese that exceed State drinking-water standards cause aesthetic problems that may require treatment of the water for some uses. Concentrations of major dissolved constitu- ents (calcium, magnesium, and bicarbonate), hard- ness, alkalinity, and dissolved solids are highest where the bedrock component of the aquifer is dolo- mite and lowest where the shallow aquifer is almost entirely sand and gravel. Concentrations of other minor constituents (sodium, potassium, sulfate, chloride, and fluoride) are less closely related to common minerals that compose the aquifer system. Sulfate and fluoride concentrations exceed State drinking-water standards locally. Extreme variability in concentrations of iron and manganese are common locally. Iron and manganese concentra- tions exceed State drinking-water standards in water from one-third and one-quarter of the wells, respectively. Likely causes of nitrate-nitrogen con- centrations that exceed State drinking-water stan- dards include local contamination from plant fertilizers, animal wastes, waste water disposed of on land, and septic systems. Water quality in the shallow aquifer system has been affected by saline water from underlying aquifers, primarily along the eastern and western boundaries of the State where the thickness of Paleozoic rocks is greatest.

Septic pulmonary arteriovenous fistula. An unusual conduit for systemic embolization in right-sided valvular endocarditis.

PubMed

Stagaman, D J; Presti, C; Rees, C; Miller, D D

1990-06-01

Right-sided valvular (tricuspid, pulmonic) endocarditis is frequently complicated by septic pulmonary embolization. Systemic embolization may also rarely occur due to associated left-sided endocarditis or right-to-left shunting in patients with septal defects. This report documents the occurrence of systemic embolization causing a cerebrovascular accident in an intravenous drug abuser with recurrent tricuspid valve endocarditis due to an isolated peripheral septic pulmonary arteriovenous fistula. Noninvasive diagnosis of the fistula by cardiac auscultation, contrast echocardiography, and nuclear magnetic resonance imaging was confirmed by selective pulmonary angiography. Subselective balloon embolization of the pulmonary arteries feeding this fistula was accomplished.

Mass balance and isotope effects during nitrogen transport through septic tank systems with packed-bed (sand) filters

USGS Publications Warehouse

Hinkle, S.R.; Böhlke, J.K.; Fisher, L.H.

2008-01-01

Septic tank systems are an important source of NO3- to many aquifers, yet characterization of N mass balance and isotope systematics following septic tank effluent discharge into unsaturated sediments has received limited attention. In this study, samples of septic tank effluent before and after transport through single-pass packed-bed filters (sand filters) were evaluated to elucidate mass balance and isotope effects associated with septic tank effluent discharge to unsaturated sediments. Chemical and isotopic data from five newly installed pairs and ten established pairs of septic tanks and packed-bed filters serving single homes in Oregon indicate that aqueous solute concentrations are affected by variations in recharge (precipitation, evapotranspiration), NH4+ sorption (primarily in immature systems), nitrification, and gaseous N loss via NH3 volatilization and(or) N2 or N2O release during nitrification/denitrification. Substantial NH4+ sorption capacity was also observed in laboratory columns with synthetic effluent. Septic tank effluent ??15N-NH4+ values were almost constant and averaged + 4.9??? ?? 0.4??? (1 ??). In contrast, ??15N values of NO3- leaving mature packed-bed filters were variable (+ 0.8 to + 14.4???) and averaged + 7.2??? ?? 2.6???. Net N loss in the two networks of packed-bed filters was indicated by average 10-30% decreases in Cl--normalized N concentrations and 2-3??? increases in ??15N, consistent with fractionation accompanying gaseous N losses and corroborating established links between septic tank effluent and NO3- in a local, shallow aquifer. Values of ??18O-NO3- leaving mature packed-bed filters ranged from - 10.2 to - 2.3??? (mean - 6.4??? ?? 1.8???), and were intermediate between a 2/3 H2O-O + 1/3 O2-O conceptualization and a 100% H2O-O conceptualization of ??18O-NO3- generation during nitrification.

Fe(III) reduction-mediated phosphate removal as vivianite (Fe3(PO4)2⋅8H2O) in septic system wastewater.

PubMed

Azam, Hossain M; Finneran, Kevin T

2014-02-01

Phosphate is a water contaminant from fertilizers, soaps, and detergents that enters municipal and onsite wastewater from households, businesses, and other commercial operations. Phosphate is a limiting nutrient for algae, and is one of the molecules that promotes eutrophication of water bodies. Phosphate is especially problematic in onsite wastewater because there are few removal mechanisms under normal operating conditions; a system must be amended specifically with compounds to bond to or adsorb phosphate in the septic tank or within the leach field. Vivianite (Fe3(PO4)2⋅8H2O) is a stable mineral formed from ferrous iron and phosphate, often as the result of Fe(III) reducing microbial activity. What was unknown was the concentration of phosphate that could be removed by this process, and whether it was relevant to mixed microbial systems like septic tank wastewater. Data presented here demonstrate that significant concentrations of phosphate (12-14mM) were removed as vivianite in growing cultures of Geobacter metallireducens strain GS-15. Vivianite precipitates were identified on the cell surfaces and within multi cell clusters using TEM-EDX; the mineral phases were directly characterized using XRD. Phosphate was also removed in dilute and raw (undiluted) septic wastewater amended with different forms of Fe(III) including solid phase and soluble Fe(III). Vivianite precipitates were recovered and identified using XRD, along with siderite (ferrous carbonate), which was expected given that the systems were likely bicarbonate buffered. These data demonstrate that ferric iron amendments in septic wastewater increase phosphate removal as the mineral vivianite, and this may be a good strategy for phosphate attenuation in the septic tank portion of onsite wastewater systems. Copyright © 2013 Elsevier Ltd. All rights reserved.

Norovirus outbreak caused by a new septic system in a dolomite aquifer

USGS Publications Warehouse

Borchardt, M. A.; Bradbury, K.R.; Alexander, E.C.; Kolberg, R.J.; Alexander, S.C.; Archer, John R.; Braatz, L.A.; Forest, B.M.; Green, J.A.; Spencer, S. K.

2011-01-01

Septic systems that are built in compliance with regulations are generally not expected to be the cause of groundwater borne disease outbreaks, especially in areas with thick vadose zones. However, this case study demonstrates that a disease outbreak can occur in such a setting and outlines the combination of epidemiological, microbiological, and hydrogeological methods used to confirm the source of the outbreak. In early June 2007, 229 patrons and employees of a new restaurant in northeastern Wisconsin were affected by acute gastroenteritis; 6 people were hospitalized. Epidemiological case-control analysis indicated that drinking the restaurant's well water was associated with illness (odds ratio = 3.2, 95% confidence interval = 0.9 to 11.4, P = 0.06). Microbiological analysis (quantitative reverse transcription-polymerase chain reaction) measured 50 genomic copies per liter of norovirus genogroup I in the well water. Nucleotide sequencing determined the genotype as GI.2 and further showed the identical virus was present in patrons' stool specimens and in the septic tank. Tracer tests using dyes injected at two points in the septic system showed that effluent was traveling from the tanks (through a leaking fitting) and infiltration field to the well in 6 and 15 d, respectively. The restaurant septic system and well (85-m deep, in a fractured dolomite aquifer) both conformed to state building codes. The early arrival of dye in the well, which was 188 m from the septic field and located beneath a 35-m thick vadose zone, demonstrates that in highly vulnerable hydrogeological settings, compliance with regulations may not provide adequate protection from fecal pathogens.

Economic Analysis of 4221 Revisions Due to Periprosthetic Joint Infection in Poland.

PubMed

Babiak, Ireneusz; Pędzisz, Piotr; Janowicz, Jakub; Kulig, Mateusz; Małdyk, Paweł

2017-01-26

Periprosthetic joint infection (PJI) is one of the most severe complications of total hip (THA) and total knee (TKA) arthroplasty. The aim of the study is to determine the number and type of hip and knee prosthesis revisions in Poland performed due to infection and reimbursement of the cost of septic revisions and to compare the costs of septic and aseptic revisions in Poland and other countries. The data published for the period 2009-2013 by the National Health Fund (NHF) were analysed and the average cost of septic and aseptic revisions was calculated. In the years 2009-2013, a total of 260,030 hip and knee arthroplasties including 23,027 revisions (incl. 4,221 septic) were performed in Poland. In 2013, septic revisions accounted for 1.38% of all hip replacement procedures, 2.56% of all knee replacement procedures and 14.67% of all hip revisions and 30.23% of all knee revisions. In 2013, the difference between the average cost incurred by the hospital and the NHF refund for septic revision due to PJI was at least €238 and the cost-refund gap for the entire year was €219198. 1. The system of reporting periprostheticjoint infections currently in use in Poland does not adequately reflect the current classification of PJI and reimbursement for septic revision of joint prosthesis does not match the actual costs. 2. The Polish DRG system does not distinguish between early and late PJI and fails to acknowledge basic guidelines for infection treatment currently followed in Poland and worldwide. 3. According to the DRG system, patients requiring different treatment are placed in one category. 4. Until the year 2013, the less expensive treatment of early infections had been reimbursed on the same basis as the more costly two-stage revision procedures.

18 CFR 1304.209 - Land-based structures/alterations.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., satellite antennas, septic tanks, and septic drainfields shall not be allowed on TVA land. (c) Utility lines... APPROVAL OF CONSTRUCTION IN THE TENNESSEE RIVER SYSTEM AND REGULATION OF STRUCTURES AND OTHER ALTERATIONS...

18 CFR 1304.209 - Land-based structures/alterations.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., satellite antennas, septic tanks, and septic drainfields shall not be allowed on TVA land. (c) Utility lines... APPROVAL OF CONSTRUCTION IN THE TENNESSEE RIVER SYSTEM AND REGULATION OF STRUCTURES AND OTHER ALTERATIONS...

Concentrations of hormones, pharmaceuticals and other micropollutants in groundwater affected by septic systems in New England and New York

USGS Publications Warehouse

Phillips, Patrick J.; Schubert, Christopher E.; Argue, Denise M.; Fisher, Irene J.; Furlong, Edward T.; Foreman, William T.; Gray, James L.; Chalmers, Ann T.

2015-01-01

The highest micropollutant concentrations for the NY network were present in the shoreline wells and reflect groundwater that is most affected by septic system discharges. One of the shoreline wells had personal care/domestic use, pharmaceutical, and plasticizer concentrations ranging from 0.4 to 5.7 μg/L. Estradiol equivalency quotient concentrations were also highest in a shoreline well sample (3.1 ng/L). Most micropollutant concentrations increase with increasing specific conductance and total nitrogen concentrations for shoreline well samples. These findings suggest that septic systems serving institutional settings and densely populated areas in coastal settings may be locally important sources of micropollutants to adjacent aquifer and marine systems.

A pilot study on the assessment of trace organic contaminants including pharmaceuticals and personal care products from on-site wastewater treatment systems along Skaneateles Lake in New York State, USA.

PubMed

Subedi, Bikram; Codru, Neculai; Dziewulski, David M; Wilson, Lloyd R; Xue, Jingchuan; Yun, Sehun; Braun-Howland, Ellen; Minihane, Christine; Kannan, Kurunthachalam

2015-04-01

On-site wastewater treatment systems (OWTSs or septic systems) are designed to treat and dispose effluents on the same property that produces the wastewater. Approximately 25% of the U.S. population is served by such facilities. Nevertheless, studies on the treatment efficiency and discharge of organic contaminants through septic effluents are lacking. This pilot study showed the occurrence of organic contaminants including pharmaceuticals and personal care products (PPCPs), perfluoroalkyl surfactants (PFASs), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs) in septic effluents, adjacent lake water samples, household drinking water in homes that use lake water or a well adjacent to the lake as a source of drinking water, and offshore lake water samples. Septic effluent as well as lake and tap water samples were collected from several households with OWTSs around Skaneateles Lake located in central New York. The advanced on-site systems were installed in some households for the purpose of limiting nutrient levels in the effluent to protect the local surface water. Additionally, because many of these systems serve homes with limited land, advanced treatment systems were needed. The median concentrations of ten PPCPs (ranged from 0.45 to 388 ng/L) and eleven PFASs (ranged from 0.20 to 14.6 ng/L) in septic water were significantly higher (p ≤ 0.01) than in lake water samples. The median concentrations of PPCPs and PFASs in lake and tap water samples were not significantly different (p ≥ 0.65). The median concentrations of ∑PBDEs in septic, lake, and tap water samples were 7.47, 3.49, and 2.22 ng/L, respectively, and those for ∑PCBs were 33.1, 29.2, and 28.6 ng/L, respectively. The mass flux of PPCPs (i.e. the mass flow of PPCPs per unit area per unit time) through the disposal of treated septic effluent from textile biofilter and aerobic treatments to the dispersal unit ranged from 12 (carbamazepine) to 66900 μg/m(2)/day (caffeine) whereas that for PFASs ranged from 7.0 (perfluorobutanesulfonate) to 833 μg/m(2)/day (perfluorooctanoic acid). Based on the ratio of measured concentrations and method detection limit, triclocarban, perfluorooctanoic acid, and perfluorooctanesulfonate have the potential to be used as chemical tracers of septic water contamination in Skaneateles Lake. The median concentrations of atenolol, a beta-blocker drug, in septic water were significantly (ρ = 0.86, p = 0.01) correlated with enterococci counts. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessment of sources and fate of nitrate in shallow groundwater of an agricultural area by using a multi-tracer approach.

PubMed

Pastén-Zapata, Ernesto; Ledesma-Ruiz, Rogelio; Harter, Thomas; Ramírez, Aldo I; Mahlknecht, Jürgen

2014-02-01

Nitrate isotopic values are often used as a tool to understand sources of contamination in order to effectively manage groundwater quality. However, recent literature describes that biogeochemical reactions may modify these values. Therefore, data interpretation is difficult and often vague. We provide a discussion on this topic and complement the study using halides as comparative tracers assessing an aquifer underneath a sub-humid to humid region in NE Mexico. Hydrogeological information and stable water isotopes indicate that active groundwater recharge occurs in the 8000km(2) study area under present-day climatic and hydrologic conditions. Nitrate isotopes and halide ratios indicate a diverse mix of nitrate sources and transformations. Nitrate sources include organic waste and wastewater, synthetic fertilizers and soil processes. Animal manure and sewage from septic tanks were the causes of groundwater nitrate pollution within orchards and vegetable agriculture. Dairy activities within a radius of 1,000 m from a sampling point significantly contributed to nitrate pollution. Leachates from septic tanks caused nitrate pollution in residential areas. Soil nitrogen and animal waste were the sources of nitrate in groundwater under shrubland and grassland. Partial denitrification processes helped to attenuate nitrate concentration underneath agricultural lands and grassland, especially during summer months. © 2013. Published by Elsevier B.V. All rights reserved.

Community-based wastewater treatment systems and water quality of an Indonesian village.

PubMed

Lim, H S; Lee, L Y; Bramono, S E

2014-03-01

This paper examines the impact of community-based water treatment systems on water quality in a peri-urban village in Yogyakarta, Indonesia. Water samples were taken from the wastewater treatment plants (WWTPs), irrigation canals, paddy fields and wells during the dry and wet seasons. The samples were tested for biological and chemical oxygen demand, nutrients (ammonia, nitrate, total nitrogen and total phosphorus) and Escherichia coli. Water quality in this village is affected by the presence of active septic tanks, WWTP effluent discharge, small-scale tempe industries and external sources. We found that the WWTPs remove oxygen-demanding wastes effectively but discharged nutrients, such as nitrate and ammonia, into irrigation canals. Irrigation canals had high levels of E. coli as well as oxygen-demanding wastes. Well samples had high E. coli, nitrate and total nitrogen levels. Rainfall tended to increase concentrations of biological and chemical oxygen demand and some nutrients. All our samples fell within the drinking water standards for nitrate but failed the international and Indonesian standards for E. coli. Water quality in this village can be improved by improving the WWTP treatment of nutrients, encouraging more villagers to be connected to WWTPs and controlling hotspot contamination areas in the village.

Closure Report for Corrective Action Unit 261: Area 25 Test Cell A Leachfield System, Nevada Test Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

T. M. Fitzmaurice

2001-04-01

The purpose of this Closure Report (CR) is to provide documentation of the completed corrective action at the Test Cell A Leachfield System and to provide data confirming the corrective action. The Test Cell A Leachfield System is identified in the Federal Facility Agreement and Consent Order (FFACO) of 1996 as Corrective Action Unit (CAU) 261. Remediation of CAU 261 is required under the FFACO (1996). CAU 261 is located in Area 25 of the Nevada Test Site (NTS) which is approximately 140 kilometers (87 miles) northwest of Las Vegas, Nevada (Figure 1). CAU 261 consists of two Corrective Actionmore » Sites (CASS): CAS 25-05-01, Leachfield; and CAS 25-05-07, Acid Waste Leach Pit (AWLP) (Figures 2 and 3). Test Cell A was operated during the 1960s and 1970s to support the Nuclear Rocket Development Station. Various operations within Building 3124 at Test Cell A resulted in liquid waste releases to the Leachfield and the AWLP. The following existing site conditions were reported in the Corrective Action Decision Document (CADD) (U.S. Department of Energy, Nevada Operations Office [DOE/NV], 1999): Soil in the leachfield was found to exceed the Nevada Division of Environmental Protection (NDEP) Action Level for petroleum hydrocarbons, the U.S. Environmental Protection Agency (EPA) preliminary remediation goals for semi volatile organic compounds, and background concentrations for strontium-90; Soil below the sewer pipe and approximately 4.5 meters (m) (15 feet [ft]) downstream of the initial outfall was found to exceed background concentrations for cesium-137 and strontium-90; Sludge in the leachfield septic tank was found to exceed the NDEP Action Level for petroleum hydrocarbons and to contain americium-241, cesium-137, uranium-234, uranium-238, potassium-40, and strontium-90; No constituents of concern (COC) were identified at the AWLP. The NDEP-approved CADD (DOWNV, 1999) recommended Corrective Action Alternative 2, ''Closure of the Septic Tank and Distribution Box, Partial Excavation, and Administrative Controls.'' The corrective action was performed following the NDEP-approved Corrective Action Plan (CAP) (DOE/NV, 2000).« less

Removal of organic wastewater contaminants in septic systems using advanced treatment technologies

USGS Publications Warehouse

Wilcox, J.D.; Bahr, J.M.; Hedman, C.J.; Hemming, J.D.C.; Barman, M.A.E.; Bradbury, K.R.

2009-01-01

The detection of pharmaceuticals and other organic wastewater contaminants (OWCs) in ground water and surface-water bodies has raised concerns about the possible ecological impacts of these compounds on nontarget organisms. On-site wastewater treatment systems represent a potentially significant route of entry for organic contaminants to the environment. In this study, effluent samples were collected and analyzed from conventional septic systems and from systems using advanced treatment technologies. Six of 13 target compounds were detected in effluent from at least one septic system. Caffeine, paraxanthine, and acetaminophen were the most frequently detected compounds, and estrogenic activity was detected in 14 of 15 systems. The OWC concentrations were significantly lower in effluent after sand filtration (p < 0.01) or aerobic treatment (p < 0.05) as compared with effluent that had not undergone advanced treatment. In general, concentrations in conventional systems were comparable to those measured in previous studies of municipal wastewater treatment plant (WWTP) influent, and concentrations in systems after advanced treatment were comparable to previously measured concentrations in WWTP effluent. These data indicate that septic systems using advanced treatment can reduce OWCs in treated effluent to similar concentrations as municipal WWTPs. Copyright ?? 2009 by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America. All rights reserved.

Alteration of the RANKL/RANK/OPG System in Periprosthetic Osteolysis with Septic Loosening.

PubMed

Wang, Long; Dai, Zixun; Xie, Jie; Liao, Hao; Lv, Cheng; Hu, Yihe

2016-02-01

The pathogenesis of periprosthetic osteolysis with septic loosening remains incompletely understood. The purpose of this study was to investigate whether expression of the RANKL/RANK/OPG system is altered in septic interface membranes (SIMs). Seventeen cases with a SIM, 26 cases with an aseptic interface membrane (AIM), and 12 cases with a normal synovium (NS) were assessed. Scanning and transmission electron microscopy (SEM and TEM, respectively) were used to observe the microscopic morphology of three tissue conditions. Differences in RANKL, RANK, and OPG expression at the mRNA level were assessed by real-time quantitative PCR, and differences at the protein level were assessed by immunohistochemical staining and Western blotting. SEM showed wear debris widely distributed on the AIM surface, and TEM showed Bacillus activity in the SIM. RANKL expression and the RANKL/OPG ratio were significantly increased in SIMs. Imbalance in the RANKL/RANK/OPG system is related to periprosthetic osteolysis with septic loosening but is not the only possible pathogenic mechanism.

Fate of pharmaceutical and trace organic compounds in three septic system plumes, Ontario, Canada.

PubMed

Carrara, Cherilyn; Ptacek, Carol J; Robertson, William D; Blowes, David W; Moncur, Michael C; Sverko, Ed; Backus, Sean

2008-04-15

Three high volume septic systems in Ontario, Canada, were examined to assess the potential for onsite wastewatertreatment systems to release pharmaceutical compounds to the environment and to evaluate the mobility of these compounds in receiving aquifers. Wastewater samples were collected from the septic tanks, and groundwater samples were collected below and down gradient of the infiltration beds and analyzed for a suite of commonly used pharmaceutical and trace organic compounds. The septic tank samples contained elevated concentrations of several pharmaceutical compounds. Ten of the 12 compounds analyzed were detected in groundwater at one or more sites at concentrations in the low ng L(-1) to low microg L(-1) range. Large differences among the sites were observed in both the number of detections and the concentrations of the pharmaceutical compounds. Of the compounds analyzed, ibuprofen, gemfibrozil, and naproxen were observed to be transported atthe highest concentrations and greatest distances from the infiltration source areas, particularly in anoxic zones of the plumes.

Necrotizing Lip Infection Causing Septic Thrombophlebitis of the Neck: A Rare Variant of Lemierre Syndrome.

PubMed

Cuddy, Karl; Saadat, Nariman; Khatib, Baber; Patel, Ashish

2018-01-01

Lemierre syndrome is an uncommon condition in which internal jugular vein thrombosis presents after recent oropharyngeal infection. Frequently, this is accompanied by septic emboli. This report outlines a variant of this disease process, with septic thrombophlebitis of the neck associated with a necrotizing skin infection of the lower lip and chin. A 25-year-old man with lower lip and chin swelling, initially managed with intravenous antibiotics, progressed to the development of a left facial vein thrombus, septic emboli to the lungs, and a necrotizing lower lip and chin infection that was managed with debridement, thrombectomy, and prolonged hemodynamic and pulmonary support. A necrotizing skin infection with thrombus of the jugular system and septic emboli is a very rare variant of Lemierre syndrome. Early recognition of an infection with septic emboli and/or necrotizing pathobiological findings allows for prompt antibiotic and surgical therapy, minimizing the mortality of these potentially lethal infections. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

EPA Homeowner's Guide to Septic Systems for Tribal Communities

EPA Pesticide Factsheets

In cooperation with the Indian Health Service (IHS), EPA has developed a tailored version of the original SepticSmart Homeowner's Guide to reflect the unique factors of Tribal communities and homeowners on Tribal lands.

CORRECTIVE ACTION PLAN FOR CORRECTIVE ACTION UNIT 516: SEPTIC SYSTEMS AND DISCHARGE POINTS, NEVADA TEST SITE, NEVADA

DOE Office of Scientific and Technical Information (OSTI.GOV)

BECHTEL NEVADA; U.S. DEPARTMENT OF ENERGY, NATIONAL NUCLEAR SECURITY ADMINISTRATION NEVADA SITE OFFICE

2005-08-01

Corrective Action Unit (CAU) 516, Septic Systems and Discharge Points, is listed in the ''Federal Facility Agreement and Consent Order'' (FFACO) of 1996 (FFACO, 1996). CAU 516 consists of six Corrective Action Sites (CASs) located in Areas 3, 6, and 22 of the Nevada Test Site (NTS), which is located approximately 65 miles northwest of Las Vegas, Nevada (Figure 1). CAU 516 is comprised of the following six CASs: (1) 03-59-01 Building 3C-36 Septic System; (2) 03-59-02 Building 3C-45 Septic System; (3) 06-51-01 Sump and Piping; (4) 06-51-02 Clay Pipe and Debris; (5) 06-51-03 Clean-Out Box and Piping; and (6)more » 22-19-04 Vehicle Decontamination Area. Details on site history and site characterization results for CAU 516 are provided in the approved Corrective Action Investigation Plan (CAIP), (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2003), and the approved Corrective Action Decision Document (CADD) (NNSA/NSO, 2004).« less

Norovirus outbreak caused by a new septic system in a dolomite aquifer.

PubMed

Borchardt, Mark A; Bradbury, Kenneth R; Alexander, E Calvin; Kolberg, Rhonda J; Alexander, Scott C; Archer, John R; Braatz, Laurel A; Forest, Brian M; Green, Jeffrey A; Spencer, Susan K

2011-01-01

Septic systems that are built in compliance with regulations are generally not expected to be the cause of groundwater borne disease outbreaks, especially in areas with thick vadose zones. However, this case study demonstrates that a disease outbreak can occur in such a setting and outlines the combination of epidemiological, microbiological, and hydrogeological methods used to confirm the source of the outbreak. In early June 2007, 229 patrons and employees of a new restaurant in northeastern Wisconsin were affected by acute gastroenteritis; 6 people were hospitalized. Epidemiological case-control analysis indicated that drinking the restaurant's well water was associated with illness (odds ratio = 3.2, 95% confidence interval = 0.9 to 11.4, P = 0.06). Microbiological analysis (quantitative reverse transcription-polymerase chain reaction) measured 50 genomic copies per liter of norovirus genogroup I in the well water. Nucleotide sequencing determined the genotype as GI.2 and further showed the identical virus was present in patrons' stool specimens and in the septic tank. Tracer tests using dyes injected at two points in the septic system showed that effluent was traveling from the tanks (through a leaking fitting) and infiltration field to the well in 6 and 15 d, respectively. The restaurant septic system and well (85-m deep, in a fractured dolomite aquifer) both conformed to state building codes. The early arrival of dye in the well, which was 188 m from the septic field and located beneath a 35-m thick vadose zone, demonstrates that in highly vulnerable hydrogeological settings, compliance with regulations may not provide adequate protection from fecal pathogens. Copyright © 2010 The Author(s). Journal compilation © 2010 National Ground Water Association.

Ferric iron amendment increases Fe(III)-reducing microbial diversity and carbon oxidation in on-site wastewater systems.

PubMed

Azam, Hossain M; Finneran, Kevin T

2013-01-01

Onsite wastewater systems, or septic tanks, serve approximately 25% of the United States population; they are therefore a critical component of the total carbon balance for natural water bodies. Septic tanks operate under strictly anaerobic conditions, and fermentation is the dominant process driving carbon transformation. Nitrate, Fe(III), and sulfate reduction may be operating to a limited extent in any given septic tank. Electron acceptor amendments will increase carbon oxidation, but nitrate is toxic and sulfate generates corrosive sulfides, which may damage septic system infrastructure. Fe(III) reducing microorganisms transform all major classes of organic carbon that are dominant in septic wastewater: low molecular weight organic acids, carbohydrate monomers and polymers, and lipids. Fe(III) is not toxic, and the reduction product Fe(II) is minimally disruptive if the starting Fe(III) is added at 50-150 mg L(-1). We used (14)C radiolabeled acetate, lactate, propionate, butyrate, glucose, starch, and oleic acid to demonstrate that short and long-term carbon oxidation is increased when different forms of Fe(III) are amended to septic wastewater. The rates of carbon mineralization to (14)CO(2) increased 2-5 times (relative to unamended systems) in the presence of Fe(III). The extent of mineralization reached 90% for some carbon compounds when Fe(III) was present, compared to levels of 50-60% in the absence of Fe(III). (14)CH(4) was not generated when Fe(III) was added, demonstrating that this strategy can limit methane emissions from septic systems. Amplified 16S rDNA restriction analysis indicated that unique Fe(III)-reducing microbial communities increased significantly in Fe(III)-amended incubations, with Fe(III)-reducers becoming the dominant microbial community in several incubations. The form of Fe(III) added had a significant impact on the rate and extent of mineralization; ferrihydrite and lepidocrocite were favored as solid phase Fe(III) and chelated Fe(III) (with nitrilotriacetic acid or EDTA) as soluble Fe(III) forms. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evaluating Contaminants of Emerging Concern as tracers of wastewater from septic systems.

PubMed

James, C Andrew; Miller-Schulze, Justin P; Ultican, Shawn; Gipe, Alex D; Baker, Joel E

2016-09-15

Bacterial and nutrient contamination from anthropogenic sources impacts fresh and marine waters, reducing water quality and restricting recreational and commercial activities. In many cases the source of this contamination is ambiguous, and a tracer or set of tracers linking contamination to source would be valuable. In this work, the effectiveness of utilizing a suite of Contaminants of Emerging Concern (CECs) as tracers of bacteria from human septic system effluent is investigated. Field sampling was performed at more than 20 locations over approximately 18 months and analyzed for a suite of CECs and fecal coliform bacteria. The sampling locations included seeps and small freshwater discharges to the shoreline. Sites were selected and grouped according to level of impact by septic systems as determined by previous field sampling programs. A subset of selected locations had been positively identified as being impacted by effluent from failing septic systems through dye testing. The CECs were selected based on their predominant use, their frequency of use, and putative fate and transport properties. In addition, two rounds of focused sampling were performed at selected sites to characterize short-term variations in CEC and fecal coliform concentrations, and to evaluate environmental persistence following source correction activities. The results indicate that a suite of common use compounds are suitable as generalized tracers of bacterial contamination from septic systems and that fate and transport properties are important in tracer selection. Highly recalcitrant or highly labile compounds likely follow different loss profiles in the subsurface compared to fecal bacteria and are not suitable tracers. The use of more than one tracer compound is recommended due to source variability of septic systems and to account for variations in the subsurface condition. In addition, concentrations of some CECs were measured in receiving waters at levels which suggested the potential for environmental harm, indicating that the possible risk presented from these sources warrants further investigation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cost-Effectiveness of Nitrogen Mitigation by Alternative ...

EPA Pesticide Factsheets

Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. We seek to address two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes, and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets and neighborhood-scale blackwater digesters are also attractive options in some cases, particularly best-case nitrogen mitigation; innovative/advanced septic system

The apelinergic system as an alternative to catecholamines in low-output septic shock.

PubMed

Coquerel, David; Sainsily, Xavier; Dumont, Lauralyne; Sarret, Philippe; Marsault, Éric; Auger-Messier, Mannix; Lesur, Olivier

2018-01-19

Catecholamines, in concert with fluid resuscitation, have long been recommended in the management of septic shock. However, not all patients respond positively and controversy surrounding the efficacy-to-safety profile of catecholamines has emerged, trending toward decatecholaminization. Contextually, it is time to re-examine the "maintaining blood pressure" paradigm by identifying safer and life-saving alternatives. We put in perspective the emerging and growing knowledge on a promising alternative avenue: the apelinergic system. This target exhibits invaluable pleiotropic properties, including inodilator activity, cardio-renal protection, and control of fluid homeostasis. Taken together, its effects are expected to be greatly beneficial for patients in septic shock.

Mass balance and isotope effects during nitrogen transport through septic tank systems with packed-bed (sand) filters.

PubMed

Hinkle, Stephen R; Böhlke, J K; Fisher, Lawrence H

2008-12-15

Septic tank systems are an important source of NO3(-) to many aquifers, yet characterization of N mass balance and isotope systematics following septic tank effluent discharge into unsaturated sediments has received limited attention. In this study, samples of septic tank effluent before and after transport through single-pass packed-bed filters (sand filters) were evaluated to elucidate mass balance and isotope effects associated with septic tank effluent discharge to unsaturated sediments. Chemical and isotopic data from five newly installed pairs and ten established pairs of septic tanks and packed-bed filters serving single homes in Oregon indicate that aqueous solute concentrations are affected by variations in recharge (precipitation, evapotranspiration), NH4+ sorption (primarily in immature systems), nitrification, and gaseous N loss via NH3 volatilization and(or) N2 or N2O release during nitrification/denitrification. Substantial NH4+ sorption capacity was also observed in laboratory columns with synthetic effluent. Septic tank effluent delta15N-NH4+ values were almost constant and averaged +4.9 per thousand+/-0.4 per thousand (1 sigma). In contrast, delta15N values of NO3(-) leaving mature packed-bed filters were variable (+0.8 to +14.4 per thousand) and averaged +7.2 per thousand+/-2.6 per thousand. Net N loss in the two networks of packed-bed filters was indicated by average 10-30% decreases in Cl(-)-normalized N concentrations and 2-3 per thousand increases in delta15N, consistent with fractionation accompanying gaseous N losses and corroborating established links between septic tank effluent and NO3(-) in a local, shallow aquifer. Values of delta18O-NO3(-) leaving mature packed-bed filters ranged from -10.2 to -2.3 per thousand (mean -6.4 per thousand+/-1.8 per thousand), and were intermediate between a 2/3 H2O-O+1/3 O2-O conceptualization and a 100% H2O-O conceptualization of delta18O-NO3(-) generation during nitrification.

Performance of a Scalable Wastewater Treatment Package Unit and Potential Military Applications.

DTIC Science & Technology

1999-08-01

best. Hawaii’s Department of Health (DOH) is investigating alternative technologies to eventually replace cesspools and septic tanks where...Department of Health ( SDOH ). These samples were collected Monday through Friday. 4.4 MEASUREMENTS AND METHODS The ultimate goal of testing The Tank" was...Washington D.C., p.p. 68-72. 23. Wenk, V.S., Water Pollution: Domestic Wastes, A Technology Assessment Methodology , Mitre Corporation with the Office of

Hyperdynamic sepsis modifies a PEEP-mediated redistribution in organ blood flows

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bersten, A.D.; Gnidec, A.A.; Rutledge, F.S.

Changes in organ blood flow (Q) produced by 20 cm H2O positive end-expiratory pressure (PEEP) were measured before and after the induction of hyperdynamic sepsis in nine unanesthetized sheep. During the baseline nonseptic study, PEEP was associated with a 9% fall in thermodilution-measured systemic Q, although arterial perfusing pressures were unaffected. Concurrently, microsphere-derived Q was maintained to the brain and heart, but fell to liver, spleen, pancreas, kidney, large intestine, and gastrocnemius. Twenty-four to 36 h after cecal ligation and perforation, a pre-PEEP septic study demonstrated an increase in all of the cardiac index (CI) and systemic O2 delivery whenmore » compared with the nonseptic study, whereas whole-body O2 extraction was depressed. Although PEEP depressed systemic Q during the septic study to a greater extent than during the nonseptic study (p less than 0.02), absolute organ Q fell only to pancreas, liver, and spleen. Relative to the simultaneous fall in the CI, Q to some splanchnic organs was not depressed by PEEP to the same magnitude in the septic as in the nonseptic study. When an infusion of Ringer's lactate subsequently restored systemic Q to pre-PEEP septic levels, individual flows that had been depressed by PEEP were not restored. Furthermore, Q-kidney continued to fall, such that the postfluid Q-kidney (-19%) was significantly less than was demonstrated in the pre-PEEP septic study. We postulate that differences noted in the distribution of organ Q between the nonseptic and hyperdynamic septic studies after the application of PEEP were secondary to the vasculopathy of sepsis and/or an alteration in the function of specific organ microcirculations. However, these data do not address whether the changes in organ Q distribution after a PEEP-mediated depression in systemic Q during sepsis significantly restricted tissue DO2.« less

Rio Grande valley Colorado new Mexico and Texas

USGS Publications Warehouse

Ellis, Sherman R.; Levings, Gary W.; Carter, Lisa F.; Richey, Steven F.; Radell, Mary Jo

1993-01-01

Two structural settings are found in the study unit: alluvial basins and bedrock basins. The alluvial basins can have through-flowing surface water or be closed basins. The discussion of streamflow and water quality for the surface-water system is based on four river reaches for the 750 miles of the main stem. the quality of the ground water is affected by both natural process and human activities and by nonpoint and point sources. Nonpoint sources for surface water include agriculture, hydromodification, and mining operations; point sources are mainly discharge from wastewater treatment plants. Nonpoint sources for ground water include agriculture and septic tanks and cesspools; point sources include leaking underground storage tanks, unlined or manure-lined holding ponds used for disposal of dairy wastes, landfills, and mining operations.

Clinical characteristics and outcomes of the meningitides in systemic lupus erythematosus.

PubMed

Baizabal-Carvallo, José Fidel; Delgadillo-Márquez, German; Estañol, Bruno; García-Ramos, Guillermo

2009-01-01

The meningitides are rare but well-identified complications in patients with systemic lupus erythematosus (SLE). To determine the clinical characteristics, risk factors, prevalence and outcomes of the meningitides (septic and aseptic) in patients with SLE. From January 1988 to December 2006, we identified patients with SLE and septic or aseptic meningitis. We identified 25 episodes of meningitis in 23 patients with SLE, from a total of 1,411 SLE patients (1.63%); in 15 out of 25 episodes, a microorganism was identified. Mycobacterium tuberculosis, Listeria monocytogenes and Criptococcus neoformans represented the main microorganisms. In 10 episodes, aseptic meningitis was diagnosed. Lymphopenia, steroid use, chronic damage and systemic activity of SLE were frequent in both kinds of meningitis. Although the clinical presentation did not differ significantly, patients with septic meningitis had more residual neurological deficits (p = 0.04). Meningitis was observed in about 1.6% of the patients with SLE; in 40% of the cases, no microorganism could be isolated. A residual neurological deficit was more common in patients with septic meningitis. Copyright (c) 2008 S. Karger AG, Basel.

Modeling the system dynamics for nutrient removal in an innovative septic tank media filter.

PubMed

Xuan, Zhemin; Chang, Ni-Bin; Wanielista, Martin

2012-05-01

A next generation septic tank media filter to replace or enhance the current on-site wastewater treatment drainfields was proposed in this study. Unit operation with known treatment efficiencies, flow pattern identification, and system dynamics modeling was cohesively concatenated in order to prove the concept of a newly developed media filter. A multicompartmental model addressing system dynamics and feedbacks based on our assumed microbiological processes accounting for aerobic, anoxic, and anaerobic conditions in the media filter was constructed and calibrated with the aid of in situ measurements and the understanding of the flow patterns. Such a calibrated system dynamics model was then applied for a sensitivity analysis under changing inflow conditions based on the rates of nitrification and denitrification characterized through the field-scale testing. This advancement may contribute to design such a drainfield media filter in household septic tank systems in the future.

Well Wishes: A Case on Septic Systems and Well Water Requiring In-Depth Analysis and Including Optional Laboratory Experiments

ERIC Educational Resources Information Center

Walczak, Mary M.; Lantz, Juliette M.

2004-01-01

The case of Well Wishes involves students in a thorough examination of the interaction among nitrogen-composed species in the septic systems and well water, which helps to clean household water. The case supports the attainment of five goals for students, and can be analyzed through classroom discussions or laboratory experiments.

Effect of extracorporeal cytokine removal on vascular barrier function in a septic shock patient.

PubMed

David, Sascha; Thamm, Kristina; Schmidt, Bernhard M W; Falk, Christine S; Kielstein, Jan T

2017-01-01

Sepsis and septic shock are major healthcare problems, affecting millions of individuals around the world each year. Pathophysiologically, septic multiple organ dysfunction (MOD) is a life-threatening condition caused by an overwhelming systemic inflammatory response of the host's organism to an infection. We experimentally tested if high circulating cytokine levels might increase vascular permeability-a critical hallmark of the disease-and if this phenomenon can be reversed by therapeutic cytokine removal (CytoSorb®) in an exemplary patient. A 32-year-old Caucasian female presented with septic shock and accompanying acute kidney injury (Sequential Organ Failure Assessment (SOFA) = 18) to our ICU. In spite of a broad anti-infective regimen, adequate fluid resuscitation, and high doses of inotropics and catecholamines, she remained refractory hypotensive. The extraordinary severity of septic shock suggested an immense overwhelming host response assumingly accompanied by a notable cytokine storm such as known from patients with toxic shock syndrome. Thus, a CytoSorb® filter was added to the dialysis circuit to remove excess shock-perpetuating cytokines. To analyze the endothelial phenotype in vitro before and after extracorporeal cytokine removal, we tested the septic shock patient's serum on human umbilical vein endothelial cells (HUVECs). The effect on endothelial integrity was assessed both on the morphological (fluorescent immunocytochemistry for VE-cadherin and F-actin) and functional (transendothelial electrical resistance (TER)) level that was recorded in real time with an "electric cell-substrate impedance sensing" (ECIS) system (ibidi). We found (1) severe alterations of cell-cell contacts and the cytoskeletal architecture and (2) profound functional permeability changes, the putative cellular correlate of the clinical vascular leakage syndrome. However, the endothelial barrier was protected from these profound adverse effects when HUVECs were challenged with septic shock serum that was collected after extracorporeal cytokine removal. Beneficial observations of extracorporeal cytokine removal in septic shock patients might-at least in part-be promoted via protection of vascular barrier function.

Septic shock: desperately seeking treatment.

PubMed

Huet, Olivier; Chin-Dusting, Jaye P F

2014-01-01

Septic shock results from the dysregulation of the innate immune response following infection. Despite major advances in fundamental and clinical research, patients diagnosed with septic shock still have a poor prognostic outcome, with a mortality rate of up to 50%. Indeed, the reasons leading to septic shock are still poorly understood. First postulated 30 years ago, the general view of septic shock as an acute and overwhelming inflammatory response still prevails today. Recently, the fact that numerous clinical trials have failed to demonstrate any positive medical outcomes has caused us to question our fundamental understanding of this condition. New and sophisticated technologies now allow us to accurately profile the various stages and contributory components of the inflammatory response defining septic shock, and many studies now report a more complex inflammatory response, particularly during the early phase of sepsis. In addition, novel experimental approaches, using more clinically relevant animal models, to standardize and stratify research outcomes are now being argued for. In the present review, we discuss the most recent findings in relation to our understanding of the underlying mechanisms involved in septic shock, and highlight the attempts made to improve animal experimental models. We also review recent studies reporting promising results with two vastly different therapeutic approaches influencing the renin-angiotensin system and applying mesenchymal stem cells for clinical intervention.

Cardiac Troponin Is a Predictor of Septic Shock Mortality in Cancer Patients in an Emergency Department: A Retrospective Cohort Study.

PubMed

Yang, Zhi; Qdaisat, Aiham; Hu, Zhihuang; Wagar, Elizabeth A; Reyes-Gibby, Cielito; Meng, Qing H; Yeung, Sai-Ching J

2016-01-01

Septic shock may be associated with myocardial damage; however, the prognostic value of cardiac enzymes in cancer patients with septic shock is unknown. In this study, we evaluated the prognostic significance of cardiac enzymes in combination with established prognostic factors in predicting the 7-day mortality rate of patients with septic shock, and we constructed a new scoring system, Septic Oncologic Patients in Emergency Department (SOPED), which includes cardiac enzymes, to predict 7-day mortality rates. We performed a retrospective cohort study of 375 adult cancer patients with septic shock who visited the emergency department of a comprehensive cancer center between 01/01/2004 and 12/31/2013. The 7-day and 28-day mortality rates were 19.7% and 37.6%, respectively. The creatine kinase myocardial band fraction and troponin-I were significantly higher in patients who died in ≤7 days and ≤28 days than in those who did not. In Cox regression models, troponin-I >0.05 ng/mL plus Predisposition, Infection, Response, and Organ Failure (PIRO2011) or Mortality in Emergency Department Sepsis (MEDS) score was a significant predictor of survival for ≤7 days. With our new SOPED scoring system, the receiver operating characteristic area under the curve was 0.836, higher than those for PIRO2011 and MEDS. Troponin-I >0.05 ng/mL was an important predictor of short-term mortality (≤7 days). The SOPED scoring system, which incorporated troponin-I, was more prognostically accurate than were other scores for 7-day mortality. Large multicenter studies are needed to verify our results and prospectively validate the prognostic performance of the SOPED score.

Estimated discharge of treated wastewater in Florida, 1990

USGS Publications Warehouse

Marella, R.L.

1994-01-01

According to the Florida Department of Environ- mental Protection, 5,100 wastewater treatment systems were in operation during 1990. Of this total, 72 percent were domestic wastewater facilities and 28 percent were industrial waste- water facilities. The number of wastewater systems inventoried for 1990 was 1,062 (systems that treated and discharged more than 0.01 Mgal/d or had a plant capacity of greater than 0.04 Mgal/d. Based on this inventory, the estimated discharge of treated wastewater in Florida during 1990 totaled 1,638 million gallons per day. Approxi- mately 65 percent of this water was discharged to surface water during 1990 and the remaining 35 percent was discharged to ground water. Discharge to surface water includes effluent outfalls into the Atlantic Ocean (32 percent), while the re- maining (68 percent) is discharged into the Gulf of Mexico, bays, rivers, wetlands, and other surface water bodies throughout Florida. Discharge to ground-water includes treated effluent outfalls to land application systems (reuse systems and spray fields), drain fields, percolation ponds (51 percent), and to injection wells (49 percent). An estimated 322 million gallons per day of the treated domestic and industrial wastewater was reused during 1990. Discharge of treated domestic wastewater from the 994 systems inventoried in Florida during 1990 totaled 1,353 million gallons per day and served an estimated 8.58 million people (66 percent of the population of Florida in 1990). The remaining 34 percent of the popu- lation (4.36 million) are served by the 2,700 smaller domestic wastewater systems or have individual septic tanks. In 1990, there were 1.56 million septic tanks in Florida. Discharge of industrial wastewater was inventoried for 68 systems in 1990 and totaled 285 million gallons per day. Discharge of domestic wastewater in- creased more than 20 percent and industrial wastewater discharge increased 5 percent from 1985 to 1990. (USGS)

The prognostic performance of the complement system in septic patients in emergency department: a cohort study.

PubMed

Zhao, Xin; Chen, Yun-Xia; Li, Chun-Sheng

2015-01-01

To investigate the prognostic performance of complement components in septic patients, complement 3, membrane attack complex (MAC) and mannose-binding lectin were measured and compared among adult patients with sepsis, severe sepsis and septic shock, as well as between in-hospital nonsurvivors and survivors. The prognostic value of complement components was compared with mortality in emergency department sepsis (MEDS) score. Median complement 3, MAC and mannose-binding lectin increased directly with the sepsis, severe sepsis and septic shock groups, and were significantly higher in nonsurvivors than in survivors. MEDS and MAC independently predicted in-hospital mortality. The prognostic performance of MAC was superior to MEDS as analyzed by receiver operating characteristic curve and area under the curve.

Closure Report for Corrective Action Unit 563: Septic Systems, Nevada Test Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

NSTec Environmental Restoration

2010-02-28

Corrective Action Unit (CAU) 563 is identified in the Federal Facility Agreement and Consent Order (FFACO) as “Septic Systems” and consists of the following four Corrective Action Sites (CASs), located in Areas 3 and 12 of the Nevada Test Site: · CAS 03-04-02, Area 3 Subdock Septic Tank · CAS 03-59-05, Area 3 Subdock Cesspool · CAS 12-59-01, Drilling/Welding Shop Septic Tanks · CAS 12-60-01, Drilling/Welding Shop Outfalls Closure activities were conducted from September to November 2009 in accordance with the FFACO (1996, as amended February 2008) and the Corrective Action Plan for CAU 563. The corrective action alternatives includedmore » No Further Action and Clean Closure.« less

Right atrium cholinergic deficit in septic rats.

PubMed

Contreras, Paola; Migliaro, Eduardo R; Suhr, Bruno

2014-02-01

Heart rate variability (HRV) is mainly determined by the influence of both branches of the Autonomic Nervous System over the sinus node. Low HRV has been associated with a worse prognosis in patients with sepsis. The objective of this study was to explain the reduction in HRV during experimental sepsis in adult rats. We recorded the heart's electrical activity by telemetry in conscious unrestrained male rats before and 1day after the induction of peritonitis (N=39) or sham peritonitis (N=15). Then, we analyzed the chronotropic responsiveness of the isolated heart to the autonomic neurotransmitters and determined catecholamine concentrations in blood plasma and acetylcholine and choline concentrations in the right atrium. The surviving septic rats (N=33) had increased heart rate (HR) and diminished HRV. Despite the higher HR in situ, the spontaneous basal HR in septic and sham isolated hearts was the same. The isolated septic hearts showed acetylcholine hypersensitivity (log (IC50,M)=-7.2±0.2 vs. -6.0±0.4, P=0.025) and lower concentrations of choline in their right atriums (in nMol/mg protein: 0.6±0.1 vs. 1.6±0.6, P=0.013). Norepinephrine concentration in blood plasma from septic rats was higher (in ng/ml: 29.2±8.4 vs. 5.8±4.1, P=0.019). In conclusion, septic rats present a deregulation of the autonomic nervous system, not only sympathetic overexcitation but also parasympathetic dysfunction. © 2013.

Closure Report for Corrective Action Unit 562: Waste Systems, Nevada National Security Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

NSTec Environmental Restoration

2012-08-15

This Closure Report (CR) presents information supporting closure of Corrective Action Unit (CAU) 562, Waste Systems, and provides documentation supporting the completed corrective actions and confirmation that closure objectives for CAU 562 were met. This CR complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; the U.S. Department of Energy (DOE), Environmental Management; the U.S. Department of Defense; and DOE, Legacy Management (FFACO, 1996 as amended). CAU 562 consists of the following 13 Corrective Action Sites (CASs), located in Areas 2, 23, and 25 of the Nevadamore » National Security Site: · CAS 02-26-11, Lead Shot · CAS 02-44-02, Paint Spills and French Drain · CAS 02-59-01, Septic System · CAS 02-60-01, Concrete Drain · CAS 02-60-02, French Drain · CAS 02-60-03, Steam Cleaning Drain · CAS 02-60-04, French Drain · CAS 02-60-05, French Drain · CAS 02-60-06, French Drain · CAS 02-60-07, French Drain · CAS 23-60-01, Mud Trap Drain and Outfall · CAS 23-99-06, Grease Trap · CAS 25-60-04, Building 3123 Outfalls Closure activities began in October 2011 and were completed in April 2012. Activities were conducted according to the Corrective Action Plan for CAU 562 (U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSA/NSO], 2011). The corrective actions included No Further Action and Clean Closure. Closure activities generated sanitary waste and hazardous waste. Some wastes exceeded land disposal limits and required offsite treatment prior to disposal. Other wastes met land disposal restrictions and were disposed in appropriate onsite or offsite landfills. NNSA/NSO requests the following: · A Notice of Completion from the Nevada Division of Environmental Protection to NNSA/NSO for closure of CAU 562 · The transfer of CAU 562 from Appendix III to Appendix IV, Closed Corrective Action Units, of the FFACO« less

The Use of Reactive Materials in Septic Systems for Pathogens and Nitrate Removal

NASA Astrophysics Data System (ADS)

Suhogusoff, A. V.; Hirata, R.; Aravena, R.; Stimson, J.; Robertson, W.

2009-05-01

The developing countries have an urgent need for cheap and efficient techniques for the improvement of sanitary conditions in areas without public water supply and sewerage system, especially in suburban regions or irregular occupation areas, where there is a great lack of social assistance. In this type of situations, the inhabitants use dug wells for water use and cesspits for disposal of sewage, which usually contaminates the groundwater with nitrate and microorganisms. As part of a study aiming to develop new sewage treatment systems in an irregular occupation area located at the District of Barragem, south region of the municipality of São Paulo (Brazil), a conventional cesspit (named as "Control") and an alternative septic system were constructed and monitored for a year. The design of the alternative septic system included a 1m thickness reactive barrier constituted by BOF (Budget Oxygen Furnace - a byproduct of the steel-making industry) for pathogens removal, then 1m sand package where the wastewater is oxidized and at the bottom the wastewater is in contact with a 0,5m thickness reactive barrier constituted by sawdust (carbon source), where redox conditions are very reducing and denitrification and even methanogenesis can take place. The chemical and biological data collected in the alternative septic system showed complete removal of the pathogens in the BOF barrier, then nitrification occurred between the BOF and the bottom of sand package. However denitrification in the sawdust barrier was incomplete because of the high pH caused by the BOF materials, which can reduced the number of denitrifiers bacteria present in the sawdust barrier. Isotope analyses that are been carried out in the residual nitrate will provided more information about the extent of the denitrification reaction in the alternative septic system. In case of the control cesspit, it was observed the occurrence of high concentration of ammonium, dissolved organic carbon, CO2, CH4 and low dissolved oxygen, which means the whole cesspit works like a septic tank, and probably nitrification will occur below the cesspit. It is possible that saturated conditions were achieved within the control cesspit, which reduced the input of oxygen in the wastewater. This study have shown for a better treatment of wastewater, the design should be a sand bed below septic tank for nitrification occurrence, followed by sawdust barrier for denitrification reaction, and then BOF barrier, whose high pH produced will be responsible for microorganisms removal.

Corrective Action Investigation Plan for Corrective Action Unit 563: Septic Systems, Nevada Test Site, Nevada, with Errata Sheet, Revision 0 (in English; Afrikaans)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alfred Wickline

Corrective Action Unit 563, Septic Systems, is located in Areas 3 and 12 of the Nevada Test Site, which is 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 563 is comprised of the four corrective action sites (CASs) below: • 03-04-02, Area 3 Subdock Septic Tank • 03-59-05, Area 3 Subdock Cesspool • 12-59-01, Drilling/Welding Shop Septic Tanks • 12-60-01, Drilling/Welding Shop Outfalls These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend corrective action alternatives. Additional information will be obtained by conducting a corrective actionmore » investigation (CAI) before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document.« less

Septic Shock Alters Mitochondrial Respiration of Lymphoid Cell-Lines and Human Peripheral Blood Mononuclear Cells: The Role of Plasma.

PubMed

Clere-Jehl, Raphael; Helms, Julie; Kassem, Mohamad; Le Borgne, Pierrick; Delabranche, Xavier; Charles, Anne-Laure; Geny, Bernard; Meziani, Ferhat; Bilbault, Pascal

2018-02-14

In septic shock patients, post-septic immunosuppression state following the systemic inflammatory response syndrome is responsible for nosocomial infections, with subsequent increased mortality. The aim of the present study was to assess the underlying cellular mechanisms of the post-septic immunosuppression state, by investigating mitochondrial functions of peripheral blood mononuclear cells (PBMCs) from septic shock patients over 7 days. Eighteen patients admitted to a French intensive care unit for septic shock were included. At days 1 and 7, PBMCs were isolated by Ficoll density gradient centrifugation. Mitochondrial respiration of intact septic PBMCs was assessed versus control group PBMCs, by measuring O2 consumption in plasma, using high-resolution respirometry. Mitochondrial respiration was then compared between septic plasmas and control plasmas for control PBMCs, septic PBMCs and lymphoid cell-line (CEM). To investigate the role of plasma, we measured several plasma cytokines, among them HMGB1, by ELISA. Basal O2 consumption of septic shock PBMCs was of 8.27 ± 3.39 and 10.48 ± 3.99 pmol/s/10 cells at days 1 and 7 respectively, significantly higher than in control PBMCs (5.37 ± 1.46 pmol/s/10 cells, p < 0.05). Septic patient PBMCs showed a lower response to oligomycin, suggesting a reduced ATP-synthase activity, as well as an increased response to FCCP suggesting an increased mitochondrial respiratory capacity. At 6 hours, septic plasmas showed a decreased O2 consumption of CEM (4.73 ± 1.46 vs. 6.58 ± 1.53, p < 0.05) as well as in control group PBMCs (1.76 ± 0.36 vs. 2.70 ± 0.42, p < 0.05), and triggered a decreased ATP-synthase activity but an increased response to FCCP. These differences are not explained by different cell survival. High HMGB1 levels were significantly associated with reduced PBMCs mitochondrial respiration. Septic plasma impairs mitochondrial respiration in immune cells, with a possible role of the proinflammatory protein HMGB1, leading to a subsequent compensation, probably by enzymatic activation. This compensation result is an improvement of global mitochondrial respiratory capacity, but without restoring ATP-synthase activity.

[Use of quantitative electroencephalogram in patients with septic shock].

PubMed

Ma, Yujie; Ouyang, Bin; Guan, Xiangdong

2016-01-19

To observe the quantitative electroencephalogram (qEEG) characteristics of the patients with septic shock in intensive care unit (ICU), and to find the early presence and severity of septic-associated encephalopathy (SAE) in these patients. During November 2014 to August 2015, 26 cases with septic shock were included from the ICU of the First Affiliated Hospital, Sun Yat-sen University.During the same period, 14 healthy volunteers were included as control. The brain function instrument was used to monitor the patients by the bed, placing leads as the internationally used 10-20 system, bipolar longitudinal F3-P3, F4-P4 four channels, and then consecutive clips of 5 minutes was chosen, using the average value of the clips, the amplitude integrated electroencephalogram (aEEG), relative frequency band energy, spectrum entropy, relative alpha ariability to carry out statistical analysis.And the qEEG features of septic shock patients with different Glasgow coma scale (GCS) levels were also analyzed. (1) 96% of the patients with septic shock had EEG abnormalities.Alpha frequency band energy, alpha ariability, aEEG amplitude, spectrum entropy decreased significantly (P<0.05=, while the delta frequency band energy significantly increased (P<0.05=. (2) aEEG amplitude decline appeared in 34% of patients with septic shock, and within the septic shock groups, amplitude decreased significantly (P<0.05= in patients with GCS under five. Patients with septic shock tends to have diffuse inhibition in EEG, and the inhibition degree can reflect cerebral lesion degree; changes of EEG frequency as early warning indicators of brain damage are sensitive, and the decline of amplitude often indicates critical injury.

Renal Blood Flow, Glomerular Filtration Rate, and Renal Oxygenation in Early Clinical Septic Shock.

PubMed

Skytte Larsson, Jenny; Krumbholz, Vitus; Enskog, Anders; Bragadottir, Gudrun; Redfors, Bengt; Ricksten, Sven-Erik

2018-06-01

Data on renal hemodynamics, function, and oxygenation in early clinical septic shock are lacking. We therefore measured renal blood flow, glomerular filtration rate, renal oxygen consumption, and oxygenation in patients with early septic shock. Prospective comparative study. General and cardiothoracic ICUs. Patients with norepinephrine-dependent early septic shock (n = 8) were studied within 24 hours after arrival in the ICU and compared with postcardiac surgery patients without acute kidney injury (comparator group, n = 58). None. Data on systemic hemodynamics and renal variables were obtained during two 30-minute periods. Renal blood flow was measured by the infusion clearance of para-aminohippuric acid, corrected for renal extraction of para-aminohippuric acid. Renal filtration fraction was measured by renal extraction of chromium-51 labeled EDTA. Renal oxygenation was estimated from renal oxygen extraction. Renal oxygen delivery (-24%; p = 0.037) and the renal blood flow-to-cardiac index ratio (-21%; p = 0.018) were lower, renal vascular resistance was higher (26%; p = 0.027), whereas renal blood flow tended to be lower (-19%; p = 0.068) in the septic group. Glomerular filtration rate (-32%; p = 0.006) and renal sodium reabsorption (-29%; p = 0.014) were both lower in the septic group. Neither renal filtration fraction nor renal oxygen consumption differed significantly between groups. Renal oxygen extraction was significantly higher in the septic group (28%; p = 0.022). In the septic group, markers of tubular injury were elevated. In early clinical septic shock, renal function was lower, which was accompanied by renal vasoconstriction, a lower renal oxygen delivery, impaired renal oxygenation, and tubular sodium reabsorption at a high oxygen cost compared with controls.

Using Major Elements to Determine Sources of Nitrate in Groundwater, Suffolk County, Long Island, NY

NASA Astrophysics Data System (ADS)

Munster, J.; Hanson, G.; Bokuniewicz, H.

2004-05-01

Suffolk County is the eastern most county on Long Island with an area of 2,500 square kilometers and a population of 1.4 million. Groundwater is the only source of potable water for Suffolk County. Nitrate levels have become a concern as a result of the continued eastward urbanization of Long Island since the mid 1900's. In 2003, 2% of 1000 public supply wells had greater than 10 ppm nitrogen as nitrate, 8% had 6 to 10 ppm nitrogen as nitrate and 62% of the wells were rated as susceptible to increased nitrate contamination based on land use, travel time and prevalence. Nitrogen as nitrate above 10 ppm is harmful to infants and is currently the drinking water standard of the Environmental Protection Agency. The major sources of the nitrate in the urbanized areas are most likely turf grass fertilizer and sewage from septic tank/cesspool systems and sewage treatment plants that provide only secondary treatment. Turf grass occupies about 28% of the land. Two-thirds of the houses have septic tank/cesspool systems and a majority of the sewage treatment plants discharge effluent to the groundwater. Previous investigators of the sources of nitrate in groundwater on Long Island have used 15N values of nitrate-nitrogen to identify nitrate contamination (Bleifuss et al., 2000; Flipse and Bonner, 1985; Flipse et al., 1984; Kreitler et al., 1978). However, due to overlapping source signatures, nitrogen isotopes alone were not sufficient to characterize the sources of nitrate. More recent studies have shown that major elements that accompany nitrate in the groundwater (Bleifuss et al., 2000; Elhatip et al., 2003; Trauth and Xanthopoulos, 1997) may distinguish sources of nitrate with less ambiguity. In this study samples of waste water from septic tank/cesspool systems and sewage treatment plants and samples of soil water collected below turf grass that is not fertilized, fertilized with organic fertilizer and fertilized with chemical fertilizer were analyzed for major elements. Major element data for groundwater from Suffolk County Water Authority municipal wells have been characterized as a function of capture zone land use (Source Water Assessment Project, CDM, 2003). The data for the groundwater and the waste water and the soil water were then compared. The elements Na, Mg, Cl, NO3 and SO4 proved most successful as nitrate tracers on element-element plots. There is a distinct relationship between land use and source of nitrate contamination such that ground waters sourced in: (1) low residential density areas (1 or less dwelling units per acre (DU/acre)) plot in turf grass cultivation fields (2) medium residential areas (2-10 DU/acre) and high residential areas (more than 10 DU/acre) plot as a mixture of turf grass cultivation and wastewater (3) agricultural areas plot in the turf grass cultivation field and (4) vacant or open land use plot close to average rain water compositions.

Anaerobic treatment as a core technology for energy, nutrients and water recovery from source-separated domestic waste(water).

PubMed

Zeeman, Grietje; Kujawa, Katarzyna; de Mes, Titia; Hernandez, Lucia; de Graaff, Marthe; Abu-Ghunmi, Lina; Mels, Adriaan; Meulman, Brendo; Temmink, Hardy; Buisman, Cees; van Lier, Jules; Lettinga, Gatze

2008-01-01

Based on results of pilot scale research with source-separated black water (BW) and grey water (GW), a new sanitation concept is proposed. BW and GW are both treated in a UASB (-septic tank) for recovery of CH4 gas. Kitchen waste is added to the anaerobic BW treatment for doubling the biogas production. Post-treatment of the effluent is providing recovery of phosphorus and removal of remaining COD and nitrogen. The total energy saving of the new sanitation concept amounts to 200 MJ/year in comparison with conventional sanitation, moreover 0.14 kg P/p/year and 90 litres of potential reusable water are produced. (c) IWA Publishing 2008.

Effluent quality from 200 on-site sewage systems: design values for guidelines.

PubMed

Charles, K J; Ashbolt, N J; Roser, D J; McGuinness, R; Deere, D A

2005-01-01

The quality of effluent from an on-site sewage treatment system is a critical factor in designing the disposal area and, hence, ensuring the sustained performance of the system. Contaminant concentrations in effluent are typically specified in regulatory guidelines or standards; however, the accuracy of these guideline values are brought into question due to the poor performance of septic tanks and the high failure rates of disposal systems reported here and elsewhere. Results from studies of septic tank effluent quality indicated that the effluent is of poorer quality than currently suggested by guidelines. Aerated wastewater treatment systems were found to perform to accreditation guidelines; however, insufficient nutrient data is presently available to assess nutrient loads. It is proposed that the 80th percentile of system performance be adopted as the design value for sizing effluent disposal areas to minimise failure associated with overloading. For septic tanks this equates to 660 mg L(-1) SS, 330 mg L(-1) BOD, 250 mg L(-1) TN and 36 mg L(-1) TP.

Cancer causes increased mortality and is associated with altered apoptosis in murine sepsis.

PubMed

Fox, Amy C; Robertson, Charles M; Belt, Brian; Clark, Andrew T; Chang, Katherine C; Leathersich, Ann M; Dominguez, Jessica A; Perrone, Erin E; Dunne, W Michael; Hotchkiss, Richard S; Buchman, Timothy G; Linehan, David C; Coopersmith, Craig M

2010-03-01

Whereas most septic patients have an underlying comorbidity, most animal models of sepsis use mice that were healthy before the onset of infection. Malignancy is the most common comorbidity associated with sepsis. The purpose of this study was to determine whether mice with cancer have a different response to sepsis than healthy animals. Prospective, randomized controlled study. Animal laboratory in a university medical center. C57Bl/6 mice. Animals received a subcutaneous injection of either 250,000 cells of the transplantable pancreatic adenocarcinoma cell line Pan02 (cancer) or phosphate-buffered saline (healthy). Three weeks later, mice given Pan02 cells had reproducible, nonmetastatic tumors. Both groups of mice then underwent intratracheal injection of either Pseudomonas aeruginosa (septic) or 0.9% NaCl (sham). Animals were killed 24 hrs postoperatively or followed-up 7 days for survival. Mice with cancer and healthy mice appeared similar when subjected to sham operation, although cancer animals had lower levels of T- and B-lymphocyte apoptosis. Septic mice with cancer had increased mortality compared to previously healthy septic mice subjected to the identical injury (52% vs. 28%; p = .04). This was associated with increased bacteremia but no difference in local pulmonary infection. Septic mice with cancer also had increased intestinal epithelial apoptosis. Although sepsis induced an increase in T- and B-lymphocyte apoptosis in all animals, septic mice with cancer had decreased T- and B-lymphocyte apoptosis compared to previously healthy septic mice. Serum and pulmonary cytokines, lung histology, complete blood counts, and intestinal proliferation were similar between septic mice with cancer and previously healthy septic mice. When subjected to the same septic insult, mice with cancer have increased mortality compared to previously healthy animals. Decreased systemic bacterial clearance and alterations in intestinal epithelial and lymphocyte apoptosis may help explain this differential response.

Chronic Alcohol Ingestion Worsens Survival and Alters Gut Epithelial Apoptosis and Cd8+ T Cell Function after Pseudomonas Aeruginosa Pneumonia-Induced Sepsis.

PubMed

Klingensmith, Nathan J; Fay, Katherine T; Lyons, John D; Chen, Ching-Wen; Otani, Shunsuke; Liang, Zhe; Chihade, Deena B; Burd, Eileen M; Ford, Mandy L; Coopersmith, Craig M

2018-04-16

Mortality is higher in septic patients with a history of alcohol use disorder than in septic patients without a history of chronic alcohol usage. We have previously described a model of chronic alcohol ingestion followed by sepsis from cecal ligation and puncture in which alcohol-fed septic mice have higher mortality than water-fed septic mice, associated with altered gut integrity and increased production of TNF and IFNγ by splenic CD4 T cells without alterations in CD8 T cell function. The purpose of this study was to determine whether this represents a common host response to the combination of alcohol and sepsis by creating a new model in which mice with chronic alcohol ingestion were subjected to a different model of sepsis. C57Bl/6 mice were randomized to receive either alcohol or water for 12 weeks and then subjected to Pseudomonas aeruginosa pneumonia. Mice were sacrificed either 24 hours after the onset of sepsis or followed for survival. Alcohol-fed septic mice had significantly higher 7-day mortality than water-fed septic mice (96% vs 58%). This was associated with a 5-fold increase in intestinal apoptosis in alcohol-fed septic animals, accompanied by an increase in the pro-apoptotic protein Bax. Serum IL-6 levels were higher and IL-2 levels were lower in alcohol-fed septic mice. In contrast, CD8 T cell frequency was lower in alcohol-fed mice than water-fed septic mice, associated with increased production of IFNγ and TNF in stimulated splenocytes. No significant differences were noted in CD4 T cells, lung injury or bacteremia. Mice with chronic alcohol ingestion thus have increased mortality regardless of their septic insult, associated with changes in both the gut and the immune system.

Cancer causes increased mortality and is associated with altered apoptosis in murine sepsis

PubMed Central

Fox, Amy C.; Robertson, Charles M.; Belt, Brian; Clark, Andrew T.; Chang, Katherine C.; Leathersich, Ann M.; Dominguez, Jessica A.; Perrone, Erin E.; Dunne, W. Michael; Hotchkiss, Richard S.; Buchman, Timothy G.; Linehan, David C.; Coopersmith, Craig M.

2009-01-01

Objective While most septic patients have an underlying comorbidity, most animal models of sepsis use mice that were healthy prior to the onset of infection. Malignancy is the most common comorbidity associated with sepsis. The purpose of this study was to determine whether mice with cancer have a different response to sepsis than healthy animals. Design Prospective, randomized controlled study. Setting Animal laboratory in a university medical center. Subjects C57Bl/6 mice. Interventions Animals received a subcutaneous injection of either 250,000 cells of the transplantable pancreatic adenocarcinoma cell line Pan02 (cancer) or phosphate-buffered saline (healthy). Three weeks later, mice given Pan02 cells developed reproducible, non-metastatic tumors. Both groups of mice then underwent intratracheal injection of either Pseudomonas aeruginosa (septic) or 0.9% NaCl (sham). Animals were sacrificed 24 hours post-operatively or followed seven days for survival. Measurements and Main Results Cancer and healthy mice appeared similar when subjected to sham operation, although cancer animals had lower levels of T and B lymphocyte apoptosis. Cancer septic mice had increased mortality compared to previously healthy septic mice subjected to the identical injury (52% vs. 28%, p=0.04). This was associated with increased bacteremia but no difference in local pulmonary infection. Cancer septic mice also had increased intestinal epithelial apoptosis. Although sepsis induced an increase in T and B lymphocyte apoptosis in all animals, cancer septic mice had decreased T and B lymphocyte apoptosis compared to previously healthy septic mice. Serum and pulmonary cytokines, lung histology, complete blood counts and intestinal proliferation were similar between cancer septic and previously healthy septic mice. Conclusions When subjected to the same septic insult, mice with cancer have increased mortality compared to previously healthy animals. Decreased systemic bacterial clearance and alterations in both intestinal epithelial and lymphocyte apoptosis may help explain this differential response. PMID:20009755

Performance of a lab-scale bio-electrochemical assisted septic tank for the anaerobic treatment of black water.

PubMed

Zamalloa, Carlos; Arends, Jan B A; Boon, Nico; Verstraete, Willy

2013-06-25

Septic tanks are used for the removal of organic particulates in wastewaters by physical accumulation instead of through the biological production of biogas. Improved biogas production in septic tanks is crucial to increase the potential of this system for both energy generation and organic matter removal. In this study, the effect on the biogas production and biogas quality of coupling a 20 L lab-scale septic tank with a microbial electrolysis cell (MEC) was investigated and compared with a standard septic tank. Both reactors were operated at a volumetric organic loading rate of 0.5gCOD/Ld and a hydraulic retention time between 20 and 40 days using black water as an input under mesophilic conditions for a period of 3 months. The MEC-septic tank was operated at an applied voltage of 2.0±0.1V and the current experienced ranged from 40 mA (0.9A/m(2) projected electrode area) to 180 mA (5A/m(2) projected electrode area). The COD removal was of the order of 85% and the concentration of residual COD was not different between both reactors. Yet, the total phosphorous in the output was on average 39% lower in the MEC-septic tank. Moreover, the biogas production rate in the MEC-septic tank was a factor of 5 higher than in the control reactor and the H2S concentration in the biogas was a factor of 2.5 lower. The extra electricity supplied to the MEC-septic tank was recovered as extra biogas produced. Overall, it appears that the combination of MEC and a septic tank offers perspectives in terms of lower discharge of phosphorus and H2S, nutrient recuperation and a more reliable supply of biogas. Copyright © 2013 Elsevier B.V. All rights reserved.

Nutrient loading on subsoils from on-site wastewater effluent, comparing septic tank and secondary treatment systems.

PubMed

Gill, L W; O'Luanaigh, N; Johnston, P M; Misstear, B D R; O'Suilleabhain, C

2009-06-01

The performance of six separate percolation areas was intensively monitored to ascertain the attenuation effects of unsaturated subsoils with respect to on-site wastewater effluent: three sites receiving septic tank effluent, the other three sites receiving secondary treated effluent. The development of a biomat across the percolation areas receiving secondary treated effluent was restricted on these sites compared to those sites receiving septic tank effluent and this created significant differences in terms of the potential nitrogen loading to groundwater. The average nitrogen loading per capita at 1.0m depth of unsaturated subsoil equated to 3.9 g total-N/d for the sites receiving secondary treated effluent, compared to 2.1 g total-N/d for the sites receiving septic tank effluent. Relatively high nitrogen loading was, however, found on the septic tank sites discharging effluent into highly permeable subsoil that counteracted any significant denitrification. Phosphorus removal was generally very good on all of the sites although a clear relationship to the soil mineralogy was determined.

Molecular signature of organic nitrogen in septic-impacted groundwater

USGS Publications Warehouse

Arnold, William A.; Longnecker, Krista; Kroeger, Kevin D.; Kujawinski, Elizabeth B.

2014-01-01

Dissolved inorganic and organic nitrogen levels are elevated in aquatic systems due to anthropogenic activities. Dissolved organic nitrogen (DON) arises from various sources, and its impact could be more clearly constrained if specific sources were identified and if the molecular-level composition of DON were better understood. In this work, the pharmaceutical carbamazepine was used to identify septic-impacted groundwater in a coastal watershed. Using ultrahigh resolution mass spectrometry data, the nitrogen-containing features of the dissolved organic matter in septic-impacted and non-impacted samples were compared. The septic-impacted groundwater samples have a larger abundance of nitrogen-containing formulas. Impacted samples have additional DON features in the regions ascribed as ‘protein-like’ and ‘lipid-like’ in van Krevelen space and have more intense nitrogen-containing features in a specific region of a carbon versus mass plot. These features are potential indicators of dissolved organic nitrogen arising from septic effluents, and this work suggests that ultrahigh resolution mass spectrometry is a valuable tool to identify and characterize sources of DON.

Management system of simple rental flats study based on technical aspect and health in Medan city

NASA Astrophysics Data System (ADS)

Novrial; Indra Cahaya, S.

2018-03-01

Medan city is a metropolis city in Sumatera that has slums area. Simple rental flats have been built to overcome the problem. However the preliminary survey result showed that the physical and non-physical environment management of simple rent flats is very bad. This study conducted in 3 simple rent flats. It has observed the simple rent flats environment and has interviewed occupants and related agencies. Results of conducted research showed the occupant’s characteristics based on the largest percentage are Javanese; last education is senior high with self-employed work with average income Rp 1,000,000 – Rp 2,500,000. Waste retribution submitted to their cleanliness except for Amplas simple rent flats, their waste management system does not manage properly and the garbage littered. The number of family members of Wisma Labuhan and Amplas simple rent flats exceeds the regulation number of occupants, so it is crowded and noisy. Physical conditions of Amplas simple rent flats are bad, septic tank is full and are not vacuumed. Clean water sources derived from wells and artesian wll are vulnerable to be contaminated by pollutants such as leachate and bad quality water. It is necessary to improve the physical, basic sanitation, and guidance for the simple rent flats occupants to the management system of Simple Rent Flats.

Load limit of a UASB fed septic tank-treated domestic wastewater.

PubMed

Lohani, Sunil Prasad; Bakke, Rune; Khanal, Sanjay N

2015-01-01

Performance of a 250 L pilot-scale up-flow anaerobic sludge blanket (UASB) reactor, operated at ambient temperatures, fed septic tank effluents intermittently, was monitored for hydraulic retention time (HRT) from 18 h to 4 h. The total suspended solids (TSS), total chemical oxygen demand (CODT), dissolved chemical oxygen demand (CODdis) and suspended chemical oxygen demand (CODss) removal efficiencies ranged from 20 to 63%, 15 to 56%, 8 to 35% and 22 to 72%, respectively, for the HRT range tested. Above 60% TSS and 47% CODT removal were obtained in the combined septic tank and UASB process. The process established stable UASB treatment at HRT≥6 h, indicating a hydraulic load design limit. The tested septic tank-UASB combined system can be a low-cost and effective on-site sanitation solution.

Early decreased neutrophil responsiveness is related to late onset sepsis in multitrauma patients: An international cohort study.

PubMed

Groeneveld, Kathelijne M; Koenderman, Leo; Warren, Brian L; Jol, Saskia; Leenen, Luke P H; Hietbrink, Falco

2017-01-01

Severe trauma can lead to the development of infectious complications after several days, such as sepsis. Early identification of patients at risk will aid anticipating these complications. The aim of this study was to test the relation between the acute (<24 hours) inflammatory response after injury measured by neutrophil responsiveness and the late (>5 days) development of septic complications and validate this in different trauma populations. Two prospective, observational, cohort series in the Netherlands and South Africa, consisting of severely injured trauma patients. Neutrophil responsiveness by fMLF-induced active FcγRII was measured in whole blood flowcytometry, as read out for the systemic immune response within hours after trauma. Sepsis was scored daily. Ten of the 36 included Dutch patients developed septic shock. In patients with septic shock, neutrophils showed a lower expression of fMLF-induced active FcγRII immediately after trauma when compared to patients without septic shock (P = 0.001). In South Africa 11 of 73 included patients developed septic shock. Again neutrophils showed lower expression of fMLF induced active FcγRII (P = 0.001). In the combined cohort, all patients who developed septic shock demonstrated a decreased neutrophil responsiveness. Low responsiveness of neutrophils for the innate stimulus fMLF immediately after trauma preceded the development of septic shock during admission by almost a week and did not depend on a geographical/racial background, hospital protocols and health care facilities. Decreased neutrophil responsiveness appears to be a prerequisite for septic shock after trauma. This might enable anticipation of this severe complication in trauma patients.

A case study characterizing animal fecal sources in surface water using a mitochondrial DNA marker.

PubMed

Bucci, John P; Shattuck, Michelle D; Aytur, Semra A; Carey, Richard; McDowell, William H

2017-08-01

Water quality impairment by fecal waste in coastal watersheds is a public health issue. The present study provided evidence for the use of a mitochondrial (mtDNA) marker to detect animal fecal sources in surface water. The accurate identification of fecal pollution is based on the notion that fecal microorganisms preferentially inhabit a host animal's gut environment. In contrast, mtDNA host-specific markers are inherent to eukaryotic host cells, which offers the advantage by detecting DNA from the host rather than its fecal bacteria. The present study focused on sampling water presumably from non-point sources (NPS), which can increase bacterial and nitrogen concentrations to receiving water bodies. Stream sampling sites located within the Piscataqua River Watershed (PRW), New Hampshire, USA, were sampled from a range of sites that experienced nitrogen inputs such as sewer and septic systems and suburban runoff. Three mitochondrial (mtDNA) gene marker assays (human, bovine, and canine) were tested from surface water. Nineteen sites were sampled during an 18-month period. Analyses of the combined single and multiplex assay results showed that the proportion of occurrence was highest for bovine (15.6%; n = 77) compared to canine (5.6%; n = 70) and human (5.7%; n = 107) mtDNA gene markers. For the human mtDNA marker, there was a statistically significant relationship between presence vs. absence and land use (Fisher's test p = 0.0031). This result was evident particularly for rural suburban septic, which showed the highest proportion of presence (19.2%) compared to the urban sewered (3.3%), suburban sewered (0%), and agricultural (0%) as well as forested septic (0%) sites. Although further testing across varied land use is needed, our study provides evidence for using the mtDNA marker in large watersheds.

Septic Systems Contribution to Phosphorus in Shallow Groundwater: Field-Scale Studies Using Conventional Drainfield Designs

PubMed Central

Mechtensimer, Sara

2017-01-01

Septic systems can be a potential source of phosphorus (P) in groundwater and contribute to eutrophication in aquatic systems. Our objective was to investigate P transport from two conventional septic systems (drip dispersal and gravel trench) to shallow groundwater. Two new in-situ drainfields (6.1 m long by 0.61 m wide) with a 3.72 m2 infiltrative surface were constructed. The drip dispersal drainfield was constructed by placing 30.5 cm commercial sand on top of natural soil and the gravel trench drainfield was constructed by placing 30.5 cm of gravel on top of 30.5 cm commercial sand and natural soil. Suction cup lysimeters were installed in the drainfields (at 30.5, 61, 106.7 cm below infiltrative surface) and piezometers were installed in the groundwater (>300 cm below infiltrative surface) to capture P dynamics from the continuum of unsaturated to saturated zones in the septic systems. Septic tank effluent (STE), soil-water, and groundwater samples were collected for 64 events (May 2012–Dec 2013) at 2 to 3 days (n = 13), weekly (n = 29), biweekly (n = 17), and monthly (n = 5) intervals. One piezometer was installed up-gradient of the drainfields to monitor background groundwater (n = 15). Samples were analyzed for total P (TP), orthophosphate-P (PO4–P), and other–P (TP—PO4-P). The gravel trench drainfield removed significantly (p<0.0001) greater TP (~20%) than the drip dispersal in the first 30.5 cm of the drainfield. However, when STE reached >300 cm in the groundwater, both systems had similar TP reductions of >97%. After 18 months of STE application, there was no significant increase in groundwater TP concentrations in both systems. We conclude that both drainfield designs are effective at reducing P transport to shallow groundwater. PMID:28107505

Septic Systems Contribution to Phosphorus in Shallow Groundwater: Field-Scale Studies Using Conventional Drainfield Designs.

PubMed

Mechtensimer, Sara; Toor, Gurpal S

2017-01-01

Septic systems can be a potential source of phosphorus (P) in groundwater and contribute to eutrophication in aquatic systems. Our objective was to investigate P transport from two conventional septic systems (drip dispersal and gravel trench) to shallow groundwater. Two new in-situ drainfields (6.1 m long by 0.61 m wide) with a 3.72 m2 infiltrative surface were constructed. The drip dispersal drainfield was constructed by placing 30.5 cm commercial sand on top of natural soil and the gravel trench drainfield was constructed by placing 30.5 cm of gravel on top of 30.5 cm commercial sand and natural soil. Suction cup lysimeters were installed in the drainfields (at 30.5, 61, 106.7 cm below infiltrative surface) and piezometers were installed in the groundwater (>300 cm below infiltrative surface) to capture P dynamics from the continuum of unsaturated to saturated zones in the septic systems. Septic tank effluent (STE), soil-water, and groundwater samples were collected for 64 events (May 2012-Dec 2013) at 2 to 3 days (n = 13), weekly (n = 29), biweekly (n = 17), and monthly (n = 5) intervals. One piezometer was installed up-gradient of the drainfields to monitor background groundwater (n = 15). Samples were analyzed for total P (TP), orthophosphate-P (PO4-P), and other-P (TP-PO4-P). The gravel trench drainfield removed significantly (p<0.0001) greater TP (~20%) than the drip dispersal in the first 30.5 cm of the drainfield. However, when STE reached >300 cm in the groundwater, both systems had similar TP reductions of >97%. After 18 months of STE application, there was no significant increase in groundwater TP concentrations in both systems. We conclude that both drainfield designs are effective at reducing P transport to shallow groundwater.

New factors in the design, operation and performance of waste-stabilization ponds

PubMed Central

Marais, G. v. R.

1966-01-01

In the developing countries, the unit costs of waste-stabilization ponds are generally low. Moreover, in the tropics and subtropics, the environmental conditions are conducive to a high level of pond performance. In view of this, the theory, operation and performance of such ponds under these conditions have been studied. It is shown that the Hermann & Gloyna and Marais & Shaw theories of the degradation action in oxidation ponds can be integrated, and that account can be taken of the effect of the sludge layer. In Lusaka, Zambia, anaerobic conditions are much more likely to occur in summer than in winter, because of intense stratification. It is confirmed that a series of maturation or oxidation ponds is more efficient than a single pond of equivalent volume. When aqua privies and septic tanks are used as anaerobic pretreatment units, the area of the primary oxidation ponds can be reduced and there is less likelihood that anaerobic conditions will develop in them in summer. The use of self-topping aqua privies, discharging through sewers to oxidation ponds, has made possible the economic installation of water-carriage systems of waste disposal in low-cost high-density housing areas. In the oxidation ponds, typhoid bacteria appear to be more resistant than indicator organisms; helminths, cysts and ova settle out; there are no snails and, if peripheral vegetation is removed, mosquitos will not breed. PMID:5296235

Complex Controls on Groundwater Quality in Growing Mid-sized Cities: A Case Study Focused on Nitrate and Emerging Contaminants

NASA Astrophysics Data System (ADS)

Ohr, C. A.; Godsey, S.; Welhan, J. A.; Larson, D. M.; Lohse, K. A.; Finney, B.; Derryberry, D.

2015-12-01

Many regions rely on quality groundwater to support urban growth. Groundwater quality often responds in a complex manner to stressors such as land use change, climate change, or policy decisions. Urban growth patterns in mid-sized cities, especially ones that are growing urban centers in water-limited regions in the western US, control and are controlled by water availability and its quality. We present a case study from southeastern Idaho where urban growth over the past 20 years has included significant ex-urban expansion of houses that rely on septic systems rather than city sewer lines for their wastewater treatment. Septic systems are designed to mitigate some contaminants, but not others. In particular, nitrates and emerging contaminants, such as pharmaceuticals, are not removed by most septic systems. Thus, even well-maintained septic systems at sufficiently high densities can impact down gradient water quality. Here we present patterns of nitrate concentrations over the period from 1985-2015 from the Lower Portneuf River Valley in southeastern Idaho. Concentrations vary from 0.03 to 27.09 nitrate-nitrogen mg/L, with average values increasing significantly over the 30 year time period from 3.15 +/- 0.065 to 3.57 +/- 0.43 mg/L. We examine temporal changes in locations of nitrate hotspots, and present pilot data on emerging contaminants of concern. Initial results suggest that high nitrate levels are generally associated with higher septic densities, but that this pattern is influenced by legacy agricultural uses and strongly controlled by underlying aquifer properties. Future work will include more detailed hydrological modeling to predict changes in hotspot locations under potential climate change scenarios.

Genome-wide expression profiling in pediatric septic shock

PubMed Central

Wong, Hector R.

2013-01-01

For nearly a decade, our research group has had the privilege of developing and mining a multi-center, microarray-based, genome-wide expression database of critically ill children (≤ 10 years of age) with septic shock. Using bioinformatic and systems biology approaches, the expression data generated through this discovery-oriented, exploratory approach have been leveraged for a variety of objectives, which will be reviewed. Fundamental observations include wide spread repression of gene programs corresponding to the adaptive immune system, and biologically significant differential patterns of gene expression across developmental age groups. The data have also identified gene expression-based subclasses of pediatric septic shock having clinically relevant phenotypic differences. The data have also been leveraged for the discovery of novel therapeutic targets, and for the discovery and development of novel stratification and diagnostic biomarkers. Almost a decade of genome-wide expression profiling in pediatric septic shock is now demonstrating tangible results. The studies have progressed from an initial discovery-oriented and exploratory phase, to a new phase where the data are being translated and applied to address several areas of clinical need. PMID:23329198

Septic tank burial: not just another skeleton in the closet.

PubMed

Lew, E O; Bannach, B; Rodriguez, W C

1996-09-01

Backed-up toilets lead to the discovery of a skeleton in the septic tank. Our challenges began with the excavation of this unconventional grave and progressed through recovery and examination of the skeleton, determination of the cause and manner of death, and ultimately, identification of the victim. Main aspects of the septic tank system are summarized, including functional theory, physical design and components, and general comments on use and maintenance. We discuss some basic principles applicable to the excavation and examination of any human skeletal remains, and offer a general approach to identification of the decedent.

Gut-kidney crosstalk in septic acute kidney injury.

PubMed

Zhang, Jingxiao; Ankawi, Ghada; Sun, Jian; Digvijay, Kumar; Yin, Yongjie; Rosner, Mitchell H; Ronco, Claudio

2018-05-03

Sepsis is the leading cause of acute kidney injury (AKI) in the intensive care unit (ICU). Septic AKI is a complex and multifactorial process that is incompletely understood. During sepsis, the disruption of the mucus membrane barrier, a shift in intestinal microbial flora, and microbial translocation may lead to systemic inflammation, which further alters host immune and metabolic homeostasis. This altered homeostasis may promote and potentiate the development of AKI. As part of this vicious cycle, when AKI develops, the clearance of inflammatory mediators and metabolic products is decreased. This will lead to further gut injury and breakdown in mucous membrane barriers. Thus, changes in the gut during sepsis can initiate and propagate septic AKI. This deleterious gut-kidney crosstalk may be a potential target for therapeutic maneuvers. This review analyses the underlying mechanisms in gut-kidney crosstalk in septic AKI.

Survival of Salmonella adelaide and fecal coliforms in coarse sands of the swan costal plain, Western Australia.

PubMed Central

Parker, W F; Mee, B J

1982-01-01

The survival of Salmonella adelaide and fecal coliforms in two coarse sands influenced by two sources of septic tank effluent was studied. The experiments were conducted in conditions that reflected the soil environment beneath functioning septic tank systems. Significant differences in survival were found with different effluent sources. In one experiment the survival of S. adelaide was similar to that of fecal coliforms; in the other it was not. The nonuniform, multiphasic nature of survival curves was variability observed in these experiments suggests that the application of such survival data for establishing management criteria for septic tank systems--by, for example, the use of soil moisture characteristic curves to give estimates of movement in the soil--is inappropriate. PMID:7103482

Kinetic comparison of microbial assemblages for the anaerobic treatment of wastewater with high sulfate and heavy metal contents.

PubMed

Sinbuathong, Nusara; Sirirote, Pramote; Liengcharernsit, Winai; Khaodhiar, Sutha; Watts, Daniel J

2009-01-01

Mixed-microbial assemblages enriched from a septic tank, coastal sediment samples, the digester sludge of a brewery wastewater treatment plant and acidic sulfate soil samples were compared on the basis of growth rate, waste and sulfate reduction rate under sulfate reducing conditions at 30 degrees C. The specific growth rate of various cultures was in the range 0.0013-0.0022 hr(-1). Estimates of waste and sulfate reduction rate were obtained by fitting substrate depletion and sulfate reduction data with the Michaelis-Menten equation. The waste reduction rates were in the range 4x10(-8)-1x10(-7) I mg(-1) hr(-1) and generally increased in the presence of copper, likely by copper sulfide precipitation that reduced sulfide and copper toxicity and thus protected the anaerobic microbes. Anaerobic microorganisms from a brewery digester sludge were found to be the most appropriate culture for the treatment of wastewater with high sulfate and heavy metal content due to their growth rate, and waste and sulfate reduction rate.

Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children.

PubMed

Gaensbauer, James T; Birkholz, Meghan; Smit, Michael A; Garcia, Roger; Todd, James K

2018-03-27

It is important for clinicians to recognize the contribution of toxic shock syndrome (TSS) to the overall burden of pediatric septic shock because the clinical features, optimal therapy and prognosis differ from non-TSS septic shock. We analyzed cases of pediatric septic shock reported to the Pediatric Health Information Systems (PHIS) database between 2009 and 2013 to define the clinical and demographic characteristics of pediatric TSS in the US. Using a validated ICD-9 coding strategy we identified patients with infectious shock among inpatients age 1 to 18 years, and classified cases of staphylococcal and streptococcal TSS for comparison with non-TSS cases. Of 8,226 cases of pediatric septic shock, 909 (11.1%) were classified as TSS and 562 (6.8%) were possible TSS cases. Staphylococcal TSS represented the majority (83%) of TSS cases, and occurred more commonly in females and at an older age. Compared with non-TSS septic shock, TSS had significantly lower fatality rates, disease severity, and length of hospital stay, and was present more often at the time of admission (p<0.001 for each). Streptococcal TSS was associated with poorer outcomes than staphylococcal TSS. Treatment for TSS differed from non-TSS septic shock in use of more clindamycin, vancomycin and IVIG, and less need for vasopressors. Results demonstrate a significant contribution of TSS to the burden of pediatric septic shock in the US. The findings emphasize the importance of inclusion of TSS diagnostic and therapeutic considerations in sepsis treatment protocols for children.

Iron dysregulation combined with aging prevents sepsis-induced apoptosis.

PubMed

Javadi, Pardis; Buchman, Timothy G; Stromberg, Paul E; Turnbull, Isaiah R; Vyas, Dinesh; Hotchkiss, Richard S; Karl, Irene E; Coopersmith, Craig M

2005-09-01

Sepsis, iron loading, and aging cause independent increases in gut epithelial and splenic apoptosis. It is unknown how their combination will affect apoptosis and systemic cytokine levels. Hfe-/- mice (a murine homologue of hemochromatosis) abnormally accumulate iron in their tissues. Aged (24-26 months) or mature (16-18 months) Hfe-/- mice and wild type (WT) littermates were subjected to cecal ligation and puncture (CLP) or sham laparotomy. Intestine, spleen, and blood were harvested 24 h later and assessed for apoptosis and cytokine levels. Gut epithelial and splenic apoptosis were low in both aged septic and sham Hfe-/- mice, regardless of the amount of iron in their diet. Mature septic WT mice had increased apoptosis compared to age-matched sham WT mice. Mature septic Hfe-/- mice had similar levels of intestinal cell death to age-matched septic WT mice but higher levels of splenic apoptosis. Apoptosis was significantly lower in septic aged Hfe-/- mice than septic mature Hfe-/- animals. Interleukin-6 was elevated in septic aged Hfe-/- mice compared to sham mice. Although sepsis, chronic iron dysregulation, and aging each increase gut and splenic apoptosis, their combination yields cell death levels similar to sham animals despite the fact that aged Hfe-/- mice are able to mount an inflammatory response following CLP and mature Hfe-/- mice have elevated sepsis-induced apoptosis. Combining sepsis with two risk factors that ordinarily increase cell death and increase mortality in CLP yields an apoptotic response that could not have been predicted based upon each element in isolation.

Suppressive effects of lysozyme on polyphosphate-mediated vascular inflammatory responses

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, Jiwoo; Ku, Sae-Kwang; Lee, Suyeon

Lysozyme, found in relatively high concentration in blood, saliva, tears, and milk, protects us from the ever-present danger of bacterial infection. Previous studies have reported proinflammatory responses of endothelial cells to the release of polyphosphate(PolyP). In this study, we examined the anti-inflammatory responses and mechanisms of lysozyme and its effects on PolyP-induced septic activities in human umbilical vein endothelial cells (HUVECs) and mice. The survival rates, septic biomarker levels, behavior of human neutrophils, and vascular permeability were determined in PolyP-activated HUVECs and mice. Lysozyme suppressed the PolyP-mediated vascular barrier permeability, upregulation of inflammatory biomarkers, adhesion/migration of leukocytes, and activation and/ormore » production of nuclear factor-κB, tumor necrosis factor-α, and interleukin-6. Furthermore, lysozyme demonstrated protective effects on PolyP-mediated lethal death and the levels of the related septic biomarkers. Therefore, these results indicated the therapeutic potential of lysozyme on various systemic inflammatory diseases, such as sepsis or septic shock. -- Highlights: •PolyP is shown to be an important mediator of vascular inflammation. •Lysozyme inhibited PolyP-mediated hyperpermeability. •Lysozyme inhibited PolyP-mediated septic response. •Lysozyme reduced PolyP-induced septic mortality.« less

Septic shock sera containing circulating histones induce dendritic cell-regulated necrosis in fatal septic shock patients.

PubMed

Raffray, Loic; Douchet, Isabelle; Augusto, Jean-Francois; Youssef, Jihad; Contin-Bordes, Cecile; Richez, Christophe; Duffau, Pierre; Truchetet, Marie-Elise; Moreau, Jean-Francois; Cazanave, Charles; Leroux, Lionel; Mourrissoux, Gaelle; Camou, Fabrice; Clouzeau, Benjamin; Jeannin, Pascale; Delneste, Yves; Gabinski, Claude; Guisset, Olivier; Lazaro, Estibaliz; Blanco, Patrick

2015-04-01

Innate immune system alterations, including dendritic cell loss, have been reproducibly observed in patients with septic shock and correlated to adverse outcomes or nosocomial infections. The goal of this study is to better understand the mechanisms behind this observation in order to better assess septic shock pathogenesis. Prospective, controlled experimental study. Research laboratory at an academic medical center. The study enrolled 71 patients, 49 with septic shock and 22 with cardiogenic shock. Seventeen healthy controls served as reference. In vitro monocyte-derived dendritic cells were generated from healthy volunteers. Sera were assessed for their ability to promote in vitro dendritic cell death through flow cytometry detection in each group of patients. The percentage of apoptotic or necrotic dendritic cells was evaluated by annexin-V and propidium iodide staining. We observed that only patients with septic shock and not patients with pure cardiogenic shock were characterized by a rapid and profound loss of circulating dendritic cells. In vitro analysis revealed that sera from patients with septic shock induced higher dendritic cell death compared to normal sera or cardiogenic shock (p<0.005). Sera from surviving patients induced dendritic cell death through a caspase-dependent apoptotic pathway, whereas sera from nonsurviving patients induced dendritic cell-regulated necrosis. Dendritic cell necrosis was not due to necroptosis but was dependent of the presence of circulating histone. The toxicity of histones toward dendritic cell could be prevented by recombinant human activated protein C. Finally, we observed a direct correlation between the levels of circulating histones in patients and the ability of the sera to promote dendritic cell-regulated necrosis. The study demonstrates a differential mechanism of dendritic cell death in patients with septic shock that is dependent on the severity of the disease.

Terlipressin: vasopressin analog and novel drug for septic shock.

PubMed

Pesaturo, Adam B; Jennings, Heath R; Voils, Stacy A

2006-12-01

To review and assess available literature on chemistry, pharmacology, pharmacodynamics, pharmacokinetics, clinical studies, adverse events, drug interactions, and dosing and administration of terlipressin in septic shock. A literature search of MEDLINE (1966-September 2006), International Pharmaceutical Abstracts (1970-September 2006), and Cochrane database (third quarter 2006) was conducted, using key terms of terlipressin, lypressin, triglycyl-lysine vasopressin, hemodynamic support, septic shock, vasopressor, and V1 receptor agonist. Bibliographies of relevant articles were reviewed for additional references. Available English-language literature, including abstracts, animal studies, preclinical studies, clinical trials, and review articles, were examined. Because of potentially favorable pharmacokinetics versus vasopressin and limited availability of vasopressin in some countries, the effects of terlipressin, a vasopressin analog, have been studied recently for the treatment of septic shock. When administered as a 1-2 mg intravenous dose in patients with septic shock, terlipressin increases mean arterial pressure, urine output, systemic vascular resistance index, pulmonary vascular resistance index, and left and right ventricular stroke work index while decreasing heart rate, cardiac output, lactate, and oxygen delivery and consumption index. It is unclear whether lower doses of terlipressin would produce a similar vasopressor response with fewer cardiopulmonary effects and whether the effects of the drug on oxygen transport indices are detrimental. Terlipressin is a promising investigational medication for treatment of septic shock. Small trials have shown terlipressin to have favorable effects on hemodynamics in patients with septic shock refractory to conventional vasopressor treatment. It should be used with extreme caution in patients with underlying cardiac or pulmonary dysfunction. Further studies are needed to verify safety, efficacy, and dosing of terlipressin in patients with septic shock, and its use cannot be recommended in lieu of vasopressin at this time.

Early antibiotic treatment (prophylaxis) of septic complications in severe acute necrotizing pancreatitis: a prospective, randomized, multicenter study comparing two regimens with imipenem-cilastatin.

PubMed

Maraví-Poma, Enrique; Gener, Joan; Alvarez-Lerma, Francisco; Olaechea, Pedro; Blanco, Armando; Domínguez-Muñoz, J Enrique

2003-11-01

We compared two imipenem regimens for prevention of septic complications in patients with severe acute necrotizing pancreatitis (ANP). Prospective, randomized open clinical trial involving intensive care units of 14 Spanish Hospitals. 92 patients with ANP. Imipenem/cilastatin was administered at 500 mg four times daily starting at the time of diagnosis of ANP, within the first 96 h from the onset of symptoms. Patients were randomized to receive antibiotic prophylaxis either for 14 days (group 1) or at least for 14 days and as long as major systemic complications of the disease persisted (group 2). Antibiotic was maintained in group 2 for 19.7+/-10.9 days. The incidence of infected pancreatic necrosis, pancreatic abscess, and extrapancreatic infections was 11%, 17%, and 28% in group 1 and 17.4%, 13%, and 35% in group 2 (n.s.). Pancreatic or extrapancreatic infection by Candida albicans occurred in 7% and 22% of patients. Global mortality was 18.5% (10.9% secondary to septic complications), without differences between groups. In patients with persisting systemic complications at day 14 mortality was almost always secondary to septic complications and decreased from 25% (group 1) to 8.8% (group 2) by maintaining antibiotic prophylaxis. Compared to a 14-day imipenem prophylaxis, a longer antibiotic administration in patients with ANP is not associated with a reduction in the incidence of septic complications of the disease. However, prolonged imipenem administration in patients with persisting systemic complications tends to reduce mortality in ANP compared to a 14-days regimen.

Ground-water quality in the Santa Rita, Buellton, and Los Olivos hydrologic subareas of the Santa Ynez River basin, Santa Barbara County, California

USGS Publications Warehouse

Hamlin, S.N.

1985-01-01

Groundwater quality in the upper Santa Ynez River Valley in Santa Barbara County has degraded due to both natural and anthropogenic causes. The semiarid climate and uneven distribution of rainfall has limited freshwater recharge and caused salt buildup in water supplies. Tertiary rocks supply mineralized water. Agricultural activities (irrigation return flow containing fertilizers and pesticides, cultivation, feedlot waste disposal) are a primary cause of water quality degradation. Urban development, which also causes water quality degradation (introduced contaminants, wastewater disposal, septic system discharge, and land fill disposal of waste), has imposed stricter requirements on water supply quality. A well network was designed to monitor changes in groundwater quality related to anthropogenic activities. Information from this network may aid in efficient management of the groundwater basins as public water supplies, centered around three basic goals. First is to increase freshwater recharge to the basins by conjunctive surface/groundwater use and surface-spreading techniques. Second is to optimize groundwater discharge by efficient timing and spacing of pumping. Third is to control and reduce sources of groundwater contamination by regulating wastewater quality and distribution and, preferably, by exporting wastewaters from the basin. (USGS)

Limnological data for Donner Lake, California, May 1973 through December 1973

USGS Publications Warehouse

Dong, Alex E.

1975-01-01

Donner Lake is easily accessible to the metropolitan areas of Sacramento and San Francisco and is close to many recreational areas in the Sierra Nevada. The lake is used for recreation and is bordered by commercial establishments, summer vacation homes, and a large state campground. Domestic wastes around the lake have received only septic tank treatment. A sewerage system under construction and partly in use at the time of this study has been completed and now (January 1975) all domestic wastes are transported out of the basin.In September of 1969 and 1970, a brief survey of the lake was conducted (Iwatsubo and others, 1972, p. 28). The results of that study indicated a well-established thermocline between 33 and 66 ft (10 and 20 m). A subsurface maximum in the dissolved-oxygen concentration occurred between 46 and 66 ft (14 and 20 m). In the shallow littoral zone, periphyton and patches of submerged rooted plants were visible.In order to remain attractive for recreational use, Donner Lake will require sound management. A thorough understanding of the water quality in the lake and the quality of inflow and outflow is of paramount importance.

Assessing nutrient flows in septic tanks by eliciting expert judgement: a promising method in the context of developing countries.

PubMed

Montangero, Agnes; Belevi, Hasan

2007-03-01

Simple models based on the physical and biochemical processes occurring in septic tanks, pit and urine diversion latrines were developed to determine the nutrient flows in these systems. Nitrogen and phosphorus separation in different output materials from these on-site sanitation installations were thus determined. Moreover, nutrient separation in septic tanks was also assessed through literature values and by eliciting expert judgement. Use of formal expert elicitation technique proved to be effective, particularly in the context of developing countries where data is often scarce but expert judgement readily available. In Vietnam, only 5-14% and 11-27% of the nitrogen and phosphorus input, respectively, are removed from septic tanks with the faecal sludge. The remaining fraction leaves the tank via the liquid effluent. Unlike septic tanks, urine diversion latrines allow to immobilize most of the nutrients either in form of stored urine or dehydrated faecal matter. These latrines thus contribute to reducing the nutrient load in the environment and lowering consumption of energy and non-renewable resources for fertiliser production.

Effect of temperature on anaerobic treatment of black water in UASB-septic tank systems.

PubMed

Luostarinen, Sari; Sanders, Wendy; Kujawa-Roeleveld, Katarzyna; Zeeman, Grietje

2007-03-01

The effect of northern European seasonal temperature changes and low temperature on the performance of upflow anaerobic sludge blanket (UASB)-septic tanks treating black water was studied. Three UASB-septic tanks were monitored with different operational parameters and at different temperatures. The results indicated the feasibility of the UASB-septic tank for (pre)treatment of black water at low temperatures with respect to removal of suspended solids and dissolved organic material. Inoculum sludge had little effect on COD(ss) removal, though in the start-up phase some poorly adapted inoculum disintegrated and washed out, thus requiring consideration when designing the process. Removal of COD(dis) was at first negative, but improved as the sludge adapted to low temperature. The UASB-septic tank alone did not comply with Finnish or Dutch treatment requirements and should therefore be considered mainly as a pre-treatment method. However, measuring the requirements as mgCOD l(-1) may not always be the best method, as the volume of the effluent discharged is also an important factor in the final amount of COD entering the receiving water bodies.

Using slaughterhouse waste in a biochemical-based biorefinery - results from pilot scale tests.

PubMed

Schwede, Sebastian; Thorin, Eva; Lindmark, Johan; Klintenberg, Patrik; Jääskeläinen, Ari; Suhonen, Anssi; Laatikainen, Reino; Hakalehto, Elias

2017-05-01

A novel biorefinery concept was piloted using protein-rich slaughterhouse waste, chicken manure and straw as feedstocks. The basic idea was to provide a proof of concept for the production of platform chemicals and biofuels from organic waste materials at non-septic conditions. The desired biochemical routes were 2,3-butanediol and acetone-butanol fermentation. The results showed that hydrolysis resulted only in low amounts of easily degradable carbohydrates. However, amino acids released from the protein-rich slaughterhouse waste were utilized and fermented by the bacteria in the process. Product formation was directed towards acidogenic compounds rather than solventogenic products due to increasing pH-value affected by ammonia release during amino acid fermentation. Hence, the process was not effective for 2,3-butanediol production, whereas butyrate, propionate, γ-aminobutyrate and valerate were predominantly produced. This offered fast means for converting tedious protein-rich waste mixtures into utilizable chemical goods. Furthermore, the residual liquid from the bioreactor showed significantly higher biogas production potential than the corresponding substrates. The combination of the biorefinery approach to produce chemicals and biofuels with anaerobic digestion of the residues to recover energy in form of methane and nutrients that can be utilized for animal feed production could be a feasible concept for organic waste utilization.

IL-1B rs16944 polymorphism is related to septic shock and death.

PubMed

Jiménez-Sousa, María Ángeles; Medrano, Luz M; Liu, Pilar; Almansa, Raquel; Fernández-Rodríguez, Amanda; Gómez-Sánchez, Esther; Rico, Lucía; Heredia-Rodríguez, María; Gómez-Pesquera, Estefanía; Tamayo, Eduardo; Resino, Salvador

2017-01-01

IL-1β is a primary mediator of systemic inflammatory response syndrome (SIRS) and it may lead to shock septic. Our aim was to analyse whether IL-1B rs16944 polymorphism is associated with the onset of septic shock and death after major surgery. We performed a case-control study on 467 patients who underwent major cardiac or abdominal surgery. Of them, 205 patients developed septic shock (cases, SS group) and 262 patients developed SIRS (controls, SIRS group). The primary outcome variables were the development of septic shock and death within 90 days after diagnosis of septic shock. The IL-1B rs16944 polymorphism was genotyped by Sequenom's MassARRAY platform. The association analysis was performed under a recessive genetic model (AA vs. GG/GC). The frequency of septic shock was higher in patients with IL-1B rs16944 AA genotype than in patients with IL-1B rs16944 GG/AG genotype when all patients were taken into account (63·6% vs. 41·8%; P = 0·006), cardiac surgery (52·2% vs. 33·3%; P = 0·072) and abdominal surgery (76·2% vs. 50·2%; P = 0·023). However, the IL-1B rs16944 AA genotype was only associated with higher likelihood of septic shock in the analysis of all population [adjusted odds ratio (aOR) = 2·26 (95%CI = 1·03; 4·97; P = 0·042], but not when it was stratified by cardiac surgery (P = 0·175) or abdominal surgery (P = 0·467). Similarly, IL-1B rs16944 AA genotype was also associated with higher likelihood of septic shock-related death in all population [aOR = 2·67 (95%CI = 1·07; 4·97); P = 0·035]. IL-1B rs16944 AA genotype seems to be related to the onset of septic shock and death in patients who underwent major surgery. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

Changes in peroxisome proliferator-activated receptor-gamma activity in children with septic shock.

PubMed

Kaplan, Jennifer M; Denenberg, Alvin; Monaco, Marie; Nowell, Marchele; Wong, Hector; Zingarelli, Basilia

2010-01-01

To assess changes in peroxisome proliferator-activated receptor-gamma (PPARgamma) in peripheral blood mononuclear cells (PBMC) from critically ill children with sepsis. Additionally, to investigate the effects of sepsis on the endogenous activator of PPARgamma, 15-deoxy-(12,14)-PGJ(2) (15d-PGJ(2)), and the downstream targets of PPARgamma activity, adiponectin and resistin. Single-center, prospective case-control study in critically ill children with systemic inflammatory response syndrome, sepsis or septic shock. PPARgamma nuclear protein expression was decreased but PPARgamma activity was increased in PBMC from children with septic shock compared with controls. PPARgamma activity on day 1 was significantly higher in patients with higher pediatric risk of mortality (PRISM) score compared with controls [mean 0.22 optical density (OD) +/- standard error of the mean (SEM) 0.03 versus 0.12 OD +/- 0.02; p < 0.001]. Patients with resolved sepsis had increased levels of the endogenous PPARgamma ligand, 15d-PGJ(2), compared with patients with systemic inflammatory response syndrome (SIRS) and septic shock (77.7 +/- 21.7 versus 58 +/- 16.5 pg/ml; p = 0.03). Plasma high-molecular-weight adiponectin (HMWA) and resistin levels were increased in patients with septic shock on day 1 and were significantly higher in patients with higher PRISM scores. Nonsurvivors from sepsis had higher resistin levels on the first day of hospitalization compared with survivors from septic shock [660 ng/ml, interquartile range (IQR) 585-833 ng/ml versus 143 ng/ml, IQR 66-342 ng/ml; p < 0.05]. Sepsis is associated with altered PPARgamma expression and activity in PBMC. Plasma adipokines correlate with risk of mortality scores in sepsis and may be useful biomarkers. Further studies are needed to understand the mechanisms underlying changes in PPARgamma in sepsis.

Examination of sludge accumulation rates and sludge characteristics for a decentralized community wastewater treatment systems with individual primary clarifier tanks located in Wardsville (Ontario, Canada).

PubMed

Lossing, Heather; Champagne, Pascale; McLellan, P James

2010-01-01

In conventional septic systems, settling and partial treatment via anaerobic digestion occurs in the septic tank. One of the byproducts of solids separation in the septic tank is a semi-liquid material known as septage, which must be periodically pumped out. Septage includes the liquid portion within the tank, as well as the sludge that settles at the bottom of the tank and the scum that floats to the surface of the liquid layer. A number of factors can influence septage characteristics, as well as the sludge and scum accumulation rates within the tank. This paper presents the results of a 2007 field sampling study conducted in Wardsville (Ontario, Canada). The field study examined 29 individual residential two-chamber septic tanks in a community serviced by a decentralized wastewater treatment system in operation for approximately 7 years without septage removal. The field investigation provided a comprehensive data set that allowed for statistical analysis of the data to assess the more critical factors influencing solids accumulation rates within each of the clarifier chambers. With this data, a number of predictive models were developed using water usage data for each residence as an explanatory variable.

Wastewater services for small communities.

PubMed

Gray, S; Booker, N

2003-01-01

Connection to centralised regional sewage systems has been too expensive for small-dispersed communities, and these townships have traditionally been serviced by on-site septic tank systems. The conventional on-site system in Australia has consisted of an anaerobic holding tank followed by adsorption trenches. This technique relies heavily on the uptake of nutrients by plants for effective removal of nitrogen and phosphorus from the effluent, and is very seasonal in its efficiency. Hence, as these small communities have grown in size, the environmental effects of the septic tank discharges have become a problem. In locations throughout Australia, such as rural Victoria and along the Hawkesbury-Nepean River, septic tanks as being replaced with the transport of sewage to regional treatment plants. For some isolated communities, this can mean spending 20,000 dollars-40,000 dollars/household, as opposed to more common connection prices of 7,000 dollars/household. This paper explores some alternative options that might be suitable for these small communities, and attempts to identify solutions that provide acceptable environmental outcomes at lower cost. The types of alternative systems that are assessed in the paper include local treatment systems, separate blackwater and greywater collection and treatment systems both with and without non-potable water recycling, a small township scale treatment plant compared to either existing septic tank systems or pumping to a remote regional treatment facility. The work demonstrated the benefits of a scenario analysis approach for the assessment of a range of alternative systems. It demonstrated that some of the alternatives systems can achieve better than 90% reductions in the discharge of nutrients to the environment at significantly lower cost than removing the wastewater to a remote regional treatment plant. These concepts allow wastewater to be retained within a community allowing for local reuse of treated effluent.

Integrated modeling approach using SELECT and SWAT models to simulate source loading and in-stream conditions of fecal indicator bacteria.

NASA Astrophysics Data System (ADS)

Ranatunga, T.

2016-12-01

Modeling of fate and transport of fecal bacteria in a watershed is generally a processed based approach that considers releases from manure, point sources, and septic systems. Overland transport with water and sediments, infiltration into soils, transport in the vadose zone and groundwater, die-off and growth processes, and in-stream transport are considered as the other major processes in bacteria simulation. This presentation will discuss a simulation of fecal indicator bacteria (E.coli) source loading and in-stream conditions of a non-tidal watershed (Cedar Bayou Watershed) in South Central Texas using two models; Spatially Explicit Load Enrichment Calculation Tool (SELECT) and Soil and Water Assessment Tool (SWAT). Furthermore, it will discuss a probable approach of bacteria source load reduction in order to meet the water quality standards in the streams. The selected watershed is listed as having levels of fecal indicator bacteria that posed a risk for contact recreation and wading by the Texas Commission of Environmental Quality (TCEQ). The SELECT modeling approach was used in estimating the bacteria source loading from land categories. Major bacteria sources considered were, failing septic systems, discharges from wastewater treatment facilities, excreta from livestock (Cattle, Horses, Sheep and Goat), excreta from Wildlife (Feral Hogs, and Deer), Pet waste (mainly from Dogs), and runoff from urban surfaces. The estimated source loads were input to the SWAT model in order to simulate the transport through the land and in-stream conditions. The calibrated SWAT model was then used to estimate the indicator bacteria in-stream concentrations for future years based on H-GAC's regional land use, population and household projections (up to 2040). Based on the in-stream reductions required to meet the water quality standards, the corresponding required source load reductions were estimated.

Application of SELECT and SWAT models to simulate source load, fate, and transport of fecal bacteria in watersheds.

NASA Astrophysics Data System (ADS)

Ranatunga, T.

2017-12-01

Modeling of fate and transport of fecal bacteria in a watershed is a processed based approach that considers releases from manure, point sources, and septic systems. Overland transport with water and sediments, infiltration into soils, transport in the vadose zone and groundwater, die-off and growth processes, and in-stream transport are considered as the other major processes in bacteria simulation. This presentation will discuss a simulation of fecal indicator bacteria source loading and in-stream conditions of a non-tidal watershed (Cedar Bayou Watershed) in South Central Texas using two models; Spatially Explicit Load Enrichment Calculation Tool (SELECT) and Soil and Water Assessment Tool (SWAT). Furthermore, it will discuss a probable approach of bacteria source load reduction in order to meet the water quality standards in the streams. The selected watershed is listed as having levels of fecal indicator bacteria that posed a risk for contact recreation and wading by the Texas Commission of Environmental Quality (TCEQ). The SELECT modeling approach was used in estimating the bacteria source loading from land categories. Major bacteria sources considered were, failing septic systems, discharges from wastewater treatment facilities, excreta from livestock (Cattle, Horses, Sheep and Goat), excreta from Wildlife (Feral Hogs, and Deer), Pet waste (mainly from Dogs), and runoff from urban surfaces. The estimated source loads from SELECT model were input to the SWAT model, and simulate the bacteria transport through the land and in-stream. The calibrated SWAT model was then used to estimate the indicator bacteria in-stream concentrations for future years based on regional land use, population and household forecast (up to 2040). Based on the reductions required to meet the water quality standards in-stream, the corresponding required source load reductions were estimated.

Iron dysregulation combined with aging prevents sepsis-induced apoptosis

PubMed Central

Javadi, Pardis; Buchman, Timothy G.; Stromberg, Paul E.; Turnbull, Isaiah R.; Vyas, Dinesh; Hotchkiss, Richard S.; Karl, Irene E.; Coopersmith, Craig M.

2005-01-01

Background Sepsis, iron loading and aging cause independent increases in gut epithelial and splenic apoptosis. It is unknown how their combination will affect apoptosis and systemic cytokine levels. Methods Hfe−/− mice (a murine homolog of hemochromatosis) abnormally accumulate iron in their tissues. Aged (24–26 months) or mature (16–18 months) Hfe−/− mice and wild type (WT) littermates were subjected to cecal ligation and puncture (CLP) or sham laparotomy. Intestine, spleen, and blood were harvested 24 hours later and assessed for apoptosis and cytokine levels. Results Gut epithelial and splenic apoptosis were low in both aged septic and sham Hfe−/− mice, regardless of the amount of iron in their diet. Mature septic WT mice had increased apoptosis compared to age-matched sham WT mice. Mature septic Hfe−/− mice had similar levels of intestinal cell death to age-matched septic WT mice but higher levels of splenic apoptosis. Apoptosis was significantly lower in septic aged Hfe−/− mice than septic mature Hfe−/− animals. Interleukin-6 was elevated in septic aged Hfe−/− mice compared to sham mice. Conclusions Although sepsis, chronic iron dysregulation, and aging each increase gut and splenic apoptosis, their combination yields cell death levels similar to sham animals despite the fact that aged Hfe−/− mice are able to mount an inflammatory response following CLP and mature Hfe−/− mice have elevated sepsis-induced apoptosis. Combining sepsis with two risk factors that ordinarily increase cell death and increase mortality in CLP yields an apoptotic response that could not have been predicted based upon each element in isolation. PMID:15921699

Overview of investigations into mercury in ground water, soils, and septage, New Jersey coastal plain

USGS Publications Warehouse

Barringer, J.L.; Szabo, Z.

2006-01-01

Since the early 1980s, investigations by health departments of eight counties in southern New Jersey, by the NJ Department of Environmental Protection (NJDEP), and subsequently by the US Geological Survey (USGS), have shown that Hg concentrations in water tapped by about 600 domestic wells exceed the maximum contaminant level (MCL) of 2 ??g/L. The wells are finished in the areally extensive unconfined Kirkwood-Cohansey aquifer system of New Jersey's Coastal Plain; background concentrations of Hg in water from this system are < 0.01 ??g/L. Evidence of contributions from point sources of Hg, such as landfills or commercial and industrial hazardous-waste sites, is lacking. During 1996-2003, the USGS collected water samples from 203 domestic, irrigation, observation, and production wells using ultraclean techniques; septage, leach-field effluent, soils, and aquifer sediments also were sampled. Elevated concentrations of NH4, B, Cl, NO3, and Na and presence of surfactants in domestic-well water indicate that septic-system effluent can affect water quality in unsewered residential areas, but neither septage nor effluent appears to be a major Hg source. Detections of hydrogen sulfide in ground water at a residential area indicate localized reducing conditions; undetectable SO4 concentrations in water from other residential areas indicate that reducing conditions, which could be conducive to Hg methylation, may be common locally. Volatile organic compounds (VOCs), mostly chlorinated solvents, also are found in ground water at the affected areas, but statistically significant associations between presence of Hg and VOCs were absent for most areas evaluated. Hg concentrations are lower in some filtered water samples than in paired unfiltered samples, likely indicating that some Hg is associated with particles or colloids. The source of colloids may be soils, which, when undisturbed, contain higher concentrations of Hg than do disturbed soils and aquifer sediments. Soil disturbance during residential development and inputs from septic systems are hypothesized to mobilize Hg from soils to ground water. ?? Springer 2006.

Use of high-dose nandrolone aggravates septic shock in a mouse model.

PubMed

Lin, Che; Chen, Shou-Tung; Chien, Su-Yu; Kuo, Shou-Jen; Chen, Dar-Ren

2011-06-01

Nandrolone, an anabolic-androgenic steroid, is widely misused by athletes who wish to rapidly increase muscle mass and performance. An increasing number of reports have indicated that nandrolone may affect and modulate the immune system. This study aimed to investigate the effects of nandrolone on septic shock-caused immune responses and the cellular mechanism of action using a sepsis murine model. Before septic shock induction, BALB/c mice were given a high dose of nandrolone or peanut oil only. After septic shock induction, mice were sacrificed at different time points. Their blood and tissue specimens were analyzed. It was found that the high-dose nandrolone group had significantly increased mortality compared with the control group (p<0.001). The serum malondialdehyde level was significantly increased in the high-dose group compared with the control group. Animals administered a high dose of nandrolone had significantly increased hepatic tumor necrosis factor-α or splenic interferon-γ at 0 and 6 hours. In lung tissue, insulin-like growth factor-1, insulin-like growth factor binding proteins (IGFBPs) and insulin-like growth factor-1 receptor, and IGFBP1 and IGFBP2 mRNA expression were increased in the high-dose nandrolone group at 6 hours. Nandrolone abuse may hasten the death of patients with septic shock and may aggravate septic shock in mice. Copyright © 2011. Published by Elsevier B.V.

Steroid estrogens, nonylphenol ethoxylate metabolites, and other wastewater contaminants in groundwater affected by a residential septic system on Cape Cod, MA.

PubMed

Swartz, Christopher H; Reddy, Sharanya; Benotti, Mark J; Yin, Haifei; Barber, Larry B; Brownawell, Bruce J; Rudel, Ruthann A

2006-08-15

Septic systems serve approximately 25% of U.S. households and may be an important source of estrogenic and other organic wastewater contaminants (OWC) to groundwater. We monitored several estrogenic OWC, including nonylphenol (NP), nonylphenol mono- and diethoxycarboxylates (NP1EC and NP2EC), the steroid hormones 17beta-estradiol (E2), estrone (E1) and their glucuronide and sulfate conjugates, and other OWC such as methylene blue active substances (MBAS), caffeine and its degradation product paraxanthine, and two fluorescent whitening agents in a residential septic system and in downgradient groundwater. E1 and E2 were present predominantly as free estrogens in groundwater, and near-source groundwater concentrations of all OWC were highest in the suboxic to anoxic portion of the wastewater plume, where concentrations of most OWC were similar to those observed in the septic tank on the same day. NP and NP2EC were up to 6- to 30-fold higher, and caffeine and paraxanthine were each 60-fold lower than septic tank concentrations, suggesting net production and removal, respectively, of these constituents. At the most shallow, oxic depth, concentrations of all OWC except for NP2EC were substantially lower than in the tank and in deeper wells. Yet boron, specific conductance, and the sum of nitrate-and ammonia-nitrogen were highest at this shallow depth, suggesting preferential losses of OWC along the more oxic flow lines. As far as 6.0 m downgradient, concentrations of many OWC were within a factor of 2 of near-source concentrations. The results suggest that there is the potential for migration of these OWC, which are unregulated and not routinely monitored, in groundwater.

Steroid estrogens, nonylphenol ethoxylate metabolites, and other wastewater contaminants in groundwater affected by a residential septic system on cape cod, MA

USGS Publications Warehouse

Swartz, C.H.; Reddy, S.; Benotti, M.J.; Yin, H.; Barber, L.B.; Brownawell, Bruce J.; Rudel, R.A.

2006-01-01

Septic systems serve approximately 25% of U.S. households and may be an important source of estrogenic and other organic wastewater contaminants (OWC) to groundwater. We monitored several estrogenic OWC, including nonylphenol (NP), nonylphenol mono- and diethoxycarboxylates (NP1EC and NP2EC), the steroid hormones 17??-estradiol (E2), estrone (E1) and their glucuronide and sulfate conjugates, and other OWC such as methylene blue active substances (MBAS), caffeine and its degradation product paraxanthine, and two fluorescent whitening agents in a residential septic system and in downgradient groundwater. E1 and E2 were present predominantly as free estrogens in groundwater, and near-source groundwater concentrations of all OWC were highest in the suboxic to anoxic portion of the wastewater plume, where concentrations of most OWC were similar to those observed in the septic tank on the same day. NP and NP2EC were up to 6- to 30-fold higher, and caffeine and paraxanthine were each 60-fold lower than septic tank concentrations, suggesting net production and removal, respectively, of these constituents. At the most shallow, oxic depth, concentrations of all OWC except for NP2EC were substantially lower than in the tank and in deeper wells. Yet boron, specific conductance, and the sum of nitrate-and ammonia-nitrogen were highest at this shallow depth, suggesting preferential losses of OWC along the more oxic flow lines. As far as 6.0 m downgradient, concentrations of many OWC were within a factor of 2 of near-source concentrations. The results suggest that there is the potential for migration of these OWC, which are unregulated and not routinely monitored, in groundwater. ?? 2006 American Chemical Society.

Partial nitrification enhances natural attenuation of nitrogen in a septic system plume.

PubMed

Caschetto, M; Robertson, W; Petitta, M; Aravena, R

2018-06-01

Natural attenuation of nitrogen (N) was investigated in a well characterized septic system plume at a campground in Ontario, Canada. Total inorganic N (TIN) concentrations in deeper portions of the plume were about one third of the septic tank value of 40.7mgL -1 . NH 4 + and NO 3 - isotopic characterization were used to provide insight into potential attenuation processes. Concentrations of NH 4 + and NO 3 - were highly variable in the plume, but approached the septic tank TIN value in some shallow zones and exhibited δ 15 N values like the tank value of +6‰. However, isotopic enrichment (up to +24‰ for NH 4 + and +45‰ for NO 3 - ) and declining TIN concentrations in the deeper zones indicated that anaerobic ammonium oxidation contributed to the TIN attenuation. The degree of isotopic enrichment increased at lower NH 4 + concentrations and was consistent with Rayleigh-type distillation with an enrichment factor (Ɛ) of -5.1‰. Additionally, decreasing DOC values with depth and the concomitant enrichment of δ 15 N NO3 and δ 18 O NO3 , suggested that denitrification was also active. The N attenuation observed in the Killarney plume was partly due to incomplete nitrification that occurred because of the shallow water table, which varied from only 0.2-0.7m below the tile bed infiltration pipes. Moreover, some of the monitoring locations with the shallowest water table distances from the infiltration pipes, had the highest degree of TIN attenuation (70-90%) in the plume. This behavior suggests that controlling water table distance from the infiltration pipes could be a useful mechanism for enhancing N attenuation in septic system plumes. Copyright © 2017 Elsevier B.V. All rights reserved.

IL-30 (IL27p28) alleviates sepsis via modulation of cytokine profiles produced by NKT cells

PubMed Central

Yan, Jun; Mitra, Abhisek; Hu, Jiemiao; Cutrera, Jeffery J; Xia, Xueqing; Doetschman, Thomas; Gagea, Mihai; Mishra, Lopa; Li, Shulin

2016-01-01

Background & Aims Sepsis is an acute systemic inflammatory response to infection associated with high patient mortality (28-40%). We hypothesized that interleukin (IL)-30, a novel cytokine protecting mice against liver injury resulted from inflammation, would generate a protective effect against systemic inflammation and sepsis-induced death. Methods Sepsis was induced by lipopolysaccharide (LPS) or cecal ligation and puncture (CLP). The inhibitory effects of IL-30 on septic inflammation and associated therapeutic effects were determined in wild-type, IL-30 (p28)−/−, IL10−/−, and CD1d−/− mice. Results Mice treated with pIL30 gene therapy or recombinant IL-30 protein (rIL30) were protected from LPS-induced septic shock or CLP-induced polymicrobial sepsis and showed markedly less liver damage and lymphocyte apoptosis than control septic mice. The resulting reduction in mortality was mediated through attenuation of the systemic pro-inflammatory response and augmentation of bacterial clearance. Mice lacking IL-30 were more sensitive to LPS-induced sepsis. Natural killer–like T cells (NKT) produced much higher levels of IL-10 and lower levels of interferon–gamma and tumor necrosis factor–alpha in IL-30–treated septic mice than in control septic mice. Likewise, deficiency in IL-10 or NKT cells abolished the protective role of IL-30 against sepsis. Furthermore, IL-30 induced IL-10 production in purified and LPS-stimulated NKT cells. Blocking IL-6R or gp130 inhibited IL-30 mediated IL-10 production. Conclusions IL-30 is important in modulating production of NKT cytokines and subsequent NKT cell–mediated immune regulation of other cells. Therefore, IL-30 has a role in prevention and treatment of sepsis via modulation of cytokine production by NKT. PMID:26767500

Rapid movement of wastewater from on-site disposal systems into surface waters in the lower Florida Keys

USGS Publications Warehouse

Paul, John H.; McLaughlin, Molly R.; Griffin, Dale W.; Lipp, Erin K.; Stokes, Rodger; Rose, Joan B.

2000-01-01

Viral tracer studies have been used previously to study the potential for wastewater contamination of surface marine waters in the Upper and Middle Florida Keys. Two bacteriophages, the marine bacteriophage φHSIC and the Salmonella phage PRD1, were used as tracers in injection well and septic tank studies in Saddlebunch Keys of the Lower Florida Keys and in septic tank studies in Boot Key Harbor, Marathon, of the Middle Keys. In Boot Key Harbor, both phages were detected in a canal adjacent to the seeded septic tank within 3 h 15 min of the end of the seed period. The tracer was then detected at all sampling sites in Boot Key Harbor, including one on the opposite side of U. S. Highway 1 in Florida Bay, and at an Atlantic Ocean beach outside Boot Key Harbor. Rates of migration based on first appearance of the phage ranged from 1.7 to 57.5 m h-1. In Saddlebunch Keys, φHSIC and PRD1 were used to seed a residential septic tank and a commercial injection well. The septic tank tracer was not found in any surface water samples. The injection well tracer was first detected at a site most distant from the seed site, a channel that connected Sugarloaf Sound with the Atlantic Ocean. The rate of tracer migration from the injection well to this channel ranged from 66.8 to 141 m h-1. Both tracer studies showed a rapid movement of wastewater from on-site sewage treatment and disposal systems in a southeasterly direction toward the reef tract and Atlantic Ocean, with preferential movement through tidal channels. These studies indicate that wastewater disposal systems currently in widespread use in the Florida Keys can rapidly contaminate the marine environment.

Removal of Nutrients from Septic Effluent with Re-circulated Hybrid Tidal Flow Constructed Wetland

Treesearch

Lihua Cui; Jigkun Feng; Ying Ouyang; Peiwen Deng

2012-01-01

Hybrid tidal flow constructed wetland (CW) with recirculation is an improved biological and engineering technique for removal of excess nutrients and certain pollutants from wastewater. This study investigated the removal efficiency of total phosphorus (TP), ammonia-nitrogen (NH3-N), and total nitrogen (TN) from septic tank effluent with the hybrid tidal flow CW system...

QUANTIFICATION OF METHANE EMISSIONS AND DISCUSSON OF NITROUS OXIDE, AND AMMONIA EMISSIONS FROM SEPTIC TANKS, LATRINES, AND STAGNANT OPEN SEWERS OF THE WORLD

EPA Science Inventory

The report gives results of a first attempt to estimate global and country-specific methane (CH4) emissons from sewers and on-site wastewater treatment systems, including latrines and septic sewage tanks. It follows a report that includes CH4 and nitrous oxide (N2O) estimates fro...

Misdirected Sympathy: The Role of Sympatholysis in Sepsis and Septic Shock.

PubMed

Ferreira, Jason A; Bissell, Brittany D

2018-02-01

The spectrum of sepsis and septic shock remains a highly prevalent disease state, carrying a high risk of morbidity and mortality. The sympathetic nervous system (SNS) plays an important role in this initial cascade, enabling the host to respond to invading pathogens; however, prolonged activation can become pathological. The potential for unregulated sympathetic tone to become of detriment in patients with sepsis has fueled interest in the role and impact of sympatholysis, the selective inhibition of sympathetic tone. The cornerstone of septic shock therapy for decades has been the supplementation of catecholamines and thus potential further perpetuation of this sympathetic dysregulation. Although the theory of sympatholysis circulates around cardiovascular effects and stroke volume optimization, the impact of augmenting the SNS may extend well beyond this, including the impacts on the immune system, inflammatory cascade, and even gene transcription. Presently, the most robust clinical evidence involves the use of the cardioselective β-blocker esmolol in patients with septic shock with persistent tachycardia secondary to catecholamine use. Evidence is isolated only to animal models with α-agonists. Future evidence stands to elucidate the balance of sympathetic and autonomic tone as well as the potential role of redirecting and maximizing sympathetic activity.

Corrective Action Decision Document for Corrective Action Unit 224: Decon Pad and Septic Systems Nevada Test Site, Nevada, Rev. No.: 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

David A. Strand

2005-05-01

This Corrective Action Decision Document has been prepared for Corrective Action Unit (CAU) 224, Decon Pad and Septic Systems, in Areas 2, 3, 5, 6, 11, and 23 of the Nevada Test Site, Nevada, in accordance with the ''Federal Facility Agreement and Consent Order'' (1996). Corrective Action Unit 224 is comprised of the following corrective action sites (CASs): (1) 02-04-01, Septic Tank (Buried); (2) 03-05-01, Leachfield; (3) 05-04-01, Septic Tanks (4)/Discharge Area; (4) 06-03-01, Sewage Lagoons (3); (5) 06-05-01, Leachfield; (6) 06-17-04, Decon Pad and Wastewater Catch; (7) 06-23-01, Decon Pad Discharge Piping; (8) 11-04-01, Sewage Lagoon; and (9) 23-05-02,more » Leachfield. The purpose of this Corrective Action Decision Document is to identify and provide the rationale for the recommendation of a corrective action alternative for the nine CASs within CAU 224. Corrective action investigation activities were performed from August 10, 2004, through January 18, 2005, as set forth in the CAU 224 Corrective Action Investigation Plan.« less

[Procalcitonin as a diagnostic marker in systemic inflammatory response syndrome (SIRS) and sepsis].

PubMed

Hryckiewicz, Katarzyna; Juszczyk, Jacek; Samet, Alfred; Arłukowicz, Elzbieta; Sledzińska, Anna; Bolewska, Beata

2006-01-01

Evaluation the value of procalcitonin as a diagnostic and prognostic marker in septic patients and patients with systemic inflammatory response syndrome (SIRS). 126 patients were included into the study. The patients were divided into four groups: 1--septic patients with positive blood cultures, 2--septic patients with negative blood cultures, 3--patients with SIRS, 4--patients without sepsis and SIRS. PCT level was measured by imunoluminometric assay (LUMItest) and immunochromatographic assay (PCT-Q). PCT level is higher in patients with sepsis than in patients with SIRS. PCT level is only slightly elevated in patients without sepsis and SIRS. The highest PCT level is found in patients with septic shock. In patients with the clinical improvement the frequency of PCT level increase is approximately twice lower than in patients who died. Measurement of PCT level on the first, second and third day of hospitalization has no prognostic value. There is no significant difference in PCT level in sepsis caused by Gram positive and Gram negative bacteria. PCT is a useful marker in diagnosis of sepsis but its role in monitoring the severity of sepsis requires more clinical studies.

Technetium phosphate bone scan in the diagnosis of septic arthritis in childhood

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sundberg, S.B.; Savage, J.P.; Foster, B.K.

1989-09-01

The technetium phosphate bone scans of 106 children with suspected septic arthritis were reviewed to determine whether the bone scan can accurately differentiate septic from nonseptic arthropathy. Only 13% of children with proved septic arthritis had correct blind scan interpretation. The clinically adjusted interpretation did not identify septic arthritis in 30%. Septic arthritis was incorrectly identified in 32% of children with no evidence of septic arthritis. No statistically significant differences were noted between the scan findings in the septic and nonseptic groups and no scan findings correlated specifically with the presence or absence of joint sepsis.

Septic and non-septic olecranon bursitis in the accident and emergency department--an approach to management.

PubMed Central

Stell, I M

1996-01-01

Olecranon bursitis is relatively common. One third of episodes are septic. Most of the remainder are non-septic, with occasional rheumatological causes. Trauma can cause both septic and non-septic olecranon bursitis. Clinical features are helpful in separating septic from non-septic olecranon bursitis, but there may be local erythema in both. Aspiration should be carried out in all cases, and if the presence of infection is still in doubt, microscopy, Gram staining, and culture of the aspirate will resolve the issue. Septic olecranon bursitis should be treated by aspiration, which may need to be repeated, and a long course of antibiotics. Some cases will need admission, and a few will need surgical treatment. Non-septic olecranon bursitis can be managed with aspiration alone. Non-steroidal anti-inflammatory drugs probably hasten symptomatic improvement. Intrabursal corticosteroids produce a rapid resolution but concern remains over their long term local effects. Recovery from septic olecranon bursitis can take months. PMID:8894865

Sewage Treatment

NASA Technical Reports Server (NTRS)

1991-01-01

Stennis Space Center's aquaculture research program has led to an attractive wastewater treatment for private homes. The system consists of a septic tank or tanks for initial sewage processing and a natural secondary treatment facility for further processing of septic tanks' effluent, consisting of a narrow trench, which contains marsh plants and rocks, providing a place for microorganisms. Plants and microorganisms absorb and digest, thus cleansing partially processed wastewater. No odors are evident and cleaned effluent may be discharged into streams or drainage canals. The system is useful in rural areas, costs about $1,900, and requires less maintenance than mechanical systems.

Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study.

PubMed

Ulla, Marco; Pizzolato, Elisa; Lucchiari, Manuela; Loiacono, Maria; Soardo, Flavia; Forno, Daniela; Morello, Fulvio; Lupia, Enrico; Moiraghi, Corrado; Mengozzi, Giulio; Battista, Stefania

2013-07-30

Sepsis, severe sepsis and septic shock are common conditions with high mortality. Their early diagnosis in the Emergency Department (ED) is one of the keys to improving survival. Procalcitonin (PCT) has been used as a biomarker in septic patients but has limited specificity and can be elevated in other scenarios of systemic inflammatory response syndrome (SIRS). Soluble CD14 (sCD14) or presepsin is the free fragment of a glycoprotein expressed on monocytes and macrophages. Preliminary reports suggest that levels of presepsin are significantly higher in septic patients than in healthy individuals. The aim of this study is to investigate the diagnostic and prognostic value of presepsin compared to PCT in people presenting at the ED with SIRS and suspected sepsis or septic shock. This study was conducted in two major hospitals in Turin, Italy. One hundred six patients presenting to the EDs with suspected sepsis or septic shock were included, and another eighty-three patients affected by SIRS, but with no clinical evidence of infection, were recruited as controls. Blood samples were collected at first medical evaluation and for some patients after 24 and 72 h. The samples were analyzed using the PATHFAST Presepsin assay for sCD14, and commercial kits were used for other determinations (for example, PCT). Definitive diagnosis and survival rates were obtained afterward by analysis of digital medical records. Elevated concentrations of presepsin at presentation were observed in septic patients compared to control patients. The same trend was observed for mean values of PCT. Higher values of presepsin were observed in septic patients at presentation (time 0). The diagnostic accuracy of PCT was generally higher, and areas under the curve (AUCs) were 0.875 for PCT and 0.701 for presepsin. Mean presepsin values were significantly higher in nonsurvivor septic patients (60-day mortality) than in survivors. No significant correlation was noted between PCT and survival. In our experience, presepsin was useful in the early diagnosis of infection in a complex population of patients with SIRS, sepsis, severe sepsis and septic shock who presented to the ED. Presepsin showed a significant prognostic value, and initial values were significantly correlated with in-hospital mortality of patients affected by sepsis, severe sepsis or septic shock.

Diagnostic and prognostic value of presepsin in the management of sepsis in the emergency department: a multicenter prospective study

PubMed Central

2013-01-01

Introduction Sepsis, severe sepsis and septic shock are common conditions with high mortality. Their early diagnosis in the Emergency Department (ED) is one of the keys to improving survival. Procalcitonin (PCT) has been used as a biomarker in septic patients but has limited specificity and can be elevated in other scenarios of systemic inflammatory response syndrome (SIRS). Soluble CD14 (sCD14) or presepsin is the free fragment of a glycoprotein expressed on monocytes and macrophages. Preliminary reports suggest that levels of presepsin are significantly higher in septic patients than in healthy individuals. The aim of this study is to investigate the diagnostic and prognostic value of presepsin compared to PCT in people presenting at the ED with SIRS and suspected sepsis or septic shock. Methods This study was conducted in two major hospitals in Turin, Italy. One hundred six patients presenting to the EDs with suspected sepsis or septic shock were included, and another eighty-three patients affected by SIRS, but with no clinical evidence of infection, were recruited as controls. Blood samples were collected at first medical evaluation and for some patients after 24 and 72 h. The samples were analyzed using the PATHFAST Presepsin assay for sCD14, and commercial kits were used for other determinations (for example, PCT). Definitive diagnosis and survival rates were obtained afterward by analysis of digital medical records. Results Elevated concentrations of presepsin at presentation were observed in septic patients compared to control patients. The same trend was observed for mean values of PCT. Higher values of presepsin were observed in septic patients at presentation (time 0). The diagnostic accuracy of PCT was generally higher, and areas under the curve (AUCs) were 0.875 for PCT and 0.701 for presepsin. Mean presepsin values were significantly higher in nonsurvivor septic patients (60-day mortality) than in survivors. No significant correlation was noted between PCT and survival. Conclusions In our experience, presepsin was useful in the early diagnosis of infection in a complex population of patients with SIRS, sepsis, severe sepsis and septic shock who presented to the ED. Presepsin showed a significant prognostic value, and initial values were significantly correlated with in-hospital mortality of patients affected by sepsis, severe sepsis or septic shock. PMID:23899120

Extracorporeal membrane oxygenation for refractory septic shock in adults.

PubMed

Park, Taek Kyu; Yang, Jeong Hoon; Jeon, Kyeongman; Choi, Seung-Hyuk; Choi, Jin-Ho; Gwon, Hyeon-Cheol; Chung, Chi Ryang; Park, Chi Min; Cho, Yang Hyun; Sung, Kiick; Suh, Gee Young

2015-02-01

The role of extracorporeal membrane oxygenation (ECMO) remains controversial in adult patients with refractory septic shock. We sought to describe the clinical outcomes of adult patients supported by ECMO during septic shock refractory to conventional treatment. We analysed consecutive adult patients with refractory septic shock, assisted by an ECMO system between January 2005 and December 2013 in a single-centre registry. The primary outcome was survival to hospital discharge. A total of 32 patients (21 males) received ECMO support for refractory septic shock. Of these, 14 patients (43.8%) had undergone cardiopulmonary resuscitation (CPR) and 7 patients (21.9%) did not achieve the return of spontaneous circulation until initiation of ECMO flow. ECMO was weaned off successfully in 13 patients (40.6%) and 7 patients (21.9%) survived to hospital discharge. The survivors had lower peak lactate (4.5 vs 15.1 mmol/l, P = 0.03), lower Sepsis-related Organ Failure Assessment day 3 score (15 vs 18, P = 0.01) and higher peak troponin I (32.8 vs 3.7 ng/ml, P = 0.02) than the non-survivors. None of the patients (31.3%) in whom ECMO was initiated more than 30.5 h after onset of septic shock, survived. In multivariable-adjusted models, CPR [adjusted hazard ratio (HR), 4.61; 95% confidence interval (CI), 1.55-13.69; P = 0.006] was an independent predictor of in-hospital mortality after ECMO in patients with refractory septic shock. Higher peak troponin I > 15 ng/ml (adjusted HR, 0.34; 95% CI, 0.12-0.97; P = 0.04) was associated with a lower risk of in-hospital mortality. Survival to hospital discharge remained low in adult patients with refractory septic shock despite ECMO support. Our findings suggest that implantation of ECMO during refractory septic shock could be considered in patients with severe myocardial injury but should be avoided in patients who have received CPR. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

[Septic shock due to infective endocarditis of stimulation system of implantable cardioverter-defibrillator].

PubMed

Porubčinová, I; Porubčin, S; Stančák, B; Beňa, M; Sabol, F

2012-01-01

We present a case of a 60-year old patient hospitalized at the Department of Infectious Diseases and Travel Medicine, Medical faculty of UPJS and L. Pasteurs University Hospital in Kosice with suspected gastroenteritis. The patient was admitted to an intensive care unit because of the signs of septic shock. Within one hour from admission, the patient was administered early goal directed therapy for septic shock. Subsequently, infectious endocarditis of stimulation electrodes and tricuspid valve was identified as the origin of the infection. The stimulation system was then explanted from a stabilized and afebrile patient at the Department of cardiac Surgery of Eastern Slovak Institute of Cardiac and Vascular Diseases in Kosice. This case should emphasise frequently atypical course of this serious disease and the need for early identification of severe sepsis to enable timely management to affect mortality.

Hydrogeology and Migration of Septic-Tank Effluent in the Surficial Aquifer System in the Northern Midlands Area, Palm Beach County, Florida

USGS Publications Warehouse

Miller, Wesley L.

1992-01-01

The northern Midlands area in Palm Beach County is an area of expected residential growth, but its flat topography, poor drainage, and near-surface marl layers retard rainfall infiltration and cause frequent flooding. Public water supplies and sewer services are not planned for the area, thus, residents must rely on domestic wells and septic tanks. The water table in the northern Midlands area is seldom more than 5 feet below land surface, and regional ground-water flows are east, southwest, and south from the north-central part of the area where ground-water levels are highest. Ground-water quality in the western part of the area and in the Loxahatchee Slough is greatly influenced by residual seawater emplaced during the Pleistocene Epoch. Chloride and dissolved-solids concentrations of ground water in the surficial aquifer system in these areas often exceed secondary drinking-water standards. Residual seawater has been more effectively flushed from the more permeable sediments elsewhere in the eastern and southwestern parts of the study area. Test at three septic-tank sites showed traces of effluent in ground water (38-92 feet from the septic tank outlets) and that near-surface marl layers greatly impede the downward migration of the effluent in the surficial aquifer system throughout the northern midlands.

Differential expression of the nuclear-encoded mitochondrial transcriptome in pediatric septic shock.

PubMed

Weiss, Scott L; Cvijanovich, Natalie Z; Allen, Geoffrey L; Thomas, Neal J; Freishtat, Robert J; Anas, Nick; Meyer, Keith; Checchia, Paul A; Shanley, Thomas P; Bigham, Michael T; Fitzgerald, Julie; Banschbach, Sharon; Beckman, Eileen; Howard, Kelli; Frank, Erin; Harmon, Kelli; Wong, Hector R

2014-11-19

Increasing evidence supports a role for mitochondrial dysfunction in organ injury and immune dysregulation in sepsis. Although differential expression of mitochondrial genes in blood cells has been reported for several diseases in which bioenergetic failure is a postulated mechanism, there are no data about the blood cell mitochondrial transcriptome in pediatric sepsis. We conducted a focused analysis using a multicenter genome-wide expression database of 180 children ≤ 10 years of age with septic shock and 53 healthy controls. Using total RNA isolated from whole blood within 24 hours of PICU admission for septic shock, we evaluated 296 nuclear-encoded mitochondrial genes using a false discovery rate of 1%. A series of bioinformatic approaches were applied to compare differentially expressed genes across previously validated gene expression-based subclasses (groups A, B, and C) of pediatric septic shock. In total, 118 genes were differentially regulated in subjects with septic shock compared to healthy controls, including 48 genes that were upregulated and 70 that were downregulated. The top scoring canonical pathway was oxidative phosphorylation, with general downregulation of the 51 genes corresponding to the electron transport system (ETS). The top two gene networks were composed primarily of mitochondrial ribosomal proteins highly connected to ETS complex I, and genes encoding for ETS complexes I, II, and IV that were highly connected to the peroxisome proliferator activated receptor (PPAR) family. There were 162 mitochondrial genes differentially regulated between groups A, B, and C. Group A, which had the highest maximum number of organ failures and mortality, exhibited a greater downregulation of mitochondrial genes compared to groups B and C. Based on a focused analysis of a pediatric septic shock transcriptomic database, nuclear-encoded mitochondrial genes were differentially regulated early in pediatric septic shock compared to healthy controls, as well as across genotypic and phenotypic distinct pediatric septic shock subclasses. The nuclear genome may be an important mechanism contributing to alterations in mitochondrial bioenergetic function and outcomes in pediatric sepsis.

Treatability of nonylphenol ethoxylate surfactants in on-site wastewater disposal systems.

PubMed

Huntsman, Brent E; Staples, Charles A; Naylor, Carter G; Williams, Jim-Bob

2006-11-01

The fate of nine-mole nonylphenol ethoxylate (NPE9) discharged to an on-site wastewater disposal (septic) system was the focus of a 2-year investigation. Known amounts of NPE9-based detergent were metered daily into the plumbing at a single-family household. The ethoxylate-containing wastewater was discharged to the highly anoxic environment of a 4500-L septic tank before distribution to the oxic subsurface via 100 m of leach line. After 180 days of injecting detergent to the septic system, periodic soil pore water and/or groundwater samples were collected and analyzed for nonylphenol ethoxylates (NPEs), nonylphenol ether carboxylates, and nonylphenol. The NPE9 and degradation intermediates that were measured were reduced by 99.99% on a molar basis. An 18% reduction in molar concentration within the septic tank was observed. This was followed by a further 96.7% reduction of molar concentration within the leach lines. As the pore water migrated through the vadose zone, an additional 99.69% reduction in molar concentration was measured between the bottom of the leach lines (leach line effluent) and the lowest vadose zone monitoring location. The results obtained from these analyses indicate that degradation of the surfactant occurs within the anoxic portion of the disposal system with continued rapid biodegradation in the oxic unsaturated zone. Only trace amounts of degradation residuals were detected in soil pore water. The concentration and distribution of various degradation intermediates with respect to location, time, and ambient physical conditions were evaluated. Rapid and systematic degradation of NPE in on-site wastewater disposal systems was documented.

Low cost anaerobic system for Indonesia: single baffled septic tank.

PubMed

Wibisono, G; Mathew, K; Ho, Goen

2003-01-01

The insertion of a single baffle into a laboratory septic tank to mix incoming feed with sludge has been shown to improve anaerobic degradation of the feed. This is particularly true of soluble organic matter such as glucose. Oil or cellulose fed separately does not undergo degradation. It is expected however that a balanced feed such as sewage will be better degraded.

Evolution of Acute Kidney Injury and Its Association With Systemic Hemodynamics in Children With Fluid-Refractory Septic Shock.

PubMed

Deep, Akash; Sagar, Hiremath; Goonasekera, Chulananda; Karthikeyan, Palaniswamy; Brierley, Joe; Douiri, Abdel

2018-07-01

There are no studies in pediatrics evaluating the progression of acute kidney injury in septic shock. We investigated the evolution of sepsis-associated acute kidney injury and its association with systemic hemodynamics in children with fluid-refractory septic shock. Prospective cohort study. PICU of a tertiary care hospital. All patients with fluid-refractory septic shock (n = 61) between September 2010 and February 2014. Hemodynamic variables using noninvasive ultrasound cardiac output monitor were measured at admission and 6 hourly thereafter till 48 hours. We used the Kidney Disease: Improving Global Outcomes criteria to define and stage acute kidney injury. Associations between various hemodynamic variables and development of acute kidney injury were evaluated. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury and was compared with no acute kidney injury or stage 1 acute kidney injury. Severe acute kidney injury developed in 29.5% (n = 18) of the 61 children with fluid-refractory septic shock, whereas 43 patients (70.49%) had either no or stage 1 acute kidney injury. Most patients who developed acute kidney injury did so within the first 48 hours of PICU admission. Severe acute kidney injury conferred a three-fold increased risk of death by day 28 (hazard ratio, 3.23; 95% CI, 1.52-6.67; p = 0.002), longer ICU stay, and increased duration of mechanical ventilation. Central venous pressure at presentation was higher in severe acute kidney injury by 5 cm H2O. Highest lactate in the first 24 hours of PICU admission, low diastolic blood pressure, low systemic vascular resistance index at admission were associated with severe acute kidney injury. This model reliably predicted stage 2/3 acute kidney injury by day 3 with area under the curve equals to 94%; 95% CI, 88.3-99.99. None of the other hemodynamic variables showed any association with severe acute kidney injury. Manifestations of sepsis-associated acute kidney injury often occur early after PICU admission and is associated with increased morbidity and mortality. There is a need to develop a predictive model in septic shock which could facilitate early detection of acute kidney injury.

Application of classification-tree methods to identify nitrate sources in ground water

USGS Publications Warehouse

Spruill, T.B.; Showers, W.J.; Howe, S.S.

2002-01-01

A study was conducted to determine if nitrate sources in ground water (fertilizer on crops, fertilizer on golf courses, irrigation spray from hog (Sus scrofa) wastes, and leachate from poultry litter and septic systems) could be classified with 80% or greater success. Two statistical classification-tree models were devised from 48 water samples containing nitrate from five source categories. Model I was constructed by evaluating 32 variables and selecting four primary predictor variables (??15N, nitrate to ammonia ratio, sodium to potassium ratio, and zinc) to identify nitrate sources. A ??15N value of nitrate plus potassium 18.2 indicated inorganic or soil organic N. A nitrate to ammonia ratio 575 indicated nitrate from golf courses. A sodium to potassium ratio 3.2 indicated spray or poultry wastes. A value for zinc 2.8 indicated poultry wastes. Model 2 was devised by using all variables except ??15N. This model also included four variables (sodium plus potassium, nitrate to ammonia ratio, calcium to magnesium ratio, and sodium to potassium ratio) to distinguish categories. Both models were able to distinguish all five source categories with better than 80% overall success and with 71 to 100% success in individual categories using the learning samples. Seventeen water samples that were not used in model development were tested using Model 2 for three categories, and all were correctly classified. Classification-tree models show great potential in identifying sources of contamination and variables important in the source-identification process.

Is Thrombocytopenia an Early Prognostic Marker in Septic Shock?

PubMed

Thiery-Antier, Nadiejda; Binquet, Christine; Vinault, Sandrine; Meziani, Ferhat; Boisramé-Helms, Julie; Quenot, Jean-Pierre

2016-04-01

To assess whether early thrombocytopenia during septic shock is associated with an increased risk of death at day 28 and to identify risk factors associated with a low platelet count. Prospective, multicenter, observational cohort study. Fourteen ICUs from 10 French university teaching and nonacademic hospitals. Consecutive adult patients with septic shock admitted between November 2009 and September 2011 were eligible. None. Of the 1,495 eligible patients, 1,486 (99.4%) were included. Simplified Acute Physiology Score II score of greater than or equal to 56, immunosuppression, age of more than 65 years, cirrhosis, bacteremia (p ≤ 0.001 for each), and urinary sepsis (p = 0.005) were globally associated with an increased risk of thrombocytopenia within the first 24 hours following the onset of septic shock. Survival at day 28 estimated by the Kaplan-Meier method was lower in patients with thrombocytopenia and decreased with thrombocytopenia severity. By multivariate Cox regression, a platelet count of less than or equal to 100,000/mm3 was independently associated with a significantly increased risk of death within the 28 days following septic shock onset. The risk of death increased with the severity of thrombocytopenia (hazard ratio, 1.65; 95% CI, 1.31-2.08 for a platelet count below 50,000/mm3 vs > 150,000/mm3; p < 0.0001). This is the first study to investigate thrombocytopenia within the first 24 hours of septic shock onset as a prognostic marker of survival at day 28 in a large cohort of ICU patients. Measuring platelet count is inexpensive and easily feasible for the physician in routine practice, and thus, it could represent an easy "alert system" among patients in septic shock.

Microparticle-associated tissue factor activity correlates with plasma levels of bacterial lipopolysaccharides in meningococcal septic shock.

PubMed

Hellum, Marit; Øvstebø, Reidun; Brusletto, Berit S; Berg, Jens P; Brandtzaeg, Petter; Henriksson, Carola E

2014-03-01

The plasma level of bacterial lipopolysaccharides (LPS) is associated with activation of the coagulation system, inhibition of fibrinolysis and the nature of the clinical presentation and outcome in patients with meningococcal disease. Tissue factor (TF)-bearing microparticles (MPs) appear to contribute to the pathogenesis of disseminated intravascular coagulation (DIC). The aim of this study was to investigate the relationship between MP-associated TF activity and the level of bacterial LPS in plasma from patients with meningococcal septic shock and meningitis. MPs isolated from citrated plasmas were assessed for TF-dependent activity with both a plasma-based thrombin generation assay (CAT) and whole blood-based thromboelastometry (ROTEM). The LPS level was measured using a chromogenic Limulus amebocyte lysate assay. MPs obtained from patients with meningococcal septic shock initiated significantly more efficient and TF-dependent thrombin generation in the CAT assay compared to MPs from patients with meningococcal meningitis. Differences in MP-associated TF activity between the septic shock patients and the meningitis patients were also evident when MPs were added to whole blood using ROTEM. The level of plasma LPS in patients with septic shock (range 2-2,100 EU/mL) was correlated with thrombogram parameters in the CAT assay; lagtime (r(s)=-0.84), time to peak (rs=-0.83), peak (r(s)=0.85) and ETP (r(s)=0.83). MPs obtained from patients with meningococcal septic shock displayed more efficient TF-dependent thrombin generation and clot formation compared to MPs from meningitis patients. MP-associated TF activity was closely associated with plasma LPS levels in the septic shock group. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pathogens and outcomes in pediatric septic shock patients supported by extracorporeal membrane oxygenation.

PubMed

Chang, Tu-Hsuan; Wu, En-Ting; Lu, Chun-Yi; Huang, Shu-Chien; Yang, Tzu-I; Wang, Ching-Chia; Chen, Jong-Min; Lee, Ping-Ing; Huang, Li-Min; Chang, Luan-Yin

2017-08-04

Refractory septic shock is the leading cause of mortality in children. There is limited evidence to support extracorporeal membrane oxygenation (ECMO) use in pediatric septic shock. We described the etiology and outcomes of septic patients in our institution and attempted to find predictive factors. We retrospectively reviewed 55 pediatric patients with septic shock who required ECMO support in a tertiary medical center from 2008 to 2015. Septic shock was defined as culture proved or clinical suspected sepsis with hypotension or end-organ hypoperfusion. ECMO would be applied when pediatric advanced life support steps were performed thoroughly without clinical response. Patient's demographics, laboratory parameters before and after ECMO, and outcomes were analyzed. Among 55 children with ECMO support, 31% of them survived on discharge. For 25 immunocompromised patients, causal pathogens were found in 17 patients: 7 due to bacteremia, 9 with preexisting virus infections and one with invasive fungal infection. Among 30 previously healthy patients, causal pathogens were found in 18 patients: 10 due to bacteremia (the most common was pneumococcus), 7 with preexisting virus infections including influenza (n = 4), adenovirus (n = 2), RSV, and 1 patient had mixed virus and bacterial infections. Predictive factors associated with death were arterial blood gas pH, CO 2 and Glasgow Coma Scale (p < 0.05). SOFA score was a valuable predictive scoring system for outcome prediction (p < 0.05). Pediatric patients with refractory septic shock had high mortality rate and ECMO could be used as a rescue modality, and SOFA score could be applied to predict outcomes. Copyright © 2017. Published by Elsevier B.V.

Fate of effluent-borne contaminants beneath septic tank drainfields overlying a Karst aquifer.

PubMed

Katz, Brian G; Griffin, Dale W; McMahon, Peter B; Harden, Harmon S; Wade, Edgar; Hicks, Richard W; Chanton, Jeffrey P

2010-01-01

Groundwater quality effects from septic tanks were investigated in the Woodville Karst Plain, an area that contains numerous sinkholes and a thin veneer of sands and clays overlying the Upper Floridan aquifer (UFA). Concerns have emerged about elevated nitrate concentrations in the UFA, which is the source of water supply in this area of northern Florida. At three sites during dry and wet periods in 2007-2008, water samples were collected from the septic tank, shallow and deep lysimeters, and drainfield and background wells in the UFA and analyzed for multiple chemical indicators including nutrients, nitrate isotopes, organic wastewater compounds (OWCs), pharmaceutical compounds, and microbiological indicators (bacteria and viruses). Median NO3-N concentration in groundwater beneath the septic tank drainfields was 20 mg L(-1) (8.0-26 mg L(-1)). After adjusting for dilution, about 25 to 40% N loss (from denitrification, ammonium sorption, and ammonia volatilization) occurs as septic tank effluent moves through the unsaturated zone to the water table. Nitrogen loading rates to groundwater were highly variable at each site (3.9-12 kg N yr(-1)), as were N and chloride depth profiles in the unsaturated zone. Most OWCs and pharmaceutical compounds were highly attenuated beneath the drainfields; however, five Cs (caffeine, 1,7-dimethylxanthine, phenol, galaxolide, and tris(dichloroisotopropyl)phosphate) and two pharmaceutical compounds (acetaminophen and sulfamethoxazole) were detected in groundwater samples. Indicator bacteria and human enteric viruses were detected in septic tank effluent samples but only intermittently in soil water and groundwater. Contaminant movement to groundwater beneath each septic tank system also was related to water use and differences in lithology at each site.

The Impact of the Sepsis-3 Septic Shock Definition on Previously Defined Septic Shock Patients.

PubMed

Sterling, Sarah A; Puskarich, Michael A; Glass, Andrew F; Guirgis, Faheem; Jones, Alan E

2017-09-01

The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the "old" (1991) criteria of septic shock only. Secondary analysis of two clinical trials of early septic shock resuscitation. Large academic emergency departments in the United States. Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90 mm Hg after fluid resuscitation. Patients were further categorized as Sepsis-3 septic shock if they demonstrated hypotension, received vasopressors, and exhibited a lactate greater than 2 mmol/L. We compared in-hospital mortality in patients who met the old definition only with those who met the Sepsis-3 criteria. Four hundred seventy patients were included in the present analysis. Two hundred (42.5%) met Sepsis-3 criteria, whereas 270 (57.4%) met only the old definition. Patients meeting Sepsis-3 criteria demonstrated higher severity of illness by Sequential Organ Failure Assessment score (9 vs 5; p < 0.001) and mortality (29% vs 14%; p < 0.001). Subgroup analysis of 127 patients meeting only the old definition demonstrated significant mortality benefit following implementation of a quantitative resuscitation protocol (35% vs 10%; p = 0.006). In this analysis, 57% of patients meeting old definition for septic shock did not meet Sepsis-3 criteria. Although Sepsis-3 criteria identified a group of patients with increased organ failure and higher mortality, those patients who met the old criteria and not Sepsis-3 criteria still demonstrated significant organ failure and 14% mortality rate.

Evaluation of Vasopressin for Septic Shock in Patients on Chronic Renin-Angiotensin-Aldosterone System Inhibitors.

PubMed

Erwin, Beth L; Denaburg, Michael A; Barker, Andrew B; McArdle, Philip J; Windham, Samuel T; Morgan, Charity J

2017-12-01

To compare the hemodynamic response in septic shock patients receiving vasopressin who were on chronic renin-angiotensin-aldosterone system inhibitor therapy with those who were not. Single-center, retrospective cohort study. Medical and surgical ICUs at a 1,100-bed academic medical center. Medical and surgical ICU patients with septic shock who received vasopressin infusion added to at least one concomitant vasopressor agent between January 2014 and December 2015, then divided into two cohorts: 1) patients who were on chronic renin-angiotensin-aldosterone system inhibitor therapy as outpatients and 2) patients who were not on chronic renin-angiotensin-aldosterone system inhibitor therapy as outpatients. None. Mean arterial pressure at 6 hours was 72.2 mm Hg in the renin-angiotensin-aldosterone system inhibitor group versus 69.7 mm Hg in the non-renin-angiotensin-aldosterone system inhibitor group (p = 0.298). There was no difference in mean arterial pressure at 1, 24, or 48 hours between groups. Total concomitant vasopressor requirements, based on norepinephrine equivalents excluding vasopressin, were significantly lower at 24 hours in the renin-angiotensin-aldosterone system inhibitor group versus the non-renin-angiotensin-aldosterone system inhibitor group (10.7 vs 18.1 µg/min, respectively; p = 0.007), but no significant differences were seen at the other time points assessed. There were no significant differences in ICU or hospital length of stay or mortality. There was no significant difference in the primary outcome of 6-hour mean arterial pressure in septic shock patients receiving vasopressin who were on chronic renin-angiotensin-aldosterone system inhibitor therapy versus those receiving vasopressin who were not on chronic renin-angiotensin-aldosterone system inhibitor therapy. Renin-angiotensin-aldosterone system inhibitor patients had lower total concomitant vasopressor requirements at 24 hours compared with non-renin-angiotensin-aldosterone system inhibitor patients.

Epidermal growth factor improves intestinal integrity and survival in murine sepsis following chronic alcohol ingestion

PubMed Central

Klingensmith, Nathan J.; Yoseph, Benyam P.; Liang, Zhe; Lyons, John D.; Burd, Eileen M.; Margoles, Lindsay M.; Koval, Michael; Ford, Mandy L.; Coopersmith, Craig M.

2016-01-01

Epidermal growth factor (EGF) is a cytoprotective protein that improves survival in preclinical models of sepsis through its beneficial effects on intestinal integrity. Alcohol use disorder worsens intestinal integrity and is associated with increased morbidity and mortality in critical illness. We sought to determine whether chronic alcohol ingestion alters the host response to systemic administration of EGF in sepsis. Six week old FVB/N mice were randomized to receive 20% alcohol or water for 12 weeks. All mice then underwent cecal ligation and puncture (CLP) to induce polymicrobial sepsis. Mice were then randomized to receive either intraperitoneal injection of EGF (150 μg/kg/day) or normal saline. Water-fed mice given EGF mice had decreased seven-day mortality compared to water-fed mice (18% vs. 55%). Alcohol-fed mice given EGF also had decreased seven day mortality compared to alcohol-fed mice (48% vs. 79%). Notably, while systemic EGF improved absolute survival to a similar degree in both water-fed and alcohol-fed mice, mortality was significantly higher in alcohol+EGF mice compared to water+EGF mice. Compared to water-fed septic mice, alcohol-fed septic mice had worsened intestinal integrity with intestinal hyperpermeability, increased intestinal epithelial apoptosis, decreased proliferation and shorter villus length. Systemic administration of EGF to septic alcohol-fed mice decreased intestinal permeability compared to septic alcohol-fed mice given vehicle, with increased levels of the tight junction mediators claudin-5 and JAM-A. Systemic administration of EGF to septic alcohol-fed mice also decreased intestinal apoptosis with an improvement in the Bax/Bcl-2 ratio. EGF also improved both crypt proliferation and villus length in septic alcohol-fed mice. EGF administration resulted in lower levels of both pro- and anti-inflammatory cytokines MCP-1, TNF and IL-10 in alcohol-fed mice. EGF is therefore effective at improving both intestinal integrity and mortality following sepsis in mice with chronic alcohol ingestion. However, the efficacy of EGF in sepsis is blunted in the setting of chronic alcohol ingestion, as intestinal integrity and mortality in alcohol-fed mice given EGF improves animals to levels seen in water-fed mice given vehicle but does not approach levels seen in water-fed mice given EGF. PMID:27465753

Epidermal Growth Factor Improves Intestinal Integrity and Survival in Murine Sepsis Following Chronic Alcohol Ingestion.

PubMed

Klingensmith, Nathan J; Yoseph, Benyam P; Liang, Zhe; Lyons, John D; Burd, Eileen M; Margoles, Lindsay M; Koval, Michael; Ford, Mandy L; Coopersmith, Craig M

2017-02-01

Epidermal growth factor (EGF) is a cytoprotective protein that improves survival in preclinical models of sepsis through its beneficial effects on intestinal integrity. Alcohol use disorder worsens intestinal integrity and is associated with increased morbidity and mortality in critical illness. We sought to determine whether chronic alcohol ingestion alters the host response to systemic administration of EGF in sepsis. Six-week-old FVB/N mice were randomized to receive 20% alcohol or water for 12 weeks. All mice then underwent cecal ligation and puncture to induce polymicrobial sepsis. Mice were then randomized to receive either intraperitoneal injection of EGF (150 μg/kg/day) or normal saline. Water-fed mice given EGF had decreased 7-day mortality compared with water-fed mice (18% vs. 55%). Alcohol-fed mice given EGF also had decreased 7-day mortality compared with alcohol-fed mice (48% vs. 79%). Notably, while systemic EGF improved absolute survival to a similar degree in both water-fed and alcohol-fed mice, mortality was significantly higher in alcohol+EGF mice compared with water+EGF mice. Compared with water-fed septic mice, alcohol-fed septic mice had worsened intestinal integrity with intestinal hyperpermeability, increased intestinal epithelial apoptosis, decreased proliferation and shorter villus length. Systemic administration of EGF to septic alcohol-fed mice decreased intestinal permeability compared with septic alcohol-fed mice given vehicle, with increased levels of the tight junction mediators claudin-5 and JAM-A. Systemic administration of EGF to septic alcohol-fed mice also decreased intestinal apoptosis with an improvement in the Bax/Bcl-2 ratio. EGF also improved both crypt proliferation and villus length in septic alcohol-fed mice. EGF administration resulted in lower levels of both pro- and anti-inflammatory cytokines monocyte chemoattractant protein-1, tumor necrosis factor, and interleukin 10 in alcohol-fed mice. EGF is therefore effective at improving both intestinal integrity and mortality following sepsis in mice with chronic alcohol ingestion. However, the efficacy of EGF in sepsis is blunted in the setting of chronic alcohol ingestion, as intestinal integrity and mortality in alcohol-fed mice given EGF improves animals to levels seen in water-fed mice given vehicle but does not approach levels seen in water-fed mice given EGF.

Septic systems as sources of organic wastewater compounds in domestic drinking water wells in a shallow sand and gravel aquifer.

PubMed

Schaider, Laurel A; Ackerman, Janet M; Rudel, Ruthann A

2016-03-15

Domestic drinking water wells serve 44 million people in the US and are common globally. They are often located in areas served by onsite wastewater treatment systems, including septic systems, which can be sources of biological and chemical pollutants to groundwater. In this study we tested 20 domestic drinking water wells in a sand and gravel aquifer on Cape Cod, Massachusetts, USA, for 117 organic wastewater compounds (OWCs) and for inorganic markers of septic system impact. We detected 27 OWCs, including 12 pharmaceuticals, five per- and polyfluoroalkyl substances (PFASs), four organophosphate flame retardants, and an artificial sweetener (acesulfame). Maximum concentrations of several PFASs and pharmaceuticals were relatively high compared to public drinking water supplies in the US. The number of detected OWCs and total concentrations of pharmaceuticals and of PFASs were positively correlated with nitrate, boron, and acesulfame and negatively correlated with well depth. These wells were all located in areas served exclusively by onsite wastewater treatment systems, which are likely the main source of the OWCs in these wells, although landfill leachate may also be a source. Our results suggest that current regulations to protect domestic wells from pathogens in septic system discharges do not prevent OWCs from reaching domestic wells, and that nitrate, a commonly measured drinking water contaminant, is a useful screening tool for OWCs in domestic wells. Nitrate concentrations of 1mg/L NO3-N, which are tenfold higher than local background and tenfold lower than the US federal drinking water standard, were associated with wastewater impacts from OWCs in this study. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Cost-effectiveness of nitrogen mitigation by alternative household wastewater management technologies.

PubMed

Wood, Alison; Blackhurst, Michael; Hawkins, Troy; Xue, Xiaobo; Ashbolt, Nicholas; Garland, Jay

2015-03-01

Household wastewater, especially from conventional septic systems, is a major contributor to nitrogen pollution. Alternative household wastewater management technologies provide similar sewerage management services but their life cycle costs and nitrogen flow implications remain uncertain. This paper addresses two key questions: (1) what are the total costs, nitrogen mitigation potential, and cost-effectiveness of a range of conventional and alternative municipal wastewater treatment technologies, and (2) what uncertainties influence these outcomes and how can we improve our understanding of these technologies? We estimate a household nitrogen mass balance for various household wastewater treatment systems and combine this mass balance with life cycle cost assessment to calculate the cost-effectiveness of nitrogen mitigation, which we define as nitrogen removed from the local watershed. We apply our methods to Falmouth, MA, where failing septic systems have caused heightened eutrophication in local receiving water bodies. We find that flushing and dry (composting) urine-diversion toilets paired with conventional septic systems for greywater management demonstrate the lowest life cycle cost and highest cost-effectiveness (dollars per kilogram of nitrogen removed from the watershed). Composting toilets are also attractive options in some cases, particularly best-case nitrogen mitigation. Innovative/advanced septic systems designed for high-level nitrogen removal are cost-competitive options for newly constructed homes, except at their most expensive. A centralized wastewater treatment plant is the most expensive and least cost-effective option in all cases. Using a greywater recycling system with any treatment technology increases the cost without adding any nitrogen removal benefits. Sensitivity analysis shows that these results are robust considering a range of cases and uncertainties. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

A model of Staphylococcus aureus bacteremia, septic arthritis, and osteomyelitis in chickens.

PubMed

Daum, R S; Davis, W H; Farris, K B; Campeau, R J; Mulvihill, D M; Shane, S M

1990-11-01

We studied the occurrence, magnitude, and kinetics of bacteremia and the resultant osteomyelitis and septic arthritis in an avian model of Staphylococcus aureus infection. Thirty-day-old male broiler chicks were inoculated i.v. with 10(5), 10(6), or 10(7) cfu of strain Duntravis, a beta-hemolytic, coagulase-producing, capsular type 8 isolate from the synovial fluid of a 2-year-old black boy. Bacteremia occurred in 80%, 90%, and 100% of animals inoculated with 10(5), 10(6), or 10(7) cfu, respectively. The magnitude of bacteremia in surviving, bacteremic animals increased for 96 hours after inoculation and then decreased after a plateau phase. Osteomyelitis and septic arthritis occurred only in chicks that were continuously bacteremic. The occurrence of osteomyelitis was uniform among continuously bacteremic animals and developed 1 to 23 hours after inoculation. Chickens are susceptible to systemic infections with S. aureus. Bacteremia, osteomyelitis, and septic arthritis may be induced in healthy chickens without prior manipulations that depress their resistance.

Prehospital triage of septic patients at the SAMU regulation: Comparison of qSOFA, MRST, MEWS and PRESEP scores.

PubMed

Jouffroy, R; Saade, A; Ellouze, S; Carpentier, A; Michaloux, M; Carli, P; Vivien, B

2018-05-01

A couple of scoring systems have been developed for risk stratification of septic patients. Their performance in the management of out-of-hospital initial care delivery is not documented. This study try to evaluate the predictive ability of Quick Sequential Organ Failure Assessment (qSOFA), Robson Screening Tool (RST), Modified Early Warning Score (MEWS) and Prehospital Early Sepsis Detection (PRESEP) scores on out of-hospital triage of septic patients, to predict intensive care unit (ICU) admission. A retrospective study using call records received by the SAMU 15 regulation call centre including all patients with presumed septic shock was performed. The primary outcome was the admission to the ICU. Among the 47 000 reports received, 37 patients with presumed septic shock were included. Twenty-two patients (59%) were admitted to ICU. AUCs of qSOFA, RST, MEWS and PRESEP scores were respectively 0.40 [0.22-0.59], 0.60 [0.43-0.78], 0.66 [0.47-0.85] and 0.67 [0.51-0.84]. RST outperformed PRESEP, MEWS and qSOFA for sensitivity (1, 0.92, 0.85 and 0.62 respectively). MEWS showed better specificity than PRESEP, MRST and qSOFA (0.33, 0.29, 0.16 and 0.16). MEWS showed comparable positive predictive value than PRESEP and outperformed MRST and qSOFA (0.41, 0.41, 0.39 and 0.29 respectively). Negative predictive value of MRST outperformed PRESEP, MEWS and qSOFA (1, 0.88, 0.80 and 0.44 respectively). Our findings suggest that screening patients at SAMU 15 regulation call centre using qSOFA, MRST, MEWS and PRESEP scores to predict ICU admission is irrelevant. Development of a specific scoring system for out-of-hospital triage of septic patients is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Intestine-Specific Mttp Deletion Decreases Mortality and Prevents Sepsis-Induced Intestinal Injury in a Murine Model of Pseudomonas aeruginosa Pneumonia

PubMed Central

Dominguez, Jessica A.; Xie, Yan; Dunne, W. Michael; Yoseph, Benyam P.; Burd, Eileen M.; Coopersmith, Craig M.; Davidson, Nicholas O.

2012-01-01

Background The small intestine plays a crucial role in the pathophysiology of sepsis and has been referred to as the “motor” of the systemic inflammatory response. One proposed mechanism is that toxic gut-derived lipid factors, transported in mesenteric lymph, induce systemic injury and distant organ failure. However, the pathways involved are yet to be defined and the role of intestinal chylomicron assembly and secretion in transporting these lipid factors is unknown. Here we studied the outcome of sepsis in mice with conditional, intestine-specific deletion of microsomal triglyceride transfer protein (Mttp-IKO), which exhibit a block in chylomicron assembly together with lipid malabsorption. Methodology/Principal Findings Mttp-IKO mice and controls underwent intratracheal injection with either Pseudomonas aeruginosa or sterile saline. Mttp-IKO mice exhibited decreased seven-day mortality, with 0/20 (0%) dying compared to 5/17 (29%) control mice (p<0.05). This survival advantage in Mttp-IKO mice, however, was not associated with improvements in pulmonary bacterial clearance or neutrophil infiltration. Rather, Mttp-IKO mice exhibited protection against sepsis-associated decreases in villus length and intestinal proliferation and were also protected against increased intestinal apoptosis, both central features in control septic mice. Serum IL-6 levels, a major predictor of mortality in human and mouse models of sepsis, were elevated 8-fold in septic control mice but remained unaltered in septic Mttp-IKO mice. Serum high density lipoprotein (HDL) levels were reduced in septic control mice but were increased in septic Mttp-IKO mice. The decreased levels of HDL were associated with decreased hepatic expression of apolipoprotein A1 in septic control mice. Conclusions/Significance These studies suggest that strategies directed at blocking intestinal chylomicron secretion may attenuate the progression and improve the outcome of sepsis through effects mediated by metabolic and physiological adaptations in both intestinal and hepatic lipid flux. PMID:23145105

A multiplex cytokine score for the prediction of disease severity in pediatric hematology/oncology patients with septic shock.

PubMed

Xu, Xiao-Jun; Tang, Yong-Min; Song, Hua; Yang, Shi-Long; Xu, Wei-Qun; Shi, Shu-Wen; Zhao, Ning; Liao, Chan

2013-11-01

Although many inflammatory cytokines are prognostic in sepsis, the utility of cytokines in evaluating disease severity in pediatric hematology/oncology patients with septic shock was rarely studied. On the other hand, a single particular cytokine is far from ideal in guiding therapeutic intervention, but combination of multiple biomarkers improves the accuracy. In this prospective observational study, 111 episodes of septic shock in pediatric hematology/oncology patients were enrolled from 2006 through 2012. Blood samples were taken for inflammatory cytokine measurement by cytometric bead array (CBA) technology at the initial onset of septic shock. Interleukin (IL)-6 and IL-10 were significantly elevated in majority of patients, while tumor necrosis factor (TNF)-α and interferon (IFN)-γ were markedly increased in patients with high pediatric index of mortality 2 (PIM2) score and non-survivors. All the four cytokines paralleled the PIM2 score and differentially correlated with hemodynamic disorder and fatal outcomes. The pediatric multiplex cytokine score (PMCS), which integrated the four cytokines into one score system, was related to hemodynamic disorder and mortality as well, but showed more powerful prediction ability than each of the four cytokines. PMCS was an independent predictive factor for fatal outcome, presenting similar discriminative power with PIM2, with accuracy of 0.83 (95% CI, 0.71-0.94). In conclusion, this study develops a cytokine scoring system based on CBA technique, which performs well in disease severity and fatality prediction in pediatric hematology/oncology patients with septic shock. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pylephlebitis and Crohn's disease: A rare case of septic shock.

PubMed

Scaringi, Stefano; Giudici, Francesco; Gabbani, Giacomo; Zambonin, Daniela; Morelli, Marco; Carrà, Rossella; Bechi, Paolo

2017-01-01

Troncular pylephlebitis, defined as septic thrombophlebitis of the portal vein, is usually secondary to suppurative infection from the regions drained by the portal system. Therefore, pylephlebitis can occur from the portal vein main tributaries. The occurrence of mesenteric pylephlebitis in Crohn's disease is extremely rare. We describe a case of septic shock due to mesenteric pylephlebitis in a 47 years old male affected with Crohn's disease. The patient was admitted to the emergency department after he had been complained from 3h of a peri-umbilical abdominal pain associated to fever and shivering quickly followed by a severe hypotension. His medical history included histologically confirmed ileal Crohn's disease diagnosed 4 years before and treated with mesalamine only. Computed tomography scan confirmed the mesenteric pylephlebitis diagnosis. After medical therapy with antibiotics and systemic nutrition, the patient was successfully operated to treat his ileal Crohn's disease. In our case, the quick onset of a septic shock was not due to a peritonitis complicating a Crohn's disease, but to a rare condition not needing an urgent surgical resolution. This report shows that, even in Crohn's disease, once diagnosis is performed, antibiotic therapy associated to enteral and parenteral nutrition can lead to a complete clinical remission of mesenteric pylephlebitis, mandatory to perform an elective surgery. This case highlights the importance of promptly considerate and treat mesenteric pylephlebitis in presence of a septic shock in a Crohn's disease patient who is not showing clinical signs of peritonitis. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Septic tank additive impacts on microbial populations.

PubMed

Pradhan, S; Hoover, M T; Clark, G H; Gumpertz, M; Wollum, A G; Cobb, C; Strock, J

2008-01-01

Environmental health specialists, other onsite wastewater professionals, scientists, and homeowners have questioned the effectiveness of septic tank additives. This paper describes an independent, third-party, field scale, research study of the effects of three liquid bacterial septic tank additives and a control (no additive) on septic tank microbial populations. Microbial populations were measured quarterly in a field study for 12 months in 48 full-size, functioning septic tanks. Bacterial populations in the 48 septic tanks were statistically analyzed with a mixed linear model. Additive effects were assessed for three septic tank maintenance levels (low, intermediate, and high). Dunnett's t-test for tank bacteria (alpha = .05) indicated that none of the treatments were significantly different, overall, from the control at the statistical level tested. In addition, the additives had no significant effects on septic tank bacterial populations at any of the septic tank maintenance levels. Additional controlled, field-based research iswarranted, however, to address additional additives and experimental conditions.

Assessment of total PPCP Pollution in Water Samples Using a New Contamination Index

NASA Astrophysics Data System (ADS)

Conkle, J. L.; Huang, W.; Sickman, J. O.; Gan, J.

2012-12-01

Numerous studies document the presence of pharmaceutical and personal care products (PPCPs) in the environment, specifically near treated wastewater effluent, septic discharge and large-scale agricultural operations. Additionally, managed aquifer recharge may be a source of these contaminants. Groundwater quality is a major concern in California, as ~40% of residents consume it domestically and some communities such as Beaumont, depend on it entirely. Groundwater in Beaumont is influenced by all of the PPCP sources mentioned above. In the Beaumont Groundwater Management Zone we observed four distinct regions of groundwater that could be described according to their levels of anthropogenic impacts. The groundwater regions heavily influenced by wastewater effluent, high densities of septic systems and managed aquifer recharge had the highest concentrations and detections of PPCPs. To better describe the total levels of pollution and place our findings in the context of the greater body of data on PPCPs in the aquatic environment, a PPCP contamination index was developed from the peer-reviewed literature. The index equation was developed and validated using 21 previously published studies (285 total samples) on PPCPs in the aquatic environment as well as through sensitivity analysis. From the published literature we determined index values that fall into three classes: light (<1.8), moderate (1.8 - 4.1) and heavy (>4.1). PPCP contamination in Coopers Creek near the Beaumont WWTP discharge was at the upper end of the moderate range (3.6 to 3.8). The groundwater wells along the flow path of Coopers Creek were lightly contaminated (1.3 to 1.8) and groundwater wells influenced by septic waste and managed aquifer recharge were all <1. These values are typical for groundwater and wastewater effluent mixed with surface water found in the literature at PPCP contaminated sites. In addition to describing total PPCP contamination within a study, this index will also allow for researchers to compare contamination levels across studies, compare the effectiveness of sampling and analytical techniques and simplify statistical analysis such as principal component analysis.

The effects of urbanization on the hydrochemistry of base flow within the Chattahoochee River Basin (Georgia, USA)

NASA Astrophysics Data System (ADS)

Rose, Seth

2007-07-01

SummaryA comprehensive network of stream data ( n = 50) was used to assess the effects of urbanization upon the hydrochemical variation within base flow in the Chattahoochee River Basin (CRB), Georgia (USA). Base flow solute concentrations (particularly sulfate, chloride, bicarbonate alkalinity, and sodium) increase with the degree of urbanization and any degree of urbanization within the Atlanta Metropolitan Region (AMR) results in elevated base flow solute concentrations. This suggests that there are pervasive low-level non-point sources of contamination such as septic tanks systems and leaky sewer lines affecting the chemistry of shallow groundwater throughout much of the AMR and CRB. Six groups or subsets representing the "rural-to-urban gradient" were defined, characterized by the following order of increasing solute concentrations: rural basins < Chattahoochee River. semi-urbanized basins < urbanized basins < urban basins with main sewer trunk lines < urbanized basins directly receiving treated effluent and combined sewer overflow (CSO) basins. There is a strong and unusual basin-wide correlation ( r2 values >0.79) between Na-K-Cl within the CRB that likely reflects the widespread input of electrolytes present in human wastes and wastewater. The most likely source and pathway for contaminant input involves the mobilization of salts, originally present in waste water, within the riparian or hypoheric zone.

Effects of septic-tank effluent on ground-water quality in northern Williamson County and southern Davidson County, Tennessee

USGS Publications Warehouse

Hanchar, D.W.

1991-01-01

An investigation of the potential contamination of ground water from septic tank systems blasted in bedrock in Williamson and Davidson Counties, Tennessee, was conducted during 1988-89. Water samples were collected from domestic and observation wells, springs, and surface-water sites in a residential subdivision in the northern part of Williamson County near Nashville. The subdivision has a high density of septic-tank field lines installed into blasted bedrock Water samples also were collected from a well located in an area of Davidson County where field lines were installed in 5 feet of soil. Samples were analyzed for major inorganic constituents, nutrients, total organic carbon, optical brighteners, and bacteria. Although results of analyses of water samples from wells indicate no effect of septic-tank effluent on ground-water quality at these sites, water from two springs located downgradient from the subdivision had slightly larger concentrations of nitrite plus nitrate (2.2 and 2.7 milligrams per liter N), and much larger concentrations of fecal coliform and fecal streptococci bacteria (2,000 to 3,200 and 700 to 900 colonies per 100 milliliters of sample, respectively), than other wells and springs sampled during 1988. Water from one of these springs contained optical brighteners, which indicates that septic-tank effluent is affecting ground-water quality.

A measure for provisional-and-urgent sanitary improvement in developing countries: septic-tank performance improvement.

PubMed

Harada, H; Dong, N T; Matsui, S

2008-01-01

Although many cities have planed to develop sewerages in developing countries, sewerage establishment still requires huge investment and engineering efforts. Improvement of existing sanitation facilities may contribute the betterment of urban sanitation before sewerage establishment. The purpose of this study is to propose a measure to improve urban sanitation in areas where a sewerage development plan is proposed but has not been yet established, based on a case study in Hanoi, Vietnam. We found that 90.5% of human excreta flowed into septic tanks. However, 89.6% of septic tanks have never been desludged in the past and their performance was observed to be at a low level. The study also showed that if they introduce regular desludging with a frequency of once a year, they can eliminate 72.8% of COD loads from septic tanks. It was indicated that the performance can be dramatically recovered by regular desludging, which could contribute urban sanitation improvement in Hanoi. In conclusion, the performance recovery of septic tanks by regular desludging was proposed as a provisional-and-urgent measure for urban sanitation improvement, together with the septage treatment in sewage sludge treatment facilities, which should be established earlier than other facilities of sewage treatment systems. IWA Publishing 2008.

Raoultella planticola bacteremia-induced fatal septic shock following burn injury.

PubMed

Yumoto, Tetsuya; Naito, Hiromichi; Ihoriya, Hiromi; Tsukahara, Kohei; Ota, Tomoyuki; Watanabe, Toshiyuki; Nakao, Atsunori

2018-05-04

Raoultella planticola, a Gram-negative, aerobic bacillus commonly isolated from soil and water, rarely causes invasive infections in humans. Septic shock from R. planticola after burn injury has not been previously reported. A 79-year-old male was admitted to the emergency intensive care unit after extensive flame burn injury. He accidently caught fire while burning trash and plunged into a nearby tank filled with contaminated rainwater to extinguish the fire. The patient developed septic shock on day 10. The blood culture detected R. planticola, which was identified using the VITEK-2 biochemical identification system. Although appropriate antibiotic treatment was continued, the patient died on day 12. Clinicians should be aware of fatal infections in patients with burn injury complicated by exposure to contaminated water.

Evaluation of risk factors and development of acute kidney injury in aneurysmal subarachnoid hemorrhage, head injury, and severe sepsis/septic shock patients during ICU treatment.

PubMed

Kamar, Ceren; Ali, Achmet; Altun, Demet; Orhun, Günseli; Sabancı, Akın; Sencer, Altay; Akıncı, İbrahim Özkan

2017-01-01

There are few studies examining development of acute kidney injury (AKI) in the various types of patients in intensive care units (ICUs). Presently described is evaluation of risk factors and development of AKI in different groups of ICU patients. Present study was performed in 3 different ICUs. Development of AKI was measured using Acute Kidney Injury Network (AKIN) classification system. Total of 300 patients who were treated in trauma, neurosurgery, or general ICU departments (due to head injury, aneurysmal subarachnoid hemorrhage [aSAH], or severe sepsis/septic shock, respectively) were assessed for incidence, risk factors, and development of AKI. AKI did not develop in aSAH patients when evaluated based on serum creatinine level; however, it was observed in 5% of aSAH patients according to volume adjusted creatinine (VACr) level. AKI developed in 76% of sepsis group, and in 20% of head injury group, based on AKIN classification, according to both serum and VACr levels. Incidence of AKI was significantly higher in sepsis group (p<0.001). Only use of vasopressor was significantly related to AKI development in sepsis and head injury groups. Mortality rate was 8%, 22%, and 42% in aSAH, head injury, and sepsis groups, respectively. AKI development and vasopressor use were significantly related to mortality in sepsis group. Despite similar characteristics and risk factors, there were fewer instances of AKI in aSAH group. Hypertension or hydration therapy used to treat vasospasm and polyuria due to cerebral salt-wasting syndrome may prevent aSAH patients from developing AKI.

Sewage contamination of a densely populated coral 'atoll' (Bermuda).

PubMed

Jones, Ross; Parsons, Rachel; Watkinson, Elaine; Kendell, David

2011-08-01

Bermuda is a densely populated coral 'atoll' located on a seamount in the mid-Atlantic (Sargasso Sea). There is no national sewerage system and the ∼20 × 10(6) L of sewage generated daily is disposed of via marine outfalls, cess pits/septic tanks underneath houses and through waste disposal (injection) wells. Gastrointestinal (GI) enterococci concentrations were measured in surface seawater samples collected monthly at multiple locations across the island over a 5-year period. According to the EU Bathing Water Directive microbial classification categories, 18 of the sites were in the 'excellent' category, four sites in the 'good', five sites were in the 'sufficient' and three sites in the 'poor' categories. One of the sites in the 'poor' category is beside a popular swimming beach. Between 20-30% of 58 sub tidal sediment samples collected from creeks, coves, bays, harbours and marinas in the Great Sound complex on the western side of Bermuda tested positive for the presence of the human specific bacterial biomarker Bacteroides (using culture-independent PCR-based methods) and for the faecal biomarker coprostanol (5β-cholestan-3-β-ol, which ranged in concentration from <0.05-0.77 mg kg( - 1). There was a significant statistical correlation between these two independent techniques for faecal contamination identification. Overall the microbial water quality and sedimentary biomarker surveys suggest sewage contamination in Bermuda was quite low compared with other published studies; nevertheless, several sewage contamination hotpots exist, and these could be attributed to discharge of raw sewage from house boats, from nearby sewage outfalls and leakage from septic tanks/cess pits.

Septic tanks as larval habitats for the mosquitoes Aedes aegypti and Culex quinquefasciatus in Playa-Playita, Puerto Rico.

PubMed

Burke, R; Barrera, R; Lewis, M; Kluchinsky, T; Claborn, D

2010-06-01

Adult Aedes aegypti (Linnaeus) (Diptera: Culicidae) were previously recovered from emergence traps on septic tanks in southeastern Puerto Rico. In this study we quantified immature mosquito abundance and its relationship with structural variables of the septic tanks and chemical properties of the water containing raw sewage. A miniaturized floating funnel trap was used to sample 89 septic tanks for larvae in the Puerto Rican community of Playa-Playita. Aedes aegypti larvae were recovered from 18% of the sampled tanks (10.3 larvae per septic tank per day). Larval presence was positively associated with cracking of the septic tank walls and uncovered access ports. Larval abundance was positively associated with cracking of the septic tank walls and larger tank surface areas, and inversely associated with the total dissolved solids (TDS). Culex quinquefasciatus (Say) larvae were also recovered from 74% of the septic tanks (129.6 larvae per septic tank per day). Larval presence was negatively associated with TDS in the water and larval abundance was positively associated with cracking of the septic tank walls. A screened, plastic emergence trap was used to sample 93 septic tanks within the community for Ae. aegypti and Cx. quinquefasciatus adults. Aedes aegypti adults were recovered from 49% of the sampled tanks (8.7 adults per septic tank per day) and Cx. quinquefasciatus adults were recovered from 97% of the sampled tanks (155.5 adults per septic tank per day). Aedes aegypti adult presence was positively associated with cracking, uncapped openings and septic water pH. The Ae. aegypti adult counts were positively associated with cracking and inversely associated with TDS and conductivity. This study marks the first published record of the recovery of Ae. aegypti larvae from holding tanks containing raw sewage in the Caribbean region. Our study indicates that Ae. aegypti larvae are present in sewage water and that septic tanks have at least the potential to maintain dengue transmission during the dry season.

Enhanced sludge reduction in septic tanks by increasing temperature.

PubMed

Pussayanavin, Tatchai; Koottatep, Thammarat; Eamrat, Rawintra; Polprasert, Chongrak

2015-01-01

Septic tanks in most developing countries are constructed without drainage trenches or leaching fields to treat toilet wastewater and /or grey water. Due to the short hydraulic retention time, effluents of these septic tanks are still highly polluted, and there is usually high accumulation of septic tank sludge or septage containing high levels of organics and pathogens that requires frequent desludging and subsequent treatment. This study aimed to reduce sludge accumulation in septic tanks by increasing temperatures of the septic tank content. An experimental study employing two laboratory-scale septic tanks fed with diluted septage and operating at temperatures of 40 and 30°C was conducted. At steady-state conditions, there were more methanogenic activities occurring in the sludge layer of the septic tank operating at the temperature of 40°C, resulting in less total volatile solids (TVS) or sludge accumulation and more methane (CH4) production than in the unit operating at 30°C. Molecular analysis found more abundance and diversity of methanogenic microorganisms in the septic tank sludge operating at 40°C than at 30°C. The reduced TVS accumulation in the 40°C septic tank would lengthen the period of septage removal, resulting in a cost-saving in desluging and septage treatment. Cost-benefit analysis of increasing temperatures in septic tanks was discussed.

Greenhouse gas emissions from on-site wastewater treatment systems

NASA Astrophysics Data System (ADS)

Somlai-Haase, Celia; Knappe, Jan; Gill, Laurence

2016-04-01

Nearly one third of the Irish population relies on decentralized domestic wastewater treatment systems which involve the discharge of effluent into the soil via a percolation area (drain field). In such systems, wastewater from single households is initially treated on-site either by a septic tank and an additional packaged secondary treatment unit, in which the influent organic matter is converted into carbon dioxide (CO2) and methane (CH4) by microbial mediated processes. The effluent from the tanks is released into the soil for further treatment in the unsaturated zone where additional CO2 and CH4 are emitted to the atmosphere as well as nitrous oxide (N2O) from the partial denitrification of nitrate. Hence, considering the large number of on-site systems in Ireland and internationally, these are potential significant sources of greenhouse gas (GHG) emissions, and yet have received almost no direct field measurement. Here we present the first attempt to quantify and qualify the production and emissions of GHGs from a septic tank system serving a single house in the County Westmeath, Ireland. We have sampled the water for dissolved CO2, CH4 and N2O and measured the gas flux from the water surface in the septic tank. We have also carried out long-term flux measurements of CO2 from the drain field, using an automated soil gas flux system (LI-8100A, Li-Cor®) covering a whole year semi-continuously. This has enabled the CO2 emissions from the unsaturated zone to be correlated against different meteorological parameters over an annual cycle. In addition, we have integrated an ultraportable GHG analyser (UGGA, Los Gatos Research Inc.) into the automated soil gas flux system to measure CH4 flux. Further, manual sampling has also provided a better understanding of N2O emissions from the septic tank system.

Systolic blood pressure variability in patients with early severe sepsis or septic shock: a prospective cohort study.

PubMed

Tang, Yi; Sorenson, Jeff; Lanspa, Michael; Grissom, Colin K; Mathews, V J; Brown, Samuel M

2017-06-17

Severe sepsis and septic shock are often lethal syndromes, in which the autonomic nervous system may fail to maintain adequate blood pressure. Heart rate variability has been associated with outcomes in sepsis. Whether systolic blood pressure (SBP) variability is associated with clinical outcomes in septic patients is unknown. The propose of this study is to determine whether variability in SBP correlates with vasopressor independence and mortality among septic patients. We prospectively studied patients with severe sepsis or septic shock, admitted to an intensive care unit (ICU) with an arterial catheter. We analyzed SBP variability on the first 5-min window immediately following ICU admission. We performed principal component analysis of multidimensional complexity, and used the first principal component (PC 1 ) as input for Firth logistic regression, controlling for mean systolic pressure (SBP) in the primary analyses, and Acute Physiology and Chronic Health Evaluation (APACHE) II score or NEE dose in the ancillary analyses. Prespecified outcomes were vasopressor independence at 24 h (primary), and 28-day mortality (secondary). We studied 51 patients, 51% of whom achieved vasopressor independence at 24 h. Ten percent died at 28 days. PC 1 represented 26% of the variance in complexity measures. PC 1 was not associated with vasopressor independence on Firth logistic regression (OR 1.04; 95% CI: 0.93-1.16; p = 0.54), but was associated with 28-day mortality (OR 1.16, 95% CI: 1.01-1.35, p = 0.040). Early SBP variability appears to be associated with 28-day mortality in patients with severe sepsis and septic shock.

Combination of Acute Physiology and Chronic Health Evaluation II score, early lactate area, and N-terminal prohormone of brain natriuretic peptide levels as a predictor of mortality in geriatric patients with septic shock.

PubMed

Wang, Hao; Li, Zhong; Yin, Mei; Chen, Xiao-Mei; Ding, Shi-Fang; Li, Chen; Zhai, Qian; Li, Yuan; Liu, Han; Wu, Da-Wei

2015-04-01

Given the high mortality rates in elderly patients with septic shock, the early recognition of patients at greatest risk of death is crucial for the implementation of early intervention strategies. Serum lactate and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels are often elevated in elderly patients with septic shock and are therefore important biomarkers of metabolic and cardiac dysfunction. We hypothesized that a risk stratification system that incorporates the Acute Physiology and Chronic Health Evaluation (APACHE) II score and lactate and NT-proBNP biomarkers would better predict mortality in geriatric patients with septic shock than the APACHE II score alone. A single-center prospective study was conducted from January 2012 to December 2013 in a 30-bed intensive care unit of a triservice hospital. The lactate area score was defined as the sum of the area under the curve of serial lactate levels measured during the 24 hours following admission divided by 24. The NT-proBNP score was assigned based on NT-proBNP levels measured at admission. The combined score was calculated by adding the lactate area and NT-proBNP scores to the APACHE II score. Multivariate logistic regression analyses and receiver operating characteristic curves were used to evaluate which variables and scoring systems served as the best predictors of mortality in elderly septic patients. A total of 115 patients with septic shock were included in the study. The overall 28-day mortality rate was 67.0%. When compared to survivors, nonsurvivors had significantly higher lactate area scores, NT-proBNP scores, APACHE II scores, and combined scores. In the multivariate regression model, the combined score, lactate area score, and mechanical ventilation were independent risk factors associated with death. Receiver operating characteristic curves indicated that the combined score had significantly greater predictive power when compared to the APACHE II score or the NT-proBNP score (P < .05). A combined score that incorporates the APACHE II score with early lactate area and NT-proBNP levels is a useful method for risk stratification in geriatric patients with septic shock. Copyright © 2014 Elsevier Inc. All rights reserved.

Corrective Action Plan for Corrective Action Unit 563: Septic Systems, Nevada Test Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

NSTec Environmental Restoration

This Corrective Action Plan (CAP) has been prepared for Corrective Action Unit (CAU) 563, Septic Systems, in accordance with the Federal Facility Agreement and Consent Order. CAU 563 consists of four Corrective Action Sites (CASs) located in Areas 3 and 12 of the Nevada Test Site. CAU 563 consists of the following CASs: CAS 03-04-02, Area 3 Subdock Septic Tank CAS 03-59-05, Area 3 Subdock Cesspool CAS 12-59-01, Drilling/Welding Shop Septic Tanks CAS 12-60-01, Drilling/Welding Shop Outfalls Site characterization activities were performed in 2007, and the results are presented in Appendix A of the CAU 563 Corrective Action Decision Document.more » The scope of work required to implement the recommended closure alternatives is summarized below. CAS 03-04-02, Area 3 Subdock Septic Tank, contains no contaminants of concern (COCs) above action levels. No further action is required for this site; however, as a best management practice (BMP), all aboveground features (e.g., riser pipes and bumper posts) will be removed, the septic tank will be removed, and all open pipe ends will be sealed with grout. CAS 03-59-05, Area 3 Subdock Cesspool, contains no COCs above action levels. No further action is required for this site; however, as a BMP, all aboveground features (e.g., riser pipes and bumper posts) will be removed, the cesspool will be abandoned by filling it with sand or native soil, and all open pipe ends will be sealed with grout. CAS 12-59-01, Drilling/Welding Shop Septic Tanks, will be clean closed by excavating approximately 4 cubic yards (yd3) of arsenic- and chromium-impacted soil. In addition, as a BMP, the liquid in the South Tank will be removed, the North Tank will be removed or filled with grout and left in place, the South Tank will be filled with grout and left in place, all open pipe ends will be sealed with grout or similar material, approximately 10 yd3 of chlordane-impacted soil will be excavated, and debris within the CAS boundary will be removed. CAS 12-60-01, Drilling/Welding Shop Outfalls, contains no COCs above action levels. No further action is required for this site; however, as a BMP, three drain pipe openings will be sealed with grout.« less

Demonstration of anaerobic stabilization of black water in accumulation systems under tropical conditions.

PubMed

Chaggu, Esnati J; Sanders, Wendy; Lettinga, Gatze

2007-11-01

The anaerobic digestion of "human waste" was studied at Mlalakuwa residential settlement in Dar-es-Salaam, Tanzania at ambient tropical temperatures (24-31 degrees C). This settlement experiences a high water table with flooding during the rainy season, resulting in a very costly emptying of the latrines once per month. To improve the situation, two plastic tanks (while one is in use, the other one is on stand-by) of 3000 l capacity each, named as Improved Pit-Latrines Without Urine Separation (IMPLWUS), were used as latrine pits. They received faeces+urine+wash water; basically, an accumulation system. Septic tank seed sludge was used. The dissolved chemical oxygen demand (COD(dis)) remaining when the reactor was closed after 380 days was about 8 g COD/l, volatile fatty acids were 100 mg COD/l and total ammonium nitrogen was about 2.8 g N/l, implying the possibility of methanogenesis inhibition. Stability results indicated a need for more degradation time after reactor closure. Estimated biogas production from wastewater generated by 10 people was 544 g COD-CH(4)/day, not enough for cooking purposes.

Availability and quality of ground water in the Piedmont Province of Virginia

USGS Publications Warehouse

Powell, John Duane; Abe, Joseph M.

1985-01-01

The Piedmont Province of Virginia has an ample supply of groundwater, (perhaps as much as 1.5 billion gallons are in storage per sq mi) generally suitable for domestic and small supply needs. The source of this groundwater is precipitation, which is stored in the pore spaces of the regolith and in fractures in the underlying bedrock of crystalline rocks. Water within the sedimentary rocks of the sedimentary basins is stored in bedding planes, fractures, and in pore spaces in the rock, and in the regolith. Well yields can be minimized in both terrains by constructing wells along lineaments and in valleys. Groundwater in the crystalline rock is generally slightly mineralized and acidic (pH is greater than 7.0). Dissolved solids concentration in deep wells ( < 500 ft) in sedimentary rock may exceed tolerable limits. Land disposal of solid wastes and sewage for domestic septic systems present the major threat to groundwater quality. A greater understanding of the groundwater system in the Virginia Piedmont could be used to anticipate future shortages so that preventive measures could be implemented to protect the groundwater reservoir. (Author 's abstract)

[Management of septic arthritis].

PubMed

Debrach, Anne-Cécile; Lazarou, Ilias; Gabay, Cem; Uçkay, Ilker

2018-03-07

Native joint septic arthritis is a medical emergency requiring urgent joint drainage and antibiotic therapy. In the absence of an artificial joint or a foreign body, the « rheumatological approach » with repetitive arthrocentesis yields similar outcomes in the literature when compared to surgical drainage. Arthrocentesis could therefore be viewed as the preferential method of joint drainage as it is associated both with reduced morbidity for patients and decreased costs for the healthcare system. In case of failure with arthrocentesis, surgical arthroscopic drainage becomes necessary. In addition, the prescription of systemic steroids is promising but requires further studies, especially in adult patient populations.

Enhancement of a UASB-septic tank performance for decentralised treatment of strong domestic sewage.

PubMed

Mahmoud, Nidal; van Lier, Jules B

2011-01-01

The possibility of enhancing the process performance of the UASB-septic tank for treating strong sewage in Palestine by means of inoculating the reactor with well adapted anaerobic sludge and/or adding a packing media to the upper part of the reactor, creating an anaerobic hybrid (AH)-septic tank, was investigated. To achieve these objectives, two community onsite UASB-septic tank and AH-septic tank were operated in parallel at 2 days HRT for around 8 months overlapping the cold and hot periods of the year in Palestine. The achieved removal efficiencies of CODtot in the UASB-septic tank and AH-septic tank during the first months of operation, coinciding with the cold period and the subsequent hot period, were respectively 50 (+/- 15)% and 48 (+/- 15)% and 66 (+/- 8)% and 55 (+/- 8)%. This shows that the UASB-septic tank performed significantly better (p < 0.05) than the AH-septic tank after rather long periods of operation. The difference in the CODtot removal efficiency was mainly due to the better CODss removal efficiencies in the UASB-septic tank. The removal efficiencies over the last 50 days of operation for CODtot, CODsus, CODcol and CODdis were 70, 72, 77 and 55% and 53, 54, 78 and 45% for the UASB-septic tank and AH-septic tank, respectively. Comparing the here achieved COD removal efficiencies with previously reported efficiencies of UASB-septic tanks operated in Palestine shows that the reactor performance in terms of COD removal and conversion, during the first 8 months of operation, has improved substantially by being started with well adapted anaerobic sludge, simulating and predicting long-term performance. Adding packing media did not lead to an improvement.

Effects of a novel cytokine haemoadsorbtion system on inflammatory response in septic shock after cephalic pancreatectomy – a case report

PubMed Central

Tomescu, Dana; Dima, Simona O.; Tănăsescu, Sabina; Tănase, Cristiana Pistol; Năstase, Anca; Popescu, Mihai

2014-01-01

Severe sepsis and septic shock are associated with an inflammatory cascade that is primarily responsible for multiple organ dysfunction. To date, there are no specific treatments designed to modulate and rebalance inflammatory cytokines levels. We present a case of a 50 years old man with postoperative septic shock after undergoing cephalic pancreatectomy for a pancreatic cystic tumor. The use of a haemoadsorbtion device (CytoSorb®) in combination with continuous veno-venous haemofiltration was associated with a decrease in TNFα, IL-1β and IFNγ and an increase in IL-10 levels measured before and after two consecutive procedures. The effect of CytoSorb® on inflammatory cytokines translated into a more stable haemodynamic profile with a stable cardiac output and normalization of systemic vascular resistance index and decreased vasopressor requirements. Further prospective large clinical trials are required in order to determine the indications for CytoSorb® and to evaluate the overall outcome. PMID:28913446

Effects of a novel cytokine haemoadsorbtion system on inflammatory response in septic shock after cephalic pancreatectomy - a case report.

PubMed

Tomescu, Dana; Dima, Simona O; Tănăsescu, Sabina; Tănase, Cristiana Pistol; Năstase, Anca; Popescu, Mihai

2014-10-01

Severe sepsis and septic shock are associated with an inflammatory cascade that is primarily responsible for multiple organ dysfunction. To date, there are no specific treatments designed to modulate and rebalance inflammatory cytokines levels. We present a case of a 50 years old man with postoperative septic shock after undergoing cephalic pancreatectomy for a pancreatic cystic tumor. The use of a haemoadsorbtion device (CytoSorb ® ) in combination with continuous veno-venous haemofiltration was associated with a decrease in TNFα, IL-1β and IFNγ and an increase in IL-10 levels measured before and after two consecutive procedures. The effect of CytoSorb ® on inflammatory cytokines translated into a more stable haemodynamic profile with a stable cardiac output and normalization of systemic vascular resistance index and decreased vasopressor requirements. Further prospective large clinical trials are required in order to determine the indications for CytoSorb ® and to evaluate the overall outcome.

Tension pneumocephalus mimicking septic shock: a case report.

PubMed

Miranda, Caroline; Mahta, Ali; Wheeler, Lee Adam; Tsiouris, A John; Kamel, Hooman

2018-02-01

Tension pneumocephalus can lead to rapid neurologic deterioration. We report for the first time its association with aseptic systemic inflammatory response syndrome mimicking septic shock and the efficacy of prompt neurosurgical intervention and critical care support in treating this condition. A 64-year-old man underwent 2-stage olfactory groove meningioma resection. The patient developed altered mental status and gait instability on postoperative day 6. Imaging showed significant pneumocephalus. The patient subsequently developed worsening mental status, respiratory failure, and profound shock requiring multiple vasopressors. Bedside needle decompression, identification and repair of the cranial fossa defect, and critical care support led to improved mental status and reversal of shock and multiorgan dysfunction. Thorough evaluation revealed no evidence of an underlying infection. In this case, tension pneumocephalus incited an aseptic systemic inflammatory response syndrome mimicking septic shock. Prompt neurosurgical correction of pneumocephalus and critical care support not only improved neurologic status, but also reversed shock. Such a complication indicates the importance of close monitoring of patients with progressive pneumocephalus.

Hemovigilance monitoring of platelet septic reactions with effective bacterial protection systems.

PubMed

Benjamin, Richard J; Braschler, Thomas; Weingand, Tina; Corash, Laurence M

2017-12-01

Delayed, large-volume bacterial culture and amotosalen/ultraviolet-A light pathogen reduction are effective at reducing the risk of bacterial proliferation in platelet concentrates (PCs). Hemovigilance programs continue to receive reports of suspected septic transfusion reactions, most with low imputability. Here, we compile national hemovigilance data to determine the relative efficacy of these interventions. Annual reports from the United Kingdom, France, Switzerland, and Belgium were reviewed between 2005 and 2016 to assess the risk of bacterial contamination and septic reactions. Approximately 1.65 million delayed, large-volume bacterial culture-screened PCs in the United Kingdom and 2.3 million amotosalen/ultraviolet-A-treated PCs worldwide were issued with no reported septic fatalities. One definite, one possible, and 12 undetermined/indeterminate septic reactions and eight contaminated "near misses" were reported with delayed, large-volume bacterial cultures between 2011 and 2016, for a lower false-negative culture rate than that in the previous 5 years (5.4 vs. 16.3 per million: odds ratio, 3.0; 95% confidence interval, 1.4-6.5). Together, the Belgian, Swiss, and French hemovigilance programs documented zero probable or definite/certain septic reactions with 609,290 amotosalen/ultraviolet-A-treated PCs (<1.6 per million). The rates were significantly lower than those reported with concurrently transfused, nonpathogen-reduced PCs in Belgium (<4.4 vs. 35.6 per million: odds ratio, 8.1; 95% confidence interval,1.1-353.3) and with historic septic reaction rates in Switzerland (<6.0 vs. 82.9 per million: odds ratio, 13.9; 95% confidence interval, 2.1-589.2), and the rates tended to be lower than those from concurrently transfused, nonpathogen-reduced PCs in France (<4.7 vs. 19.0 per million: odds ratio, 4.1; 95% confidence interval, 0.7-164.3). Pathogen reduction and bacterial culture both reduced the incidence of septic reactions, although under-reporting and strict imputability criteria resulted in an underestimation of risk. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

Impact of Dobutamine in Patients With Septic Shock: A Meta-Regression Analysis.

PubMed

Nadeem, Rashid; Sockanathan, Shivani; Singh, Mukesh; Hussain, Tamseela; Kent, Patrick; AbuAlreesh, Sarah

2017-05-01

Septic shock frequently requires vasopressor agents. Conflicting evidence exists for use of inotropes in patients with septic shock. Data from English studies on human adult septic shock patients were collected. A total of 83 studies were reviewed, while 11 studies with 21 data sets including 239 patients were pooled for meta-regression analysis. For VO2, pooled difference in means (PDM) was 0.274. For cardiac index (CI), PDM was 0.783. For delivery of oxygen, PDM was -0.890. For heart rate, PDM was -0.714. For left ventricle stroke work index, PDM was 0.375. For mean arterial pressure, PDM was -0.204. For mean pulmonary artery pressure, PDM was 0.085. For O2 extraction, PDM was 0.647. For PaCO2, PDM was -0.053. For PaO2, PDM was 0.282. For pulmonary artery occlusive pressure, PDM was 0.270. For pulmonary capillary wedge pressure, PDM was 0.300. For PVO2, PDM was -0.492. For right atrial pressure, PDM was 0.246. For SaO2, PDM was 0.604. For stroke volume index, PDM was 0.446. For SvO2, PDM was -0.816. For systemic vascular resistance, PDM was -0.600. For systemic vascular resistance index, PDM was 0.319. Meta-regression analysis was performed for VO2, DO2, CI, and O2 extraction. Age was found to be significant confounding factor for CI, DO2, and O2 extraction. APACHE score was not found to be a significant confounding factor for any of the parameters. Dobutamine seems to have a positive effect on cardiovascular parameters in patients with septic shock. Prospective studies with larger samples are required to further validate this observation.

Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study.

PubMed

Contou, Damien; Roux, Damien; Jochmans, Sébastien; Coudroy, Rémi; Guérot, Emmanuel; Grimaldi, David; Ricome, Sylvie; Maury, Eric; Plantefève, Gaëtan; Mayaux, Julien; Mekontso Dessap, Armand; Brun-Buisson, Christian; de Prost, Nicolas

2016-11-06

The lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others. We conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France. We included all consecutive patients admitted to the ICU with suspected septic shock defined by clinical suspicion of infection leading to antibiotic prescription plus acute circulatory failure requiring vasopressor support. A total of 508 patients were admitted with suspected septic shock. Among them, 374 (74 %) had early-confirmed septic shock, while the 134 others (26 %) had no source of infection identified nor microbiological documentation retrieved 24 hours after shock onset. Among these, 37/134 (28 %) had late-confirmed septic shock diagnosed after 24 hours, 59/134 (44 %) had a condition mimicking septic (septic shock mimicker, mainly related to adverse drug reactions, acute mesenteric ischemia and malignancies) and 38/134 (28 %) had shock of unknown origin by the end of the ICU stay. There were no differences between patients with early-confirmed septic shock and the remainder in ICU mortality and the median duration of ICU stay, of tracheal intubation and of vasopressor support. The multivariable Cox model showed that the risk of day-60 mortality did not differ between patients with or without early-confirmed septic shock. A sensitivity analysis was performed in the subgroup (n = 369/508) of patients meeting the Sepsis-3 definition criteria and displayed consistent results. One quarter of the patients admitted in the ICU with suspected septic shock had no infection identified 24 hours after its onset and almost half of them were eventually diagnosed with a septic shock mimicker. Outcome did not differ between patients with early-confirmed septic shock and other patients.

Recent (2008-10) concentrations and isotopic compositions of nitrate and concentrations of wastewater compounds in the Barton Springs zone, south-central Texas, and their potential relation to urban development in the contributing zone

USGS Publications Warehouse

Mahler, Barbara J.; Musgrove, MaryLynn; Herrington, Chris; Sample, Thomas L.

2011-01-01

During 2008–10, the U.S. Geological Survey, in cooperation with the City of Austin, the City of Dripping Springs, the Barton Springs/Edwards Aquifer Conservation District, the Lower Colorado River Authority, Hays County, and Travis County, collected and analyzed water samples from five streams (Barton, Williamson, Slaughter, Bear, and Onion Creeks), two groundwater wells (Marbridge well [YD–58–50–704] and Buda well [LR–58–58–403]), and the main orifice of Barton Springs in Austin, Texas, with the objective of characterizing concentrations and isotopic compositions of nitrate and concentrations of wastewater compounds in the Barton Springs zone. The Barton Springs zone is in south-central Texas, an area undergoing rapid growth in population and in land area affected by development, with associated increases in wastewater generation. Over a period of 17 months, during which the hydrologic conditions transitioned from dry to wet, samples were collected routinely from the streams, wells, and spring and, in response to storms, from the streams and spring; some or all samples were analyzed for nitrate, nitrogen and oxygen isotopes of nitrate, and waste­water compounds. The median nitrate concentrations in routine samples from all sites were higher in samples collected during the wet period than in samples collected during the dry period, with the greatest difference for stream samples (0.05 milligram per liter during the dry period to 0.96 milligram per liter for the wet period). Nitrate concentrations in recent (2008–10) samples were elevated relative to concentrations in historical (1990–2008) samples from streams and from Barton Springs under medium- and high-flow conditions. Recent nitrate concentrations were higher than historical concentrations at the Marbridge well but the reverse was true at the Buda well. The elevated concentrations likely are related to the cessation of dry conditions coupled with increased nitrogen loading in the contributing watersheds. An isotopic composition of nitrate (delta nitrogen–15) greater than 8 per mil in many of the samples indicated there was a contribution of nitrate with a biogenic (human and or animal waste, or both) origin. Wastewater compounds measured in routine samples were detected infrequently (3 percent of cases), and concentrations were very low (less than the method reporting level in most cases). There was no correlation between nitrate concentrations and the frequency of detection of wastewater compounds, indicating that wastewater compounds might be undergoing removal during such processes as infiltration through soil. Three potential sources of biogenic nitrate to the contributing zone were considered: septic systems, land application of treated wastewater, and domesticated dogs and cats. During 2001–10, the estimated densities of septic systems and domesticated dogs and cats (number per acre) increased in the watersheds of all five creeks, and the rate of land application of treated wastewater (gallons per day per acre) increased in the watersheds of Barton, Bear, and Onion Creeks. Considering the timing and location of the increases in the three sources, septic systems were considered a likely source of increased nitrate to Bear Creek; land application of treated wastewater a likely source to Barton, Bear, and Onion Creeks; and domestic dogs and cats a potential source principally to Williamson Creek. The results of this investigation indicate that baseline water quality, in terms of nitrate, has shifted upward between 2001 and 2010, even without any direct discharges of treated wastewater to the creeks.

Biomarkers for pediatric sepsis and septic shock

PubMed Central

Standage, Stephen W; Wong, Hector R

2011-01-01

Sepsis is a clinical syndrome defined by physiologic changes indicative of systemic inflammation, which are likely attributable to documented or suspected infection. Septic shock is the progression of those physiologic changes to the extent that delivery of oxygen and metabolic substrate to tissues is compromised. Biomarkers have the potential to diagnose, monitor, stratify and predict outcome in these syndromes. C-reactive protein is elevated in inflammatory and infectious conditions and has long been used as a biomarker indicating infection. Procalcitonin has more recently been shown to better distinguish infection from inflammation. Newer candidate biomarkers for infection include IL-18 and CD64. Lactate facilitates the diagnosis of septic shock and the monitoring of its progression. Multiple stratification biomarkers based on genome-wide expression profiling are under active investigation and present exciting future possibilities. PMID:21171879

Using terlipressin in a pediatric patient with septic shock resistant to catecholamines

PubMed Central

Erdogan, Seher; Bosnak, Mehmet

2017-01-01

Sepsis and septic shock are important causes of morbidity and mortality in critically ill children. The goal of treatment is to ensure adequate mean arterial pressure to maintain organ perfusion. The growing number of instances of peripheral vascular hyporeactivity to catecholamines has necessitated the search for alternative vasopressors. A 14-year-old boy had septic shock, with a high cardiac index and low systemic vascular resistance index (SVRI) measurements according to pulse contour analysis, despite treatment with dopamine, dobutamine, adrenaline, and noradrenaline infusions. A terlipressin (TP) 10 μg/kg intravenous bolus was administered, followed by a 1 μg/kg/minute continuous infusion. The response to TP treatment was assessed using pulse contour analysis. The mean arterial pressure and SVRI increased, and the cardiac index and heart rate decreased within 10 minutes after bolus administration of TP. Noradrenaline infusion could be reduced to 0.7 μg/kg/minute within 5 hours. The goal in presenting this case was to evaluate the vasoconstrictor effects of TP, a long-acting vasopressin analogue, in septic shock. PMID:29270582

Angiotensin II in Refractory Septic Shock.

PubMed

Antonucci, Elio; Gleeson, Patrick J; Annoni, Filippo; Agosta, Sara; Orlando, Sergio; Taccone, Fabio Silvio; Velissaris, Dimitrios; Scolletta, Sabino

2017-05-01

Refractory septic shock is defined as persistently low mean arterial blood pressure despite volume resuscitation and titrated vasopressors/inotropes in patients with a proven or suspected infection and concomitant organ dysfunction. Its management typically requires high doses of catecholamines, which can induce significant adverse effects such as ischemia and arrhythmias. Angiotensin II (Ang II), a key product of the renin-angiotensin-aldosterone system, is a vasopressor agent that could be used in conjunction with other vasopressors to stabilize critically ill patients during refractory septic shock, and reduce catecholamine requirements. However, very few clinical data are available to support Ang II administration in this setting. Here, we review the current literature on this topic to better understand the role of Ang II administration during refractory septic shock, differentiating experimental from clinical studies. We also consider the potential role of exogenous Ang II administration in specific organ dysfunction and possible pitfalls with Ang II in sepsis. Various issues remain unresolved and future studies should investigate important topics such as: the optimal dose and timing of Ang II administration, a comparison between Ang II and the other vasopressors (epinephrine; vasopressin), and Ang II effects on microcirculation.

Using terlipressin in a pediatric patient with septic shock resistant to catecholamines.

PubMed

Erdogan, Seher; Bosnak, Mehmet

2017-01-01

Sepsis and septic shock are important causes of morbidity and mortality in critically ill children. The goal of treatment is to ensure adequate mean arterial pressure to maintain organ perfusion. The growing number of instances of peripheral vascular hyporeactivity to catecholamines has necessitated the search for alternative vasopressors. A 14-year-old boy had septic shock, with a high cardiac index and low systemic vascular resistance index (SVRI) measurements according to pulse contour analysis, despite treatment with dopamine, dobutamine, adrenaline, and noradrenaline infusions. A terlipressin (TP) 10 μg/kg intravenous bolus was administered, followed by a 1 μg/kg/minute continuous infusion. The response to TP treatment was assessed using pulse contour analysis. The mean arterial pressure and SVRI increased, and the cardiac index and heart rate decreased within 10 minutes after bolus administration of TP. Noradrenaline infusion could be reduced to 0.7 μg/kg/minute within 5 hours. The goal in presenting this case was to evaluate the vasoconstrictor effects of TP, a long-acting vasopressin analogue, in septic shock.

Removal of nutrients from septic tank effluent with baffle subsurface-flow constructed wetlands.

PubMed

Cui, Lihua; Ouyang, Ying; Yang, Weizhi; Huang, Zhujian; Xu, Qiaoling; Yu, Guangwei

2015-04-15

Three new baffle flow constructed wetlands (CWs), namely the baffle horizontal flow CW (Z1), baffle vertical flow CW (Z2) and baffle hybrid flow CW (Z3), along with one traditional horizontal subsurface flow CW (Z4) were designed to test the removal efficiency of nitrogen (N) and phosphorus (P) from the septic tank effluent under varying hydraulic retention times (HRTs). Results showed that the optimal HRT was two days for maximal removal of N and P from the septic tank effluent among the four CWs. At this HRT, the Z1, Z2, Z3 and Z4 CWs removed, respectively, 49.93, 58.50, 46.01 and 44.44% of TN as well as 87.82, 93.23, 95.97 and 91.30% of TP. Our study further revealed that the Z3 CW was the best design for overall removal of N and P from the septic tank effluent due to its hybrid flow directions with better oxygen supply inside the CW system. Copyright © 2015 Elsevier Ltd. All rights reserved.

Plasma interferon-gamma and interleukin-10 concentrations in systemic meningococcal disease compared with severe systemic Gram-positive septic shock.

PubMed

Bjerre, Anna; Brusletto, Berit; Høiby, Ernst Arne; Kierulf, Peter; Brandtzaeg, Petter

2004-02-01

To analyze plasma interferon-gamma and interleukin-10 concentrations in patients with systemic meningococcal disease and patients with severe Gram-positive septic shock caused by Streptococcus pneumoniae or Staphylococcus aureus. To study the in vitro cytokine (interferon-gamma and interleukin-10) responses in a whole blood model boosted with heat-killed Neisseria meningitidis, S. pneumoniae, and S. aureus before and after treatment with recombinant interleukin-10 or recombinant interferon-gamma. Experimental study. Laboratory. Plasma samples were collected from patients with systemic meningococcal disease (n = 66) and patients with severe Gram-positive septic shock caused by S. pneumoniae (n = 4) or S. aureus (n = 3). Whole blood was boosted with heat-killed N. meningitidis, S. pneumoniae, and S. aureus (1 x 106 colony forming units/mL), and plasmas were analyzed for interleukin-10 or interferon-gamma at 0, 5, 12, and 24 hrs. Furthermore, recombinant interleukin-10 or recombinant interferon-gamma was added before bacteria, and the effect on the secretion of interferon-gamma and interleukin-10, respectively, was analyzed after 24 hrs. The median concentration of interferon-gamma was 15 pg/mL and of interleukin-10 was 10,269 pg/mL in patients with meningococcal septic shock (n = 24) compared with median interferon-gamma concentration of 3400 pg/mL and interleukin-10 concentration of 465 pg/mL in patients with severe Gram-positive shock (p =.001). Increased interferon-gamma concentrations were associated with case fatality (p =.011). In a whole blood model we demonstrated that 1 x 106 colony forming units/mL of N. meningitidis induced more interleukin-10 but less interferon-gamma than S. pneumoniae. S. aureus induced minimal secretion of both cytokines. Recombinant interleukin-10 efficiently down-regulated the secretion of interferon-gamma, and vice versa, as shown in a whole blood model. We speculate whether high concentrations of interleukin-10 contribute to the low concentrations of interferon-gamma in fulminant meningococcal septicemia. In addition, it appears as if interferon-gamma plays a minor role in the pathophysiology of meningococcal septic shock.

Bench-to-bedside review: Toll-like receptors and their role in septic shock

PubMed Central

Opal, Steven M; Huber, Christian E

2002-01-01

The Toll-like receptors (TLRs) are essential transmembrane signaling receptors of the innate immune system that alert the host to the presence of a microbial invader. The recent discovery of the TLRs has rapidly expanded our knowledge of molecular events that initiate host–pathogen interactions. These functional attributes of the cellular receptors provide insights into the nature of pattern recognition receptors that activate the human antimicrobial defense systems. The fundamental significance of the TLRs in the generation of systemic inflammation and the pathogenesis of septic shock is reviewed. The potential clinical implications of therapeutic modulation of these recently characterized receptors of innate immunity are also discussed. PMID:11983038

Determination of toxic inorganic elements pollution in ground waters of Kahuta Industrial Triangle Islamabad, Pakistan using inductively coupled plasma mass spectrometry.

PubMed

Kausar, Rubina; Ahmad, Zulfiqar

2009-10-01

The present study deals with the ground water quality assessment in Kahuta Industrial Triangle Islamabad, Pakistan. The objective of the study was to assess ground water quality against the drinking water standards for various toxic inorganic elements. Representative groundwater samples were collected and analyzed in the Water Quality Laboratory of Pakistan Council of Research in Water Resources (PCRWR) at Islamabad, Pakistan. The samples were run on ICP-MS (Inductively coupled plasma mass spectrometry), which has the capability to separate and quantify 70 elements at a time. One of the finding of study is that ICP-MS is a very good tool to analyze broad range of toxic inorganic elements to the level of parts per billion (ppb). World Health Organization drinking water standards shows that these toxic inorganic elements such as heavy metals even at this concentration level (ppb) are injurious to human health. This analysis indicated pollution of various toxic elements including Selenium. Vertical leachate through industrial waste septic tanks is identified as major cause of groundwater pollution in the Industrial Triangle. Monitoring of the septic tanks and groundwater quality in study area is suggested along with remedial measures.

Peripheral 5-HT7 receptors as a new target for prevention of lung injury and mortality in septic rats.

PubMed

Cadirci, Elif; Halici, Zekai; Bayir, Yasin; Albayrak, Abdulmecit; Karakus, Emre; Polat, Beyzagul; Unal, Deniz; Atamanalp, Sabri S; Aksak, Selina; Gundogdu, Cemal

2013-10-01

Sepsis is a complex pathophysiological event involving metabolic acidosis, systemic inflammatory response syndrome, tissue damage and multiple organ dysfunction syndrome. Although many new mechanisms are being investigated to enlighten the pathophysiology of sepsis, there is no effective treatment protocol yet. Presence of 5-HT7 receptors in immune tissues prompted us to hypothesize that these receptors have roles in inflammation and sepsis. We investigated the effects of 5-HT7 receptor agonists and antagonists on serum cytokine levels, lung oxidative stress, lung histopathology, nuclear factor κB (NF-κB) positivity and lung 5-HT7 receptor density in cecal ligation and puncture (CLP) induced sepsis model of rats. Agonist administration to septic rats increased survival time; decreased serum cytokine response against CLP; decreased oxidative stress and increased antioxidant system in lungs; decreased the tissue NF-κB immunopositivity, which is high in septic rats; and decreased the sepsis-induced lung injury. In septic rats, as a result of high inflammatory response, 5-HT7 receptor expression in lungs increased significantly and agonist administration, which decreased inflammatory response and related mortality, decreased the 5-HT7 receptor expression. In conclusion, all these data suggest that stimulation of 5-HT7 receptors may be a new therapeutic target for prevention of impaired inflammatory response related lung injury and mortality. Copyright © 2013 Elsevier GmbH. All rights reserved.

Olecranon bursitis.

PubMed

Reilly, Danielle; Kamineni, Srinath

2016-01-01

Bursitis is a common medical condition, and of all the bursae in the body, the olecranon bursa is one of the most frequently affected. Bursitis at this location can be acute or chronic in timing and septic or aseptic. Distinguishing between septic and aseptic bursitis can be difficult, and the current literature is not clear on the optimum length or route of antibiotic treatment for septic cases. The current literature was reviewed to clarify these points. The reported data for olecranon bursitis were compiled from the current literature. The most common physical examination findings were tenderness (88% septic, 36% aseptic), erythema/cellulitis (83% septic, 27% aseptic), warmth (84% septic, 56% aseptic), report of trauma or evidence of a skin lesion (50% septic, 25% aseptic), and fever (38% septic, 0% aseptic). General laboratory data ranges were also summarized. Distinguishing between septic and aseptic olecranon bursitis can be difficult because the physical and laboratory data overlap. Evidence for the optimum length and route of antibiotic treatment for septic cases also differs. In this review we have presented the current data of offending bacteria, frequency of key physical examination findings, ranges of reported laboratory data, and treatment practices so that clinicians might have a better guide for treatment. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Incidence of the enterococcal surface protein (esp) gene in human and animal fecal sources

USGS Publications Warehouse

Whitman, R.L.; Przybyla-Kelly, K.; Shively, D.A.; Byappanahalli, M.N.

2007-01-01

The occurrence of the enterococcal surface protein (esp) gene in the opportunistic pathogens Enterococcus faecalis and E. faecium is well-documented in clinical research. Recently, the esp gene has been proposed as a marker of human pollution in environmental waters; however, information on its relative incidence in various human and animal fecal sources is limited. We have determined the occurrence of the esp gene in enterococci from human (n = 64) and animal (n = 233) fecal samples by polymerase chain reaction using two primer sets: one presumably specific for E. faecium (espfm) and the other for both E. faecalis and E. faecium (espfs/fm). We believe that this research is the first to explore the use of espfs/fm for the detection of human waste in natural environmental settings. The incidence in human sources was 93.1% espfm and 100% espfs/fm in raw sewage influent; 30% for both espfm and espfs/fm in septic waste; and 0% espfm and 80% espfs/fm in active pit toilets. The overall occurrence of the gene in animal feces was 7.7% (espfs/fm) and 4.7% (espfm); animal types with positive results included dogs (9/43, all espfm), gulls (10/34, espfs/fm; 2/34, espfm), mice (3/22, all espfs/fm), and songbirds (5/55, all espfs/fm). The esp gene was not detected in cat (0/34), deer (0/4), goose (0/18), or raccoon (0/23) feces. The inconsistent occurrence, especially in septic and pit toilet sewage, suggests a low statistical power of discrimination between animal and human sources, which means a large number of replicates should be collected. Both espfm and espfs/fm were common in raw sewage, but neither one efficiently differentiated between animal and other human sources.

Fate, mass balance, and transport of phosphorus in the septic system drainfields.

PubMed

Mechtensimer, Sara; Toor, Gurpal S

2016-09-01

Septic systems can be a potential source of phosphorus (P) in shallow groundwater. Our objective was to investigate the fate, mass balance, and transport of P in the drainfield of a drip-dispersal septic system. Drainfields were replicated in lysimeters (152.4 cm long, 91.4 cm wide, and 91.4 cm high). Leachate and effluent samples were collected over 67 events (n = 15 daily; n = 52 weekly flow-weighted) and analyzed for total P (TP), orthophosphate (PO4P), and other P (TP - PO4P). Mean TP was 15 mg L(-1) (84% PO4P; 16% other P) in the effluent and 0.16 mg L(-1) (47% PO4P, 53% other P) in the leachate. After one year, 46.8 g of TP was added with effluent and rainfall to each drainfield, of which, <1% leached, 3.8% was taken up by St. Augustine grass, leaving >95% in the drainfield. Effluent dispersal increased water extractable P (WEP) in the drainfield from <5 to >10 mg kg(-1). Using the P sorption maxima of sand (118 mg kg(-1)) and soil (260 mg kg(-1)), we estimated that ∼18% of the drainfield P sorption capacity was saturated after one year of effluent dispersal. We conclude that despite the low leaching potential of P dispersed with effluent in the first year of drainfield operation, a growing WEP pool in the drainfield and low P sorption capacity of Florida's sandy soils may have the potential to transport P to shallow groundwater in long-running septic systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of decentralized treatment of sewage employing Upflow Septic Tank/Baffled Reactor (USBR) in developing countries.

PubMed

Sabry, Tarek

2010-02-15

A new concept for a low-cost modified septic tank, named Upflow Septic Tank/Baffled Reactor (USBR), was constructed and tested in a small village in Egypt. During almost one year of continuous operation and monitoring, this system was found to have very satisfactory removal results, where the average results of COD, BOD, and TSS removal efficiencies were 84%, 81%, and 89%, respectively, and the results of the experiment proved that the second compartment (Anaerobic Baffled Reactor) was the main treatment unit in removing the pollutants during the start-up period and at the very early steady-state stage. However, after this period and during the steady-state operation conditions, the second compartment served as a polishing step. Also, it was observed that the USBR system was not affected by the imposed shock loads at the peak flow and organic periods. The results showed that the system is slightly influenced by the drop in the temperature. Decreasing in BOD and COD removal by factor of 9% was observed, when temperature decreases from the average of 35 degrees C in summer time (for the first 127 days) to the average of 22 degrees C in winter time (between day 252 and day 280). Whereas, the TSS removals were not affected by the drop in temperature. The results of the sewage flow variations during one year of operation were compared with Goodrich Formula to see the applicability of this equation in rural developing countries. MAIN FINDING OF THE WORK: The Upflow Septic Tank/Baffled Reactor system could become a promising alternative to the conventional treatment plants in rural developing countries.

The impact of co-contaminants and septic system effluent quality on the transport of estrogens and nonylphenols through soil.

PubMed

Stanford, Benjamin D; Amoozegar, Aziz; Weinberg, Howard S

2010-03-01

The impact that varying qualities of wastewater may have on the movement of steroid estrogens through soils into groundwater is little understood. In this study, the steroid estrogens 17beta-estradiol (E2) and estrone (E1) were followed through batch and column studies to examine the impact that organic wastewater constituents from on-site wastewater treatment systems (i.e., septic systems or decentralized systems) may have on influencing the rate of transport of estrogens through soils. Total organic carbon (TOC) content (as a surrogate indicator of overall wastewater quality) and the presence of nonyl-phenol polyethoxylate surfactants (NPEO) at concentrations well below the critical micelle concentration were independently shown to be indicative of earlier breakthrough and less partitioning to soil in batch and column experiments. Both NPEO and wastewater with increasing TOC concentrations led to shifts in the equilibrium of E1 and E2 towards the aqueous phase and caused the analytes to have an earlier breakthrough than in control experiments. The presence of nonylphenols, on the other hand, did not appreciably impact partitioning of E1 or E2. Biodegradation of the steroids in soil was also lower in the presence of septic tank effluents than in an organic-free control water. Furthermore, the data indicate that the rate of movement of E1 and E2 present in septic tank effluent through soils and into groundwater can be decreased by removing the NPEOs and TOC through wastewater treatment prior to sub-surface disposal. This study offers some insights into mechanisms which impact degradation, transformation, and retardation, and shows that TOC and NPEO surfactants play a role in estrogen transport. Copyright 2009 Elsevier Ltd. All rights reserved.

Pharmaceuticals, perfluorosurfactants, and other organic wastewater compounds in public drinking water wells in a shallow sand and gravel aquifer.

PubMed

Schaider, Laurel A; Rudel, Ruthann A; Ackerman, Janet M; Dunagan, Sarah C; Brody, Julia Green

2014-01-15

Approximately 40% of U.S. residents rely on groundwater as a source of drinking water. Groundwater, especially unconfined sand and gravel aquifers, is vulnerable to contamination from septic systems and infiltration of wastewater treatment plant effluent. In this study, we characterized concentrations of pharmaceuticals, perfluorosurfactants, and other organic wastewater compounds (OWCs) in the unconfined sand and gravel aquifer of Cape Cod, Massachusetts, USA, where septic systems are prevalent. Raw water samples from 20 public drinking water supply wells on Cape Cod were tested for 92 OWCs, as well as surrogates of wastewater impact. Fifteen of 20 wells contained at least one OWC; the two most frequently-detected chemicals were sulfamethoxazole (antibiotic) and perfluorooctane sulfonate (perfluorosurfactant). Maximum concentrations of sulfamethoxazole (113 ng/L) and the anticonvulsant phenytoin (66 ng/L) matched or exceeded maximum reported concentrations in other U.S. public drinking water sources. The sum of pharmaceutical concentrations and the number of detected chemicals were both significantly correlated with nitrate, boron, and extent of unsewered residential and commercial development within 500 m, indicating that wastewater surrogates can be useful for identifying wells most likely to contain OWCs. Septic systems appear to be the primary source of OWCs in Cape Cod groundwater, although wastewater treatment plants and other sources were potential contributors to several wells. These results show that drinking water supplies in unconfined aquifers where septic systems are prevalent may be among the most vulnerable to OWCs. The presence of mixtures of OWCs in drinking water raises human health concerns; a full evaluation of potential risks is limited by a lack of health-based guidelines and toxicity assessments. © 2013. Published by Elsevier B.V. All rights reserved.

Estrogen Maintains Skeletal Muscle in Septic Rats Associated with Altering Hypothalamic Inflammation and Neuropeptides.

PubMed

Zhao, Chenyan; Li, Jun; Cheng, Minhua; Shi, Jialing; Shen, Juanhong; Gao, Tao; Xi, Fengchan; Yu, Wenkui

2017-03-01

Muscle wasting is one of the main contributors to the worse outcomes in sepsis. Whether estrogen could alleviate muscle wasting induced by sepsis remains unclear. This study was designed to test the effect of estrogen on muscle wasting and its relationship with central alteration in sepsis. Thirty Sprague-Dawley rats were divided into 3 groups: control group, sepsis group, and estrogen treated sepsis group. Animals were intraperitoneally injected with lipopolysaccharide (10 mg/kg) or saline, followed by subcutaneous injection of 17β-estradiol (1 mg/kg) or saline. Twenty-four hours later, all animals were killed and their hypothalamus and skeletal muscles were harvested for analysis. Muscle wasting markers, hypothalamic neuropeptides, and hypothalamic inflammatory markers were measured. As a result, lipopolysaccharide administration caused a significant increase in muscle wasting, hypothalamic inflammation, and anorexigenic neuropeptides (POMC and CART) gene expression, and a significant decrease in orexigenic neuropeptides (AgRP and NPY) gene expression. Administration of estrogen signifcantl attenuated lipopolysaccharide-induced muscle wasting (body weight and extensor digitorum longus loss [52 and 62 %], tyrosine and 3-methylhistidine release [17 and 22 %], muscle ring fnger 1 [MuRF-1; 65 %], and muscle atrophy F-box [MAFbx] gene expression), hypothalamic inflammation (Tumor necrosis factor-α and interlukin-1β [69 and 70%]) as well as alteration of POMC, CART and AgRP (61, 37, and 1008 %) expression.In conclusion, estrogen could alleviate sepsis-induced muscle wasting and it was associated with reducing hypothalamic inflammation and alteration of hypothalamic neuropeptides. © Georg Thieme Verlag KG Stuttgart · New York.

Coagulation phenotypes in septic shock as evaluated by calibrated automated thrombography.

PubMed

Perrin, Julien; Charron, Cyril; François, Jean-Hugues; Cramer-Bordé, Elisabeth; Lévy, Bruno; Borgel, Delphine; Vieillard-Baron, Antoine

2015-01-01

Sepsis induces alterations of coagulation suggesting both hypercoagulable or hypocoagulable features. The result of their combination remains unknown, making it difficult to predict whether one prevails over the other. Thrombin generation tests (TGTs) stand as an interesting tool to establish an integrative phenotype of coagulation. It has been reported that septic patients display a hypocoagulable trait using TGT. However, protein C (PC) system response was not evaluated. We aimed at describing the thrombin generation profile in patients with septic shock under conditions that are sensitive to PC system to evaluate the net results of coagulation abnormalities and to determine whether hypercoagulable or hypocoagulable traits coexist within a given individual. Thrombin generation was studied in plasma from patients presenting with septic shock at diagnosis and 6 h after a conventional therapeutic management using calibrated automated thrombography with or without thrombomodulin (TM) addition. Patients exhibit clear alterations of TGT that present as both consumption-related hypocoagulability (evidenced without TM addition) but also hypercoagulability by decreased sensitivity to the PC system evidenced with TM addition. No difference could be demonstrated between survivors and nonsurvivors at Day 28, but patients who do not respond to therapeutics at 6 h seem to be more hypercoagulable. More importantly, if our results evidence heterogeneity between patients, we show that alterations of coagulation result in an equilibrium in the majority of patients, thus suggesting "normocoagulability"; but, in the presence of a biological imbalance between baseline thrombin generation and sensitivity to TM, the global effect mostly tends toward hypercoagulability. Thus, TGT may help identify distinct biological coagulation phenotypes in the complex alterations induced by sepsis.

Very high volume hemofiltration with the Cascade system in septic shock patients.

PubMed

Quenot, Jean-Pierre; Binquet, Christine; Vinsonneau, Christophe; Barbar, Saber-David; Vinault, Sandrine; Deckert, Valerie; Lemaire, Stéphanie; Hassain, Ali Ait; Bruyère, Rémi; Souweine, Bertrand; Lagrost, Laurent; Adrie, Christophe

2015-12-01

We compared hemodynamic and biological effects of the Cascade system, which uses very high volume hemofiltration (HVHF) (120 mL kg(-1) h(-1)), with those of usual care in patients with septic shock. Multicenter, prospective, randomized, open-label trial in three intensive care units (ICU). Adults with septic shock with administration of epinephrine/norepinephrine were eligible. Patients were randomized to usual care plus HVHF (Cascade group), or usual care alone (control group). Primary end point was the number of catecholamine-free days up to 28 days after randomization. Secondary end points were number of days free of mechanical ventilation, renal replacement therapy (RRT) or ICU up to 90 days, and 7-, 28-, and 90-day mortality. We included 60 patients (29 Cascade, 31 usual care). Baseline characteristics were comparable. Median number of catecholamine-free days was 22 [IQR 11-23] vs 20 [0-25] for Cascade vs control; there was no significant difference even after adjustment. There was no significant difference in number of mechanical ventilation-free days or ICU requirement. Median number of RRT-free days was 85 [46-90] vs 74 [0-90] for Cascade vs control groups, p = 0.42. By multivariate analysis, the number of RRT-free days was significantly higher in the Cascade group (up to 25 days higher after adjustment). There was no difference in mortality at 7, 28, or 90 days. Very HVHF using the Cascade system can safely be used in patients presenting with septic shock, but it was not associated with a reduction in the need for catecholamines during the first 28 days.

Hypoalbuminemia, Low Base Excess Values, and Tachypnea Predict 28-Day Mortality in Severe Sepsis and Septic Shock Patients in the Emergency Department.

PubMed

Seo, Min Ho; Choa, Minhong; You, Je Sung; Lee, Hye Sun; Hong, Jung Hwa; Park, Yoo Seok; Chung, Sung Phil; Park, Incheol

2016-11-01

The objective of this study was to develop a new nomogram that can predict 28-day mortality in severe sepsis and/or septic shock patients using a combination of several biomarkers that are inexpensive and readily available in most emergency departments, with and without scoring systems. We enrolled 561 patients who were admitted to an emergency department (ED) and received early goal-directed therapy for severe sepsis or septic shock. We collected demographic data, initial vital signs, and laboratory data sampled at the time of ED admission. Patients were randomly assigned to a training set or validation set. For the training set, we generated models using independent variables associated with 28-day mortality by multivariate analysis, and developed a new nomogram for the prediction of 28-day mortality. Thereafter, the diagnostic accuracy of the nomogram was tested using the validation set. The prediction model that included albumin, base excess, and respiratory rate demonstrated the largest area under the receiver operating characteristic curve (AUC) value of 0.8173 [95% confidence interval (CI), 0.7605-0.8741]. The logistic analysis revealed that a conventional scoring system was not associated with 28-day mortality. In the validation set, the discrimination of a newly developed nomogram was also good, with an AUC value of 0.7537 (95% CI, 0.6563-0.8512). Our new nomogram is valuable in predicting the 28-day mortality of patients with severe sepsis and/or septic shock in the emergency department. Moreover, our readily available nomogram is superior to conventional scoring systems in predicting mortality.

Corrective Action Investigation Plan for Corrective Action Unit 560: Septic Systems, Nevada Test Site, Nevada with ROTC1, Revision 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grant Evenson

2008-05-01

Corrective Action Unit (CAU) 560 is located in Areas 3 and 6 of the Nevada Test Site, which is approximately 65 miles northwest of Las Vegas, Nevada. Corrective Action Unit 560 is comprised of the seven corrective action sites (CASs) listed below: • 03-51-01, Leach Pit • 06-04-02, Septic Tank • 06-05-03, Leach Pit • 06-05-04, Leach Bed • 06-59-03, Building CP-400 Septic System • 06-59-04, Office Trailer Complex Sewage Pond • 06-59-05, Control Point Septic System These sites are being investigated because existing information on the nature and extent of potential contamination is insufficient to evaluate and recommend correctivemore » action alternatives. Additional information will be obtained by conducting a corrective action investigation before evaluating corrective action alternatives and selecting the appropriate corrective action for each CAS. The results of the field investigation will support a defensible evaluation of viable corrective action alternatives that will be presented in the Corrective Action Decision Document. The sites will be investigated based on the data quality objectives (DQOs) developed on January 22, 2008, by representatives from the Nevada Division of Environmental Protection; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to develop and evaluate appropriate corrective actions for CAU 560.« less

Immune cell phenotype and function in sepsis

PubMed Central

Rimmelé, Thomas; Payen, Didier; Cantaluppi, Vincenzo; Marshall, John; Gomez, Hernando; Gomez, Alonso; Murray, Patrick; Kellum, John A.

2015-01-01

Cells of the innate and adaptive immune systems play a critical role in the host response to sepsis. Moreover, their accessibility for sampling and their capacity to respond dynamically to an acute threat increases the possibility that leukocytes might serve as a measure of a systemic state of altered responsiveness in sepsis. The working group of the 14th Acute Dialysis Quality Initiative (ADQI) conference sought to obtain consensus on the characteristic functional and phenotypic changes in cells of the innate and adaptive immune system in the setting of sepsis. Techniques for the study of circulating leukocytes were also reviewed and the impact on cellular phenotypes and leukocyte function of non extracorporeal treatments and extracorporeal blood purification therapies proposed for sepsis was analyzed. A large number of alterations in the expression of distinct neutrophil and monocyte surface markers have been reported in septic patients. The most consistent alteration seen in septic neutrophils is their activation of a survival program that resists apoptotic death. Reduced expression of HLA-DR is a characteristic finding on septic monocytes but monocyte antimicrobial function does not appear to be significantly altered in sepsis. Regarding adaptive immunity, sepsis-induced apoptosis leads to lymphopenia in patients with septic shock and it involves all types of T cells (CD4, CD8 and Natural Killer) except T regulatory cells, thus favoring immunosuppression. Finally, numerous promising therapies targeting the host immune response to sepsis are under investigation. These potential treatments can have an effect on the number of immune cells, the proportion of cell subtypes and the cell function. PMID:26529661

IMMUNE CELL PHENOTYPE AND FUNCTION IN SEPSIS.

PubMed

Rimmelé, Thomas; Payen, Didier; Cantaluppi, Vincenzo; Marshall, John; Gomez, Hernando; Gomez, Alonso; Murray, Patrick; Kellum, John A

2016-03-01

Cells of the innate and adaptive immune systems play a critical role in the host response to sepsis. Moreover, their accessibility for sampling and their capacity to respond dynamically to an acute threat increases the possibility that leukocytes might serve as a measure of a systemic state of altered responsiveness in sepsis.The working group of the 14th Acute Dialysis Quality Initiative (ADQI) conference sought to obtain consensus on the characteristic functional and phenotypic changes in cells of the innate and adaptive immune system in the setting of sepsis. Techniques for the study of circulating leukocytes were also reviewed and the impact on cellular phenotypes and leukocyte function of nonextracorporeal treatments and extracorporeal blood purification therapies proposed for sepsis was analyzed.A large number of alterations in the expression of distinct neutrophil and monocyte surface markers have been reported in septic patients. The most consistent alteration seen in septic neutrophils is their activation of a survival program that resists apoptotic death. Reduced expression of HLA-DR is a characteristic finding on septic monocytes, but monocyte antimicrobial function does not appear to be significantly altered in sepsis. Regarding adaptive immunity, sepsis-induced apoptosis leads to lymphopenia in patients with septic shock and it involves all types of T cells (CD4, CD8, and Natural Killer) except T regulatory cells, thus favoring immunosuppression. Finally, numerous promising therapies targeting the host immune response to sepsis are under investigation. These potential treatments can have an effect on the number of immune cells, the proportion of cell subtypes, and the cell function.

Geologic and Landuse Controls of the Risk for Domestic Well Pollution from Septic Tank Leachate

NASA Astrophysics Data System (ADS)

Horn, J.; Harter, T.

2006-12-01

A highly resolved three-dimensional groundwater model containing a domestic drinking water well and its surrounding gravel pack is simulated with MODFLOW. Typical recharge rates, domestic well depths and well sealing lengths are obtained by analyzing well log data from eastern Stanislaus County, California, an area with a significant rural and suburban population relying on domestic wells and septic tank systems. The domestic well model is run for a range of hydraulic conductivities of both, the gravel pack and the aquifer. Reverse particle tracking with MODPATH 3D is carried out to determine the capture zone of the well as a function of hydraulic conductivity. The resulting capture zone is divided into two areas: Particles representing water entering the top of the well screen represent water that flows downward through the gravel pack from somewhere below the well seal and above the well screen. The source area associated with these particles forms a narrow well-ward elongation of the main capture zone, which represents that of particles flowing horizontally across the gravel pack into the well screen. The properties of the modeled capture zones are compared to existing analytical capture zone models. A clear influence of the gravel pack on capture zone shape and size is shown. Using the information on capture zone geometry, a risk assessment tool is developed to estimate the chance that a domestic well capture zone intersects at least one septic tank drainfield in a checkerboard of rural or suburban lots of a given size, but random drainfield and domestic well distribution. Risk is computed as a function of aquifer and gravel pack hydraulic conductivity, and as a function of lot size. We show the risk of collocation of a septic tank leach field with a domestic well capture zone for various scenarios. This risk is generally highest for high hydraulic conductivities of the gravel pack and the aquifer, limited anisotropy, and higher septic system densities. Under typical conditions, the risk of septic leachate reaching a domestic well is significant and may range from 5% to over 50%.

Probiotics improve survival of septic rats by suppressing conditioned pathogens in ascites

PubMed Central

Liu, Da-Quan; Gao, Qiao-Ying; Liu, Hong-Bin; Li, Dong-Hua; Wu, Shang-Wei

2013-01-01

AIM: To investigate the benefits of probiotics treatment in septic rats. METHODS: The septic rats were induced by cecal ligation and puncture. The animals of control, septic model and probiotics treated groups were treated with vehicle and mixed probiotics, respectively. The mixture of probiotics included Bifidobacterium longum, Lactobacillus bulgaricus and Streptococcus thermophilus. We observed the survival of septic rats using different amounts of mixed probiotics. We also detected the bacterial population in ascites and blood of experimental sepsis using cultivation and real-time polymerase chain reaction. The severity of mucosal inflammation in colonic tissues was determined. RESULTS: Probiotics treatment improved survival of the rats significantly and this effect was dose dependent. The survival rate was 30% for vehicle-treated septic model group. However, 1 and 1/4 doses of probiotics treatment increased survival rate significantly compared with septic model group (80% and 55% vs 30%, P < 0.05). The total viable counts of bacteria in ascites decreased significantly in probiotics treated group compared with septic model group (5.20 ± 0.57 vs 9.81 ± 0.67, P < 0.05). The total positive rate of hemoculture decreased significantly in probiotics treated group compared with septic model group (33.3% vs 100.0%, P < 0.05). The population of Escherichia coli and Staphylococcus aureus in ascites of probiotics treated group were decreased significantly compared with that of septic model group (3.93 ± 0.73 vs 8.80 ± 0.83, P < 0.05; 2.80 ± 1.04 vs 5.39 ± 1.21, P < 0.05). With probiotics treatment, there was a decrease in the scores of inflammatory cell infiltration into the intestinal mucosa in septic animals (1.50 ± 0.25 vs 2.88 ± 0.14, P < 0.01). CONCLUSION: Escherichia coli and Staphylococcus aureus may be primary pathogens in septic rats. Probiotics improve survival of septic rats by suppressing these conditioned pathogens. PMID:23840152

Effect of unfractionated heparin on endothelial glycocalyx in a septic shock model.

PubMed

Yini, S; Heng, Z; Xin, A; Xiaochun, M

2015-02-01

The constituents of vascular endothelial glycocalyx, such as syndecan-1 and heparan sulphate (HS), can be detected in the plasma of patients and animals with septic shock. However, the dynamics of glycocalyx degradation and its association with inflammation remains largely unknown. In this study, we investigated the association between the biomarkers of acute endothelial glycocalyx degradation and inflammatory factors. We also evaluated the effect of unfractionated heparin (UFH) on glycocalyx shedding in a canine septic shock model. Twenty adult beagle dogs were randomly allocated to one of the following four groups (n = 5): (1) a sham group; (2) a shock group [3.5 × 10(8) colony-forming unit (cfu) Escherichia coli (E. coli)/kg]; (3) a basic therapy group (sensitive antibiotics and 0.9% saline, 10 ml/kg/h); and (4) a heparin group (40 units/kg/h UFH plus basic therapy). After the onset of septic shock, systemic haemodynamic indices were measured. Endothelial glycocalyx degradation markers (i.e., syndecan-1, HS) and inflammatory factors [i.e., interleukin 6 (IL-6), tumour necrosis factor (TNF)-α], platelet count and activated partial thromboplastin time were measured at various time points. A lethal dose of E. coli induced a progressive septic shock model. We observed increased syndecan-1 and HS levels, which correlated with IL-6 and TNF-α in the septic shock model. The glycocalyx shedding was reduced by UFH, which might be regulated by the inhibition of inflammatory factors. A therapeutic dose of UFH can protect glycocalyx from shedding by inhibiting inflammation. Additional studies with larger sample sizes are needed to confirm our conclusions. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Effect of dobutamine on extravascular lung water index, ventilator function, and perfusion parameters in acute respiratory distress syndrome associated with septic shock.

PubMed

Zhou, Min; Dai, Ji; Du, Min; Wang, Wei; Guo, Changxing; Wang, Yi; Tang, Rui; Xu, Fengling; Rao, Zhuqing; Sun, Gengyun

2016-08-01

The role of dobutamine in the relief of pulmonary edema during septic shock-induced acute respiratory distress syndrome (ARDS) remains undetermined, due to a lack of controllable and quantitative clinical studies. Our objective was to assess the potential effects of dobutamine on extravascular lung water index (ELWI) in septic shock-induced ARDS, reflecting its importance in pulmonary edema. At the same time, ventilator function and perfusion parameters were evaluated. We designed a prospective, non-randomized, non-blinded, controlled study to compare the differences in PiCCO parameters after 6 h of constant dobutamine infusion (15 μg/kg/min), in the baseline parameters in 26 septic shock-related ARDS patients with cardiac index ≥ 2.5I/min/m(2) and hyperlactatemia. These patients (12 survivors/14 non-survivors) were monitored using the PiCCO catheter system within 48 h of onset of septic shock. The dynamic changes in ELWI, which is typically used for quantifying the extent of pulmonary edema, were evaluated, and the corresponding ventilator function and tissue perfusion parameters were also measured. Decreasing ELWI (p = 0.0376) was accompanied by significantly decreased SVRI (p < 0.0001). Despite a significant increase in cardiac output (p < 0.0001), no differences were found in ITBI or GEDI. Moreover, the required dose of norepinephrine was decreased (p = 0.0389), and urine output was increased (p = 0.0358), accompanied by stabilized lactacidemia and MAP. Additionally, airway pressure was moderately improved. During the early stage of septic shock-induced ARDS, dobutamine treatment demonstrated a beneficial effect by relieving pulmonary edema in patients, without a negative elevation in preload or hemodynamics, which might account for the improvements in ventilator function and tissue hypoperfusion.

Comparative safety and efficacy of vasopressors for mortality in septic shock: A network meta-analysis.

PubMed

Nagendran, Myura; Maruthappu, Mahiben; Gordon, Anthony C; Gurusamy, Kurinchi S

2016-05-01

Septic shock is a life-threatening condition requiring vasopressor agents to support the circulatory system. Several agents exist with choice typically guided by the specific clinical scenario. We used a network meta-analysis approach to rate the comparative efficacy and safety of vasopressors for mortality and arrhythmia incidence in septic shock patients. We performed a comprehensive electronic database search including Medline, Embase, Science Citation Index Expanded and the Cochrane database. Randomised trials investigating vasopressor agents in septic shock patients and specifically assessing 28-day mortality or arrhythmia incidence were included. A Bayesian network meta-analysis was performed using Markov chain Monte Carlo methods. Thirteen trials of low to moderate risk of bias in which 3146 patients were randomised were included. There was no pairwise evidence to suggest one agent was superior over another for mortality. In the network meta-analysis, vasopressin was significantly superior to dopamine (OR 0.68 (95% CI 0.5 to 0.94)) for mortality. For arrhythmia incidence, standard pairwise meta-analyses confirmed that dopamine led to a higher incidence of arrhythmias than norepinephrine (OR 2.69 (95% CI 2.08 to 3.47)). In the network meta-analysis, there was no evidence of superiority of one agent over another. In this network meta-analysis, vasopressin was superior to dopamine for 28-day mortality in septic shock. Existing pairwise information supports the use of norepinephrine over dopamine. Our findings suggest that dopamine should be avoided in patients with septic shock and that other vasopressor agents should continue to be based on existing guidelines and clinical judgement of the specific presentation of the patient.

[Treatment Strategies for Septic Arthritis of the Sternoclavicular Joint].

PubMed

Kuhtin, O; Schmidt-Rohlfing, B; Dittrich, M; Lampl, L; Hohls, M; Haas, V

2015-10-01

Septic arthritis of the sternoclavicular joint (SCJ) is a relatively rare disease. Due to serious complications including mediastinitis and generalised sepsis early diagnosis and rapid onset of treatment are mandatory. The disease often affects immunocompromised patients, diabetics, or patients with other infectious diseases. The therapeutic options range from administration of antibiotics to extended surgery including reconstructive procedures. Apart from rare situations where conservative treatment with antibiotics is sufficient, joint resection followed by plastic surgical procedures are required. We present a retrospective analysis with data from two hospitals. From January 2008 to December 2012 23 patients with radiographically confirmed septic arthritis of various aetiology were included. Fourteen (60.8 %) male, nine (39.2 %) female patients with an average age of 60.3 ± 14.2 years (range: 23-88 years) with septic arthritis of the SCJ were treated. Seven (30.4 %) patients suffered from Diabetes mellitus, nine (39.1 %) had underlying diseases with a compromised immune system. In 14 (60.8 %) out of 23 patients a bacterial focus was detected. Only six (26 %) patients suffered from confined septic arthritis of the SCG, in 17 (73,9 %) patients osteomyelitis of the adjacent sternum, and the clavicle was present. In addition, 15 (65.2 %) patients already suffered from mediastinitis at the time of diagnosis, eight (35 %) patients even from septicaemia. In conclusion, septic arthritis requires an active surgical treatment. Limited incision of the joint and debridement alone is only successful at early stages of the disease. The treatment concept has to include the local joint and bone resection as well as complications like mediastinitis. After successful treatment of the infection, the defect of the chest wall requires secondary reconstructive surgery using a pedicled pectoralis muscle flap. Georg Thieme Verlag KG Stuttgart · New York.

Effects of Gravity on Cells, Tissues, and Organisms: Their Implications on Habitat and Human Support in Microgravity

NASA Technical Reports Server (NTRS)

Kizito, John

2004-01-01

This presentation will demonstrate that gravity plays a major role in advanced human life support in a closed habitat. The examples include, but are not limited to, control of purity in drinking water supplies (application of biocides), control of urine in space rodent habitats and operation of space septic tanks (waste management). Our goal is to understand and determine possible mechanisms that describe the process by which cells anchor to a substrate to form dynamic, vibrant communities of cells which influence human health in absence of gravity. The balance of all forces (mechanotransduction) acting on a cell will determine whether a cell thrives and multiplies or dies in a process called apoptosis and/or necrosis. The balance of forces are tightly coupled to the transport of nutrients and metabolic products (biochemotransduction) to and from the cell interface. We will highlight our effort to improve astronaut health by showing that microgravity life support systems have to be designed differently from those on Earth.

Sepsis induces long-term metabolic and mitochondrial muscle stem cell dysfunction amenable by mesenchymal stem cell therapy

PubMed Central

Rocheteau, P.; Chatre, L.; Briand, D.; Mebarki, M.; Jouvion, G.; Bardon, J.; Crochemore, C.; Serrani, P.; Lecci, P. P.; Latil, M.; Matot, B.; Carlier, P. G.; Latronico, N.; Huchet, C.; Lafoux, A.; Sharshar, T.; Ricchetti, M.; Chrétien, F.

2015-01-01

Sepsis, or systemic inflammatory response syndrome, is the major cause of critical illness resulting in admission to intensive care units. Sepsis is caused by severe infection and is associated with mortality in 60% of cases. Morbidity due to sepsis is complicated by neuromyopathy, and patients face long-term disability due to muscle weakness, energetic dysfunction, proteolysis and muscle wasting. These processes are triggered by pro-inflammatory cytokines and metabolic imbalances and are aggravated by malnutrition and drugs. Skeletal muscle regeneration depends on stem (satellite) cells. Herein we show that mitochondrial and metabolic alterations underlie the sepsis-induced long-term impairment of satellite cells and lead to inefficient muscle regeneration. Engrafting mesenchymal stem cells improves the septic status by decreasing cytokine levels, restoring mitochondrial and metabolic function in satellite cells, and improving muscle strength. These findings indicate that sepsis affects quiescent muscle stem cells and that mesenchymal stem cells might act as a preventive therapeutic approach for sepsis-related morbidity. PMID:26666572

Sepsis induces long-term metabolic and mitochondrial muscle stem cell dysfunction amenable by mesenchymal stem cell therapy.

PubMed

Rocheteau, P; Chatre, L; Briand, D; Mebarki, M; Jouvion, G; Bardon, J; Crochemore, C; Serrani, P; Lecci, P P; Latil, M; Matot, B; Carlier, P G; Latronico, N; Huchet, C; Lafoux, A; Sharshar, T; Ricchetti, M; Chrétien, F

2015-12-15

Sepsis, or systemic inflammatory response syndrome, is the major cause of critical illness resulting in admission to intensive care units. Sepsis is caused by severe infection and is associated with mortality in 60% of cases. Morbidity due to sepsis is complicated by neuromyopathy, and patients face long-term disability due to muscle weakness, energetic dysfunction, proteolysis and muscle wasting. These processes are triggered by pro-inflammatory cytokines and metabolic imbalances and are aggravated by malnutrition and drugs. Skeletal muscle regeneration depends on stem (satellite) cells. Herein we show that mitochondrial and metabolic alterations underlie the sepsis-induced long-term impairment of satellite cells and lead to inefficient muscle regeneration. Engrafting mesenchymal stem cells improves the septic status by decreasing cytokine levels, restoring mitochondrial and metabolic function in satellite cells, and improving muscle strength. These findings indicate that sepsis affects quiescent muscle stem cells and that mesenchymal stem cells might act as a preventive therapeutic approach for sepsis-related morbidity.

Biscayne aquifer, southeast Florida

USGS Publications Warehouse

Klein, Howard; Hull, John E.

1978-01-01

Peak daily pumpage from the highly permeable, unconfined Biscayne aquifer for public water-supply systems in southeast Florida in 1975 was about 500 million gallons. Another 165 million gallons was withdrawn daily for irrigation. Recharge to the aquifer is primarily by local rainfall. Discharge is by evapotranspiration, canal drainage, coastal seepage, and pumping. Pollutants can enter the aquifer by direct infiltration from land surface or controlled canals, septic-tank and other drainfields, drainage wells, and solid-waste dumps. Most of the pollutants are concentrated in the upper 20 to 30 feet of the aquifer; public supply wells generally range in depth from about 75 to 150 feet. Dilution, dispersion, and adsorption tend to reduce the concentrations. Seasonal heavy rainfall and canal discharge accelerate ground-water circulation, thereby tending to dilute and flush upper zones of the aquifer. The ultimate fate of pollutants in the aquifer is the ocean, although some may be adsorbed by the aquifer materials en route to the ocean, and some are diverted to pumping wells. (Woodard-USGS)

The Septic Shock 3.0 Definition and Trials: A Vasopressin and Septic Shock Trial Experience.

PubMed

Russell, James A; Lee, Terry; Singer, Joel; Boyd, John H; Walley, Keith R

2017-06-01

The Septic Shock 3.0 definition could alter treatment comparisons in randomized controlled trials in septic shock. Our first hypothesis was that the vasopressin versus norepinephrine comparison and 28-day mortality of patients with Septic Shock 3.0 definition (lactate > 2 mmol/L) differ from vasopressin versus norepinephrine and mortality in Vasopressin and Septic Shock Trial. Our second hypothesis was that there are differences in plasma cytokine levels in Vasopressin and Septic Shock Trial for lactate less than or equal to 2 versus greater than 2 mmol/L. Retrospective analysis of randomized controlled trial. Multicenter ICUs. We compared vasopressin-to-norepinephrine group 28- and 90-day mortality in Vasopressin and Septic Shock Trial in lactate subgroups. We measured 39 cytokines to compare patients with lactate less than or equal to 2 versus greater than 2 mmol/L. Patients with septic shock with lactate greater than 2 mmol/L or less than or equal to 2 mmol/L, randomized to vasopressin or norepinephrine. Concealed vasopressin (0.03 U/min.) or norepinephrine infusions. The Septic Shock 3.0 definition would have decreased sample size by about half. The 28- and 90-day mortality rates were 10-12 % higher than the original Vasopressin and Septic Shock Trial mortality. There was a significantly (p = 0.028) lower mortality with vasopressin versus norepinephrine in lactate less than or equal to 2 mmol/L but no difference between treatment groups in lactate greater than 2 mmol/L. Nearly all cytokine levels were significantly higher in patients with lactate greater than 2 versus less than or equal to 2 mmol/L. The Septic Shock 3.0 definition decreased sample size by half and increased 28-day mortality rates by about 10%. Vasopressin lowered mortality versus norepinephrine if lactate was less than or equal to 2 mmol/L. Patients had higher plasma cytokines in lactate greater than 2 versus less than or equal to 2 mmol/L, a brisker cytokine response to infection. The Septic Shock 3.0 definition and our findings have important implications for trial design in septic shock.

A Practical Predictive Index for Intra-abdominal Septic Complications After Primary Anastomosis for Crohn's Disease: Change in C-Reactive Protein Level Before Surgery.

PubMed

Zuo, Lugen; Li, Yi; Wang, Honggang; Zhu, Weiming; Zhang, Wei; Gong, Jianfeng; Li, Ning; Li, Jieshou

2015-08-01

Postoperative intra-abdominal septic complications are difficult to manage in Crohn's disease, which makes prevention especially important. The purpose of this study was to examine the risk factors for intra-abdominal septic complications after primary anastomosis for Crohn's disease and to seek a practical predictive index for intra-abdominal septic complications. This was a retrospective study. The study was conducted in a tertiary referral hospital. Based on a computerized database of 344 patients with Crohn's disease who underwent primary anastomosis between 2004 and 2013, the patients were placed into an intra-abdominal septic complications group and a group without intra-abdominal septic complications. Univariate and multivariate analyses were performed to identify risk factors, and the predictive accuracy of possible predictors was assessed using receiver operating characteristic curves. Overall, 39 patients (11.34%) developed intra-abdominal septic complications. Preoperative C-reactive protein level >10 mg/L was found to be an independent risk factor (p < 0.01) for intra-abdominal septic complications. For prediction of intra-abdominal septic complications, receiver operating characteristic curve analysis showed that a C-reactive protein cutoff of 14.50 mg/L provided negative and positive predictive values of 96.84% and 34.07%. In addition, the change in C-reactive protein levels over the 2 weeks before surgery was greater in the intra-abdominal septic complications group than the group with no intra-abdominal septic complications (p < 0.01), and the directions of change were opposite, upward in the former and downward in the latter. Apart from being a risk factor for intra-abdominal septic complications (p < 0.01), receiver operating characteristic curve analysis showed that the change in C-reactive protein levels before surgery had a negative predictive value for intra-abdominal septic complications of 98.66% and a positive predictive value of 76.09%. This was a retrospective study. Changes in C-reactive protein before surgical treatment of Crohn's disease could serve as a practical predictive index for postoperative intra-abdominal septic complications.

Soil and groundwater attenuation factors for nitrogen from septic systems in the Chesapeake Bay TMDL

NASA Astrophysics Data System (ADS)

Radcliffe, D. E.; Geza, M.; O'Drisoll, M.; Humphrey, C., Jr.

2015-12-01

An expert panel was tasked with estimating the percent of the nitrogen (N) load from septic systems that was lost in the flow path from a typical home to third-order streams as part of the Chesapeake Bay Total Maximum Daily Load (TMDL). These losses were referred to as attenuation factors. We developed values for the soil (unsaturated) zone and for the Piedmont and Coastal Plain groundwater zones. For the soil zone, we used the Soil Treatment Unit MODel (STUMOD) to estimate loses due to denitrification for all 12 soil textural classes and then averaged the results over three textural groups. Assuming hydraulic loading at the design rate and a conventional system, the attenuation factors were 16% for sand, loamy sand, sandy loam, and loam soils; 34% for silt loam, clay loam, sandy clay loam, silty clay loam, and silt soils; and 54% for sandy clay, silty clay, and clay soils. Attenuation factors increased in the more clayey soils due to wetter conditions and more losses due to denitrification. Attenuation factors were also developed for reduced hydraulic loading rates and for systems using advanced N pre-treatment. For the Piedmont groundwater zone, we used data from a recent study in Georgia of small suburban streams with high-density septic systems. Stream base-flow load was estimated using simultaneous measurements of total N concentration and discharge and compared to the estimated groundwater input load, resulting in an attenuation factor of 81%. For the Coastal Plain groundwater zone, literature values of groundwater N concentrations within septic system plumes in Virginia, North Carolina, and Florida were used to estimate an attenuation factor of approximately 60% at 100m downgradient from the drainfield. These attenuation factors will be used to estimate the contribution of N to the Chesapeake Bay in the Phase 6 TMDL models.

Clean Water State Revolving Fund (CWSRF): Decentralized Wastewater Treatment

EPA Pesticide Factsheets

Decentralized wastewater treatment is an onsite or clustered system used to collect, treat, and disperse or reclaim wastewater from a small community or service area (e.g., septic systems, cluster systems, lagoons).

Addendum to the Closure Report for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point, Nevada Test Site, Nevada

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lynn Kidman

2008-10-01

This document constitutes an addendum to the July 2003, Closure Report for Corrective Action Unit 262: Area 25 Septic Systems and Underground Discharge Point as described in the document Recommendations and Justifications for Modifications for Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office Federal Facility Agreement and Consent Order (UR Modification document) dated February 2008. The UR Modification document was approved by NDEP on February 26, 2008. The approval of the UR Modification document constituted approval of each of the recommended UR modifications.

Incremental sanitation improvement strategy: comparison of options for Hanoi, Vietnam.

PubMed

Harada, H; Matsui, S; Dong, N T; Shimizu, Y; Fujii, S

2010-01-01

Urban sanitation issues should be tackled strategically, and may be addressed effectively when sewage development is pursued in conjunction with complementary sanitation measures. Five sanitation improvement scenarios employing sewage, night-soil collection-and-treatment (NSCT) system, and/or septic-tank improvement by annual dislodging were analyzed from the perspective of COD loads, total nitrogen loads, and cost under the conditions found in Hanoi, Vietnam. Compared to the development of sewage alone, the scenario of developing NSCT systems in a complementary manner with sewage development was estimated to be the most effective for a rapid decrease of both COD and total nitrogen loads. However, it may be difficult in some cases to replace ordinary water-flush toilet by the micro-flush toilet that are used in NSCT systems. In this case, the scenario employing septic-tank improvement in conjunction with sewage development may be effective for a rapid decrease of COD in locations where septic tanks are widely used under poor maintenance conditions and nitrogen pollution is not serious compared to COD. It was calculated that the two scenarios above would respectively require cost increases of 16 and 22% over the sewage development scenario.

Risk stratification and prognostic performance of the predisposition, infection, response, and organ dysfunction (PIRO) scoring system in septic patients in the emergency department: a cohort study.

PubMed

Chen, Yun-Xia; Li, Chun-Sheng

2014-04-16

The predisposition, infection, response and organ dysfunction (PIRO) staging system was designed as a stratification tool to deal with the inherent heterogeneity of septic patients. The present study was conducted to assess the performance of PIRO in predicting multiple organ dysfunction (MOD), intensive care unit (ICU) admission, and 28-day mortality in septic patients in the emergency department (ED), and to compare this scoring system with the Mortality in Emergency Department Sepsis (MEDS) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores. Consecutive septic patients (n = 680) admitted to the ED of Beijing Chao-Yang Hospital were enrolled. PIRO, MEDS, and APACHE II scores were calculated for each patient on ED arrival. Organ function was reassessed within 3 days of enrollment. All patients were followed up for 28 days. Outcome criteria were the development of MOD within 3 days, ICU admission or death within 28 days after enrollment. The predictive ability of the four components of PIRO was analyzed separately. Receiver operating characteristic (ROC) curve and logistic regression analysis were used to assess the prognostic and risk stratification value of the scoring systems. Organ dysfunction independently predicted ICU admission, MOD, and 28-day mortality, with areas under the ROC curve (AUC) of 0.888, 0.851, and 0.816, respectively. The predictive value of predisposition, infection, and response was weaker than that of organ dysfunction. A negative correlation was found between the response component and MOD, as well as mortality. PIRO, MEDS, and APACHE II scores significantly differed between patients who did and did not meet the outcome criteria (P < 0.001). PIRO and APACHE II independently predicted ICU admission and MOD, but MEDS did not. All three systems were independent predictors of 28-day mortality with similar AUC values. The AUC of PIRO was 0.889 for ICU admission, 0.817 for MOD, and 0.744 for 28-day mortality. The AUCs of PIRO were significantly greater than those of APACHE II and MEDS (P < 0.05) in predicting ICU admission and MOD. The study indicates that PIRO is helpful for risk stratification and prognostic determinations in septic patients in the ED.

Clinical Factors and Outcomes of Dialysis-Dependent End-Stage Renal Disease Patients with Emergency Department Septic Shock.

PubMed

Lowe, Kevin M; Heffner, Alan C; Karvetski, Colleen H

2018-01-01

Infection is the second leading cause of death in end-stage renal disease (ESRD) patients. Prior investigations of acute septic shock in this specific population are limited. We aimed to evaluate the clinical presentation and factors associated with outcome among ESRD patients with acute septic shock. We reviewed patients prospectively enrolled in an emergency department (ED) septic shock treatment pathway registry between January 2014 and May 2016. Clinical and treatment variables for ESRD patients were compared with non-ESRD patients. A second analysis focused on ESRD septic shock survivors and nonsurvivors. Among 4126 registry enrollees, 3564 (86.4%) met inclusion for the study. End-stage renal disease was present in 3.8% (n = 137) of ED septic shock patients. Hospital mortality was 20.4% and 17.1% for the ESRD and non-ESRD septic shock patient groups (p = 0.31). Septic shock patients with ESRD had a higher burden of chronic illness, but similar admission clinical profiles to non-ESRD patients. End-stage renal disease status was independently associated with lower fluid resuscitation dose, even when controlling for severity of illness. Age and admission lactate were independently associated with mortality in ESRD septic shock patients. ESRD patients comprise a small but important portion of patients with ED septic shock. Although presentation clinical profiles are similar to patients without ESRD, ESRD status is independently associated with lower fluid dose and compliance with the 30-mL/kg fluid goal. Hyperlactatemia is a marker of mortality in ESRD septic shock. Copyright © 2017 Elsevier Inc. All rights reserved.

Life-threatening urethral hemorrhage after placement of a Foley catheter in a patient with uroseptic disseminated intravascular coagulation due to chronic urinary retention induced by untreated benign prostatic hyperplasia.

PubMed

Ikegami, Yukihiro; Yoshida, Keisuke; Imaizumi, Tsuyoshi; Isosu, Tsuyoshi; Kurosawa, Shin; Murakawa, Masahiro

2016-10-01

A 77-year-old man with severe septic disseminated intravascular coagulation following urinary infection was transported to our hospital. He had developed urinary retention induced by untreated prostatic hyperplasia. Immediate drainage with a Foley catheter was successfully carried out, but the hematuria progressed to life-threatening hemorrhage. Complete hemostasis was impossible by surgical treatment because the tissue around the prostatic urethra was very fragile and hemorrhagic. Organized treatments (continuous hemodiafiltration combined with polymyxin-B immobilized fiber column hemoperfusion and systemic treatment with antibiotics and coagulation factors) were commenced soon after the operation. The patient eventually recovered from the septic disseminated intravascular coagulation. This case report illustrates the risk of placement of Foley catheters in patients with severe septic disseminated intravascular coagulation.

Septic Systems

EPA Pesticide Factsheets

The web site provides guidance and technical assistance for homeowners, government officials, industry professionals, and EPA partners about how to properly develop and manage individual onsite and community cluster systems that treat domestic wastewater.

Nitrogen isotopes as indicators of nitrate sources in Minnesota sand-plain aquifers

USGS Publications Warehouse

Komor, Stephen C.; Anderson, Henry W.

1993-01-01

Nitrate concentrations in excess of national drinking-water standards (10 mg/1 as N) are present in certain sand-plain aquifers in central Minnesota. To investigate nitrate sources in the aquifers, nitrogen-isotope values of nitrate (δ15NNO3No3) were measured in shallow ground water from 51 wells in five land-use settings. The land-use settings and corresponding average nitrate concentrations (as N) and δ15NNO3 values are: livestock feedlots, 12.7 mg/1, 21.3%0; cultivated-irrigated fields, 13 mg/1, 7.4%0; residential areas with septic systems, 8.3 mg/1, 6.0%0; cultivated-nonirrigated fields, 15.5 mg/1, 3.4%0; and natural, undeveloped areas, 3.8 mg/1, 3.1%0. Values of δ15NNO3 less than 2%0 suggest that nitrogen from commercial inorganic fertilizers exists in ground water beneath all settings except the feedlots. Values of δ15NNO3 greater than 10%0 suggest that nitrogen from animal waste is present in ground water beneath certain feedlots, cultivated-irrigated fields that are fertilized with manure, and residential areas with septic systems. Values of δ15NNO3 between 22 and 43%0 in ground water beneath the feedlots probably result from denitrification. Values of δ15NNO3 increase with depth in many locations in the sand-plain aquifers. These increases may be caused by progressive denitrification with depth or by changes with depth in the proportions of nitrate from different sources. Similarly, variations of δ15NNO3 values from 1986 to 1987 in certain locations may be due to temporal variations in the amounts of denitrification or to changes in the proportions of nitrate from different sources. Ambiguities in the interpretation of changes in δ15NNO3 values could be eliminated by increasing the spatial and temporal frequency of sampling.

Particle transport in porous media

NASA Astrophysics Data System (ADS)

Corapcioglu, M. Yavuz; Hunt, James R.

The migration and capture of particles (such as colloidal materials and microorganisms) through porous media occur in fields as diversified as water and wastewater treatment, well drilling, and various liquid-solid separation processes. In liquid waste disposal projects, suspended solids can cause the injection well to become clogged, and groundwater quality can be endangered by suspended clay and silt particles because of migration to the formation adjacent to the well bore. In addition to reducing the permeability of the soil, mobile particles can carry groundwater contaminants adsorbed onto their surfaces. Furthermore, as in the case of contamination from septic tanks, the particles themselves may be pathogens, i.e., bacteria and viruses.

Estimating the water budget for a peat filter treating septic tank effluent in the field

NASA Astrophysics Data System (ADS)

Van Geel, Paul J.; Parker, Wayne J.

2003-02-01

The use of peat as a filter medium for the treatment of a variety of liquid and gas waste streams has increased over the past decade. Peat has been used as an alternate treatment medium to treat septic tank effluent (STE) from domestic and small communal systems. Very little research has been completed to study the hydraulics and water budget of a peat filter operating in the field. This study evaluated the water budget of a peat filter operating at an elementary school near Ottawa, Canada. The peat filter was instrumented with tensiometers to measure the pore water pressures within the filter and a weather station to collect weather data required to estimate potential evapotranspiration. A one-dimensional unsaturated flow model, SoilCover, was calibrated using the pressure data and weather data collected in the field. The calibrated model was use to estimate the water budget for the filter operating with and without STE loading. The calibrated model predicted that the annual precipitation exceeded evapotranspiration for both scenarios. For the filter treating 50 mm/day of STE, there was a slight dilution due to the infiltration resulting in a net dilution factor of 0.97 (loading divided by the loading plus infiltration). The largest rainfall event of 49.9 mm resulted in a dilution factor of approximately 0.87, which corresponded to an approximate decrease in the hydraulic retention time (HRT) of between 12 and 33% depending on the calculation used to determine the HRT. When the filter does not receive STE, the precipitation exceeds evapotranspiration and hence the filter should not dry out when the filter is not in use.

Polymicrobial sepsis and non-specific immunization induce adaptive immunosuppression to a similar degree.

PubMed

Schmoeckel, Katrin; Mrochen, Daniel M; Hühn, Jochen; Pötschke, Christian; Bröker, Barbara M

2018-01-01

Sepsis is frequently complicated by a state of profound immunosuppression, in its extreme form known as immunoparalysis. We have studied the role of the adaptive immune system in the murine acute peritonitis model. To read out adaptive immunosuppression, we primed post-septic and control animals by immunization with the model antigen TNP-ovalbumin in alum, and measured the specific antibody-responses via ELISA and ELISpot assay as well as T-cell responses in a proliferation assay after restimulation. Specific antibody titers, antibody affinity and plasma cell counts in the bone marrow were reduced in post-septic animals. The antigen-induced splenic proliferation was also impaired. The adaptive immunosuppression was positively correlated with an overwhelming general antibody response to the septic insult. Remarkably, antigen "overload" by non-specific immunization induced a similar degree of adaptive immunosuppression in the absence of sepsis. In both settings, depletion of regulatory T cells before priming reversed some parameters of the immunosuppression. In conclusion, our data show that adaptive immunosuppression occurs independent of profound systemic inflammation and life-threatening illness.

Polymicrobial sepsis and non-specific immunization induce adaptive immunosuppression to a similar degree

PubMed Central

Hühn, Jochen; Pötschke, Christian

2018-01-01

Sepsis is frequently complicated by a state of profound immunosuppression, in its extreme form known as immunoparalysis. We have studied the role of the adaptive immune system in the murine acute peritonitis model. To read out adaptive immunosuppression, we primed post-septic and control animals by immunization with the model antigen TNP-ovalbumin in alum, and measured the specific antibody-responses via ELISA and ELISpot assay as well as T-cell responses in a proliferation assay after restimulation. Specific antibody titers, antibody affinity and plasma cell counts in the bone marrow were reduced in post-septic animals. The antigen-induced splenic proliferation was also impaired. The adaptive immunosuppression was positively correlated with an overwhelming general antibody response to the septic insult. Remarkably, antigen “overload” by non-specific immunization induced a similar degree of adaptive immunosuppression in the absence of sepsis. In both settings, depletion of regulatory T cells before priming reversed some parameters of the immunosuppression. In conclusion, our data show that adaptive immunosuppression occurs independent of profound systemic inflammation and life-threatening illness. PMID:29415028

Relative Bradycardia in Patients with Septic Shock Requiring Vasopressor Therapy

PubMed Central

Beesley, Sarah J.; Wilson, Emily L.; Lanspa, Michael J.; Grissom, Colin K.; Shahul, Sajid; Talmor, Daniel; Brown, Samuel M.

2017-01-01

Importance Tachycardia is common in septic shock, but many patients with septic shock are relatively bradycardic. The incidence, determinants, and implications of relative bradycardia (heart rate <80 beats/min) in septic shock are unknown. Objective To determine mortality associated with patients who are relatively bradycardic while in septic shock. Design Retrospective study of patients admitted for septic shock to study ICUs during 2005-2013. Setting One large academic referral hospital and two community hospitals. Participants Adult patients with septic shock requiring vasopressors. Intervention None. Measurements Primary outcome was 28-day mortality. We used multivariate logistic regression to evaluate the association between relative bradycardia and mortality, controlling for confounding with inverse probability treatment weighting using a propensity score. Results We identified 1,554 patients with septic shock, of whom 686 (44%) met criteria for relative bradycardia at some time. Twenty-eight day mortality in this group was 21% compared to 34% in the never-bradycardic group (p<0.001). Relatively bradycardic patients were older (65 vs. 60 years, p<0.001) and had slightly lower illness severity (SOFA 10 vs 11, p = 0.004, and APACHE II 27 vs. 28, p=0.008). After inverse probability treatment weighting, covariates were balanced, and the association between relative bradycardia and survival persisted (p<0.001). Conclusions Relative bradycardia in patients with septic shock is associated with lower mortality, even after adjustment for confounding. Our data support expanded investigation into whether inducing relative bradycardia will benefit patients with septic shock. PMID:27618277

Relative Bradycardia in Patients With Septic Shock Requiring Vasopressor Therapy.

PubMed

Beesley, Sarah J; Wilson, Emily L; Lanspa, Michael J; Grissom, Colin K; Shahul, Sajid; Talmor, Daniel; Brown, Samuel M

2017-02-01

Tachycardia is common in septic shock, but many patients with septic shock are relatively bradycardic. The prevalence, determinants, and implications of relative bradycardia (heart rate, < 80 beats/min) in septic shock are unknown. To determine mortality associated with patients who are relatively bradycardic while in septic shock. Retrospective study of patients admitted for septic shock to study ICUs during 2005-2013. One large academic referral hospital and two community hospitals. Adult patients with septic shock requiring vasopressors. None. Primary outcome was 28-day mortality. We used multivariate logistic regression to evaluate the association between relative bradycardia and mortality, controlling for confounding with inverse probability treatment weighting using a propensity score. We identified 1,554 patients with septic shock, of whom 686 (44%) met criteria for relative bradycardia at some time. Twenty-eight-day mortality in this group was 21% compared to 34% in the never-bradycardic group (p < 0.001). Relatively bradycardic patients were older (65 vs 60 yr; p < 0.001) and had slightly lower illness severity (Sequential Organ Failure Assessment, 10 vs 11; p = 0.004; and Acute Physiology and Chronic Health Evaluation II, 27 vs 28; p = 0.008). After inverse probability treatment weighting, covariates were balanced, and the association between relative bradycardia and survival persisted (p < 0.001). Relative bradycardia in patients with septic shock is associated with lower mortality, even after adjustment for confounding. Our data support expanded investigation into whether inducing relative bradycardia will benefit patients with septic shock.

A novel method for a fast diagnosis of septic arthritis using mid infrared and deported spectroscopy.

PubMed

Albert, Jean-David; Monbet, Valérie; Jolivet-Gougeon, Anne; Fatih, Nadia; Le Corvec, Maëna; Seck, Malik; Charpentier, Frédéric; Coiffier, Guillaume; Boussard-Pledel, Catherine; Bureau, Bruno; Guggenbuhl, Pascal; Loréal, Olivier

2016-05-01

To assess the ability of mid infrared deported spectroscopy to discriminate synovial fluids samples of septic arthritis patients from other causes of joint effusion. Synovial fluids obtained from patients with clinically suspected arthritis were collected, analysed and classified according to standard diagnostic procedures as septic or non-septic. A spectroscopic analysis on synovial fluid samples was then performed using a coiled optical fiber made with chalcogenide glass. After a factorial analysis of the normalized spectra and the computation of a Fisher test used to select the most relevant components, a logistic regression model was fitted, allowing to attribute a score between 0 - non-septic -, and 1 - septic. In a first phase, we analysed the synovial fluids from 122 different synovial fluids including 6 septic arthritis among arthritis of various origins. Septic synovial fluids were identified with a sensitivity of 95.8% and a specificity of 93.9% and an AUROC of 0.977. The analysis of an independent set of samples (n=42, including two septic arthritis) gave similar values. Our data strongly supports the interest of mid infrared deported spectroscopy, which could be used potentially at point of care, for a rapid and easy diagnosis of septic arthritis. Now, the precision of the diagnosis must be evaluated through a multicentric study on a larger panel of patients. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Mortality Measures to Profile Hospital Performance for Patients With Septic Shock.

PubMed

Walkey, Allan J; Shieh, Meng-Shiou; Liu, Vincent X; Lindenauer, Peter K

2018-04-30

Sepsis care is becoming a more common target for hospital performance measurement, but few studies have evaluated the acceptability of sepsis or septic shock mortality as a potential performance measure. In the absence of a gold standard to identify septic shock in claims data, we assessed agreement and stability of hospital mortality performance under different case definitions. Retrospective cohort study. U.S. acute care hospitals. Hospitalized with septic shock at admission, identified by either implicit diagnosis criteria (charges for antibiotics, cultures, and vasopressors) or by explicit International Classification of Diseases, 9th revision, codes. None. We used hierarchical logistic regression models to determine hospital risk-standardized mortality rates and hospital performance outliers. We assessed agreement in hospital mortality rankings when septic shock cases were identified by either explicit International Classification of Diseases, 9th revision, codes or implicit diagnosis criteria. Kappa statistics and intraclass correlation coefficients were used to assess agreement in hospital risk-standardized mortality and hospital outlier status, respectively. Fifty-six thousand six-hundred seventy-three patients in 308 hospitals fulfilled at least one case definition for septic shock, whereas 19,136 (33.8%) met both the explicit International Classification of Diseases, 9th revision, and implicit septic shock definition. Hospitals varied widely in risk-standardized septic shock mortality (interquartile range of implicit diagnosis mortality: 25.4-33.5%; International Classification of Diseases, 9th revision, diagnosis: 30.2-38.0%). The median absolute difference in hospital ranking between septic shock cohorts defined by International Classification of Diseases, 9th revision, versus implicit criteria was 37 places (interquartile range, 16-70), with an intraclass correlation coefficient of 0.72, p value of less than 0.001; agreement between case definitions for identification of outlier hospitals was moderate (kappa, 0.44 [95% CI, 0.30-0.58]). Risk-standardized septic shock mortality rates varied considerably between hospitals, suggesting that septic shock is an important performance target. However, efforts to profile hospital performance were sensitive to septic shock case definitions, suggesting that septic shock mortality is not currently ready for widespread use as a hospital quality measure.

ArcNLET: A GIS-based software to simulate groundwater nitrate load from septic systems to surface water bodies

NASA Astrophysics Data System (ADS)

Rios, J. Fernando; Ye, Ming; Wang, Liying; Lee, Paul Z.; Davis, Hal; Hicks, Rick

2013-03-01

Onsite wastewater treatment systems (OWTS), or septic systems, can be a significant source of nitrates in groundwater and surface water. The adverse effects that nitrates have on human and environmental health have given rise to the need to estimate the actual or potential level of nitrate contamination. With the goal of reducing data collection and preparation costs, and decreasing the time required to produce an estimate compared to complex nitrate modeling tools, we developed the ArcGIS-based Nitrate Load Estimation Toolkit (ArcNLET) software. Leveraging the power of geographic information systems (GIS), ArcNLET is an easy-to-use software capable of simulating nitrate transport in groundwater and estimating long-term nitrate loads from groundwater to surface water bodies. Data requirements are reduced by using simplified models of groundwater flow and nitrate transport which consider nitrate attenuation mechanisms (subsurface dispersion and denitrification) as well as spatial variability in the hydraulic parameters and septic tank distribution. ArcNLET provides a spatial distribution of nitrate plumes from multiple septic systems and a load estimate to water bodies. ArcNLET's conceptual model is divided into three sub-models: a groundwater flow model, a nitrate transport and fate model, and a load estimation model which are implemented as an extension to ArcGIS. The groundwater flow model uses a map of topography in order to generate a steady-state approximation of the water table. In a validation study, this approximation was found to correlate well with a water table produced by a calibrated numerical model although it was found that the degree to which the water table resembles the topography can vary greatly across the modeling domain. The transport model uses a semi-analytical solution to estimate the distribution of nitrate within groundwater, which is then used to estimate a nitrate load using a mass balance argument. The estimates given by ArcNLET are suitable for a screening-level analysis.

Clinical Features, Short-Term Mortality, and Prognostic Risk Factors of Septic Patients Admitted to Internal Medicine Units

PubMed Central

Mazzone, Antonino; Dentali, Francesco; La Regina, Micaela; Foglia, Emanuela; Gambacorta, Maurizia; Garagiola, Elisabetta; Bonardi, Giorgio; Clerici, Pierangelo; Concia, Ercole; Colombo, Fabrizio; Campanini, Mauro

2016-01-01

Abstract Only a few studies provided data on the clinical history of sepsis within internal Medicine units. The aim of the study was to assess the short-term mortality and to evaluate the prognostic risk factors in a large cohort of septic patients treated in internal medicine units. Thirty-one internal medicine units participated to the study. Within each participating unit, all admitted patients were screened for the presence of sepsis. A total of 533 patients were included; 78 patients (14.6%, 95%CI 11.9, 18.0%) died during hospitalization; mortality rate was 5.5% (95% CI 3.1, 9.6%) in patients with nonsevere sepsis and 20.1% (95%CI 16.2, 28.8%) in patients with severe sepsis or septic shock. Severe sepsis or septic shock (OR 4.41, 95%CI 1.93, 10.05), immune system weakening (OR 2.10, 95%CI 1.12, 3.94), active solid cancer (OR 2.14, 95% CI 1.16, 3.94), and age (OR 1.03 per year, 95% CI 1.01, 1.06) were significantly associated with an increased mortality risk, whereas blood culture positive for Escherichia coli was significantly associated with a reduced mortality risk (OR 0.46, 95%CI 0.24, 0.88). In-hospital mortality of septic patients treated in internal medicine units appeared similar to the mortality rate obtained in recent studies conducted in the ICU setting. PMID:26825876

Leukemia inhibitory factor protects against experimental lethal Escherichia coli septic shock in mice.

PubMed Central

Waring, P M; Waring, L J; Billington, T; Metcalf, D

1995-01-01

Leukemia inhibitory factor (LIF) has recently been associated with septic shock in humans. In this study we sought to determine, in mice, the role of LIF in septic shock. During sublethal endotoxemia, serum LIF levels, as determined by radio-receptor competition assay, peaked at 2 h and were low (3 ng/ml), whereas in lethal Escherichia coli septic shock serum LIF levels rose progressively (> 30 ng/ml) in the premorbid phase coincident with the development of tissue injury. Single i.v. injections of high doses (up to 50 micrograms per mouse) of recombinant murine LIF had no obvious acute detrimental effects, whereas continued i.p. administration (30 micrograms per mouse per day) for 3-4 days induced a fatal catabolic state without evidence of preceding hemodynamic collapse or shock. Simultaneous or subsequent administration of high doses of LIF had no effect on mortality from sublethal and lethal E. coli septic shock, whereas prior administration conferred significant protection against lethality (P << 0.001 by log-rank test), an effect that was dose and interval dependent. This protective effect resembled endotoxin tolerance and was characterized by suppression of E. coli-induced serum tumor necrosis factor concentration (P < 0.05), reduction in the number of viable bacteria (P < 0.05), and prevention of sepsis-induced tissue injury. These observations suggest that systemic LIF production is part of the host response to both endotoxin and sepsis-induced tissue injury. Images Fig. 2 Fig. 5 PMID:7877978

UASB-septic tank as an alternative for decentralized wastewater treatment in Mexico.

PubMed

Santiago-Díaz, Ángel L; García-Albortante, Julisa; Salazar-Peláez, Mónica L

2018-02-05

The aim of this work was to evaluate the performance of a UASB-septic tank as a decentralized treatment of high-strength municipal wastewater under two different HRTs (48 and 72 h). Thus, a lab-scale (44.85 L) UASB-septic tank constituted by three compartments was operated under HRT 72 and 48 h. Removal efficiencies of total chemical oxygen demand (COD), biological oxygen demand (BOD 5 ) and suspended solids (SS) ranged from 60% to 80% for the first two parameters and from 70% to 90% for the last one. According to the statistical analysis, it was established that decreasing HRT from 72 to 48 h did not affect the performance of the UASB-septic tank; therefore, the latter HRT is recommended to be used for operation. In the first compartment, most of the organic matter removal was carried out, while the other two compartments served as polishing. Over the course of six months, the VS concentration and VS/TS ratio in sludge blanket decreased, indicating digestion and stabilization of the retained solids. Also, an increase of 4% in sludge volume was observed; thus, time for desludging would be approximately five years. Comparison of the UASB-septic tank and the UASB reactor showed that both systems had similar performance regarding effluent concentrations of organic matter and solids. Thus, under low volumetric organic load conditions (less than 20 mg COD/L h), the former is an attractive option for municipal wastewater treatment.

Clinical Features, Short-Term Mortality, and Prognostic Risk Factors of Septic Patients Admitted to Internal Medicine Units: Results of an Italian Multicenter Prospective Study.

PubMed

Mazzone, Antonino; Dentali, Francesco; La Regina, Micaela; Foglia, Emanuela; Gambacorta, Maurizia; Garagiola, Elisabetta; Bonardi, Giorgio; Clerici, Pierangelo; Concia, Ercole; Colombo, Fabrizio; Campanini, Mauro

2016-01-01

Only a few studies provided data on the clinical history of sepsis within internal Medicine units. The aim of the study was to assess the short-term mortality and to evaluate the prognostic risk factors in a large cohort of septic patients treated in internal medicine units. Thirty-one internal medicine units participated to the study. Within each participating unit, all admitted patients were screened for the presence of sepsis. A total of 533 patients were included; 78 patients (14.6%, 95%CI 11.9, 18.0%) died during hospitalization; mortality rate was 5.5% (95% CI 3.1, 9.6%) in patients with nonsevere sepsis and 20.1% (95%CI 16.2, 28.8%) in patients with severe sepsis or septic shock. Severe sepsis or septic shock (OR 4.41, 95%CI 1.93, 10.05), immune system weakening (OR 2.10, 95%CI 1.12, 3.94), active solid cancer (OR 2.14, 95% CI 1.16, 3.94), and age (OR 1.03 per year, 95% CI 1.01, 1.06) were significantly associated with an increased mortality risk, whereas blood culture positive for Escherichia coli was significantly associated with a reduced mortality risk (OR 0.46, 95%CI 0.24, 0.88). In-hospital mortality of septic patients treated in internal medicine units appeared similar to the mortality rate obtained in recent studies conducted in the ICU setting.

Mass Balance of Water and Nitrogen in the Mounded Drainfield of a Drip-Dispersal Septic System.

PubMed

De, Mriganka; Toor, Gurpal S

2016-07-01

Quantitative assessment of nitrogen (N) loading from septic systems is needed to protect groundwater contamination. We determined the mass balance of water and N in the mounded drainfield of a drip-dispersal septic system. Three lysimeters (152.4 cm long, 91.4 cm wide, 91.4 cm high, with 1:1 side slope) were constructed using pressure-treated wood to mimic mounded drainfields. Of total water inputs, septic tank effluent (STE) added 57% water and natural rainfall added 43% water from January 2013 to January 2014. Outputs included leached water (46%) from the lysimeters over 67 sampling events ( = 15 daily and = 52 weekly flow-weighted), potential evapotranspiration (28%), and water stored in the drainfields (26%). Over 13 mo, each drainfield received 227 g of total N (STE, 99%; rainfall, 1%), of which 33% leached, 23% accumulated in the drainfield, and 6% was taken up by grass, with the remainder (38%) estimated to be gaseous N loss. Using these data, the leaching of water from 2.5 million drip-dispersal drainfields in the state of Florida was estimated to be 2.29 × 10 L yr, which would transport 2.4 × 10 kg of total N yr from the drainfields to shallow groundwater. Further reduction of N below drainfields in the soil profile could be expected before STE reaches groundwater. Our results provide quantitative information on the water and N loading and can be used to optimize drainfield conditions to attenuate N and protect groundwater quality. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 274: Septic Systems, Nevada Test Site, Nevada, Rev. No.: 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grant Evenson

2006-09-01

This Corrective Action Decision Document/Closure Report has been prepared for Corrective Action Unit 274, Septic Systems, Nevada Test Site (NTS), Nevada in accordance with the ''Federal Facility Agreement and Consent Order'' (1996). Corrective Action Unit (CAU) 274 is comprised of five corrective action sites (CASs): (1) CAS 03-02-01, WX-6 ETS Building Septic System; (2) CAS 06-02-01, Cesspool; (3) CAS 09-01-01, Spill Site; (4) CAS 09-05-01, Leaching Pit; and (5) CAS 20-05-01, Septic System. The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the closure of CAU 274 with no further corrective action. Tomore » achieve this, corrective action investigation (CAI) activities were performed from November 14 through December 17, 2005 as set forth in the CAU 274 Corrective Action Investigation Plan. The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective (DQO) process: (1) Determine whether contaminants of concern (COCs) are present. (2) If contaminants of concern are present, determine their nature and extent. (3) Provide sufficient information and data to complete appropriate corrective actions. The CAU 274 dataset from the investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the quality and acceptability of the dataset for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. No analytes were detected at concentrations exceeding the FALs. No COCs have been released to the soil at CAU 274, and corrective action is not required. Therefore, the DQO data needs were met, and it was determined that no corrective action based on risk to human receptors is necessary for the site. All FALs were calculated using the industrial site worker scenario except for benzo(a)pyrene, which was calculated based on the occasional use scenario. Benzo(a)pyrene was detected above the preliminary action level at CAS 20-05-01; however, it was not identified as a COC because the concentration was below the FAL. As a best management practice and to ensure that future site workers are not exposed to this site contaminant for more than this decision-basis exposure duration, an administrative use restriction was established around the leachfield at CAS 20-05-01. In addition, the removal of the septic tanks and septic tank contents at CASs 03-02-01, 06-02-01, and 20-05-01 was performed.« less

Ecohealth approach to urban waste management: exposure to environmental pollutants and health risks in Yamoussoukro, Côte d'Ivoire.

PubMed

Kouamé, Parfait K; Dongo, Kouassi; Nguyen-Viet, Hung; Zurbrügg, Christian; Lüthi, Christoph; Hattendorf, Jan; Utzinger, Jürg; Biémi, Jean; Bonfoh, Bassirou

2014-10-02

Poor waste management is a key driver of ill-health in urban settlements of developing countries. The current study aimed at assessing environmental and human health risks related to urban waste management in Yamoussoukro, the political capital of Côte d'Ivoire. We undertook trans-disciplinary research within an Ecohealth approach, comprised of a participatory workshop with stakeholders and mapping of exposure patterns. A total of 492 randomly selected households participated in a cross-sectional survey. Waste deposit sites were characterised and 108 wastewater samples were subjected to laboratory examinations. The physico-chemical parameters of the surface water (temperature, pH, conductivity, potential oxidise reduction, BOD5, COD, dissolved oxygen, nitrates, ammonia and total Kendal nitrogen) did not comply with World Health Organization standards of surface water quality. Questionnaire results showed that malaria was the most commonly reported disease. Diarrhoea and malaria were associated with poor sanitation. Households having dry latrines had a higher risk of diarrhoea (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.2-2.7) compared to latrines with septic tanks and also a higher risk for malaria (OR = 1.9, 95% (CI) 1.1-3.3). Our research showed that combining health and environmental assessments enables a deeper understanding of environmental threats and disease burdens linked to poor waste management. Further study should investigate the sanitation strategy aspects that could reduce the environmental and health risks in the study area.

Ecohealth Approach to Urban Waste Management: Exposure to Environmental Pollutants and Health Risks in Yamoussoukro, Côte d’Ivoire

PubMed Central

Kouamé, Parfait K.; Dongo, Kouassi; Nguyen-Viet, Hung; Zurbrügg, Christian; Lüthi, Christoph; Hattendorf, Jan; Utzinger, Jürg; Biémi, Jean; Bonfoh, Bassirou

2014-01-01

Poor waste management is a key driver of ill-health in urban settlements of developing countries. The current study aimed at assessing environmental and human health risks related to urban waste management in Yamoussoukro, the political capital of Côte d’Ivoire. We undertook trans-disciplinary research within an Ecohealth approach, comprised of a participatory workshop with stakeholders and mapping of exposure patterns. A total of 492 randomly selected households participated in a cross-sectional survey. Waste deposit sites were characterised and 108 wastewater samples were subjected to laboratory examinations. The physico-chemical parameters of the surface water (temperature, pH, conductivity, potential oxidise reduction, BOD5, COD, dissolved oxygen, nitrates, ammonia and total Kendal nitrogen) did not comply with World Health Organization standards of surface water quality. Questionnaire results showed that malaria was the most commonly reported disease. Diarrhoea and malaria were associated with poor sanitation. Households having dry latrines had a higher risk of diarrhoea (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.2–2.7) compared to latrines with septic tanks and also a higher risk for malaria (OR = 1.9, 95% (CI) 1.1–3.3). Our research showed that combining health and environmental assessments enables a deeper understanding of environmental threats and disease burdens linked to poor waste management. Further study should investigate the sanitation strategy aspects that could reduce the environmental and health risks in the study area. PMID:25279545

Applicability of geochemical techniques and artificial sweeteners in discriminating the anthropogenic sources of chloride in shallow groundwater north of Toronto, Canada.

PubMed

Khazaei, Esmaeil; Milne-Home, William

2017-05-01

Elevated levels of chloride concentration due to anthropogenic activities including the road salts, septic effluent and agricultural sources are common in shallow groundwater of the recent glacial deposits north of Toronto, Ontario, Canada. Identifying suitable techniques for discriminating the source of the chloride concentration helps to better plan the protection of groundwater in the area. This paper examines the applicability of geochemical techniques with emphasis on Panno et al. (Ground Water 44: 176-187, 2006) and Mullaney et al. (2009) graphical approaches for discriminating the sources of chloride with known causes of impacts. The results indicated that the graphical methods developed using Cl - , Br - and/or total nitrogen (N) could identify the combined sources of road salts and septic systems. However, discriminating between the road salts, septic effluent or agricultural sources needs to be complemented by other techniques including the artificial sweeteners and isotope tracers.

Analysis of the bacterial community changes in soil for septic tank effluent treatment in response to bio-clogging.

PubMed

Nie, J Y; Zhu, N W; Zhao, K; Wu, L; Hu, Y H

2011-01-01

Soil columns were set up to survey the bacterial community in the soil for septic tank effluent treatment. When bio-clogging occurred in the soil columns, the effluent from the columns was in poorer quality. To evaluate changes of the soil bacterial community in response to bio-clogging, the bacterial community was characterized by DNA gene sequences from soil samples after polymerase chain reaction coupled with denaturing gradient gel electrophoresis process. Correspondence analysis showed that Proteobacteria related bacteria were the main bacteria within the soil when treating septic tank effluent. However, Betaproteobacteria related bacteria were the dominant microorganisms in the normal soil, whereas Alphaproteobacteria related bacteria were more abundant in the clogged soil. This study provided insight into changes of the soil bacterial community in response to bio-clogging. The results can supply some useful information for the design and management of soil infiltration systems.

Initial resuscitation and management of pediatric septic shock

PubMed Central

Martin, Kelly; Weiss, Scott L.

2015-01-01

The pediatric sepsis syndrome remains a common cause of morbidity, mortality, and health care utilization costs worldwide. The initial resuscitation and management of pediatric sepsis is focused on 1) rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function, 2) eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications, and 3) supportive care of organ system dysfunction. Efforts to improve early and aggressive initial resuscitation and ongoing management strategies have improved outcomes in pediatric severe sepsis and septic shock, though many questions still remain as to the optimal therapeutic strategies for many patients. In this article, we will briefly review the definitions, epidemiology, clinical manifestations, and pathophysiology of sepsis and provide an extensive overview of both current and novel therapeutic strategies used to resuscitate and manage pediatric patients with severe sepsis and septic shock. PMID:25604591

Clinical significance of delta neutrophil index in the differential diagnosis between septic arthritis and acute gout attack within 24 hours after hospitalization

PubMed Central

Pyo, Jung Yoon; Kim, Dae Sik; Jung, Seung Min; Song, Jason Jungsik; Park, Yong-Beom; Lee, Sang-Won

2017-01-01

Abstract The most important differential diagnoses of acute monoarticular arthritis are septic arthritis and acute gout attack. Identifying infection is crucial in preventing the devastating outcome of septic arthritis. The delta neutrophil index (DNI) is a value that corresponds to the fraction of circulating immature granulocytes. As DNI reflects the burden of infection, we evaluated this index as a differentiating marker between septic arthritis and acute gout attack. The medical records of 149 patients with septic arthritis and 194 patients with acute gout attack were reviewed. A specific cell analyzer, ADVIA 2120, was used to measure DNI. Clinical and laboratory markers associated with predicting septic arthritis were assessed by using logistic regression. Patients with septic arthritis showed higher levels of DNI than those with acute gout attack (3.3 vs 0.6%, P < .001). Similar results were observed in patients without monosodium urate (MSU) crystal confirmation or those with normouricemia (3.3 vs 0.5 and 3.1 vs 0.7%, respectively; P < .001 for both). A DNI level of 1.9% was determined as the cutoff value for predicting septic arthritis. In the multivariate analysis, DNI was the most powerful independent value for predicting septic arthritis (odds ratio 14.003). This study showed the possibility of using DNI as a differentiating marker between septic arthritis and acute gout attack at the crucial early phase. DNI showed its relevance regardless of confirmation of MSU crystal deposition or serum level of uric acid. PMID:28746185

Early Immune Function and Duration of Organ Dysfunction in Critically Ill Septic Children.

PubMed

Muszynski, Jennifer A; Nofziger, Ryan; Moore-Clingenpeel, Melissa; Greathouse, Kristin; Anglim, Larissa; Steele, Lisa; Hensley, Josey; Hanson-Huber, Lisa; Nateri, Jyotsna; Ramilo, Octavio; Hall, Mark W

2018-02-22

Late immune suppression is associated with nosocomial infection and mortality in septic adults and children. Relationships between early immune suppression and outcomes in septic children remain unclear. Prospective observational study to test the hypothesis that early innate and adaptive immune suppression are associated with longer duration of organ dysfunction in children with severe sepsis/septic shock. Methods, Measurements and Main Results: Children aged < 18 years meeting consensus criteria for severe sepsis or septic shock were sampled within 48 hours of sepsis onset. Healthy controls were sampled once. Innate immune function was quantified by whole blood ex vivo lipopolysaccharide-induced TNFα production capacity. Adaptive immune function was quantified by ex vivo phytohemagglutinin-induced IFNγ production capacity. 102 septic children and 35 healthy children were enrolled. Compared to healthy children, septic children demonstrated lower LPS-induced TNFα production (p < 0.0001) and lower PHA-induced IFNγ production (p<0.0001). Among septic children, early innate and adaptive immune suppression were associated with greater number of days with multiple organ dysfunction (MODS) and greater number of days with any organ dysfunction. On multivariable analyses, early innate immune suppression remained independently associated with increased MODS days [aRR 1.2 (1.03, 1.5)] and organ dysfunction days [aRR 1.2 (1.1, 1.3)]. Critically ill children with severe sepsis or septic shock demonstrate early innate and adaptive immune suppression. Early suppression of both innate and adaptive immunity are associated with longer duration of organ dysfunction and may be useful markers to guide investigations of immunomodulatory therapies in septic children.

Increased incidence of patella baja after total knee arthroplasty revision for infection.

PubMed

Chen, Antonia F; Tetreault, Matthew W; Levicoff, Eric A; Fedorka, Catherine J; Rothenberg, Adam C; Klatt, Brian A

2014-12-01

The incidence of patella baja in total knee arthroplasty (TKA) revisions for aseptic and septic causes is not well defined. We retrospectively reviewed 101 mobile-bearing TKA revisions performed between 2003 and 2009. Aseptic (n=67) and septic (n=34) revisions were compared for patella baja. A nonarticulating spacer was used as the initial treatment for infected cases. The Insall-Salvati ratio was radiographically measured before surgery (preexplant for septic revisions) and at latest follow-up (postreplant for septic revisions). Mean (SD) Insall-Salvati ratio did not differ between groups before surgery, 1.00 (0.25) for aseptic and 0.96 (0.22) for septic, but differed significantly after surgery, 0.99 (0.23) for aseptic and 0.77 (0.24) for septic. After correcting for preoperative patellar height, there was a statistically significant postoperative difference between aseptic cases, 1.09 (0.19), and septic cases, 0.82 (0.21). There was also a significant difference in mean (SD) postoperative range of motion (ROM) between aseptic cases, 108.0° (20.7°), and septic cases, 92.2° (34.6°), and decreased ROM between cases with patella baja, 95.1° (31.6°) and cases without patella baja, 106.8° (23.6°). TKA revisions done for septic causes using a nonarticulating spacer resulted in a higher incidence of patella baja and decreased ROM.

Paecilomyces lilacinus septic olecranon bursitis in an immunocompetent host.

PubMed

Schweitzer, Karl M; Richard, Marc J; Leversedge, Fraser J; Ruch, David S

2012-05-01

Paecilomyces lilacinus is a filamentous fungus that is a rare cause of infection in immunocompromised human hosts. We present a case of lilacinus septic olecranon bursitis in an otherwise healthy 78-year-old male. This patient's case was complicated by wound breakdown after bursectomy and appropriate anti-fungal treatment, requiring a local soft tissue rearrangement. This case demonstrates the need for appropriate and timely medical and surgical treatment in infections involving lilacinus, which are not isolated solely to systemically immunocompromised and medically-ill patient populations. In cases where the patient is systemically immumocompromised or has been rendered locally immunocompromised, it is essential to obtain a full culture work-up, including fungi.

Septic trochanteric bursitis in an adolescent.

PubMed

Makki, Daoud; Watson, Alex James

2010-01-01

Trochanteric bursitis, whether septic or inflammatory in origin, is a condition that affects middle-aged patients. Here we report the rare case of an adolescent with septic trochanteric bursitis (treated successfully with intravenous antibiotics), review the available literature on septic bursitis, illustrate the importance of prompt recognition and treatment of this condition in any age group, and describe the clinical presentation and the radiologic findings.

Field study comparing the effect of hydraulic mixing on septic tank performance and sludge accumulation.

PubMed

Almomani, Fares

2016-01-01

This study investigates the effect of hydraulic mixing on anaerobic digestion and sludge accumulation in a septic tank. The performance of a septic tank equipped with a hydraulic mixer was compared with that of a similar standard septic tank over a period of 10 months. The study was conducted in two phases: Phase-I--from May to November 2013 (6 months); Phase-II--from January to May 2014 (4 months). Hydraulic mixing effectively reduced the effluent biological oxygen demand (BOD) and total suspended solids, and reduced the sludge accumulation rate in the septic tank. The BOD removal efficiencies during Phase-II were 65% and 75% in the standard septic tank and a septic tank equipped with hydraulic mixer (Smart Digester™), respectively. The effect of hydraulic mixing reduced the rate of sludge accumulation from 0.64 cm/day to 0.27 cm/day, and increased the pump-out interval by a factor of 3.

Utility Bill Insert for Wastewater Services

EPA Pesticide Factsheets

Intended for use by wastewater and water supply utilities, one side of the utility bill insert has information for customers that discharge to sanitary sewer systems; the other side is for customers with septic systems.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 560: Septic Systems, Nevada Test Site, Nevada, Revision 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grant Evenson

2010-04-01

Corrective Action Unit 560 comprises seven corrective action sites (CASs): •03-51-01, Leach Pit •06-04-02, Septic Tank •06-05-03, Leach Pit •06-05-04, Leach Bed •06-59-03, Building CP-400 Septic System •06-59-04, Office Trailer Complex Sewage Pond •06-59-05, Control Point Septic System The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure of CAU 560 with no further corrective action. To achieve this, corrective action investigation (CAI) activities were performed from October 7, 2008, through February 24, 2010, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 560: Septic Systems, Nevada Test Site, Nevada, and Recordmore » of Technical Change No. 1. The purpose of the CAI was to fulfill the following data needs as defined during the data quality objective (DQO) process: •Determine whether contaminants of concern (COCs) are present. •If COCs are present, determine their nature and extent. •Provide sufficient information and data to complete appropriate corrective actions. The CAU 560 dataset from the investigation results was evaluated based on the data quality indicator parameters. This evaluation demonstrated the quality and acceptability of the dataset for use in fulfilling the DQO data needs. Analytes detected during the CAI were evaluated against final action levels (FALs) established in this document. The following contaminants were determined to be present at concentrations exceeding their corresponding FALs: •No contamination exceeding the FALs was identified at CASs 03-51-01, 06-04-02, and 06-59-04. •The soil at the base of the leach pit chamber at CAS 06-05-03 contains arsenic above the FAL of 23 milligrams per kilogram (mg/kg) and polychlorinated biphenyl (PCBs) above the FAL of 0.74 mg/kg, confined vertically from a depth of approximately 5 to 20 feet (ft) below ground surface. The contamination is confined laterally to the walls of the leach pit chamber and leach rock. The contamination present at CAS 06-05-03 within the leach pit was not feasible to remove. •The surface and subsurface soils within and surrounding the septic system at CAS 06-05-04 contained PCB concentrations above the FAL of 0.74 mg/kg. The lateral and vertical extent of COCs was determined for this CAS. Contaminated soils were removed up to within 18 ft of the building. The remaining contamination is confined to subsurface soils adjacent to and beneath Building CP-162 and was not feasible to remove. •The solid materials within the septic tank and soils immediately surrounding the inlet end of the tank at CAS 06-59-03 contained benzo(a)pyrene above the FAL of 0.21 mg/kg. The soils, tank contents, and tank were removed. Materials remaining at this CAS do not contain contamination exceeding FALs. •The solids contained within the septic tank and inlet pipe at CAS 06-59-05 contained the following contaminants above their respective FALs: PCBs, arsenic, lead, benzo(a)pyrene, and pesticides. The tank and inlet pipe contents were removed. Materials remaining at this CAS do not contain contamination exceeding FALs. Therefore, the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) provides the following corrective action recommendations: •No further action for CASs 03-51-01, 06-04-02, and 06-59-04, as no contaminants of potential concern were present that exceed FALs. •Closure in place for CAS 06-05-03 under a corrective action with a use restriction (UR) for remaining PCB- and arsenic-impacted potential source material (PSM). The UR form and map have been filed in the NNSA/NSO Facility Information Management System, the FFACO database, and NNSA/NSO CAU/CAS files. •Closure in place for CAS 06-05-04 under a corrective action with a UR for remaining PCBs in soil adjacent to and beneath Building CP-162. The UR form and map have been filed in the NNSA/NSO Facility Information Management System, the FFACO database, and NNSA/NSO CAU/CAS files. •No further action for CAS 06-59-03, as the COC of benzo(a)pyrene in soil and PSM have been removed. •No further action for CAS 06-59-05, as the COCs in PSM within the septic tank and inlet piping have been removed and the tank was filled with concrete.« less

Design and Specification of Low Pressure Sewer Systems for Recreation Areas.

DTIC Science & Technology

1985-02-01

holding tank receives wastewater Iflows by gravity. Level scitsors act ivate the grinder pump operation pump at preset levels. Emergency 40 overf low aid...above the septic 0 Lank floor, the septic tank should be secured against flotation . Test in. 70. Septir t.ank s shouldt Ihe wat’rtight and must be...8217 , pump i rig je,j , aind powt, r cost . Annual power cost can he estimated using the fo I I owi rig express ion: APC =ae PC (4) whe -e 0 APIC annual

Effects of residential wastewater treatment systems on ground-water quality in west-central Jefferson County, Colorado

USGS Publications Warehouse

Hall, Dennis C.; Hillier, D.E.; Nickum, Edward; Dorrance, W.G.

1981-01-01

The use of residential wastewater-treatment systems in Evergreen Meadows, Marshdale, and Herzman Mesa, Colo., has degraded ground-water quality to some extent in each community. Age of community; average lot size; slope of land surface; composition, permeability, and thickness of surficial material; density, size , and orientation of fractures; maintenance of wastewater-treatment systems; and presence of animals are factors possibly contributing to the degradation of ground-water quality. When compared with effluent from aeration-treatment tanks, effluent fom septic-treatment tanks is characterized by greater biochemical oxygen demand and greater concentrations of detergents. When compared with effluent from septic-treatment tanks, effluent from aeration-treatment tanks is characterized by greater concentrations of dissolved oxygen, nitrite, nitrate, sulfate, and dissolved solids. (USGS)

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

PubMed Central

Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

2017-01-01

Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001). On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001). Conclusions Our study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department. PMID:28107366

Effect of total parenteral nutrition, systemic sepsis, and glutamine on gut mucosa in rats

NASA Technical Reports Server (NTRS)

Yoshida, S.; Leskiw, M. J.; Schluter, M. D.; Bush, K. T.; Nagele, R. G.; Lanza-Jacoby, S.; Stein, T. P.

1992-01-01

The effect of the combination of total parenteral nutrition (TPN) and systemic sepsis on mucosal morphology and protein synthesis was investigated. Rats were given a standard TPN mixture consisting of glucose (216 kcal.kg-1.day-1), lipid (24 kcal.kg-1.day-1), and amino acids (1.5 g N.kg-1.day-1) for 5 days. On the 5th day the rats (n = 37) were randomized into four groups according to diet as follows: 1) control nonseptic on standard TPN, 2) control nonseptic on TPN with glutamine, 3) septic on standard TPN, and 4) septic with the TPN supplemented with glutamine. Twenty hours after the injection of Escherichia coli, the rats were given a 4-h constant infusion of [U-14C]leucine to determine the mucosal fractional protein synthesis rates. The following results were obtained. 1) Histological examination showed that systemic sepsis caused tissue damage to the ileum and jejunum. 2) Glutamine supplementation attenuated these changes. 3) There were no visible changes to the colon either from glutamine supplementation or sepsis. 4) Sepsis was associated with an increase in mucosal protein synthesis and decreased muscle synthesis. 5) Addition of glutamine to the TPN mix further increased protein synthesis in the intestinal mucosa of septic rats.

Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial.

PubMed

Zhang, Zhongheng; Xu, Xiao; Yao, Min; Chen, Huilan; Ni, Hongying; Fan, Haozhe

2013-02-01

Hemodynamic monitoring is very important in critically ill patients with shock or acute respiratory distress syndrome(ARDS). The PiCCO (Pulse index Contour Continuous Cardiac Output, Pulsion Medical Systems, Germany) system has been developed and used in critical care settings for several years. However, its impact on clinical outcomes remains unknown. The study is a randomized controlled multi-center trial. A total of 708 patients with ARDS, septic shock or both will be included from January 2012 to January 2014. Subjects will be randomized to receive PiCCO monitoring or not. Our primary end point is 30-day mortality, and secondary outcome measures include ICU length of stay, days on mechanical ventilation, days of vasoactive agent support, ICU-free survival days during a 30-day period, mechanical-ventilation-free survival days during a 30-day period, and maximum SOFA score during the first 7 days. We investigate whether the use of PiCCO monitoring will improve patient outcomes in critically ill patients with ARDS or septic shock. This will provide additional data on hemodynamic monitoring and help clinicians to make decisions on the use of PiCCO. http://www.clinicaltrials.gov NCT01526382.

Septic acute kidney injury patients in emergency department: The risk factors and its correlation to serum lactate.

PubMed

Hsu, Yin-Chou; Hsu, Chih-Wei

2018-05-15

Acute kidney injury (AKI) is a common complication in septic patients, imposing a heavy burden of illness in terms of morbidity and mortality. Serum lactate is a widely used marker predicting the severity of sepsis. A paucity of research has investigated septic AKI in emergency departments (EDs) and its correlation with initial serum lactate level. This study aimed at identifying risk factors for septic AKI and clarifying the link between initial serum lactate level and septic AKI in ED patients. A retrospective cohort study was conducted at a single tertiary referral medical center. The medical records of all adult ED patients with measurement of serum lactate and creatinine between January 2012 and December 2016 were reviewed. A total of 696 septic patients were stratified into AKI and non-AKI groups according to Acute Kidney Injury Network (AKIN) criteria for further statistical analysis. Ninety-nine septic patients (14.2%) had AKI, with AKIN-I, AKIN-II, and AKIN-III in 71.7%, 11.1%, and 17.2% of patients, respectively. Compared with the non-AKI group, the AKI group had a significantly higher mortality rate (71.7% vs. 21.3%, p < 0.001). Independent risk factors for septic AKI included liver disease (adjusted odds ratio [AOR] = 2.02, 95% confidence interval [CI] = 1.16-3.52), diabetes mellitus (AOR = 1.73, 95% CI = 1.11-2.69), chronic kidney disease (AOR = 1.68, 95% CI = 1.06-2.66), and initial serum lactate (AOR = 1.08, 95% CI = 1.02-1.14). Patients with septic AKI had an overwhelmingly higher mortality rate. The comorbidities of liver disease, diabetes mellitus, and chronic kidney disease were correlated with septic AKI and in combination with an elevated initial serum lactate level had predictive regarding AKI and further mortality in ED septic patients. Copyright © 2018 Elsevier Inc. All rights reserved.

Sepsis in general surgery: the 2005-2007 national surgical quality improvement program perspective.

PubMed

Moore, Laura J; Moore, Frederick A; Todd, S Rob; Jones, Stephen L; Turner, Krista L; Bass, Barbara L

2010-07-01

To document the incidence, mortality rate, and risk factors for sepsis and septic shock compared with pulmonary embolism and myocardial infarction in the general-surgery population. Retrospective review. American College of Surgeons National Surgical Quality Improvement Program institutions. General-surgery patients in the 2005-2007 National Surgical Quality Improvement Program data set. Incidence, mortality rate, and risk factors for sepsis and septic shock. Of 363 897 general-surgery patients, sepsis occurred in 8350 (2.3%), septic shock in 5977 (1.6%), pulmonary embolism in 1078 (0.3%), and myocardial infarction in 615 (0.2%). Thirty-day mortality rates for each of the groups were as follows: 5.4% for sepsis, 33.7% for septic shock, 9.1% for pulmonary embolism, and 32.0% for myocardial infarction. The septic-shock group had a greater percentage of patients older than 60 years (no sepsis, 40.2%; sepsis, 51.7%; and septic shock, 70.3%; P < .001). The need for emergency surgery resulted in more cases of sepsis (4.5%) and septic shock (4.9%) than did elective surgery (sepsis, 2.0%; septic shock, 1.2%) (P < .001). The presence of any comorbidity increased the risk of sepsis and septic shock 6-fold (odds ratio, 5.8; 95% confidence interval, 5.5-6.2) and increased the 30-day mortality rate 22-fold (odds ratio, 21.8; 95% confidence interval, 17.6-26.9). The incidences of sepsis and septic shock exceed those of pulmonary embolism and myocardial infarction. The risk factors for mortality include age older than 60 years, the need for emergency surgery, and the presence of any comorbidity. This study emphasizes the need for early recognition of patients at risk via aggressive screening and the rapid implementation of evidence-based guidelines.

Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia.

PubMed

Kang, Cheol-In; Song, Jae-Hoon; Chung, Doo Ryeon; Peck, Kyong Ran; Ko, Kwan Soo; Yeom, Joon-Sup; Ki, Hyun Kyun; Son, Jun Seong; Lee, Seung Soon; Kim, Yeon-Sook; Jung, Sook-In; Kim, Shin-Woo; Chang, Hyun-Ha; Ryu, Seong Yeol; Kwon, Ki Tae; Lee, Hyuck; Moon, Chisook

2011-01-01

The aim of this study was to identify risk factors for development of severe sepsis or septic shock and to evaluate the clinical impact of severe sepsis on outcome in patients with gram-negative bacteremia (GNB). From the database of a nationwide surveillance for bacteremia, patients with GNB were analyzed. Data of patients with severe sepsis or septic shock were compared with those of patient with sepsis. Of 2286 patients with GNB, 506 (22.1%) fulfilled the criteria of severe sepsis or septic shock. Factors associated with severe sepsis or septic shock in the multivariate analysis included renal disease, indwelling urinary catheter, hematologic malignancy, and neutropenia. The 30-day mortality of patients with severe sepsis or septic shock was significantly higher than that of patients with sepsis (39.5% [172/435] vs. 7.4% [86/1170]; P < 0.001). Multivariable analysis revealed that solid tumor, liver disease, pulmonary disease, pneumonia, and pathogens other than Escherichia coli, which were risk factors of development of severe sepsis or septic shock, were also found to be strong predictors of mortality. Severe sepsis or septic shock was a significant factor associated with mortality (OR, 3.34; 95% CI, 2.35-4.74), after adjustment for other variables predicting poor prognosis. Severe sepsis or septic shock was a common finding in patients with GNB, predicting a higher mortality rate. Renal disease and indwelling urinary catheter were the most important risk factors significantly associated with severe sepsis or septic shock among patients with GNB. Copyright © 2010 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Hypercapnia-Induced Amelioration of the Intestinal Microvascular Oxygenation in Sepsis is Independent of the Endogenous Sympathetic Nervous System.

PubMed

Schulz, Jan; Schöneborn, Sabrina; Vollmer, Christian; Truse, Richard; Herminghaus, Anna; Bauer, Inge; Beck, Christopher; Picker, Olaf

2018-03-01

Insufficient microvascular oxygenation (μHBO2) of the intestinal mucosa worsens outcome of septic patients. Hypercapnia ameliorates μHBO2, mediated via endogenous vasopressin release. Under physiological conditions, blockade of the endogenous sympathetic nervous system abolishes this protective effect of hypercapnia. The aim of our study was therefore to evaluate the role of the endogenous sympathetic nervous system during hypercapnia on intestinal μHBO2 under septic conditions. We randomized 80 male Wistar rats into eight groups. Sepsis was induced via colon ascendens stent peritonitis. The animals were subjected to 120 min of normocapnic (pCO2 35 mm Hg-45 mm Hg) or moderate hypercapnic (pCO2 65 mm Hg-75 mm Hg) ventilation 24 h after surgery. Animals received sympathetic blockade (hexamethonium 15 mg · kg (bolus) followed by 15 mg · kg · h (infusion) intravenously) or the same volume as vehicle (NaCl 0.9%). Microcirculatory oxygenation (μHBO2) and perfusion (μflow) were recorded using tissue reflectance spectrophotometry and laser Doppler. In septic animals, μHBO2 decreased during normocapnia (-8.9 ± 4%) and increased during hypercapnia (+7.8 ± 7.5%). The additional application of hexamethonium did not influence these effects. μHBO2 declined in normocapnic septic animals treated with hexamethonium similar to normocapnia alone (-6.1 ± 5.4%) and increased in hypercapnic animals treated with hexamethonium similar to hypercapnia alone (+7.9 ± 11.7%). Furthermore, hypercapnic ventilation ameliorated microcirculatory perfusion (μflow) irrespective of whether animals received hexamethonium (from 113 ± 54 [AU] to 206 ± 87 [AU]) or vehicle (from 97 ± 37 [AU]-169 ± 52 [AU]). The amelioration of the intestinal microcirculation during hypercapnia in sepsis is independent of the endogenous sympathetic nervous system.

Microbial Load in Septic and Aseptic Procedure Rooms.

PubMed

Harnoss, Julian-Camill; Assadian, Ojan; Diener, Markus Karl; Müller, Thomas; Baguhl, Romy; Dettenkofer, Markus; Scheerer, Lukas; Kohlmann, Thomas; Heidecke, Claus-Dieter; Gessner, Stephan; Büchler, Markus Wolfgang; Kramer, Axel

2017-07-10

Highly effective measures to prevent surgical wound infections have been established over the last two decades. We studied whether the strict separation of septic and aseptic procedure rooms is still necessary. In an exploratory, prospective observational study, the microbial concentration in an operating room without a room ventilating system (RVS) was analyzed during 16 septic and 14 aseptic operations with the aid of an air sampler (50 cm and 1 m from the operative field) and sedimentation plates (1 m from the operative field, and contact culture on the walls). The means and standard deviations of the microbial loads were compared with the aid of GEE models (generalized estimation equations). In the comparison of septic and aseptic operations, no relevant differences were found with respect to the overall microbial concentration in the room air (401.7 ± 176.3 versus 388.2 ± 178.3 CFU/m 3 ; p = 0.692 [CFU, colony-forming units]) or sedimentation 1 m from the operative field (45.3 ± 22.0 versus 48.7 ± 18.5 CFU/m 2 /min; p = 0.603) and on the walls (35.7 ± 43.7 versus 29.0 ± 49.4 CFU/m 2 /min; p = 0.685). The only relevant differences between the microbial spectra associated with the two types of procedure were a small amount of sedimentation of Escherichia coli and Enterococcus faecalis in septic operations, and of staphylococcus aureus and pseudomonas stutzeri in aseptic operations, up to 30 minutes after the end of the procedure. These data do not suggest that septic and aseptic procedure rooms need to be separated. In interpreting the findings, one should recall that the study was not planned as an equivalence or non-inferiority study. Wherever patient safety is concerned, high-level safety concepts should only be demoted to lower levels if new and convincing evidence becomes available.

Plant available nitrogen from anaerobically digested sludge and septic tank sludge applied to crops grown in the tropics.

PubMed

Sripanomtanakorn, S; Polprasert, C

2002-04-01

Agricultural land is an attractive alternative for the disposal of biosolids since it utilises the recyclable nutrients in the production of crops. In Thailand and other tropical regions, limited field-study information exists on the effect of biosolids management strategies on crop N utilisation and plant available N (PAN) of biosolids. A field study was conducted to quantify the PAN of the applied biosolids, and to evaluate the N uptake rates of some tropical crops. Sunflower (Helianthus annuus) and tomato (Lycopersicon esculentum) were chosen in this study. Two types of biosolids used were: anaerobically digested sludge and septic tank sludge. The soil is acid sulfate and is classified as Sulfic Tropaquepts with heavy clay in texture. The anaerobically digested sludge applied rates were: 0, 156 and 312 kg N ha(-1) for the sunflower plots, and 0, 586, and 1172 kg N ha(-1) for the tomato plots. The septic tank sludge applied rates were: 0, 95 and 190 kg N ha(-1) for the sunflower plots, and 0, 354 and 708 kg N ha(-1) for the tomato plots, respectively. The results indicated the feasibility of applying biosolids to grow tropical crops. The applications of the anaerobically digested sludge and the septic tank sludge resulted in the yields of sunflower seeds and tomato fruits and the plant N uptakes comparable or better than that applied with only the chemical fertiliser. The estimated PAN of the anaerobically digested sludge was about 27-42% of the sludge organic N during the growing season. For the septic tank sludge, the PAN was about 15-58% of the sludge organic N. It is interesting to observe that an increase of the rate of septic tank sludge incorporated into this heavy clay soil under the cropping system resulted in the decrease of N mineralisation rate. This situation could cause the reduction of yield and N uptake of crops.

An alternate pathophysiologic paradigm of sepsis and septic shock

PubMed Central

Kumar, Anand

2014-01-01

The advent of modern antimicrobial therapy following the discovery of penicillin during the 1940s yielded remarkable improvements in case fatality rate of serious infections including septic shock. Since then, pathogens have continuously evolved under selective antimicrobial pressure resulting in a lack of significant improvement in clinical effectiveness in the antimicrobial therapy of septic shock despite ever more broad-spectrum and potent drugs. In addition, although substantial effort and money has been expended on the development novel non-antimicrobial therapies of sepsis in the past 30 years, clinical progress in this regard has been limited. This review explores the possibility that the current pathophysiologic paradigm of septic shock fails to appropriately consider the primacy of the microbial burden of infection as the primary driver of septic organ dysfunction. An alternate paradigm is offered that suggests that has substantial implications for optimizing antimicrobial therapy in septic shock. This model of disease progression suggests the key to significant improvement in the outcome of septic shock may lie, in great part, with improvements in delivery of existing antimicrobials and other anti-infectious strategies. Recognition of the role of delays in administration of antimicrobial therapy in the poor outcomes of septic shock is central to this effort. However, therapeutic strategies that improve the degree of antimicrobial cidality likely also have a crucial role. PMID:24184742

Transduced PEP-1-Heme Oxygenase-1 Fusion Protein Attenuates Lung Injury in Septic Shock Rats

PubMed Central

Yan, Xue-Tao; Wang, Yan-Lin; Zhang, Zong-Ze; Tang, Jun-Jiao

2018-01-01

Oxidative stress and inflammation have been identified to play a vital role in the pathogenesis of lung injury induced by septic shock. Heme oxygenase-1 (HO-1), an effective antioxidant and anti-inflammatory and antiapoptotic substance, has been used for the treatment of heart, lung, and liver diseases. Thus, we postulated that administration of exogenous HO-1 protein transduced by cell-penetrating peptide PEP-1 has a protective role against septic shock-induced lung injury. Septic shock produced by cecal ligation and puncture caused severe lung damage, manifested in the increase in the lung wet/dry ratio, oxidative stress, inflammation, and apoptosis. However, these changes were reversed by treatment with the PEP-1-HO-1 fusion protein, whereas lung injury in septic shock rats was alleviated. Furthermore, the septic shock upregulated the expression of Toll-like receptor 4 (TLR4) and transcription factor NF-κB, accompanied by the increase of lung injury. Administration of PEP-1-HO-1 fusion protein reversed septic shock-induced lung injury by downregulating the expression of TLR4 and NF-κB. Our study indicates that treatment with HO-1 protein transduced by PEP-1 confers protection against septic shock-induced lung injury by its antioxidant, anti-inflammatory, and antiapoptotic effects. PMID:29682161

Transport of Nitrogen and Phosphorus from Onsite Wastewater Treatment Systems to Shallow Groundwater

NASA Astrophysics Data System (ADS)

Toor, G.

2014-12-01

The knowledge about the nutrients transport from the vadose zone of onsite wastewater treatment systems (commonly called septic systems) is crucial to protect groundwater quality as 25% of US population uses septic systems to discharge household wastewater. For example, our preliminary data showed that about 47% of applied water was recovered at 60-cm below drainfield of septic systems. This implies that contaminants present in wastewater, if not attenuated in the vadose zone, can be transported to shallow groundwater. This presentation will focus on the biophysical and hydrologic controls on the transport of nitrogen (N) and phosphorus (P) from the vadose of two conventional (drip dispersal, gravel trench) and an advanced (with aerobic and anaerobic medias) system. These systems were constructed using two rows of drip pipe (37 emitters/mound) placed 0.3 m apart in the center of 6 m x 0.6 m drainfield. Each system received 120 L of wastewater per day. During 20-month period (May 2012 to December 2013), soil-water samples were collected from the vadose zone using suction cup lysimeters installed at 0.30, 0.60, and 1.05 m depth and groundwater samples were collected from piezometers installed at 3-3.30 m depth below the drainfield. A complimentary 1-year study using smaller drainfields (0.5 m long, 0.9 m wide, 0.9 m high) was conducted to obtain better insights in the vadose zone. A variety of instruments (multi-probe sensors, suction cup lysimeters, piezometers, tensiometers) were installed in the vadose zones. Results showed that nitrification controlled N evolution in drainfield and subsequent transport of N plumes (>10 mg/L) into groundwater. Most of the wastewater applied soluble inorganic P (>10 mg/L) was quickly attenuated in the drainfield due to fixation (sorption, precipitation) in the vadose zone (<0.10 mg/L), which was further reduced to <0.05 mg/L in groundwater. The hydrologic controls (primarily rainfall during June-September) facilitated transport of N, but not P, to shallow groundwater. The advanced system was extremely effective as it removed >95% N from wastewater, but was less effective at removing P. This presentation will conclude with importance of better septic system design and soil-based processes in reducing N and P transport to groundwater and protecting water quality in aquifers.

Speckle tracking echocardiography in patients with septic shock: a case control study (SPECKSS).

PubMed

Ng, Pauline Yeung; Sin, Wai Ching; Ng, Andrew Kei-Yan; Chan, Wai Ming

2016-05-14

Sepsis-induced myocardial dysfunction is a well-recognized condition and confers worse outcomes in septic patients. Echocardiographic assessment by conventional parameters such as left ventricular ejection fraction (LVEF) is often affected by ongoing changes in preload and afterload conditions. Novel echocardiographic technologies such as speckle tracking echocardiography (STE) have evolved for direct assessment of the myocardial function. We investigate the measurement of myocardial strain by speckle tracking echocardiography for the diagnosis of sepsis-induced myocardial dysfunction. This is a case-control study at a university-affiliated medical intensive care unit. Consecutive adult medical patients admitted with a diagnosis of septic shock were included. Patients with other causes of myocardial dysfunction were excluded. They were compared to age-matched, gender-matched, and cardiovascular risk-factor-matched controls, who were admitted to hospital for sepsis but did not develop septic shock. Transthoracic echocardiography was performed on all patients within 24 hours of diagnosis, and a reassessment echocardiogram was performed in the study group of patients upon recovery. Patients with septic shock (n = 33) (study group) and 29 matched patients with sepsis but no septic shock (control group) were recruited. The mean sequential organ failure assessment (SOFA) score for the study and control groups were 10.2 and 1.6, respectively (P < 0.001). In patients with septic shock, the mean arterial pressure was lower (76 mmHg vs 82 mmHg, P = 0.032), and the heart rate was higher (99 bpm vs 86 bpm, P = 0.008). The cardiac output (5.9 L/min vs 5.5 L/min, P = 0.401) and systemic vascular resistance (1090 dynes•sec/cm(5) vs 1194 dynes•sec/cm(5), P = 0.303) were similar. The study group had a greater degree of myocardial dysfunction measured by global longitudinal strain (GLS) (-14.5 % vs -18.3 %, P <0.001), and the myocardial strain differed upon diagnosis and recovery (-14.5 % vs -16.0 %, P = 0.010). Conventional echocardiographic measurements such as LVEF (59 % in the study group vs 61 % in the control group, P = 0.169) did not differ between the two groups. Speckle tracking echocardiography can detect significant left ventricular impairment in patients with septic shock, which was not otherwise detectable by conventional echocardiography. The reversible nature of myocardial dysfunction in sepsis was also demonstrable. This echocardiographic technique is useful in the diagnosis and monitoring of sepsis-induced myocardial dysfunction.

New perspectives on immunomodulatory therapy for bacteraemia and sepsis.

PubMed

Opal, Steven M

2010-12-01

Systemic immune dysregulation is generally acknowledged to be the fundamental molecular mechanism that underlies the pathophysiology of severe sepsis and septic shock. In the presence of a systemic infection, microbial pathogens and their soluble mediators induce generalised immune activation and coagulation activation, leading to severe sepsis and septic shock. For decades, immune-based therapies have been devised with the specific intent of inhibiting the pro-inflammatory events that are thought to precipitate the septic process. Despite a clear therapeutic rationale based upon the available experimental evidence, anti-inflammatory therapies targeting the innate or acquired immune response have largely been unsuccessful in clinical trials of sepsis. Compelling evidence now exists that a prolonged state of sepsis-induced immune suppression follows the initial period of stabilisation and resuscitation in many critically ill patients. Sepsis-related immune suppression is evidenced by histological findings of markedly enhanced lymphocytic and monocytic apoptosis, poor response to neoantigens and recall antigens, and increased incidence of infections by opportunistic pathogens. Candidiasis, cytomegalovirus activation and secondary infections by relatively avirulent bacterial pathogens such as Stenotrophomonas and Acinetobacter spp. are commonplace in septic patients during prolonged Intensive Care Unit stays. Immunological tools to detect sepsis-induced immunosuppression are now available, and novel immunoadjuvants are in development to re-establish immune competence in sepsis patients. The intelligent use of immunomodulatory agents in sepsis will necessitate a personalised medicine approach to treat each patient at the appropriate time and with the optimal therapy. Copyright © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Accuracy of a real-time continuous glucose monitoring system in children with septic shock: A pilot study.

PubMed

Prabhudesai, Sumant; Kanjani, Amruta; Bhagat, Isha; Ravikumar, Karnam G; Ramachandran, Bala

2015-11-01

The aim of this prospective, observational study was to determine the accuracy of a real-time continuous glucose monitoring system (CGMS) in children with septic shock. Children aged 30 days to 18 years admitted to the Pediatric Intensive Care Unit with septic shock were included. A real-time CGMS sensor was used to obtain interstitial glucose readings. CGMS readings were compared statistically with simultaneous laboratory blood glucose (BG). Nineteen children were included, and 235 pairs of BG-CGMS readings were obtained. BG and CGMS had a correlation coefficient of 0.61 (P < 0.001) and a median relative absolute difference of 17.29%. On Clarke's error grid analysis, 222 (94.5%) readings were in the clinically acceptable zones (A and B). When BG was < 70, 70-180, and > 180 mg/dL, 44%, 100%, and 76.9% readings were in zones A and B, respectively (P < 0.001). The accuracy of CGMS was not affected by the presence of edema, acidosis, vasopressors, steroids, or renal replacement therapy. On receiver operating characteristics curve analysis, a CGMS reading <97 mg/dL predicted hypoglycemia (sensitivity 85.2%, specificity 75%, area under the curve [AUC] =0.85). A reading > 141 mg/dL predicted hyperglycemia (sensitivity 84.6%, specificity 89.6%, AUC = 0.87). CGMS provides a fairly, accurate estimate of BG in children with septic shock. It is unaffected by a variety of clinical variables. The accuracy over extremes of blood sugar may be a concern. We recommend larger studies to evaluate its use for the early detection of hypoglycemia and hyperglycemia.

Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ognibene, F.P.; Parker, M.M.; Natanson, C.

Volume infusion, to increase preload and to enhance ventricular performance, is accepted as initial management of septic shock. Recent evidence has demonstrated depressed myocardial function in human septic shock. We analyzed left ventricular performance during volume infusion using serial data from simultaneously obtained pulmonary artery catheter hemodynamic measurements and radionuclide cineangiography. Critically ill control subjects (n = 14), patients with sepsis but without shock (n = 21), and patients with septic shock (n = 21) had prevolume infusion hemodynamic measurements determined and received statistically similar volumes of fluid resulting in similar increases in pulmonary capillary wedge pressure. There was amore » strong trend (p = 0.004) toward less of a change in left ventricular stroke work index (LVSWI) after volume infusion in patients with sepsis and septic shock compared with control subjects. The LVSWI response after volume infusion was significantly less in patients with septic shock when compared with critically ill control subjects (p less than 0.05). These data demonstrate significantly altered ventricular performance, as measured by LVSWI, in response to volume infusion in patients with septic shock.« less

Quantification of the contribution of nitrogen from septic tanks to ground water in Spanish Springs Valley, Nevada

USGS Publications Warehouse

Rosen, Michael R.; Kropf, Christian; Thomas, Karen A.

2006-01-01

Analysis of total dissolved nitrogen concentrations from soil water samples collected within the soil zone under septic tank leach fields in Spanish Springs Valley, Nevada, shows a median concentration of approximately 44 milligrams per liter (mg/L) from more than 300 measurements taken from four septic tank systems. Using two simple mass balance calculations, the concentration of total dissolved nitrogen potentially reaching the ground-water table ranges from 25 to 29 mg/L. This indicates that approximately 29 to 32 metric tons of nitrogen enters the aquifer every year from natural recharge and from the 2,070 houses that use septic tanks in the densely populated portion of Spanish Springs Valley. Natural recharge contributes only 0.25 metric tons because the total dissolved nitrogen concentration of natural recharge was estimated to be low (0.8 mg/L). Although there are many uncertainties in this estimate, the sensitivity of these uncertainties to the calculated load is relatively small, indicating that these values likely are accurate to within an order of magnitude. The nitrogen load calculation will be used as an input function for a ground-water flow and transport model that will be used to test management options for controlling nitrogen contamination in the basin.

Fever is not responsible for the elevated glucose kinetics in sepsis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lang, C.H.; Bagby, G.J.; Blakesley, H.L.

Previous studies have suggested that alterations in the classical neuroendocrine system may not be responsible for the increased glucose metabolism observed during hypermetabolic sepsis. The purpose of the present study was to determine whether inhibition of the cyclooxygenase pathway with indomethacin, which prevents the production of arachidonic acid metabolites by this pathway and the sepsis-induced increase in body temperature, would abolish the increases in glucose appearance (Ra), recycling, and hyperlactacidemia. Sepsis was induced in chronically catheterized conscious rats by multiple injections of live Escherichia coli via a subcutaneous catheter. Septic animals received iv injections of indomethacin every 6-8 hr tomore » block the cyclooxygenase pathway. Glucose kinetics were assessed in 24-hr fasted rats using a constant iv infusion of (6-/sup 3/H)- and (U-/sup 14/C) glucose. Treatment with indomethacin prevented the 1-2/sup 0/C increase in body temperature observed in septic animals. Septic rats exhibited an elevated plasma lactate concentration and increased rates of glucose appearance and recycling. The sepsis-induced alterations in these variables were not attenuated by indomethacin. These results suggest that neither elevated body temperature nor the generation of arachidonic acid metabolites of the cyclooxygenase pathway is responsible for increasing glucose production in hypermetabolic septic rats.« less

Community onsite treatment of cold strong sewage in a UASB-septic tank.

PubMed

Al-Jamal, Wafa; Mahmoud, Nidal

2009-02-01

Two community onsite UASB-septic tanks namely R1 and R2 were operated under two different HRT (2 days for R1 and 4 days for R2) in parallel over a year and monitored over the cold half of the year. During the monitoring period, the sewage was characterised by a high COD(tot) of 905mg/l with a high fraction of COD(ss), viz. about 43.7%, and rather low temperature of 17.3 degrees C. The achieved removal efficiencies in R1 and R2 for COD(tot), COD(sus), COD(col), COD(dis), BOD(5) and TSS were "51%, 83%, 20%, 24%, 45% and 74%" and "54%, 87%, 10%, 28%, 49% and 78%", respectively. The difference in the removal efficiencies of those parameters in R1 and R2 is marginal and was only significant (p<0.05) for COD(sus). The sludge filling period of the reactors is expected to be 4-7 years. In view of that, the UASB-septic tank system is a robust and compact system as it can be adequately designed in Palestine at 2 days HRT.

Viral Tracer Studies Indicate Contamination of Marine Waters by Sewage Disposal Practices in Key Largo, Florida

PubMed Central

Paul, J. H.; Rose, J. B.; Brown, J.; Shinn, E. A.; Miller, S.; Farrah, S. R.

1995-01-01

Domestic wastewater disposal practices in the Florida Keys are primarily limited to on-site disposal systems such as septic tanks, injection wells, and illegal cesspits. Poorly treated sewage is thus released into the highly porous subsurface Key Largo limestone matrix. To investigate the fate and transport of sewage in the subsurface environment and the potential for contamination of marine surface waters, we employed bacteriophages as tracers in a domestic septic system and a simulated injection well in Key Largo, Florida. Transport of bacteriophage (Phi)HSIC-1 from the septic tank to adjacent surface canal waters and outstanding marine waters occurred in as little as 11 and 23 h, respectively. Transport of the Salmonella phage PRD1 from the simulated injection well to a canal adjacent to the injection site occurred in 11.2 h. Estimated rates of migration of viral tracers ranged from 0.57 to 24.2 m/h, over 500-fold greater than flow rates measured previously by subsurface flow meters in similar environments. These results suggest that current on-site disposal practices can lead to contamination of the subsurface and surface marine waters in the Keys. PMID:16535046

Viral tracer studies indicate contamination of marine waters by sewage disposal practices in key largo, Florida.

PubMed

Paul, J H; Rose, J B; Brown, J; Shinn, E A; Miller, S; Farrah, S R

1995-06-01

Domestic wastewater disposal practices in the Florida Keys are primarily limited to on-site disposal systems such as septic tanks, injection wells, and illegal cesspits. Poorly treated sewage is thus released into the highly porous subsurface Key Largo limestone matrix. To investigate the fate and transport of sewage in the subsurface environment and the potential for contamination of marine surface waters, we employed bacteriophages as tracers in a domestic septic system and a simulated injection well in Key Largo, Florida. Transport of bacteriophage (Phi)HSIC-1 from the septic tank to adjacent surface canal waters and outstanding marine waters occurred in as little as 11 and 23 h, respectively. Transport of the Salmonella phage PRD1 from the simulated injection well to a canal adjacent to the injection site occurred in 11.2 h. Estimated rates of migration of viral tracers ranged from 0.57 to 24.2 m/h, over 500-fold greater than flow rates measured previously by subsurface flow meters in similar environments. These results suggest that current on-site disposal practices can lead to contamination of the subsurface and surface marine waters in the Keys.

Early diagnosis of septic arthritis in immunocompromised patients.

PubMed

Butler, Bennet A; Fitz, David W; Lawton, Cort D; Li, Daniel D; Balderama, Earvin S; Stover, Michael D

2018-05-01

Septic arthritis results in rapid joint destruction if not properly diagnosed and treated. A work up for septic arthritis includes a peripheral white blood cell count, inflammatory markers, and a joint aspiration. In the general population, the interpretation of these labs has been well-defined by prior studies. To this point, no study has determined how immunosuppressive states affect this work up. Patients with immunosuppressive conditions who received a joint aspiration for a painful joint were retrospectively identified. Laboratory results from their work up were gathered and analyzed. 216 patients were included in the study, 21 of whom were diagnosed with septic arthritis. The average aspiration WBC count was 74,190 with 88% PMNs. 81% had a positive gram stain. Laboratory values for immunosuppressed patients with septic arthritis were similar to those associated with septic arthritis in historical general population controls. Copyright © 2018. Published by Elsevier B.V.

[Cardiac index, oxygen and serum lactate consumption in infants with hypovolemic and septic shock].

PubMed

Gaytán Becerril, A; Olvera Hidalgo, C; Vieto Rodríguez, E E; Chávez Angeles, D S; Elena Salas, M

1980-01-01

Determination was made of cardiac output (using the stain dilution technique), gases in blood and serum lactate levels in eight infants with hypovolemic shock and sixteen with septic shock. The data were carried to indexes (values per square meter of body surface). In children with hypovolemic shock the cardiac index was 1.88 +/- 0.031/min/m,2 while in septic patients it was 4.02 +/- 1.011/min/m2. The peripheral resistances were 3,079 din/min/cm.5 in hypovolemic cases and 907 din/min in the septic. In both groups serum lactante levels rised close to 4 mM 61. Oxigen consumption was found low in hypovolemic patients and slightly high in the septic. It is concluded that our data are similar to those reported in similar studies in adults and hypodynamic shock is shown in hypovolemic patients, while hyperdynamic shock appears in septic cases.

Model Test of Proposed Loading Rates for Onsite Wastewater Treatment Systems

EPA Science Inventory

State regulatory agencies set standards for onsite wastewater treatment system (OWTS), commonly known as septic systems, based on expected hydraulic performance and nitrogen (N) treatment in soils of differing texture. In a previous study, hydraulic loading rates were proposed fo...

Bench-to-bedside review: Vasopressin in the management of septic shock

PubMed Central

2011-01-01

This review of vasopressin in septic shock differs from previous reviews by providing more information on the physiology and pathophysiology of vasopressin and vasopressin receptors, particularly because of recent interest in more specific AVPR1a agonists and new information from the Vasopressin and Septic Shock Trial (VASST), a randomized trial of vasopressin versus norepinephrine in septic shock. Relevant literature regarding vasopressin and other AVPR1a agonists was reviewed and synthesized. Vasopressin, a key stress hormone in response to hypotension, stimulates a family of receptors: AVPR1a, AVPR1b, AVPR2, oxytocin receptors and purinergic receptors. Rationales for use of vasopressin in septic shock are as follows: first, a deficiency of vasopressin in septic shock; second, low-dose vasopressin infusion improves blood pressure, decreases requirements for norepinephrine and improves renal function; and third, a recent randomized, controlled, concealed trial of vasopressin versus norepinephrine (VASST) suggests low-dose vasopressin may decrease mortality of less severe septic shock. Previous clinical studies of vasopressin in septic shock were small or not controlled. There was no difference in 28-day mortality between vasopressin-treated versus norepinephrine-treated patients (35% versus 39%, respectively) in VASST. There was potential benefit in the prospectively defined stratum of patients with less severe septic shock (5 to 14 μg/minute norepinephrine at randomization): vasopressin may have lowered mortality compared with norepinephrine (26% versus 36%, respectively, P = 0.04 within stratum). The result was robust: vasopressin also decreased mortality (compared with norepinephrine) if less severe septic shock was defined by the lowest quartile of arterial lactate or by use of one (versus more than one) vasopressor at baseline. Other investigators found greater hemodynamic effects of higher dose of vasopressin (0.06 units/minute) but also unique adverse effects (elevated liver enzymes and serum bilirubin). Use of higher dose vasopressin requires further evaluation of efficacy and safety. There are very few studies of interactions of therapies in critical care - or septic shock - and effects on mortality. Therefore, the interaction of vasopressin infusion, corticosteroid treatment and mortality of septic shock was evaluated in VASST. Low-dose vasopressin infusion plus corticosteroids significantly decreased 28-day mortality compared with corticosteroids plus norepinephrine (44% versus 35%, respectively, P = 0.03; P = 0.008 interaction statistic). Prospective randomized controlled trials would be necessary to confirm this interesting interaction. In conclusion, low-dose vasopressin may be effective in patients who have less severe septic shock already receiving norepinephrine (such as patients with modest norepinephrine infusion (5 to 15 μg/minute) or low serum lactate levels). The interaction of vasopressin infusion and corticosteroid treatment in septic shock requires further study. PMID:21892977

Fecal-indicator bacteria in streams alonga gradient of residential development

USGS Publications Warehouse

Frenzel, Steven A.; Couvillion, Charles S.

2002-01-01

Fecal-indicator bacteria were sampled at 14 stream sites in Anchorage, Alaska, USA, as part of a study to determine the effects of urbanization on water quality. Population density in the subbasins sampled ranged from zero to 1,750 persons per square kilometer. Higher concentrations of fecal-coliform, E. coli, and enterococci bacteria were measured at the most urbanized sites. Although fecal-indicator bacteria concentrations were higher in summer than in winter, seasonal differences in bacteria concentrations generally were not significant. Areas served by sewer systems had significantly higher fecal-indicator bacteria concentrations than did areas served by septic systems. The areas served by sewer systems also had storm drains that discharged directly to the streams, whereas storm sewers were not present in the areas served by septic systems. Fecal-indicator bacteria concentrations were highly variable over a two-day period of stable streamflow, which may have implications for testing of compliance to water-quality standards.

Questions and Answers About the Effects of Septic Systems on Water Quality in the La Pine Area, Oregon

USGS Publications Warehouse

Williams, John S.; Morgan, David S.; Hinkle, Stephen R.

2007-01-01

Nitrate levels in the ground-water aquifer underlying the central Oregon city of La Pine and the surrounding area are increasing due to contamination from residential septic systems. This contamination has public health implications because ground water is the sole source of drinking water for area residents. The U.S. Geological Survey, in cooperation with Deschutes County and the Oregon Department of Environmental Quality, studied the movement and chemistry of nitrate in the aquifer and developed computer models that can be used to predict future nitrate levels and to evaluate alternatives for protecting water quality. This fact sheet summarizes the results of that study in the form of questions and answers.

Longer time to antibiotics and higher mortality among septic patients with non-specific presentations--a cross sectional study of Emergency Department patients indicating that a screening tool may improve identification.

PubMed

Wallgren, Ulrika Margareta; Antonsson, Viktor Erik; Castrén, Maaret Kaarina; Kurland, Lisa

2016-01-06

The presentation of sepsis is varied and our hypotheses were that septic patients with non-specific presentations such as decreased general condition (DGC) have a less favourable outcome, and that a screening tool could increase identification of these patients. We aimed to: 1) assess time to antibiotics and in-hospital mortality among septic patients with ED chief complaint DGC, as compared with septic patients with other ED chief complaints, and 2) determine whether a screening tool could improve identification of septic patients with non-specific presentations such as DGC. Cross sectional study comparing time to antibiotics (Mann Whitney and Kaplan-Meier tests), and in-hospital mortality (logistic regression), between 61 septic patients with ED chief complaint DGC and 516 septic patients with other ED chief complaints. The sensitivity and specificity of the modified Robson screening tool was compared with that of ED doctor clinical judgment (McNemar's two related samples test) among 122 patients presenting to the ED with chief complaint DGC, of which 61 were discharged with ICD code sepsis. Septic patients presenting to the ED with the chief complaint DGC had a longer median time to antibiotics (05:26 h:minutes; IQR 4:00-10:40, vs. 03:56 h:minutes; IQR 2:21-7:32) and an increased in-hospital mortality (crude OR = 4.01; 95% CI, 2.19-7.32), compared to septic patients with other ED chief complaints. This association remained significant when adjusting for sex, age, priority, comorbidity and fulfilment of the Robson score (OR 4.31; 95% CI, 2.12-8.77). The modified Robson screening tool had a higher sensitivity (63.0 vs. 24.6%, p < 0.001), but a lower specificity (68.3 vs. 100.0%, p < 0.001), as compared to clinical judgment. This is, to the best of our knowledge, the first study comparing outcome of septic patients according to ED chief complaint. Septic patients presenting with a non-specific ED presentation, here exemplified as the chief complaint DGC, have a less favourable outcome. Our results indicate that implementation of a screening tool may increase the identification of septic patients. The results indicate that septic patients presenting with ED chief complaint DGC constitute a vulnerable patient group with delayed time to antibiotics and high in-hospital mortality. Furthermore, the results support that implementation of a screening tool may be beneficial to improve identification of these patients.

Differential expression of the Nrf2-linked genes in pediatric septic shock.

PubMed

Grunwell, Jocelyn R; Weiss, Scott L; Cvijanovich, Natalie Z; Allen, Geoffrey L; Thomas, Neal J; Freishtat, Robert J; Anas, Nick; Meyer, Keith; Checchia, Paul A; Shanley, Thomas P; Bigham, Michael T; Fitzgerald, Julie; Howard, Kelli; Frank, Erin; Harmon, Kelli; Wong, Hector R

2015-09-17

Experimental data from animal models of sepsis support a role for a transcription factor, nuclear erythroid-related factor 2 p45-related factor 2 (Nrf2), as a master regulator of antioxidant and detoxifying genes and intermediary metabolism during stress. Prior analysis of a pediatric septic shock transcriptomic database showed that the Nrf2 response is a top 5 upregulated signaling pathway in early pediatric septic shock. We conducted a focused analysis of 267 Nrf2-linked genes using a multicenter, genome-wide expression database of 180 children with septic shock 10 years of age or younger and 53 healthy controls. The analysis involved RNA isolated from whole blood within 24 h of pediatric intensive care unit admission for septic shock and a false discovery rate of 5 %. We compared differentially expressed genes from (1) patients with septic shock and healthy controls and (2) across validated gene expression-based subclasses of pediatric septic shock (endotypes A and B) using several bioinformatic methods. We found upregulation of 123 Nrf2-linked genes in children with septic shock. The top gene network represented by these genes contained primarily enzymes with oxidoreductase activity involved in cellular lipid metabolism that were highly connected to the peroxisome proliferator activated receptor and the retinoic acid receptor families. Endotype A, which had higher organ failure burden and mortality, exhibited a greater downregulation of Nrf2-linked genes than endotype B, with 92 genes differentially regulated between endotypes. Our findings indicate that Nrf2-linked genes may contribute to alterations in oxidative signaling and intermediary metabolism in pediatric septic shock.

Time to antibiotics for septic shock: evaluating a proposed performance measure.

PubMed

Venkatesh, Arjun K; Avula, Umakanth; Bartimus, Holly; Reif, Justin; Schmidt, Michael J; Powell, Emilie S

2013-04-01

International guidelines recommend antibiotics within 1 hour of septic shock recognition; however, a recently proposed performance measure is focused on measuring antibiotic administration within 3 hours of emergency department (ED) arrival. Our objective was to describe the time course of septic shock and subsequent implications for performance measurement. Cross-sectional study of consecutive ED patients ultimately diagnosed with septic shock. All patients were evaluated at an urban, academic ED in 2006 to 2008. Primary outcomes included time to definition of septic shock and performance on 2 measures: antibiotics within 3 hours of ED arrival vs antibiotics within 1 hour of septic shock definition. Of 267 patients with septic shock, the median time to definition was 88 minutes (interquartile range, 37-156), and 217 patients (81.9%) met the definition within 3 hours of arrival. Of 221 (83.4%) of patients who received antibiotics within 3 hours of arrival, 38 (17.2%) did not receive antibiotics within 1 hour of definition. Of 207 patients who received antibiotics within 1 hour of definition, 11.6% (n = 24) did not receive antibiotics within 3 hours of arrival. The arrival measure did not accurately classify performance in 23.4% of patients. Nearly 1 of 5 patients cannot be captured for performance measurement within 3 hours of ED arrival due to the variable progression of septic shock. Use of this measure would misclassify performance in 23% of patients. Measuring antibiotic administration based on the clinical course of septic shock rather than from ED arrival would be more appropriate. Copyright © 2013 Elsevier Inc. All rights reserved.

Radiological features of experimental staphylococcal septic arthritis by micro computed tomography scan

PubMed Central

Fatima, Farah; Fei, Ying; Ali, Abukar; Mohammad, Majd; Erlandsson, Malin C.; Bokarewa, Maria I.; Nawaz, Muhammad; Valadi, Hadi; Na, Manli

2017-01-01

Background Permanent joint dysfunction due to bone destruction occurs in up to 50% of patients with septic arthritis. Recently, imaging technologies such as micro computed tomography (μCT) scan have been widely used for preclinical models of autoimmune joint disorders. However, the radiological features of septic arthritis in mice are still largely unknown. Methods NMRI mice were intravenously or intra-articularly inoculated with S. aureus Newman or LS-1 strain. The radiological and clinical signs of septic arthritis were followed for 10 days using μCT. We assessed the correlations between joint radiological changes and clinical signs, histological changes, and serum levels of cytokines. Results On days 5–7 after intravenous infection, bone destruction verified by μCT became evident in most of the infected joints. Radiological signs of bone destruction were dependent on the bacterial dose. The site most commonly affected by septic arthritis was the distal femur in knees. The bone destruction detected by μCT was positively correlated with histological changes in both local and hematogenous septic arthritis. The serum levels of IL-6 were significantly correlated with the severity of joint destruction. Conclusion μCT is a sensitive method for monitoring disease progression and determining the severity of bone destruction in a mouse model of septic arthritis. IL-6 may be used as a biomarker for bone destruction in septic arthritis. PMID:28152087

Inhibition of IKKβ in enterocytes exacerbates sepsis-induced intestinal injury and worsens mortality.

PubMed

Dominguez, Jessica A; Samocha, Alexandr J; Liang, Zhe; Burd, Eileen M; Farris, Alton B; Coopersmith, Craig M

2013-10-01

Nuclear factor-κB is a critical regulator of cell-survival genes and the host inflammatory response. The purpose of this study was to investigate the role of enterocyte-specific NF-kB in sepsis through selective ablation of IkB kinase. Prospective, randomized controlled study. Animal laboratories in university medical centers. Mice lacking functional NF-kB in their intestinal epithelium (Vil-Cre/Ikkβ) and wild-type mice were subjected to sham laparotomy or cecal ligation and puncture. Animals were killed at 24 hours or followed 7 days for survival. Septic wild-type mice had decreased villus length compared with sham mice, whereas villus atrophy was further exacerbated in septic Vil-Cre/Ikkβ mice. Sepsis induced an increase in intestinal epithelial apoptosis compared with sham mice, which was further exacerbated in Vil-Cre/Ikkβ mice. Sepsis induced intestinal hyperpermeability in wild-type mice compared with sham mice, which was further exacerbated in septic Vil-Cre/Ikkβ mice. This was associated with increased intestinal expression of claudin-2 in septic wild-type mice, which was further increased in septic Vil-Cre/Ikkβ mice. Both, pro-inflammatory and anti-inflammatory cytokines were increased in serum following cecal ligation and puncture, and interleukin 10 and monocyte chemoattractant protein-1 levels were higher in septic Vil-Cre/Ikkβ mice than in septic wild-type mice. All septic mice were bacteremic, but no differences in bacterial load were identified between wild-type and Vil-Cre/Ikkβ mice. To determine the functional significance of these results, animals were followed for survival. Septic wild-type mice had lower mortality than septic Vil-Cre/Ikkβ mice (47% vs 80%, p<0.05). Antitumor necrosis factor administration decreased intestinal apoptosis, permeability, and mortality in wild-type septic mice, and a similar improvement in intestinal integrity and survival were seen when antitumor necrosis factor was given to Vil-Cre/Ikkβ mice. Enterocyte-specific NF-kB has a beneficial role in sepsis by partially preventing sepsis-induced increases in apoptosis and permeability, which are associated with worsening mortality.

Modified septic tank-anaerobic filter unit as a two-stage onsite domestic wastewater treatment system.

PubMed

Sharma, Meena Kumari; Khursheed, Anwar; Kazmi, Absar Ahmad

2014-01-01

This study demonstrates the performance evaluation of a uniquely designed two-stage system for onsite treatment of domestic wastewater. The system consisted of two upflow anaerobic bioreactors, a modified septic tank followed by an upflow anaerobic filter, accommodated within a single cylindrical unit. The system was started up without inoculation at 24 h hydraulic retention time (HRT). It achieved a steady-state condition after 120 days. The system was observed to be remarkably efficient in removing pollutants during steady-state condition with the average removal efficiency of 88.6 +/- 3.7% for chemical oxygen demand, 86.3 +/- 4.9% for biochemical oxygen demand and 91.2 +/- 9.7% for total suspended solids. The microbial analysis revealed a high reduction (>90%) capacity of the system for indicator organism and pathogens. It also showed a very good endurance against imposed hydraulic shock load. Tracer study showed that the flow pattern was close to plug flow reactor. Mean HRT was also found to be close to the designed value.

Cardiovascular response to dobutamine stress predicts outcome in severe sepsis and septic shock.

PubMed

Kumar, Anand; Schupp, Elizabeth; Bunnell, Eugene; Ali, Amjad; Milcarek, Barry; Parrillo, Joseph E

2008-01-01

During septic shock, resistance to the haemodynamic effects of catecholamine vasopressors and inotropes is a well-recognised marker of mortality risk. However, the specific cardiovascular or metabolic response elements that are most closely associated with outcome have not been well defined. The objective of this study was to assess cardiovascular and metabolic responses to dobutamine as correlates of outcome in patients with severe sepsis or septic shock. A prospective, non-randomised, non-blinded interventional study of graded dobutamine challenge (0, 5, 10, and 15 mug/kg/min) in adult patients who had undergone pulmonary artery catheterisation within 48 hours of onset of severe sepsis or septic shock (8 survivors/15 non-survivors) was performed. Radionuclide cineangiography during graded infusion was used to determine biventricular ejection fractions at each increment of dobutamine. In univariate analysis, a variety of cardiovascular or haemodynamic and oxygen transport or metabolic variables (at the point of maximum cardiac index response for a given subject) were associated with survival including: increased stroke volume index (p = 0.0003); right ventricular end-diastolic volume index (p = 0.0047); left ventricular stroke work index (p = 0.0054); oxygen delivery index (p = 0.0084); cardiac index (p = 0.0093); systolic blood pressure/left ventricular end-systolic volume index ratio (p = 0.0188); left ventricular ejection fraction (p = 0.0160); venous oxygen content (p = 0.0208); mixed venous oxygen saturation (p = 0.0234); pulse pressure (p = 0.0403); decreased pulmonary artery diastolic pressure (p = 0.0133); systemic vascular resistance index (p = 0.0154); extraction ratio (p = 0.0160); and pulmonary vascular resistance index (p = 0.0390). Increases of stroke volume index of greater than or less than 8.5 mL/m2 were concordant with survival or death in 21 of 23 cases. Multivariate profile construction showed stroke volume index as the dominant discriminating variable for survival with the systolic blood pressure/left ventricular end-systolic volume index ratio alone among all other variables significantly improving the model. Survivors maintain cardiac responsiveness to catecholamine stimulation during septic shock. Survival from severe sepsis or septic shock is associated with increased cardiac performance and contractility indices during dobutamine infusion. Further studies are required to determine whether these parameters are predictive of outcome in a larger severe sepsis/septic shock population.

The innate immune response in HIV/AIDS septic shock patients: a comparative study.

PubMed

Amancio, Rodrigo T; Japiassu, Andre M; Gomes, Rachel N; Mesquita, Emersom C; Assis, Edson F; Medeiros, Denise M; Grinsztejn, Beatriz; Bozza, Patrícia T; Castro-Faria Neto, Hugo C; Bozza, Fernando A

2013-01-01

In recent years, the incidence of sepsis has increased in critically ill HIV/AIDS patients, and the presence of severe sepsis emerged as a major determinant of outcomes in this population. The inflammatory response and deregulated cytokine production play key roles in the pathophysiology of sepsis; however, these mechanisms have not been fully characterized in HIV/AIDS septic patients. We conducted a prospective cohort study that included HIV/AIDS and non-HIV patients with septic shock. We measured clinical parameters and biomarkers (C-reactive protein and cytokine levels) on the first day of septic shock and compared these parameters between HIV/AIDS and non-HIV patients. We included 30 HIV/AIDS septic shock patients and 30 non-HIV septic shock patients. The HIV/AIDS patients presented low CD4 cell counts (72 [7-268] cells/mm(3)), and 17 (57%) patients were on HAART before hospital admission. Both groups were similar according to the acute severity scores and hospital mortality. The IL-6, IL-10 and G-CSF levels were associated with hospital mortality in the HIV/AIDS septic group; however, the CRP levels and the surrogates of innate immune activation (cytokines) were similar among HIV/AIDS and non-HIV septic patients. Age (odds ratio 1.05, CI 95% 1.02-1.09, p=0.002) and the IL-6 levels (odds ratio 1.00, CI 95% 1.00-1.01, p=0.05) were independent risk factors for hospital mortality. IL-6, IL-10 and G-CSF are biomarkers that can be used to predict prognosis and outcomes in HIV/AIDS septic patients. Although HIV/AIDS patients are immunocompromised, an innate immune response can be activated in these patients, which is similar to that in the non-HIV septic population. In addition, age and the IL-6 levels are independent risk factors for hospital mortality irrespective of HIV/AIDS disease.

Murine Lung Cancer Increases CD4+ T Cell Apoptosis and Decreases Gut Proliferative Capacity in Sepsis.

PubMed

Lyons, John D; Mittal, Rohit; Fay, Katherine T; Chen, Ching-Wen; Liang, Zhe; Margoles, Lindsay M; Burd, Eileen M; Farris, Alton B; Ford, Mandy L; Coopersmith, Craig M

2016-01-01

Mortality is significantly higher in septic patients with cancer than in septic patients without a history of cancer. We have previously described a model of pancreatic cancer followed by sepsis from Pseudomonas aeruginosa pneumonia in which cancer septic mice have higher mortality than previously healthy septic mice, associated with increased gut epithelial apoptosis and decreased T cell apoptosis. The purpose of this study was to determine whether this represents a common host response by creating a new model in which both the type of cancer and the model of sepsis are altered. C57Bl/6 mice received an injection of 250,000 cells of the lung cancer line LLC-1 into their right thigh and were followed three weeks for development of palpable tumors. Mice with cancer and mice without cancer were then subjected to cecal ligation and puncture and sacrificed 24 hours after the onset of sepsis or followed 7 days for survival. Cancer septic mice had a higher mortality than previously healthy septic mice (60% vs. 18%, p = 0.003). Cancer septic mice had decreased number and frequency of splenic CD4+ lymphocytes secondary to increased apoptosis without changes in splenic CD8+ numbers. Intestinal proliferation was also decreased in cancer septic mice. Cancer septic mice had a higher bacterial burden in the peritoneal cavity, but this was not associated with alterations in local cytokine, neutrophil or dendritic cell responses. Cancer septic mice had biochemical evidence of worsened renal function, but there was no histologic evidence of renal injury. Animals with cancer have a significantly higher mortality than previously healthy animals following sepsis. The potential mechanisms associated with this elevated mortality differ significantly based upon the model of cancer and sepsis utilized. While lymphocyte apoptosis and intestinal integrity are both altered by the combination of cancer and sepsis, the patterns of these alterations vary greatly depending on the models used.

Murine Lung Cancer Increases CD4+ T Cell Apoptosis and Decreases Gut Proliferative Capacity in Sepsis

PubMed Central

Lyons, John D.; Mittal, Rohit; Fay, Katherine T.; Chen, Ching-Wen; Liang, Zhe; Margoles, Lindsay M.; Burd, Eileen M.; Farris, Alton B.

2016-01-01

Background Mortality is significantly higher in septic patients with cancer than in septic patients without a history of cancer. We have previously described a model of pancreatic cancer followed by sepsis from Pseudomonas aeruginosa pneumonia in which cancer septic mice have higher mortality than previously healthy septic mice, associated with increased gut epithelial apoptosis and decreased T cell apoptosis. The purpose of this study was to determine whether this represents a common host response by creating a new model in which both the type of cancer and the model of sepsis are altered. Methods C57Bl/6 mice received an injection of 250,000 cells of the lung cancer line LLC-1 into their right thigh and were followed three weeks for development of palpable tumors. Mice with cancer and mice without cancer were then subjected to cecal ligation and puncture and sacrificed 24 hours after the onset of sepsis or followed 7 days for survival. Results Cancer septic mice had a higher mortality than previously healthy septic mice (60% vs. 18%, p = 0.003). Cancer septic mice had decreased number and frequency of splenic CD4+ lymphocytes secondary to increased apoptosis without changes in splenic CD8+ numbers. Intestinal proliferation was also decreased in cancer septic mice. Cancer septic mice had a higher bacterial burden in the peritoneal cavity, but this was not associated with alterations in local cytokine, neutrophil or dendritic cell responses. Cancer septic mice had biochemical evidence of worsened renal function, but there was no histologic evidence of renal injury. Conclusions Animals with cancer have a significantly higher mortality than previously healthy animals following sepsis. The potential mechanisms associated with this elevated mortality differ significantly based upon the model of cancer and sepsis utilized. While lymphocyte apoptosis and intestinal integrity are both altered by the combination of cancer and sepsis, the patterns of these alterations vary greatly depending on the models used. PMID:27018973

[The influence of lactate Ringer solution versus hydroxyethyl starch on coagulation and fibrinolytic system in patients with septic shock].

PubMed

Lv, Jie; Zhao, Hui-ying; Liu, Fang; An, You-zhong

2012-01-01

To investigate the influence of lactate Ringer solution (RL) versus hydroxyethyl starch 130/0.4 (HES130/0.4) solution on coagulation and fibrinolytic system in the patients with septic shock. Forty-two consecutive patients with septic shock diagnosed between September 2009 and June 2011 were randomized to two study groups: RL resuscitation group (RL group) with 20 patients, and HES130/0.4 resuscitation group (HES group) with 22 patients. In all of them peripheral blood was collected at four points of time: before resuscitation, 6, 12, 24 hours after resuscitation, and then prothrombin time (PT), activated partial thromboplastin time (APTT) and levels of plasma tissue plasminogen activator (t-PA), and plasminogen activator inhibitor (PAI) were determined. Meanwhile, the patients' outcome and the length of intensive care unit stay (ICU-LOS) were recorded. ICU-LOS (days) in HES group was significantly shorter than the RL group (12.5 ± 8.8 vs. 17.1 ± 16.6, P < 0.01). Meanwhile, the volume of fluid (L: 2.77 ± 0.59) as well as vasoactive drugs [μg×kg(-1)×min(-1): 0.56 ± 0.15] used in the HES group were significantly lower than RL group (3.46 ± 0.73, 0.81 ± 0.41, both P < 0.01). In RL group, 12 patients died and 8 patients survived, while in HES group, 7 patients died and 15 patients survived, showing no difference between two groups. PT, APTT and the levels of t-PA showed no significant differences between two groups at different time points, but the levels of plasma PAI (μg/L) of the HES group decreased gradually, and was significantly lower than that before resuscitation and RL group at 24 hours after resuscitation (41.76 ± 25.95 vs. 89.11 ± 14.27, 55.08 ± 35.43, both P < 0.05). Both RL and HES130/0.4 fluid resuscitation did not affect the outcome of the patients with septic shock, but the resuscitation efficiency of HES130/0.4 is much better than RL. Both type of fluids did not show the effect on coagulability of the septic patients, but colloid fluid resuscitation may protect the vascular endothelial cell, reduce the inhibition of fibrinolytic system, and alleviate hypercoagulability state of patients in early stage.

Quantifying the impact of septic tank systems on eutrophication risk in rural headwaters.

PubMed

Withers, P J A; Jarvie, H P; Stoate, C

2011-04-01

Septic tank systems (STS) are a potential source of nutrient emissions to surface waters but few data exist in the UK to quantify their significance for eutrophication. We monitored the impact of STS on nutrient concentrations in a stream network around a typical English village over a 1-year period. Septic tank effluent discharging via a pipe directly into one stream was highly concentrated in soluble N (8-63mgL(-1)) and P (<1-14mgL(-1)) and other nutrients (Na, K, Cl, B and Mn) typical of detergent and household inputs. Ammonium-N (NH(4)N) and soluble reactive P (SRP) fractions were dominant (70-85% of total) and average concentrations of nitrite-N (NO(2)N) were above levels considered harmful to fish (0.1mgL(-1)). Lower nutrient concentrations were recorded at a ditch and a stream site, but range and average values downstream of rural habitation were still 4 to 10-fold greater than those in upstream sections. At the ditch site, where flow volumes were low, annual flow-weighted concentrations of NH(4)N and SRP increased from 0.04 and 0.07mgL(-1), respectively upstream to 0.55 and 0.21mgL(-1) downstream. At the stream site, flow volumes were twice as large and flow-weighted concentrations increased much less; from 0.04 to 0.21mgL(-1) for NH(4)N and from 0.06 to 0.08mgL(-1) for SRP. At all sites, largest nutrient concentrations were recorded under low flow and stream discharge was the most important factor determining the eutrophication impact of septic tank systems. The very high concentrations, intercorrelation and dilution patterns of SRP, NH(4)-N and the effluent markers Na and B suggested that soakaways in the heavy clay catchment soils were not retaining and treating the septic tank effluents efficiently, with profound implications for stream biodiversity. Water companies, water regulators and rural communities therefore need to be made more aware of the potential impacts of STS on water quality so that their management can be optimised to reduce the risk of potential eutrophication and toxicity to aquatic ecosystems during summer low flow periods. Copyright © 2011 Elsevier Ltd. All rights reserved.

Sepsis

MedlinePlus

... pressure drops and the heart weakens, leading to septic shock. Anyone can get sepsis, but the risk is higher in People with weakened immune systems Infants and children The elderly People with chronic ...

Sepsis

MedlinePlus

Septicemia; Sepsis syndrome; Systemic inflammatory response syndrome; SIRS; Septic shock ... The symptoms of sepsis are not caused by the germs themselves. Instead, chemicals the body releases cause the response. A bacterial infection anywhere ...

Genetics and morphology of Aedes aegypti (Diptera: Culicidae) in septic tanks in Puerto Rico.

PubMed

Somers, Gerard; Brown, Julia E; Barrera, Roberto; Powell, Jeffrey R

2011-11-01

Dengue viruses, primarily transmitted by the mosquito Aedes aegypti (L.), affect an estimated 50-100 million people yearly. Traditional approaches to control mosquito population numbers, such as the use of pesticides, have had only limited success. Atypical mosquito behavior may be one reason why current vector control efforts have been less efficacious than expected. In Puerto Rico, for example, adult Ae. aegypti have been observed emerging from septic tanks. Interestingly, adults emerging from septic tanks are larger on average than adults collected from surface containers. To determine whether adults colonizing septic tanks constitute a separate Ae. aegypti population, we used 12 previously validated microsatellite loci to examine adult mosquitoes collected from both septic tanks and surface containers, but found no evidence to suggest genetic differentiation. Size differences between septic tank and surface mosquitoes were reduced when nutrient levels were held constant across experimental groups. Despite the absence of evidence suggesting a genetic difference between experimental groups in this study, Ae. aegypti emerging from septic tanks may still represent a more dangerous phenotype and should be given special consideration when developing vector control programs and designing public health interventions in the future.

Genetics and Morphology of Aedes aegypti (Diptera: Culicidae) in Septic Tanks in Puerto Rico

PubMed Central

SOMERS, GERARD; BROWN, JULIA E.; BARRERA, ROBERTO; POWELL, JEFFREY R.

2012-01-01

Dengue viruses, primarily transmitted by the mosquito Aedes aegypti (L.), affect an estimated 50–100 million people yearly. Traditional approaches to control mosquito population numbers, such as the use of pesticides, have had only limited success. Atypical mosquito behavior may be one reason why current vector control efforts have been less efficacious than expected. In Puerto Rico, for example, adult Ae. aegypti have been observed emerging from septic tanks. Interestingly, adults emerging from septic tanks are larger on average than adults collected from surface containers. To determine whether adults colonizing septic tanks constitute a separate Ae. aegypti population, we used 12 previously validated microsatellite loci to examine adult mosquitoes collected from both septic tanks and surface containers, but found no evidence to suggest genetic differentiation. Size differences between septic tank and surface mosquitoes were reduced when nutrient levels were held constant across experimental groups. Despite the absence of evidence suggesting a genetic difference between experimental groups in this study, Ae. aegypti emerging from septic tanks may still represent a more dangerous phenotype and should be given special consideration when developing vector control programs and designing public health interventions in the future. PMID:22238867

Getting older can be exhausting.

PubMed

Mittal, Rohit; Ford, Mandy L; Coopersmith, Craig M

2014-07-29

Sepsis is a disease that affects primarily the aged. Although mortality is higher in both older septic patients and aged septic mice, the mechanisms underlying decreased survival in older hosts are incompletely understood. New work by Inoue and colleagues demonstrates persistent inflammation and T-cell exhaustion in older septic patients and aged septic mice. The clinical significance of these findings is manifested not only in increased mortality but also in a marked difference in secondary infections in older patients as long as a month following ICU admission.

Estimating nitrogen loading to ground water and assessing vulnerability to nitrate contamination in a large karstic springs Basin, Florida

USGS Publications Warehouse

Katz, B.G.; Sepulveda, A.A.; Verdi, R.J.

2009-01-01

A nitrogen (N) mass-balance budget was developed to assess the sources of N affecting increasing ground-water nitrate concentrations in the 960-km 2 karstic Ichetucknee Springs basin. This budget included direct measurements of N species in rainfall, ground water, and spring waters, along with estimates of N loading from fertilizers, septic tanks, animal wastes, and the land application of treated municipal wastewater and residual solids. Based on a range of N leaching estimates, N loads to ground water ranged from 262,000 to 1.3 million kg/year; and were similar to N export from the basin in spring waters (266,000 kg/year) when 80-90% N losses were assumed. Fertilizers applied to cropland, lawns, and pine stands contributed about 51% of the estimated total annual N load to ground water in the basin. Other sources contributed the following percentages of total N load to ground water: animal wastes, 27%; septic tanks, 12%; atmospheric deposition, 8%; and the land application of treated wastewater and biosolids, 2%. Due to below normal rainfall (97.3 cm) during the 12-month rainfall collection period, N inputs from rainfall likely were about 30% lower than estimates for normal annual rainfall (136 cm). Low N-isotope values for six spring waters (??15N-NO3 = 3.3 to 6.3???) and elevated potassium concentrations in ground water and spring waters were consistent with the large N contribution from fertilizers. Given ground-water residence times on the order of decades for spring waters, possible sinks for excess N inputs to the basin include N storage in the unsaturated zone and parts of the aquifer with relatively sluggish ground-water movement and denitrification. A geographical-based model of spatial loading from fertilizers indicated that areas most vulnerable to nitrate contamination were located in closed depressions containing sinkholes and other dissolution features in the southern half of the basin. ?? 2009 American Water Resources Association.

Vasopressin compared with norepinephrine augments the decline of plasma cytokine levels in septic shock.

PubMed

Russell, James A; Fjell, Chris; Hsu, Joseph L; Lee, Terry; Boyd, John; Thair, Simone; Singer, Joel; Patterson, Andrew J; Walley, Keith R

2013-08-01

Changes in plasma cytokine levels may predict mortality, and therapies (vasopressin versus norepinephrine) could change plasma cytokine levels in early septic shock. Our hypotheses were that changes in plasma cytokine levels over 24 hours differ between survivors and nonsurvivors, and that there are different effects of vasopressin and norepinephrine on plasma cytokine levels in septic shock. We studied 394 patients in a randomized, controlled trial of vasopressin versus norepinephrine in septic shock. We used hierarchical clustering and principal components analysis of the baseline cytokine concentrations to subgroup cytokines; we then compared survivors to nonsurvivors (28 d) and compared vasopressin- versus norepinephrine-induced changes in cytokine levels over 24 hours. A total of 39 plasma cytokines were measured at baseline and at 24 hours. Hierarchical clustering and principal components analysis grouped cytokines similarly. Survivors (versus nonsurvivors) had greater decreases of overall cytokine levels (P < 0.001). Vasopressin decreased overall 24-hour cytokine concentration compared with norepinephrine (P = 0.037). In less severe septic shock, the difference in plasma cytokine reduction over 24 hours between survivors and nonsurvivors was less pronounced than that seen in more severe septic shock. Furthermore, vasopressin decreased interferon-inducible protein 10 and granulocyte colony-stimulating factor more than did norepinephrine in less severe septic shock, whereas vasopressin decreased granulocyte-macrophage colony-stimulating factor in patients who had more severe shock. Survivors of septic shock had greater decreases of cytokines, chemokines and growth factors in early septic shock. Vasopressin decreased 24-hour plasma cytokine levels more than did norepinephrine. The vasopressin-associated decrease of cytokines differed according to severity of shock. Clinical trial registered with www.controlled-trials.com (ISRCTN94845869).

Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

PubMed

Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S

2016-03-01

The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p < .001 and p = 0.019) for ex- and implantation (€4147 vs. €6680 and €429 vs. €306) while length of stay and reimbursement were comparable. This is the first detailed analysis of the hospital department's cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

Derivation and Validation of a Biomarker-Based Clinical Algorithm to Rule Out Sepsis From Noninfectious Systemic Inflammatory Response Syndrome at Emergency Department Admission: A Multicenter Prospective Study.

PubMed

Mearelli, Filippo; Fiotti, Nicola; Giansante, Carlo; Casarsa, Chiara; Orso, Daniele; De Helmersen, Marco; Altamura, Nicola; Ruscio, Maurizio; Castello, Luigi Mario; Colonetti, Efrem; Marino, Rossella; Barbati, Giulia; Bregnocchi, Andrea; Ronco, Claudio; Lupia, Enrico; Montrucchio, Giuseppe; Muiesan, Maria Lorenza; Di Somma, Salvatore; Avanzi, Gian Carlo; Biolo, Gianni

2018-05-07

To derive and validate a predictive algorithm integrating a nomogram-based prediction of the pretest probability of infection with a panel of serum biomarkers, which could robustly differentiate sepsis/septic shock from noninfectious systemic inflammatory response syndrome. Multicenter prospective study. At emergency department admission in five University hospitals. Nine-hundred forty-seven adults in inception cohort and 185 adults in validation cohort. None. A nomogram, including age, Sequential Organ Failure Assessment score, recent antimicrobial therapy, hyperthermia, leukocytosis, and high C-reactive protein values, was built in order to take data from 716 infected patients and 120 patients with noninfectious systemic inflammatory response syndrome to predict pretest probability of infection. Then, the best combination of procalcitonin, soluble phospholypase A2 group IIA, presepsin, soluble interleukin-2 receptor α, and soluble triggering receptor expressed on myeloid cell-1 was applied in order to categorize patients as "likely" or "unlikely" to be infected. The predictive algorithm required only procalcitonin backed up with soluble phospholypase A2 group IIA determined in 29% of the patients to rule out sepsis/septic shock with a negative predictive value of 93%. In a validation cohort of 158 patients, predictive algorithm reached 100% of negative predictive value requiring biomarker measurements in 18% of the population. We have developed and validated a high-performing, reproducible, and parsimonious algorithm to assist emergency department physicians in distinguishing sepsis/septic shock from noninfectious systemic inflammatory response syndrome.

Mitochondrial DNA: An Endogenous Trigger for Immune Paralysis.

PubMed

Schäfer, Simon T; Franken, Lars; Adamzik, Michael; Schumak, Beatrix; Scherag, André; Engler, Andrea; Schönborn, Niels; Walden, Jennifer; Koch, Susanne; Baba, Hideo A; Steinmann, Jörg; Westendorf, Astrid M; Fandrey, Joachim; Bieber, Thomas; Kurts, Christian; Frede, Stilla; Peters, Jürgen; Limmer, Andreas

2016-04-01

Critically ill patients are at high risk to suffer from sepsis, even in the absence of an initial infectious source, but the molecular mechanisms for their increased sepsis susceptibility, including a suppressed immune system, remain unclear. Although microbes and pathogen-associated molecular pattern are accepted inducers of sepsis and septic immunosuppression, the role of endogenous Toll-like receptor (TLR) ligands, such as mitochondrial DNA (mtDNA), in altering the immune response is unknown. Mitochondrial DNA serum concentrations of the mitochondrial genes D-Loop and adenosine triphosphatase 6 were determined (quantitative polymerase chain reaction) in 165 septic patients and 50 healthy volunteers. Furthermore, cytotoxic T-cell activity was analyzed in wild-type and TLR9 knockout mice, with/without previous mtDNA administration, followed by injection of an ovalbumin-expressing adenoviral vector. Mitochondrial DNA serum concentrations were increased in septic patients (adenosine triphosphatase 6, 123-fold; D-Loop, 76-fold, P < 0.0001) compared with volunteers. Furthermore, a single mtDNA injection caused profound, TLR9-dependent immunosuppression of adaptive T-cell cytotoxicity in wild-type but not in TLR9 knockout mice and evoked various immunosuppressive mechanisms including the destruction of the splenic microstructure, deletion of cross-presenting dendritic cells, and up-regulation of programmed cell death ligand 1 and indoleamine 2,3-dioxygenase. Several of these findings in mice were mirrored in septic patients, and mtDNA concentrations were associated with an increased 30-day mortality. The findings of this study imply that mtDNA, an endogenous danger associated molecular pattern, is a hitherto unknown inducer of septic immunoparalysis and one possible link between initial inflammation and subsequent immunosuppression in critically ill patients.

[Treatment of septic olecranon and patellar bursitis by excision and vacuum-assisted closure therapy].

PubMed

Walter, G; Kemmerer, M; Hoffmann, R

2013-08-01

Treatment of septic olecranon and patellar bursitis differs considerably and is currently under discussion. We therefore performed a retrospective study of our patients with septic bursitis in the past 5 years. Between March 2007 and February 2012 we treated 79 patients with septic olecranon (n = 43) and patellar (n = 36) bursitis surgically: 61-males, 18 females, age 51 (range: 11-91) years. Four patients had not been treated before, 25 had suffered recurrences after 1-10 previous procedures, and 9 patients had not improved after conservative therapy. 34 patients presented with traumatic rupture or fistula of their bursae. In all cases we performed a radical bursectomy and vacuum-assisted therapy for 4 to 5 days. In addition, patients received systemic antibiotics. We phoned all patients and were successful in 57 cases (72 %). We questioned these patients for range of movement, limitations at work, pain, sensibility disorder, satisfaction with the result and further surgical procedures. In all cases we took tissue specimens for cultures, in 48 preparations histological examination was performed. Microbiological and histological results are discussed in detail. 40 patients were free of complaints, 15 complained of mild pain, 54 of 57 had unlimited range of motion. Minor discomforts at desk work were reported by 5 of 43 patients, 12 out of 36 patient reported discomfort when performing on their knees. There was no recurrence in the period of investigation. We recommend our treatment concept for septic olecranon and patellar bursitis because patient satisfaction is high and recurrences are reliably avoided. The soft tissue is spared, so that plastic covering procedures are seldom necessary. Georg Thieme Verlag KG Stuttgart · New York.

Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery.

PubMed

Mokart, D; Merlin, M; Sannini, A; Brun, J P; Delpero, J R; Houvenaeghel, G; Moutardier, V; Blache, J L

2005-06-01

Patients who undergo major surgery for cancer are at high risk of postoperative sepsis. Early markers of septic complications would be useful for diagnosis and therapeutic management in patients with postoperative sepsis. The aim of this study was to investigate the association between early (first postoperative day) changes in interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) serum concentrations and the occurrence of subsequent septic complications after major surgery. Serial blood samples were collected from 50 consecutive patients for determination of IL-6, PCT and CRP serum levels. Blood samples were obtained on the morning of surgery and on the morning of the first postoperative day. Sixteen patients developed septic complications during the first five postoperative days (group 1), and 34 patients developed no septic complications (group 2). On day 1, PCT and IL-6 levels were significantly higher in group 1 (P-values of 0.003 and 0.006, respectively) but CRP levels were similar. An IL-6 cut-off point set at 310 pg ml(-1) yielded a sensitivity of 90% and a specificity of 58% to differentiate group 1 patients from group 2 patients. When associated with the occurrence of SIRS on day 1 these values reached 100% and 79%, respectively. A PCT cut-off point set at 1.1 ng ml(-1) yielded a sensitivity of 81% and a specificity of 72%. When associated with the occurrence of SIRS on day 1, these values reached 100% and 86%, respectively. PCT and IL-6 appear to be early markers of subsequent postoperative sepsis in patients undergoing major surgery for cancer. These findings could allow identification of postoperative septic complications.

Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock.

PubMed

Wheeler, Derek S; Devarajan, Prasad; Ma, Qing; Harmon, Kelli; Monaco, Marie; Cvijanovich, Natalie; Wong, Hector R

2008-04-01

To validate serum neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for acute kidney injury in critically ill children with septic shock. Observational cohort study. Fifteen North American pediatric intensive care units (PICUs). A total of 143 critically ill children with systemic inflammatory response syndrome (SIRS) or septic shock and 25 healthy controls. None. Serum NGAL was measured during the first 24 hrs of admission to the PICU. Acute kidney injury was defined as a blood urea nitrogen concentration >100 mg/dL, serum creatinine >2 mg/dL in the absence of preexisting renal disease, or the need for dialysis. There was a significant difference in serum NGAL between healthy children (median 80 ng/mL, interquartile ratio [IQR] 55.5-85.5 ng/mL), critically ill children with SIRS (median 107.5 ng/mL, IQR 89-178.5 ng/mL), and critically ill children with septic shock (median 302 ng/mL, IQR 151-570 ng/mL; p < .001). Acute kidney injury developed in 22 of 143 (15.4%) critically ill children. Serum NGAL was significantly increased in critically ill children with acute kidney injury (median 355 ng/mL, IQR 166-1322 ng/mL) compared with those without acute kidney injury (median 186 ng/mL, IQR 98-365 ng/mL; p = .009). Serum NGAL is a highly sensitive but nonspecific predictor of acute kidney injury in critically ill children with septic shock. Further validation of serum NGAL as a biomarker of acute kidney injury in this population is warranted.

Giardiasis in the United States - an epidemiologic and geospatial analysis of county-level drinking water and sanitation data, 1993-2010.

PubMed

Schnell, Kerry; Collier, Sarah; Derado, Gordana; Yoder, Jonathan; Gargano, Julia Warner

2016-04-01

Giardiasis is the most commonly reported intestinal parasitic infection in the United States. Outbreak investigations have implicated poorly maintained private wells, and hypothesized a role for wastewater systems in giardiasis transmission. Surveillance data consistently show geographic variability in reported giardiasis incidence. We explored county-level associations between giardiasis cases, household water and sanitation (1990 census), and US Census division. Using 368,847 reported giardiasis cases (1993-2010), we mapped county-level giardiasis incidence rates, private well reliance, and septic system reliance, and assessed spatiotemporal clustering of giardiasis. We used negative binomial regression to evaluate county-level associations between giardiasis rates, region, and well and septic reliance, adjusted for demographics. Adjusted giardiasis incidence rate ratios (aIRRs) were highest (aIRR 1.3; 95% confidence interval 1.2-1.5) in counties with higher private well reliance. There was no significant association between giardiasis and septic system reliance in adjusted models. Consistent with visual geographic distributions, the aIRR of giardiasis was highest in New England (aIRR 3.3; 95% CI 2.9-3.9; reference West South Central region). Our results suggest that, in the USA, private wells are relevant to giardiasis transmission; giardiasis risk factors might vary regionally; and up-to-date, location-specific national data on water sources and sanitation methods are needed.

Corrective Action Decision Document for Corrective Action Unit 151: Septic Systems and Discharge Area, Nevada Test Site, Nevada, Rev. No.: 0

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grant Evenson

2006-05-01

This Corrective Action Decision Document has been prepared for Corrective Action Unit (CAU) 151, Septic Systems and Discharge Area, at the Nevada Test Site, Nevada, according to the ''Federal Facility Agreement and Consent Order'' (FFACO) (1996). Corrective Action Unit 151 is comprised of eight corrective action sites (CASs): (1) CAS 02-05-01, UE-2ce Pond; (2) CAS 12-03-01, Sewage Lagoons (6); (3) CAS 12-04-01, Septic Tanks; (4) CAS 12-04-02, Septic Tanks; (5) CAS 12-04-03, Septic Tank; (6) CAS 12-47-01, Wastewater Pond; (7) CAS 18-03-01, Sewage Lagoon; and (8) CAS 18-99-09, Sewer Line (Exposed). The purpose of this Corrective Action Decision Document ismore » to identify and provide the rationale for the recommendation of corrective action alternatives (CAAs) for each of the eight CASs within CAU 151. Corrective action investigation (CAI) activities were performed from September 12 through November 18, 2005, as set forth in the CAU 151 Corrective Action Investigation Plan and Record of Technical Change No. 1. Additional confirmation sampling was performed on December 9, 2005; January 10, 2006; and February 13, 2006. Analytes detected during the CAI were evaluated against appropriate final action levels (FALs) to identify the contaminants of concern for each CAS. The results of the CAI identified contaminants of concern at two of the eight CASs in CAU 151 and required the evaluation of CAAs. Assessment of the data generated from investigation activities conducted at CAU 151 revealed the following: (1) Soils at CASs 02-05-01, 12-04-01, 12-04-02, 12-04-03, 12-47-01, 18-03-01, 18-99-09, and Lagoons B through G of CAS 12-03-01 do not contain contamination at concentrations exceeding the FALs. (2) Lagoon A of CAS 12-03-01 has arsenic above FALs in shallow subsurface soils. (3) One of the two tanks of CAS 12-04-01, System No.1, has polychlorinated biphenyls (aroclor-1254), trichloroethane, and cesium-137 above FALs in the sludge. Both CAS 12-04-01, System No.1 tanks contain trichloroethane and 1,4-dichlorobenzene above ''Resource Conservation and Recovery Act'' toxicity characteristic limits. Based on the evaluation of analytical data from the CAI, review of future and current operations at the eight CASs, and the detailed and comparative analysis of the potential CAAs, the following corrective actions are recommended for CAU 151. No Further Action is the recommended corrective action for soils at CASs 02-05-01, 12-04-01, 12-04-02, 12-04-03, 18-03-01, and 18-99-09; and Lagoons C, D, F, and G of CAS 12-03-01. No Further Action with implementation of a best management practice (BMP) is recommended for soils at CAS 12-47-01 and Lagoons B and E of CAS 12-03-01. To be protective of future workers should the present scenario used to calculate FALs change, an administrative use restriction will be recorded per the FFACO agreement as a BMP. Close in Place with Administrative Controls is the recommended corrective action for Lagoon A of CAS 12-03-01. Based on the evaluation of analytical data from the CAI; review of future and current operations at CASs 12-04-01, 12-04-02, and 12-04-03; and the detailed and comparative analysis of the potential CAAs, the following corrective actions are recommended for the septic tanks at these CASs. No Further Action with implementation of BMPs is the recommended corrective action for septic tanks that do not contain potential source material from CAS 12-04-01, System No.4 (four tanks); CAS 12-04-02, System No.5 (six tanks); and CAS 12-04-03, System No.3 (four tanks). Clean Closure with implementation of BMPs is the recommended corrective action for the septic tanks from CAS 12-04-01, System No.1 (two tanks). The preferred CAAs were evaluated on technical merit focusing on performance, reliability, feasibility, safety, and cost. The alternatives were judged to meet all requirements for the technical components evaluated. The alternatives meet all applicable federal and state regulations for closure of the site and will reduce potential exposure pathways to the contaminated media to an acceptable level at CAU 151.« less

Response to glucose and lipid infusions in sepsis: a kinetic analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shaw, J.H.; Wolfe, R.R.

The kinetics and oxidation of glucose and free fatty acid (FFA) metabolism were assessed in control and Escherichia coli septicemic dogs by using primed, constant infusions of U-/sup 14/C-glucose and 1,2, /sup 13/C-palmitic acid. In the controls, the infusion of glucose suppressed endogenous glucose production completely, whereas, in the septic dogs, only a 30% suppression of glucose production occurred. The ability of the septic dogs to oxidize endogenous or exogenous glucose was decreased significantly. The basal rate of appearance of FFA was significantly higher in the septic dogs, but their ability to oxidize FFA was comparable to that of themore » control dogs; therefore, the basal rate of FFA oxidation was higher in the septic dogs. These studies indicate that septic dogs have a decreased capacity to oxidize glucose, but that they retain their ability to oxidize long-chain fatty acids. Because the rate of lipolysis was increased in sepsis, lipid was the predominate energy substrate in this septic model.« less

Septic encephalopathy and septic encephalitis‬‬.

PubMed

Tauber, Simone C; Eiffert, Helmut; Brück, Wolfgang; Nau, Roland

2017-02-01

During the last two decades, septic encephalopathy (SE) was recognized as a clinically relevant problem with a high prevalence in patients at admission and during their hospital stay. SE is a condition associated with increased mortality and morbidity such as long-term cognitive impairment. Areas covered: This review illustrates the pathophysiology of sepsis-associated encephalopathy and encephalitis involving blood-brain-barrier dysfunction and neuroinflammation caused by endothelial and microglial activation by endogenous or pathogen-derived compounds, hypoxia by impaired microvascular regulation and septic shock as well as imbalance of neurotransmitters. The continuum between septic-embolic and septic-metastatic encephalitis and SE is underlined by histological findings. The options of technical examinations and biomarkers to diagnose SE are discussed together with established therapeutic options as well as current experimental approaches. Expert commentary: An outlook for clinicians is provided including promising diagnostic approaches by means of new imaging techniques. Clinical trials with drugs already established for other indications such as statins, erythropoietin and minocycline are warranted in the future.

Anaerobic treatment of domestic sewage in modified septic tanks at low temperature.

PubMed

Chen, Zhiqiang; Wen, Qinxue; Guan, Huabin; Bakke, Rune; Ren, Nanqi

2014-01-01

Three laboratory-scale septic tanks, an anaerobic baffled reactor (ABR)-septic tank (R1), a Yuhuan drawing three-dimensional-carrier-septic tank (R2) and a conventional septic tank (R3), were operated in parallel over half a year under hydraulic retention times (HRTs) of 36, 24 and 12 h, with a sewage temperature of 16 degrees C. The removal efficiencies of total chemical oxygen demand (CODtot) achieved in R1 and R2 increased by 14%, 21% and 12% and 18%, 3% and 16%, respectively, under three different HRTs, as compared to those in R3. The total nitrogen and phosphorus removal efficiencies were negligible. R1 sludges had a higher specific methane production rate as compared to that of R2 and R3 sludges. The results indicated that the two modified septic tanks can improve the performance in terms of COD and total solids removal, both were suitable technologies for domestic sewage (pre) treatment at low temperature in northern China.

Application of Genotyping during an Extensive Outbreak of Waterborne Giardiasis in Bergen, Norway, during Autumn and Winter 2004†

PubMed Central

Robertson, L. J.; Hermansen, L.; Gjerde, B. K.; Strand, E.; Alvsvåg, J. O.; Langeland, N.

2006-01-01

During the autumn and winter of 2004 and 2005, an extensive outbreak of waterborne giardiasis occurred in Bergen, Norway. Over 1,500 patients were diagnosed with giardiasis. Analysis of water from the implicated source revealed low numbers of Giardia cysts, but the initial contamination event probably occurred up to 10 weeks previously. While sewage leakage from a residential area is now considered to be the probable source of contamination, during the episode waste from one particular septic tank was thought to be a possible source. Genotyping of cysts from the septic tank demonstrated that they were assemblage A cysts, although the sequences were not identical to any previously published sequences. For the β-giardin gene, the closest published subgenotype was subgenotype A3; for the gdh gene, the closest published subgenotype was subgenotype A2. Genotyping of cysts from 21 patient samples revealed that they were assemblage B cysts; thus, the septic tank was unlikely to be the contamination source. Sequencing of the β-giardin and gdh genes from patient samples and a comparison of the sequences gave complex results. For the β-giardin gene, three isolates had sequences identical to subgenotype B3 sequences. However, other isolates had between one and four single-nucleotide polymorphisms (SNPs). For the gdh gene, none of the sequences were identical to the sequence published for subgenotype B3, and the sequences had between one and three SNPs. One isolate, which was identical to subgenotype B3 at the β-giardin gene, was more similar to subgenotype B2 at the gdh gene. Grouping the isolates on the basis of SNPs resulted in different groups for the two genes. The results are discussed in relation to giardiasis in Norway and to other Giardia genotyping studies. PMID:16517674

Endotoxins and other sepsis triggers.

PubMed

Opal, Steven M

2010-01-01

Endotoxin, or more accurately termed bacterial lipopolysaccharide (LPS), is recognized as the most potent microbial mediator implicated in the pathogenesis of sepsis and septic shock. Yet despite its discovery well over a century ago, the fundamental role of circulating endotoxin in the blood of most patients with septic shock remains enigmatic and a subject of considerable controversy. LPS is the most prominent 'alarm molecule' sensed by the host's early warning system of innate immunity presaging the threat of invasion of the internal milieu by Gram-negative bacterial pathogens. In small doses within a localized tissue space, LPS signaling is advantageous to the host in orchestrating an appropriate antimicrobial defense and bacterial clearance mechanisms. Conversely, the sudden release of large quantities of LPS into the bloodstream is clearly deleterious to the host, initiating the release of a dysregulated and potentially lethal array of inflammatory mediators and procoagulant factors in the systemic circulation. The massive host response to this single bacterial pattern recognition molecule is sufficient to generate diffuse endothelial injury, tissue hypoperfusion, disseminated intravascular coagulation and refractory shock. Numerous attempts to block endotoxin activity in clinical trials with septic patients have met with inconsistent and largely negative results. Yet the groundbreaking discoveries within the past decade into the precise molecular basis for LPS-mediated cellular activation and tissue injury has rekindled optimism that a new generation of therapies that specifically disrupt LPS signaling might succeed. Other microbial mediators found in Gram-positive bacterial and viral and fungal pathogens are now appreciated to activate many of the same host defense networks induced by LPS. This information is providing novel interventions in the continuing effots to improve the care of septic patients. Copyright 2010 S. Karger AG, Basel.

The thromboelastometric discrepancy between septic and trauma induced disseminated intravascular coagulation diagnosed by the scoring system from the Japanese association for acute medicine.

PubMed

Koami, Hiroyuki; Sakamoto, Yuichiro; Sakurai, Ryota; Ohta, Miho; Imahase, Hisashi; Yahata, Mayuko; Umeka, Mitsuru; Miike, Toru; Nagashima, Futoshi; Iwamura, Takashi; Yamada, Kosuke Chris; Inoue, Satoshi

2016-08-01

The aim of this study is to evaluate the hematological differences between septic and traumatic disseminated intravascular coagulation (DIC) using the rotational thromboelastometry (ROTEM).This retrospective study includes all sepsis or severe trauma patients transported to our emergency department who underwent ROTEM from 2013 to 2014. All patients were divided into 2 groups based on the presence of DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC score. We statistically analyzed the demographics, clinical characteristics, laboratory data, ROTEM findings (EXTEM and FIBTEM), and outcome.Fifty-seven patients (30 sepsis and 27 severe trauma) were included in primary analysis. Sepsis cases were significantly older and had higher systemic inflammatory response syndrome (SIRS) scores, whereas there were no significant differences in other parameters including Acute Physiology and Chronic Health Evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score. Twenty-six patients (14 sepsis and 12 severe trauma) were diagnosed with DIC. The Septic DIC (S-DIC) group was significantly older and had higher DIC scores than the traumatic DIC (T-DIC) group. Hematologic examination revealed significantly higher CRP, fibrinogen, lower FDP, DD, and higher FDP/DD ratio were found in the S-DIC group in comparison with the T-DIC group. ROTEM findings showed that the A10, A20, and MCF in the FIBTEM test were significantly higher in the S-DIC group. However, no statistical differences were confirmed in the LI30, LI45, and ML in EXTEM test.The plasma fibrinogen level and fibrinogen based clot firmness in whole-blood test revealed statistical significance between septic and traumatic DIC patients.

A non-synonymous SNP in the NOS2 associated with septic shock in patients with sepsis in Chinese populations.

PubMed

Wang, Zhifu; Feng, Kai; Yue, Maoxing; Lu, Xiaoguang; Zheng, Qihan; Zhang, Hongxing; Zhai, Yun; Li, Peiyao; Yu, Lixia; Cai, Mi; Zhang, Xiumei; Kang, Xin; Shi, Weihai; Xia, Xia; Chen, Xi; Cao, Pengbo; Li, Yuanfeng; Chen, Huipeng; Ling, Yan; Li, Yuxia; He, Fuchu; Zhou, Gangqiao

2013-03-01

Sepsis represents a systemic inflammatory response to infection and its sequelae include severe sepsis, septic shock, multiple organ dysfunction syndrome (MODS) and death. Studies in mice and humans indicate that the inducible nitric oxide synthase (iNOS, NOS2) plays an important role in the development of sepsis and its sequelae. It was reported that several single nucleotide polymorphisms (SNPs) within NOS2 could influence the production or activity of NOS2. In this study, we assessed whether SNPs within NOS2 gene were associated with severity of sepsis in Chinese populations. A case-control study was conducted, which included 299 and 280 unrelated patients with sepsis recruited from Liaoning and Jiangsu provinces in China, respectively. Six SNPs within NOS2 were genotyped using Sequenom MassARRAY system. The associations between the SNPs and risk of sepsis complications were estimated by a binary logistic regression model adjusted for confounding factors. Functional assay was performed to assess the biological significance. The GA + AA genotype of a non-synonymous SNP in the exon 16 of NOS2 (rs2297518: G>A) was significantly associated with increased susceptibility to septic shock compared with GG genotype in Liaoning population (OR = 3.29, 95% CI = 1.40-7.72, P = 0.0047). This association was confirmed in the Jiangsu population (OR = 3.49, 95% CI = 1.57-7.79, P = 0.0019). Furthermore, the functional assay performed in the immortalized lymphocyte cell lines indicated that the at-risk GA genotype had a tendency of higher NOS2 activity than the GG genotype (P = 0.32). Our findings suggest that the NOS2 rs2297518 may play a role in mediating the susceptibility to septic shock in patients with sepsis in Chinese populations.

Serum Concentrations of Interleukin-6, Procalcitonin, and C-Reactive Protein: Discrimination of Septical Complications and Systemic Inflammatory Response Syndrome after Pediatric Surgery.

PubMed

Neunhoeffer, Felix; Plinke, Swantje; Renk, Hanna; Hofbeck, Michael; Fuchs, Jörg; Kumpf, Matthias; Zundel, Sabine; Seitz, Guido

2016-04-01

Early differentiation between sepsis and systemic inflammatory response syndrome (SIRS) is useful for therapeutic management in neonates and infants after surgery. To compare the early (first 2 days) diagnostic value of interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) after surgery in the differentiation of subsequent SIRS and septic complications. IL-6, PCT, and CRP were measured 0, 24, and 48 hours after surgery in neonates and infants with clinical suspicion of postoperative sepsis. Sensitivity, specificity, and predictive values for SIRS/septic complications were calculated. A total of 31 out of 205 neonates and infants showed clinical signs for postoperative sepsis and underwent sepsis work-up. Nine patients developed septic complications, sixteen patients met criteria for SIRS, and six patients showed an uneventful postoperative course during the first five postoperative days. IL-6, PCT, and CRP levels increased in all subgroups after surgery and were significantly higher in the sepsis group (p < 0.05). IL-6 peaked immediately, CRP at 24 to 48 hours, and PCT at 24 hours after surgery. Sensitivity and specificity (area under the curve) for IL-6 (cutoff 673 ng/dL) were 94.4 and 75% (86.2%), for CRP (cutoff 1.48 mg/dL) 76.2 and 75.0% (88.1%), and for PCT (cutoff 16.1 mg/L) 66.7 and 57.1% (65.6%). IL-6 appears to be an early marker for severe bacterial infections with high sensitivity. IL-6 and CRP were the most reliable markers for the discrimination between SIRS and sepsis within the postoperative period. Georg Thieme Verlag KG Stuttgart · New York.

Monitoring plant tissue nitrogen isotopes to assess nearshore inputs of nitrogen to Lake Crescent, Olympic National Park, Washington

USGS Publications Warehouse

Cox, Stephen E.; Moran, Patrick W.; Huffman, Raegan L.; Fradkin, Steven C.

2016-05-31

Mats of filamentous-periphytic algae present in some nearshore areas of Lake Crescent, Olympic National Park, Washington, may indicate early stages of eutrophication from nutrient enrichment of an otherwise highly oligotrophic lake. Natural abundance ratios of stable isotopes of nitrogen (δ15N) measured in plant tissue growing in nearshore areas of the lake indicate that the major source of nitrogen used by these primary producing plants is derived mainly from atmospherically fixed nitrogen in an undeveloped forested ecosystem. Exceptions to this pattern occurred in the Barnes Point area where elevated δ15N ratios indicate that effluent from septic systems also contribute nitrogen to filamentous-periphytic algae growing in the littoral zone of that area. Near the Lyre River outlet of Lake Crescent, the δ15N of filamentous-periphytic algae growing in close proximity to the spawning areas of a unique species of trout show little evidence of elevated δ15N indicating that nitrogen from on-site septic systems is not a substantial source of nitrogen for these plants. The δ15N data corroborate estimates that nitrogen input to Lake Crescent from septic sources is comparatively small relative to input from motor vehicle exhaust and vegetative sources in undeveloped forests, including litterfall, pollen, and symbiotic nitrogen fixation. The seasonal timing of blooms of filamentous-periphytic algal near the lake shoreline is also consistent with nitrogen exported from stands of red alder trees (Alnus rubra). Isotope biomonitoring of filamentous-periphytic algae may be an effective approach to monitoring the littoral zone for nutrient input to Lake Crescent from septic sources.

Preliminary evaluation of septic-system absorption-field architecture types in a profile-limited soil.

PubMed

Mathis, Amanda J; Brye, Kristofor R; Dunn, Sam

2011-01-01

Managing household wastewater is an issue that affects hundreds of thousands of people in rural communities nationwide, many of whom rely on septic systems as their primary means of household wastewater disposal. Septic system absorption field products with architectures quite different from traditional pipe-and-gravel systems are being installed in many states with variances from initial design specifications. The objective of this study was to evaluate the performance, as measured by the in-product height of stored solution, of four differing absorption-field product architecture types in a profile-limited soil that was loaded at the maximum allowable rate based on soil morphology. Five chamber, two gravel-less pipe, two polystyrene aggregate, and four pipe-and-gravel systems were installed in a profile-limited, Captina silt loam soil (fine-silty, siliceous, active, mesic Typic Fragiudult) and dosed with raw effluent at rates determined by current State of Arkansas regulations via individual peristaltic pumps. Free-solution monitoring ports were installed within each product, where the depth to free solution was measured periodically and used to evaluate product performance. Data collected from January through August 2009 indicated that preliminary system performance was unaffected by product architecture type. All products performed similarly under dry soil conditions. However, differences among individual products were observed during periods of hydrologic stress (i.e., wet soil conditions). Surfacing of effluent was not observed atop any product, indicating that the current loading rate design method is functioning properly. Preliminary results indicate that some alternative absorption-field products perform similarly to the traditional pipe-and-gravel system, thus providing flexibility and options for homeowners. by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy.

PubMed

Frask, Agata; Orłowski, Michał; Dowgiałło-Wnukiewicz, Natalia; Lech, Paweł; Gajewski, Krzysztof; Michalik, Maciej

2017-06-01

Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. To develop and implement certain standards for early detection of complications. The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1 st and 2 nd postoperative day (POD). Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2 nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1 st and 2 nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2 nd POD compared to the remainder. The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG.

Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy

PubMed Central

Frask, Agata; Orłowski, Michał; Lech, Paweł; Gajewski, Krzysztof; Michalik, Maciej

2017-01-01

Introduction Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. Aim To develop and implement certain standards for early detection of complications. Material and methods The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1st and 2nd postoperative day (POD). Results Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1st and 2nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2nd POD compared to the remainder. Conclusions The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG. PMID:28694902

SEPTIC TANK SETBACK DISTANCES: A WAY TO MINIMIZE VIRUS CONTAMINATION OF DRINKING WATER

EPA Science Inventory

Septic tanks are the most frequently reported causes of contamination in ground-water disease outbreaks associated with the consumption of untreated ground water in the United States. The placement of septic tanks is generally controlled by county-wide or state-wide regulations, ...

Predictive value of the complement system for sepsis-induced disseminated intravascular coagulation in septic patients in emergency department.

PubMed

Zhao, Xin; Chen, Yun-Xia; Li, Chun-Sheng

2015-04-01

To investigate changes in circulating complement component C3, membrane attack complex (MAC), and mannose-binding lectin (MBL) in patients with sepsis-induced disseminated intravascular coagulation (DIC). Adult septic patients admitted to the emergency department (ED) of Beijing Chao-Yang Hospital were enrolled. A DIC score of 5 or higher was considered sepsis-induced DIC. Circulating C3, MAC, and MBL levels were detected on ED arrival and compared between patients with and without DIC. The predictive value of C3, MAC, and MBL for sepsis-induced DIC at ED arrival and development of DIC after admission were assessed by receiver operating characteristic curve and logistic regression. We enrolled 267 septic patients between February and December 2013. Complement 3, MAC, and MBL were higher in the DIC group (P < .01). Membrane attack complex was the independent predictor of sepsis-induced DIC. The area under the curve of MAC in predicting sepsis-induced DIC was 0.793. During hospitalization, 25 patients without DIC at enrollment developed DIC. Membrane attack complex and Sequential Organ Failure Assessment independently predicted progress to DIC. The area under the curve of MAC was 0.741. Complement 3, MAC, and MBL were significantly increased in septic patients with DIC. Membrane attack complex independently predicted sepsis-induced DIC and development of DIC after ED admission. Copyright © 2014 Elsevier Inc. All rights reserved.

Rethinking the concept of sepsis and septic shock.

PubMed

A Cabrita, Joana; Pinheiro, Isabel; Menezes Falcão, L

2018-06-16

Sepsis is a major global health problem and represents a challenge for physicians all over the world. The knowledge of sepsis and septic shock is a topic of interest among the scientific community and society in general. New guidelines for management of sepsis and septic shock were developed in 2016, providing an update on this area. In Sepsis-3 new definitions for sepsis and septic shock were published. The purpose of this narrative review is to discuss and compare the new criteria of 2016 with the old criteria, purposing at the same time an alternative approach for this topic. SOFA criteria (Sequential Organ Failure Assessment Score) are more complete, but too extensive and usually difficult to apply outside the intensive care units, therefore inducing potentially delay in the proper treatment. We purpose combined criteria for the selection of sepsis patients. Initially, we could apply qSOFA (quick Sepsis Related Organ Failure Assessment) criteria, due to its easy application, associated with the SIRS (systemic inflammatory response syndrome) criteria, allowing to select the patients who are infected and need faster treatment. In that way we would use the best of old and newest criteria, allowing the early selection of patients who are infected and require faster treatment, while the search for a better and faster tool continues. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Prognostic significance of brain natriuretic peptide obtained in the ED in patients with SIRS or sepsis.

PubMed

Chen, Yunxia; Li, Chunsheng

2009-07-01

The study was conducted to know the significance of brain natriuretic peptide (BNP) for prognosis of septic patients. The subjects were 1000 patients selected in emergency department of Beijing Chaoyang Hospital of the Capital Medical University (Beijing, China) and were classified into 3 groups as follows: systemic inflammatory response syndrome (SIRS), non-SIRS, and sepsis groups. Plasma serum brain natriuretic peptide (BNP) levels and the positive detection rates of BNP were examined. The BNP level of 100 pg/mL or more was regarded as positive, and then the positive detection rates of BNP of these groups were compared. The prognostic values of BNP and APACHE (Acute physiology and chronic health evaluation) II score for the 28-day mortality were investigated, and their cutoff values for death were determined. There were significant differences in the positive detection rates of BNP between any 2 groups and in 28-day mortality between the patients with SIRS and non-SIRS groups. The BNP level had positive correlation to APACHE II score in 3 groups. Brain natriuretic peptide level of more than 113 pg/mL was independent predictor of death in septic patients. The positive rates of BNP in SIRS and septic patients were significantly higher than that of non-SIRS patients, and this is an index for unfavorable prognosis in septic patients.

A single-blinded randomised clinical trial of permissive underfeeding in patients requiring parenteral nutrition.

PubMed

Owais, Anwar Elias; Kabir, Syed Irfan; Mcnaught, Clare; Gatt, Marcel; MacFie, John

2014-12-01

The importance of adequate nutritional support is well established, but characterising what 'adequate nutrition' represents remains contentious. In recent years there has been increasing interest in the concept of 'permissive underfeeding' where patients are intentionally prescribed less nutrition than their calculated requirements. The aim of this study was to evaluate the effect of permissive underfeeding on septic and nutrition related morbidity in patients requiring short term parenteral nutrition (PN). This was a single-blinded randomised clinical trial of 50 consecutive patients requiring parenteral nutritional support. Patients were randomized to receive either normocaloric or hypocaloric feeding (respectively 100% vs. 60% of estimated requirements). The primary end point was septic complications. Secondary end points included the metabolic, physiological and clinical outcomes to the two feeding protocols. Permissive underfeeding was associated with fewer septic complications (3 vs. 12 patients; p = 0.003), and a lower incidence of the systemic inflammatory response syndrome (9 vs. 16 patients; p = 0.017). Permissively underfed patients had fewer feed related complications (2 vs. 9 patients; p = 0.016). Permissive underfeeding in patients requiring short term PN appears to be safe and may results in reduced septic and feed-related complications. NCT01154179 TRIAL REGISTRY: http://clinicaltrials.gov/ct2/show/NCT01154179. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Septic arthritis of the shoulder in a dental patient: a case report and review.

PubMed

Dolin, Elana; Perlmutter, Leigh D; Segelnick, Stuart L; Weinberg, Mea A; Schoor, Robert

2014-04-01

Septic arthritis of the glenohumoral joint is rare following dental procedures, comprising approximately 3% of all joint infections. Septic arthritis following bacteremia from dental procedures is uncommon and generally occurs in prosthetic joints. Predisposing causes may include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. We report a rare case of unilateral glenohumoral joint septic arthritis in a 60-year-old male patient (without a prosthetic joint) secondary to a dental procedure. The insidious nature of the presentation is highlighted. Septic arthritis infections, though rare, require a high level of clinical suspicion. Vague symptoms of shoulder pain may mask the initial diagnosis, as was the case in our patient. Incision and drainage via surgical intervention are often required, followed by parenteral antibiotics.

Genome-Level Longitudinal Expression of Signaling Pathways and Gene Networks in Pediatric Septic Shock

PubMed Central

Shanley, Thomas P; Cvijanovich, Natalie; Lin, Richard; Allen, Geoffrey L; Thomas, Neal J; Doctor, Allan; Kalyanaraman, Meena; Tofil, Nancy M; Penfil, Scott; Monaco, Marie; Odoms, Kelli; Barnes, Michael; Sakthivel, Bhuvaneswari; Aronow, Bruce J; Wong, Hector R

2007-01-01

We have conducted longitudinal studies focused on the expression profiles of signaling pathways and gene networks in children with septic shock. Genome-level expression profiles were generated from whole blood-derived RNA of children with septic shock (n = 30) corresponding to day one and day three of septic shock, respectively. Based on sequential statistical and expression filters, day one and day three of septic shock were characterized by differential regulation of 2,142 and 2,504 gene probes, respectively, relative to controls (n = 15). Venn analysis demonstrated 239 unique genes in the day one dataset, 598 unique genes in the day three dataset, and 1,906 genes common to both datasets. Functional analyses demonstrated time-dependent, differential regulation of genes involved in multiple signaling pathways and gene networks primarily related to immunity and inflammation. Notably, multiple and distinct gene networks involving T cell- and MHC antigen-related biology were persistently downregulated on both day one and day three. Further analyses demonstrated large scale, persistent downregulation of genes corresponding to functional annotations related to zinc homeostasis. These data represent the largest reported cohort of patients with septic shock subjected to longitudinal genome-level expression profiling. The data further advance our genome-level understanding of pediatric septic shock and support novel hypotheses. PMID:17932561

Diagnostic value of Pentraxin-3 in patients with sepsis and septic shock in accordance with latest sepsis-3 definitions.

PubMed

Hamed, Sonja; Behnes, Michael; Pauly, Dominic; Lepiorz, Dominic; Barre, Max; Becher, Tobias; Lang, Siegfried; Akin, Ibrahim; Borggrefe, Martin; Bertsch, Thomas; Hoffmann, Ursula

2017-08-09

Pentraxin-3 (PTX-3) is an acute-phase protein involved in inflammatory and infectious processes. This study assesses its diagnostic and prognostic value in patients with sepsis or septic shock in a medical intensive care unit (ICU). The study includes 213 ICU patients with clinical criteria of sepsis and septic shock. 77 donors served as controls. Plasma levels of PTX-3, procalcitonin (PCT) and interleukin-6 were measured on day 1, 3 and 8. PTX-3 correlated with higher lactate levels as well as with APACHE II and SOFA scores (p = 0.0001). PTX-3 levels of patients with sepsis or septic shock were consistently significantly higher than in the control group (p ≤ 0.001). Plasma levels were able to discriminate sepsis and septic shock significantly on day 1, 3 and 8 (range of AUC 0.73-0.92, p = 0.0001). Uniform cut-off levels were defined at ≥5 ng/ml for at least sepsis, ≥9 ng/ml for septic shock (p = 0.0001). PTX-3 reveals diagnostic value for sepsis and septic shock during the first week of intensive care treatment, comparable to interleukin-6 according to latest Sepsis-3 definitions. NCT01535534 . Registered 14.02.2012.

Effectiveness of anisodamine for the treatment of critically ill patients with septic shock (ACIdoSIS study): study protocol for randomized controlled trial

PubMed Central

Zhou, Jiancang; Shang, You; Wang, Xin’an; Yin, Rui; Zhu, Zhenhua; Chen, Wensen; Tian, Xin; Yu, Yuetian; Zuo, Xiangrong; Chen, Kun; Ji, Xuqing; Ni, Hongying

2015-01-01

Background Septic shock is an important contributor of mortality in the intensive care unit (ICU). Although strenuous effort has been made to improve its outcome, the mortality rate is only marginally decreased. The present study aimed to investigate the effectiveness of anisodamine in the treatment of septic shock, in the hope that the drug will provide alternatives to the treatment of septic shock. Methods The study is a multi-center randomized controlled clinical trial. Study population will include critically ill patients with septic shock requiring vasopressor use. Blocked randomization was performed where anisodamine and control treatments were allocated at random in a ratio of 1:1 in blocks of sizes 2, 4, 6, 8, and 10 to 354 subjects. Interim analysis will be performed. The primary study end point is the hospital mortality, and other secondary study endpoints include ICU mortality, length of stay in ICU and hospital, organ failure free days. Adverse events including new onset psychosis, urinary retention, significant hypotension and tachycardia will be reported. Discussion The study will provide new insight into the treatment of septic shock and can help to reduce mortality rate of septic shock. Trial registration NCT02442440 (https://register.clinicaltrials.gov/). PMID:26605292

Inhibition of IKKß in enterocytes exacerbates sepsis-induced intestinal injury and worsens mortality

PubMed Central

Dominguez, Jessica A.; Samocha, Alexandr J.; Liang, Zhe; Burd, Eileen M.; Farris, Alton B.; Coopersmith, Craig M.

2013-01-01

Objective NF-kB is a critical regulator of cell survival genes and the host inflammatory response. The purpose of this study was to investigate the role of enterocyte-specific NF-kB in sepsis through selective ablation of IkB kinase (IKK)-ß. Design Prospective, randomized, controlled study. Setting Animal laboratories in university medical centers. Subjects and Interventions Mice lacking functional NF-kB in their intestinal epithelium (Vil-Cre/Ikkßf/Δ) and wild type (WT) mice were subjected to sham laparotomy or cecal ligation and puncture (CLP). Animals were sacrified at 24 hours or followed seven days for survival. Measurements and Main Results Septic WT mice had decreased villus length compared to sham mice while villus atrophy was further exacerbated in septic Vil-Cre/Ikkßf/Δ mice. Sepsis induced an increase in intestinal epithelial apoptosis compared to sham mice which was further exacerbated in Vil-Cre/Ikkßf/Δ mice. Sepsis induced intestinal hyperpermeability in WT mice compared to sham mice, which was further exacerbated in septic Vil-Cre/Ikkßf/Δ mice. This was associated with increased intestinal expression of claudin-2 in septic WT mice, which was further increased in septic Vil-Cre/Ikkßf/Δ mice. Both, pro-inflammatory and anti-inflammatory cytokines were increased in serum following CLP, and IL-10 and MCP-1 levels were higher in septic Vil-Cre/Ikkßf/Δ mice than septic WT mice. All septic mice were bacteremic, but no differences in bacterial load were identified between WT and Vil-Cre/Ikkßf/Δ mice. To determine the functional significance of these results, animals were followed for survival. Septic WT mice had lower mortality than septic Vil-Cre/Ikkßf/Δ mice (47% vs. 80%, p<0.05). Anti-TNF administration decreased intestinal apoptosis, permeability and mortality in WT septic mice and a similar improvement in intestinal integrity and survival were seen when anti-TNF was given to Vil-Cre/Ikkßf/Δ mice. Conclusions Enterocyte-specific NF-kB has a beneficial role in sepsis by partially preventing sepsis-induced increases in apoptosis and permeability, which are associated with worsening mortality. PMID:23939348

Predictive Factors for Differentiating Between Septic Arthritis and Lyme Disease of the Knee in Children.

PubMed

Baldwin, Keith D; Brusalis, Christopher M; Nduaguba, Afamefuna M; Sankar, Wudbhav N

2016-05-04

Differentiating between septic arthritis and Lyme disease of the knee in endemic areas can be challenging and has major implications for patient management. The purpose of this study was to identify a prediction rule to differentiate septic arthritis from Lyme disease in children presenting with knee pain and effusion. We retrospectively reviewed the records of patients younger than 18 years of age with knee effusions who underwent arthrocentesis at our institution from 2005 to 2013. Patients with either septic arthritis (positive joint fluid culture or synovial white blood-cell count of >60,000 white blood cells/mm(3) with negative Lyme titer) or Lyme disease (positive Lyme immunoglobulin G on Western blot analysis) were included. To avoid misclassification bias, undiagnosed knee effusions and joints with both a positive culture and positive Lyme titers were excluded. Historical, clinical, and laboratory data were compared between groups to identify variables for comparison. Binary logistic regression analysis was used to identify independent predictive variables. One hundred and eighty-nine patients were studied: 23 with culture-positive septic arthritis, 26 with culture-negative septic arthritis, and 140 with Lyme disease. Multivariate binary logistic regression identified pain with short arc motion, history of fever reported by the patient or a family member, C-reactive protein of >4 mg/L, and age younger than 2 years as independent predictive factors for septic arthritis. A simpler model was developed that showed that the risk of septic arthritis with none of these factors was 2%, with 1 of these factors was 18%, with 2 of these factors was 45%, with 3 of these factors was 84%, or with all 4 of these factors was 100%. Although septic arthritis of the knee and Lyme monoarthritis share common features that can make them difficult to distinguish clinically, the presence of pain with short arc motion, C-reactive protein of >4.0 mg/L, patient-reported history of fever, and age younger than 2 years were independent predictive factors of septic arthritis in pediatric patients. The more factors that are present, the higher the risk of having septic arthritis. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Nutrient concentrations in surface water and groundwater, and nitrate source identification using stable isotope analysis, in the Barnegat Bay-Little Egg Harbor watershed, New Jersey, 2010–11

USGS Publications Warehouse

Wieben, Christine M.; Baker, Ronald J.; Nicholson, Robert S.

2013-01-01

Five streams in the Barnegat Bay-Little Egg Harbor (BB-LEH) watershed in southern New Jersey were sampled for nutrient concentrations and stable isotope composition under base-flow and stormflow conditions, and during the growing and nongrowing seasons, to help quantify and identify sources of nutrient loading. Samples were analyzed for concentrations of total nitrogen, ammonia, nitrate plus nitrite, organic nitrogen, total phosphorus, and orthophosphate, and for nitrogen and oxygen stable isotope ratios. Concentrations of total nitrogen in the five streams appear to be related to land use, such that streams in subbasins characterized by extensive urban development (and historical agricultural land use)—North Branch Metedeconk and Toms Rivers—exhibited the highest total nitrogen concentrations (0.84–1.36 milligrams per liter (mg/L) in base flow). Base-flow total nitrogen concentrations in these two streams were dominated by nitrate; nitrate concentrations decreased during storm events as a result of dilution by storm runoff. The two streams in subbasins with the least development—Cedar Creek and Westecunk Creek—exhibited the lowest total nitrogen concentrations (0.16–0.26 mg/L in base flow), with organic nitrogen as the dominant species in both base flow and stormflow. A large proportion of these subbasins lies within forested parts of the Pinelands Area, indicating the likelihood of natural inputs of organic nitrogen to the streams that increase during periods of storm runoff. Base-flow total nitrogen concentrations in Mill Creek, in a moderately developed basin, were 0.43 to 0.62 mg/L and were dominated by ammonia, likely associated with leachate from a landfill located upstream. Total phosphorus and orthophosphate were not found at detectable concentrations in most of the surface-water samples, with the exception of samples collected from the North Branch Metedeconk River, where concentrations ranged from 0.02 to 0.09 mg/L for total phosphorus and 0.008 to 0.011 mg/L for orthophosphate. Measurements of nitrogen and oxygen stable isotope ratios of nitrate in surface-water samples revealed that a mixture of multiple subsurface sources, which may include some combination of animal and septic waste, soil nitrogen, and commercial fertilizers, likely contribute to the base-flow nitrogen load. The results also indicate that atmospheric deposition is not a predominant source of nitrogen transported to the BB-LEH estuary from the watershed, although the contribution of nitrate from the atmosphere increases during stormflow. Atmospheric deposition of nitrate has a greater influence in the less developed subbasins within the BB-LEH watershed, likely because few other major sources of nitrogen (animal and septic waste, fertilizers) are present in the less developed subbasins. Atmospheric sources appear to contribute proportionally less of the overall nitrate as development increases within the BB-LEH watershed. Groundwater samples collected from five wells located within the BB-LEH watershed and screened in the unconfined Kirkwood-Cohansey aquifer system were analyzed for nutrient and stable isotope composition. Concentrations of nitrate ranged from not detected to 3.63 mg/L, with the higher concentrations occurring in the highly developed northern portion of the watershed, indicating the likelihood of anthropogenic sources of nitrogen. Isotope data for the two wells with the highest nitrate concentrations are more consistent with fertilizer sources than with animal or septic waste. Total phosphorus was not detected in any of the wells sampled, and orthophosphate was either not detected or measured at very low concentrations (0.005–0.009 mg/L) in each of the wells sampled.

PROCESS DESIGN MANUAL: SURFACE DISPOSAL OF SEWAGE SLUDGE AND DOMESTIC SEPTAGE

EPA Science Inventory

Human domestic activities generate wastewater that is piped into municipal sewer systems, underground septic tanks, or portable sanitation devices. Wastewater in municipal systems is treated before being discharged into the environment, as required under the Clean Water Act. This...

Pre-existing malignancy results in increased prevalence of distinct populations of CD4+ T cells during sepsis.

PubMed

Xie, Jianfeng; Robertson, Jennifer M; Chen, Ching-Wen; Zhang, Wenxiao; Coopersmith, Craig M; Ford, Mandy L

2018-01-01

The presence of pre-existing malignancy in murine hosts results in increased immune dysregulation and risk of mortality following a septic insult. Based on the known systemic immunologic changes that occur in cancer hosts, we hypothesized that the presence of pre-existing malignancy would result in phenotypic and functional changes in CD4+ T cell responses following sepsis. In order to conduct a non-biased, unsupervised analysis of phenotypic differences between CD4+ T cell compartments, cohorts of mice were injected with LLC1 tumor cells and tumors were allowed to grow for 3 weeks. These cancer hosts and age-matched non-cancer controls were then subjected to CLP. Splenocytes were harvested at 24h post CLP and flow cytometry and SPADE (Spanning-tree Progression Analysis of Density-normalized Events) were used to analyze populations of CD4+ cells most different between the two groups. Results indicated that relative to non-cancer controls, cancer mice contained more resting memory CD4+ T cells, more activated CD4+ effectors, and fewer naïve CD4+ T cells during sepsis, suggesting that the CD4+ T cell compartment in cancer septic hosts is one of increased activation and differentiation. Moreover, cancer septic animals exhibited expansion of two distinct subsets of CD4+ T cells relative to previously healthy septic controls. Specifically, we identified increases in both a PD-1hi population and a distinct 2B4hi BTLAhi LAG-3hi population in cancer septic animals. By combining phenotypic analysis of exhaustion markers with functional analysis of cytokine production, we found that PD-1+ CD4+ cells in cancer hosts failed to make any cytokines following CLP, while the 2B4+ PD-1lo cells in cancer mice secreted increased TNF during sepsis. In sum, the immunophenotypic landscape of cancer septic animals is characterized by both increased CD4+ T cell activation and exhaustion, findings that may underlie the observed increased mortality in mice with pre-existing malignancy following sepsis.

Dispatch and prehospital transport for acute septic patients: an observational study.

PubMed

Pedersen, Peter Bank; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren; Lassen, Annmarie Touborg

2017-05-12

In order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources. As urgency is not clear in all clinical situations, some high urgency patients may end up with a suboptimal mode of transport. Patients with severe sepsis or septic shock suffer from highly time dependent conditions but they present with a wide range of symptoms, which might be difficult to identify in the dispatch system. The aim of the study is to investigate the modes of prehospital transport among acute admitted patients with sepsis, severe sepsis and septic shock. We included all adult patients (≥15 years) presenting to an acute medical unit at Odense University Hospital with a first-time admission of community-acquired sepsis between September 2010-August 2011. Cases and prehospital ambulance transport were identified by structured manual chart review. In all cases it was registered, whether the ordinary ambulance was assisted by the mobile emergency care unit (MECU), manned by anesthesiologists. We included 1,713 patients median age 72 years (IQR 57-81), 793 (46.3%) male, 621 (36.3%) had sepsis, 1,071 (62.5%) severe sepsis, and 21 (1.2%) septic shock. In the group of sepsis patients, 390 (62.8%) arrived without public prehospital transport, 197 (31.7%) were transported by ambulance, and 34 (5.5%) were assisted by MECU. In the group of severe sepsis patients, the same percentage 62.8% arrived without public pre-hospital transport, a lower percentage 28.2% were transported by ambulance, and a larger percentage 9.0% were transported by MECU. Among 21 patients with septic shock, 10 arrived without public pre-hospital transport (47.7%), 7 (33.3%) were transported by ambulance, and 4 (19.0%) by MECU. The 30-day mortality hazard ratio was associated with mode of transport, with the adjusted highest hazard ratio found in the group of MECU transported patients 1.76 (95%Cl 1.16-2.66). A substantial proportion of patients with severe sepsis and septic shock arrive to hospital without public prehospital transport or by unspecialized ambulances.

Pre-existing malignancy results in increased prevalence of distinct populations of CD4+ T cells during sepsis

PubMed Central

Xie, Jianfeng; Robertson, Jennifer M.; Chen, Ching-wen; Zhang, Wenxiao

2018-01-01

The presence of pre-existing malignancy in murine hosts results in increased immune dysregulation and risk of mortality following a septic insult. Based on the known systemic immunologic changes that occur in cancer hosts, we hypothesized that the presence of pre-existing malignancy would result in phenotypic and functional changes in CD4+ T cell responses following sepsis. In order to conduct a non-biased, unsupervised analysis of phenotypic differences between CD4+ T cell compartments, cohorts of mice were injected with LLC1 tumor cells and tumors were allowed to grow for 3 weeks. These cancer hosts and age-matched non-cancer controls were then subjected to CLP. Splenocytes were harvested at 24h post CLP and flow cytometry and SPADE (Spanning-tree Progression Analysis of Density-normalized Events) were used to analyze populations of CD4+ cells most different between the two groups. Results indicated that relative to non-cancer controls, cancer mice contained more resting memory CD4+ T cells, more activated CD4+ effectors, and fewer naïve CD4+ T cells during sepsis, suggesting that the CD4+ T cell compartment in cancer septic hosts is one of increased activation and differentiation. Moreover, cancer septic animals exhibited expansion of two distinct subsets of CD4+ T cells relative to previously healthy septic controls. Specifically, we identified increases in both a PD-1hi population and a distinct 2B4hi BTLAhi LAG-3hi population in cancer septic animals. By combining phenotypic analysis of exhaustion markers with functional analysis of cytokine production, we found that PD-1+ CD4+ cells in cancer hosts failed to make any cytokines following CLP, while the 2B4+ PD-1lo cells in cancer mice secreted increased TNF during sepsis. In sum, the immunophenotypic landscape of cancer septic animals is characterized by both increased CD4+ T cell activation and exhaustion, findings that may underlie the observed increased mortality in mice with pre-existing malignancy following sepsis. PMID:29338031

Initial fractal exponent of heart-rate variability is associated with success of early resuscitation in patients with severe sepsis or septic shock: a prospective cohort study

PubMed Central

Brown, Samuel M.; Tate, Quinn; Jones, Jason P.; Knox, Daniel; Kuttler, Kathryn G.; Lanspa, Michael; Rondina, Matthew T.; Grissom, Colin K.; Behera, Subhasis; Mathews, V.J.; Morris, Alan

2013-01-01

Introduction Heart-rate variability reflects autonomic nervous system tone as well as the overall health of the baroreflex system. We hypothesized that loss of complexity in heart-rate variability upon ICU admission would be associated with unsuccessful early resuscitation of sepsis. Methods We prospectively enrolled patients admitted to ICUs with severe sepsis or septic shock from 2009 to 2011. We studied 30 minutes of EKG, sampled at 500 Hz, at ICU admission and calculated heart-rate complexity via detrended fluctuation analysis. Primary outcome was vasopressor independence at 24 hours after ICU admission. Secondary outcome was 28-day mortality. Results We studied 48 patients, of whom 60% were vasopressor independent at 24 hours. Five (10%) died within 28 days. The ratio of fractal alpha parameters was associated with both vasopressor independence and 28-day mortality (p=0.04) after controlling for mean heart rate. In the optimal model, SOFA score and the long-term fractal alpha parameter were associated with vasopressor independence. Conclusions Loss of complexity in heart rate variability is associated with worse outcome early in severe sepsis and septic shock. Further work should evaluate whether complexity of heart rate variability (HRV) could guide treatment in sepsis. PMID:23958243

Scintigraphy for pulmonary capillary protein leak. Final report, 1 October 1981-30 September 1985

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sugerman, H.J.; Tatum, J.L.; Hirsch, J.I.

1986-06-01

Computerized scintigraphy, employing the gamma camera, has been used to study the dynamics of the pulmonary capillary membrane leak of 99m-technetium-tagged human serum albumin (Tc-HSA). In preliminary canine studies, the severity of an oleic acid-induced albumin leak was proportional to the slope of lung: heart radioactivity ratio and was more sensitive than arterial blood gases or standard chest roentgenograms. This rising ratio is called slope of injury slope index. A number of agents were studied in an attempt to prevent oleic acid-induced pulmonary microvascular injury. Following a series of five control dogs, five dogs each were studied with each ofmore » the following agents: methylprednisolone, ibuprofen, the superoxide radical scavenger, MK-44, and, in three dogs, calcium gluconate. None of these agents was able to alter the rise in lung: heart radioactivity ratio following oleic acid injury. A septic pig model was developed for study of bacterially induced ARDS. Septic-induced ARDS and multi-system organ failure are probably secondary to the systemic release of several mediators of inflammation, treatment will probably require a combination of anti-inflammatory agents. This should impact significantly on the mortality and morbidity of septic complications in traumatized combat soldiers.« less

Initial assessment of the ground-water resources in the Monterey Bay region, California

USGS Publications Warehouse

Muir, K.S.

1977-01-01

Because urban growth has placed an increasing demand on the ground-water resources of the Monterey Bay region, Calif., an assessment of the ground-water conditions was made to aid the development of local and regional plans. Ground water provides 80 percent of the water used in the region, which includes six ground-water subbasins. In several of the subbasins, pumpage exceeds safe yield. Existing water-quality degradation results from seawater intrusion, septic-tank effluent, and irrigation-return water. Potential sources of degradation include municipal sewage disposal, leachates from solid-waste disposal sites, and poor-quality connate water. High-priority items for future study include location of recharge areas, detection of seawater intrusion, and well-monitoring of landfill sites. (Woodard-USGS)

Assessment of the application of an ecotoxicological procedure to screen illicit toxic discharges in domestic septic tank sludge.

PubMed

López-Gastey, J; Choucri, A; Robidoux, P Y; Sunahara, G I

2000-06-01

An innovative screening procedure has been developed to detect illicit toxic discharges in domestic septic tank sludge hauled to the Montreal Urban Community waste-water treatment plant. This new means of control is based on an integrative approach, using bioassays and chemical analyses. Conservative criteria are applied to detect abnormal toxicity with great reliability while avoiding false positive results. The complementary data obtained from toxicity tests and chemical analyses support the use of this efficient and easy-to-apply procedure. This study assesses the control procedure in which 231 samples were analyzed over a 30-month period. Data clearly demonstrate the deterrent power of an efficient control procedure combined with a public awareness campaign among the carriers. In the first 15 months of application, between January 1996 and March 1997, approximately 30% of the 123 samples analyzed showed abnormal toxicity. Between April 1997 and June 1998, that is, after a public hearing presentation of this procedure, this proportion dropped significantly to approximately 9% based on 108 analyzed samples. The results of a 30-month application of this new control procedure show the superior efficiency of the ecotoxicological approach compared with the previously used chemical control procedure. To be able to apply it effectively and, if necessary, to apply the appropriate coercive measures, ecotoxicological criteria should be included in regulatory guidelines.

Study on anaerobic treatment of hazardous steel-mill waste rolling oil (SmWRO) for multi-benefit disposal route.

PubMed

Ma, Huanhuan; Li, Zifu; Yin, Fubin; Kao, William; Yin, Yi; Bai, Xiaofeng

2014-01-01

Steel-mill waste rolling oil (SmWRO) is considered as hazardous substance with high treatment and disposal fees. Anaerobic process could not only transform the hazardous substance into activated sludge, but also generate valuable biogas. This study aimed at studying the biochemical methane potential of SmWRO under inoculum to substrate VS ratios (ISRs) of 0.25, 0.5, 1, 1.5, 2 and 3 using septic tank sludge as inoculum in mesophilic and thermophilic conditions, with blank tests for control. Specific biogas yield (mL/g VS(added)), net biogas yield (mL/g VS(removed)) and VS removal were analyzed. The ANOVA results indicated great influence of ISR and temperature on studied parameters. ISR of 1.5 at 55°C and ISR of 1.5 and 2 at 35°C were suggested with the highest specific biogas yield (262-265 and 303mL/g VS(added)). Kinetic analysis showed that Gompertz model fit the experimental data best with the least RMSE and largest R(2). Copyright © 2013 Elsevier Ltd. All rights reserved.

Nitrogen and COD Removal from Septic Tank Wastewater in Subsurface Flow Constructed Wetlands: Plants Effects.

PubMed

Collison, R S; Grismer, M E

2015-11-01

We evaluated subsurface flow (SSF) constructed wetland treatment performance with respect to organics (COD) and nitrogen (ammonium and nitrate) removal from domestic (septic tank) wastewater as affected by the presence of plants, substrate "rock" cation exchange capacity (CEC), laboratory versus field conditions and use of synthetic as compared to actual domestic wastewater. This article considers the effects of plants on constructed wetland treatment in the field. Each constructed wetland system was comprised of two beds (2.6 m long by 0.28 m wide and deep filled with ~18 mm crushed lava rock) separated by an aeration tank connected in series. The lava rock had a porosity of ~47% and a CEC of 4 meq/100 gm. One pair of constructed wetland systems was planted with cattails in May 2008, while an adjacent pair of systems remained un-planted. Collected septic tank or synthesized wastewater was allowed to gravity feed each constructed wetland system and effluent samples were regularly collected and tested for COD and nitrogen species during four time periods spanning November 2008 through June 2009. These effluent concentrations were tested for statistical differences at the 95% level for individual time periods as well as the overall 6-month period. Organics removal from domestic wastewater was 78.8% and 76.1% in the planted and un-planted constructed wetland systems, respectively, while ammonium removal was 94.5% and 90.2%, respectively. Similarly, organics removal from the synthetic wastewater of equivalent strength was 88.8% and 90.1% for planted and un-planted constructed wetland systems, respectively, while ammonium removal was 96.9% and 97.3%, respectively.

Performance of hybrid constructed wetland systems for treating septic tank effluent.

PubMed

Cui, Li-hua; Liu, Wen; Zhu, Xi-zhen; Ma, Mei; Huang, Xi-hua; Xia, Yan-yang

2006-01-01

The integrated wetland systems were constructed by combining horizontal-flow and vertical-flow bed, and their purification efficiencies for septic tank effluent were detected when the hydraulic retention time (HRT) was 1 d, 3 d, 5 d under different seasons. The results showed that the removal efficiencies of the organics, phosphorus were steady in the hybrid systems, but the removal efficiency of total nitrogen was not steady due to high total nitrogen concentration in the septic tank effluent. The average removal rates of COD (chemical oxygen demand) were 89%, 87%, 83%, and 86% in summer, autumn, winter and spring, respectively, and it was up to 88%, 85%, 73%, and 74% for BOD5 (5 d biochemical oxygen demand) removal rate in four seasons. The average removal rates of TP (total phosphorous) could reach up to 97%, 98%, 95%, 98% in four seasons, but the removal rate of TN (total nitrogen) was very low. The results of this study also indicated that the capability of purification was the worst in winter. Cultivating with plants could improve the treated effluent quality from the hybrid systems. The results of the operation of the horizontal-flow and vertical-flow cells (hybrid systems) showed that the removal efficiencies of the organics, TP and TN in horizontal-flow and vertical-flow cells were improved significantly with the extension of HRT under the same season. The removal rate of 3 d HRT was obviously higher than that of 1 d HRT, and the removal rate of 5 d HRT was better than that of 3 d HRT, but the removal efficiency was not very obvious with the increment of HRT. Therefore, 3 d HRT might be recommended in the actual operation of the hybrid systems for economic and technical reasons.

Ground-water movement and nitrate in ground water, East Erda area, Tooele County, Utah, 1997-2000

USGS Publications Warehouse

Susong, D.D.

2005-01-01

Nitrate was discovered in ground water in the east Erda area of Tooele County, Utah, in 1994. The U.S. Geological Survey, in cooperation with Tooele County, investigated the ground-water flow system and water quality in the eastern part of Tooele Valley to determine (1) the vertical and horizontal distribution of nitrate, (2) the direction of movement of the nitrate contamination, and (3) the source of the nitrate. The potentiometric surface of the upper part of the basin-fill aquifer indicates that the general direction of ground-water flow is to the northwest, the flow system is complex, and there is a ground-water mound probably associated with springs. The spatial distribution of nitrate reflects the flow system with the nitrate contamination split into a north and south part by the ground-water mound. The distribution of dissolved solids and sulfate in ground water varies spatially. Vertical profiles of nitrate in water from selected wells indicate that nitrate contamination generally is in the upper part of the saturated zone and in some wells has moved downward. Septic systems, mining and smelting, agriculture, and natural sources were considered to be possible sources of nitrate contamination in the east Erda area. Septic systems are not the source of nitrate because water from wells drilled upgradient of all septic systems in the area had elevated nitrate concentrations. Mining and smelting activity are a possible source of nitrate contamination but few data are available to link nitrate contamination with mining sites. Natural and agricultural sources of nitrate are present east of the Erda area but few data are available about these sources. The source(s) of nitrate in the east Erda area could not be clearly delineated in spite of considerable effort and expenditure of resources.

Programs Related to Septic Systems

EPA Pesticide Factsheets

There are many programs, both at the EPA and elsewhere, that relate to the decentralized wastewater program and provide information about how decentralized wastewater is integrated in environmental quality, planning, protection, and conservation.

Study on Clinical Presentation and Outcome of Septic Abortion and Its Relationship with Person Inducing Abortion.

PubMed

Nahar, S; Akhter, S; Ahamed, F; Akhtar, K; Noor, F

2017-10-01

Abortion is a global problem. Maternal mortality and morbidity is still high due to uncontrolled abortion mainly induced abortion which may turn to septic abortion. A total of 50 cases of septic abortion cases admitted in Dhaka Medical College Hospital were included in this study. This cross sectional study was designed to find out the clinical presentation and outcome of septic abortion from January 2010 to January 2011. Out of 50 cases of septic abortion admitted where 44(88%) were induced abortion. Majority of the cases were parous (2-3 parity 32%; 4-6 parity 38%; and 6+ parity 4%) and housewives 42(84%), living with their husbands 49(98%), hailing from urban, semi urban and urban slums. Nineteen (38%) having no education and 21(42%) had primary education. Most of the women 20(45.45%) wanted no more child, decided to terminate pregnancy not to overburden their families or due to disturbed marital relationship. The termination of pregnancy was carried out in first trimester 20(40%) and between (13-16) weeks it was 17(34%). Complications of septic abortion still remain a lethal threat to the life and health of women. The death rate was found 6(12%). And the leading causes of death were generalized peritonitis with septicaemia 3(50%), septicaemia with renal failure 2(33.30%), septic abortion with Disseminated Intravascular Coagulation 1(16.70%). Effective and widespread contraceptive use and continuing health and sex education remain pivotal if the incidence of septic abortion and their complications are to be reduced.

The limitations of Gram-stain microscopy of synovial fluid in concomitant septic and crystal arthritis.

PubMed

Stirling, Paul; Tahir, Mohammed; Atkinson, Henry Dushan

2017-03-29

Rapid diagnosis of septic arthritis from Gram-stain microscopy is limited by an inherent false-negative rate of 25-78%. The presence of concomitant crystal arthritis in 5% of cases represents a particular diagnostic challenge. This study aims to investigate the effects that a concomitant crystal arthropathy have on the ability of Gram-stain microscopy of synovial fluid to diagnose a septic arthritis. This is a 12-year retrospective cohort study. Inclusion criteria were a positive synovial fluid culture result with a positive clinical diagnosis of septic arthritis. Results were correlated with presence or absence of urate and calcium pyrophosphate crystals, and Gram-stain result. During this time our collection and analysis methods remained unchanged. All samples were collected in Lithium Heparin containers. Chi-squared test with a p value < 0.05 was considered significant. 602 synovial fluid samples were included. 162 cases of concomitant crystal arthritis were identified (27%). Of these, 16 (10%) had an initial negative Gram-stain. Of the 440 samples with no crystals detected, 18 (4%) had an initial negative Gram-stain microscopy result (p < 0.05). The incidence of concurrent septic and crystal arthritis may be higher than previously thought. Synovial fluid samples in concomitant septic and crystal arthritis are significantly less likely to have a positive Gram-stain at microscopy than in cases of an isolated septic arthritis. We would advise the clinician to maintain a high index of suspicion for septic arthritis in these patients. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Revision total knee arthroplasty for septic versus aseptic failure.

PubMed

Rajgopal, Ashok; Vasdev, Attique; Gupta, Himanshu; Dahiya, Vivek

2013-12-01

To compare the medium-term outcome of revision total knee arthroplasty (TKA) for septic versus aseptic failure. Records of 142 patients who underwent revision TKA by a single senior surgeon for septic (n=65) or aseptic (n=77) failure were reviewed. In the septic group, 67 knees in 42 women and 23 men were included. In the aseptic group, 88 knees in 51 women and 26 men were included. The Knee Society Score was measured. The Kaplan Meier survival curve at months 36, 60, and 95 was plotted, with revision as the end point. The survival rates at each specific time point between the 2 groups were compared using the Z test. The Knee Society Scores improved 18% from 51 to 69 in the septic group and 18% from 52 to 70 in the aseptic group (p=0.72). The range of motion improved 30% from 72 to 102 degrees in the septic group and 39% from 62 to 100 degrees in the aseptic group (p<0.001). Results of the 2 groups were similar in terms of the Knee Society Score, range of motion, and the Kaplan-Meier survivorship.

Mitigation of septic shock in mice and rhesus monkeys by human chorionic gonadotrophin-related oligopeptides

PubMed Central

Khan, N A; Vierboom, M P M; van Holten – Neelen, C; Breedveld, E; Zuiderwijk-Sick, E; Khan, A; Kondova, I; Braskamp, G; Savelkoul, H F J; Dik, W A; ‘t Hart, B A; Benner, R

2010-01-01

The marked improvement of several immune-mediated inflammatory diseases during pregnancy has drawn attention to pregnancy hormones as potential therapeutics for such disorders. Low molecular weight fractions derived from the pregnancy hormone human chorionic gonadotrophin (hCG) have remarkable potent immunosuppressive effects in mouse models of diabetes and septic shock. Based on these data we have designed a set of oligopeptides related to the primary structure of hCG and tested these in models of septic shock in mice and rhesus monkeys. We demonstrate that mice exposed to lipopolysaccharide (LPS) and treated subsequently with selected tri-, tetra-, penta- and hepta-meric oligopeptides (i.e. MTR, VVC, MTRV, LQGV, AQGV, VLPALP, VLPALPQ) are protected against fatal LPS-induced septic shock. Moreover, administration of a cocktail of three selected oligopeptides (LQGV, AQGV and VLPALP) improved the pathological features markedly and nearly improved haemodynamic parameters associated with intravenous Escherichia coli-induced septic shock in rhesus monkeys. These data indicate that the designed hCG-related oligopeptides may present a potential treatment for the initial hyperdynamic phase of septic shock in humans. PMID:20345979

[Proteus mirabilis septic arthritis].

PubMed

Sbiti, Mohammed; Bouhamidi, Bahia; Louzi, Lhoussaine

2017-01-01

Acute septic arthritis is rare. It is associated with poor prognosis in terms of mortality and morbidity. We report the case of a 61-year old patient with spontaneous Proteus mirabilis septic arthritis. He suffered from complicated diabetes associated with positive blood cultures and synovial fluid cultures. Patient's evolution was favorable thanks to early diagnosis and initiation of adequate antibiotic therapy. Proteus mirabilis septic arthritis is rare. On that basis we conducted a literature review of cases of Proteus mirabilis pyogenic arthritis to highlight the risk factors, pathogenesis, treatment and evolution of these diseases. Diagnosis is commonly based on microbiological analysis, early articular puncture biopsy is performed before the initiation of antibiotic treatment, direct examination, culture and antibiogram which are useful as guidance for antibiotic therapy. Septic arthritis is a diagnostic and therapeutic emergency; early management of this disease allows total healing without after-effects.