The prevalence of pulmonary nontuberculous mycobacteria (NTM) disease is increasing in the United States. Associations were evaluated among residents of central North Carolina between pulmonary isolation of NTM and environmental risk factors including: surface water, drinking water source, urbanicity, and exposures to soils favorable to NTM growth. Reports of pulmonary NTM isolation from patients residing in three counties in central North Carolina during 2006-2010 were collected from clinical laboratories and from the Slate Laboratory of Public Health. This analysis was restricted to patients residing in single family homes with a valid residential street address and conducted at the census block level (n = 13,495 blocks). Negative binomial regression models with thin-plate spline smoothing function of geographic coordinates were applied to assess effects of census block-level environmental characteristics on pulmonary NTM isolation count. Patients (n 507) resided in 473 (34%) blocks within the study area. Blocks with >20% hydric soils had 26.8% (95% confidence interval (CI): 1.8%, 58.0%), p = 0.03, higher adjusted mean patient counts compared to blocks with <= 20% hydric soil, while blocks with >50% acidic soil had 24.8% (-2.4%, 59.6%), p = 0.08 greater mean patient count compared to blocks with <= 50% acidic soil. Isolation Fates varied by county after adjusting for covariates. The effects of using disinfected public water supplies vs. private wells, and of various measures of urbanicity were not significantly associated with NTM. Our results suggest that proximity to certain soil types (hydric and acidic) could be a risk factor for pulmonary NTM isolation in central North Carolina. Published by Elsevier B.V.

The American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) have provided guidelines to assist in the accurate diagnosis of lung disease caused by nontuberculous mycobacteria (NTM). These microbiologic, radiographic, and clinical criteria are considered equally important and all must be met to make the diagnosis of NTM lung disease. To assess the significance of the three criteria, each was evaluated for its contribution to the diagnosis of NTM lung disease in a case series. Laboratory reports of any specimen positive for NTM isolation were collected between January 1, 2006 and December 31, 2010 at a university medical center. Medical records were reviewed in detail using a standardized form. The total number of patients with a culture from any site positive for NTM was 297 while the number from respiratory specimens during the same period was 232 (78%). Samples from two of these patients also yielded M. tuberculosis complex and were excluded. While 128 of the remaining 230 patients (55.7%) in the cohort met the microbiologic criterion for diagnosis of NTM lung disease, 151 (65.6%) and 189 (78.3%) met the radiologic and clinical criteria respectively. Only 78 patients (33.9%) met all three criteria provided by the ATS/IDSA for diagnosis of NTM lung disease. This evaluation reaffirms that defining NTM lung disease using either one or two of the criteria provided by the 2007 ATS/IDSA guidelines may significantly overestimate the number of cases of NTM lung disease. Based on the experience of defining NTM lung disease in this case series, recommendations for modification of the ATS/IDSA guidelines are provided which include expansion of both radiologic patterns and the list of symptoms associated with NTM lung disease.

The widespread occurrence of natural and synthetic organic chemicals in surface waters can cause ecological risks and human health concerns. This study measured a suite of contaminants of emerging concern (CECs) in water samples collected by the U.S. Environmental Protection Agency Region 8 around the Denver, Colorado, metropolitan area. The results showed that 109 of 144 analyzed pharmaceutical compounds, 42 of 55 analyzed waste-indicator compounds (e.g., flame retardants, hormones, and personal care products), and 39 of 72 analyzed pesticides were detected in the water samples collected monthly between April and November in both 2014 and 2015. Pharmaceutical compounds were most abundant in the surface waters and their median concentrations were measured up to a few hundred nanograms per liter. The CEC concentrations varied depending on sampling locations and seasons. The primary source of CECs was speculated to be wastewater effluent. The CEC concentrations were correlated to streamflow volume and showed significant seasonal effects. The CECs were less persistent during spring runoff season compared with baseflow season at most sampling sites. These results are useful for providing baseline data for surface CEC monitoring and assessing the environmental risks and potential human exposure to CECs.

Rivers in the arid Western United States face increasing influences from anthropogenic contaminants due to population growth, urbanization, and drought. To better understand and more effectively track the impacts of these contaminants, biologically-based monitoring tools are increasingly being used to complement routine chemical monitoring. This study was initiated to assess the ability of both targeted and untargeted biologically-based monitoring tools to discriminate impacts of two adjacent wastewater treatment plants (WWTPs) on Colorado's South Platte River. A cell-based estrogen assay (in vitro, targeted) determined that water samples collected downstream of the larger of the two WWTPs displayed considerable estrogenic activity in its two separate effluent streams. Hepatic vitellogenin mRNA expression (in vivo, targeted) and NMR-based metabolomic analyses (in vivo, untargeted) from caged male fathead minnows also suggested estrogenic activity downstream of the larger WWTP, but detected significant differences in responses from its two effluent streams. The metabolomic results suggested that these differences were associated with oxidative stress levels. Finally, partial least squares regression was used to explore linkages between the metabolomics responses and the chemical contaminants that were detected at the sites. This analysis, along with univariate statistical approaches, identified significant covariance between the biological endpoints and estrone concentrations, suggesting the importance of this contaminant and recommending increased focus on its presence in the environment. These results underscore the benefits of a combined targeted and untargeted biologically-based monitoring strategy when used alongside contaminant monitoring to more effectively assess ecological impacts of exposures to complex mixtures in surface waters.

Attributing nitrogen (N) in the environment to emissions from agricultural management practices is difficult because of the complex and inter-related chemical and biological reactions associated with N and its cascading effects across land, air and water. Such analyses are critical, however, in understanding the benefits and disbenefits associated with environmental management options. Coupled physical models present new opportunities to understand relationships among environmental variables across multiple sources, pathways and scenarios. Because they trace the environmental fate of pollutant concentrations found in the environment through first-principle physical and chemical processes, they shed new light on these complex interactions and how they will respond under various management scenarios. In this study, we use a coupled modeling system to holistically assess the impacts of increased corn production on groundwater and air quality. In particular, we show how the models provide new information on the drivers for contamination in groundwater and air, and then relate pollutant concentration changes attributed to potential changes in corn production between 2002 and 2022 to health and cost outcomes.

Background: Nontuberculous mycobacteria (NTM) are environmental mycobacteria associated with a range of infections. Reports of NTM epidemiology have primarily focused on pulmonary infections and isolations, however extrapulmonary infections of the skin, soft tissues and sterile sites are less frequently described.Methods: We comprehensively reviewed laboratory reports of NTM isolation from North Carolina residents of three counties during 2006-2010. We describe age, gender, and race of patients, and anatomic site of isolation for NTM species.Results: Among 1033 patients, overall NTM isolation prevalence was 15.9/100,000 persons (13.7/100,000 excluding Mycobacterium gordonae). Prevalence was similar between genders and increased significantly with age. Extrapulmonary isolations among middle-aged black males and pulmonary isolations among elderly white females were most frequently detected. Most isolations from pulmonary sites and blood cultures were Mycobacterium avium complex; rapidly growing NTM (e.g. Mycobacterium chelonae, Mycobacterium fortuitum) were most often isolated from paranasal sinuses, wounds and skin.Conclusions: We provide the first characterization of NTM isolation prevalence in the Southeastern United States (U.S.). Variation in isolation prevalence among counties and races likely represent differences in detection, demographics and risk factors. Further characterization of NTM epidemiology is increasingly important as percentages of immunocompromised individuals and the elderly increase in the U.S. population. Published by Elsevier Ltd on behalf of The British Infection Association.

Two USEPA Regional Laboratories developed direct-injection LC/MS/MS methods to measure Pharmaceuticals and Personal Care Products (PPCPs) in water matrices. Combined, the laboratories were prepared to analyze 185 PPCPs (with 74 overlapping) belonging to more than 20 therapeutical categories with reporting limits at low part-per-trillion. In partnership with Suffolk County in NY, the laboratories conducted PPCP analysis on 72 samples belonging to 4 Water Systems (WS). Samples were collected at different stages of the WS (hospital effluents, WWTP influents/effluents) to assess PPCP relevance in hospital discharges, impact on WWTP performance and potential ecological risk posed by analytes not eliminated during treatment. Major findings include: a) acceptable accuracy between the two laboratories for most overlapping PPCPs with better agreement for higher concentrations; b) the measurement of PPCPs throughout all investigated WSwith total PPCP concentrations ranging between 324 and 965 mu g L-1 for hospital effluent, 259 and 573 mu g L-1 forWWTP influent and 19 and 118 mu g L-1 for WWTP effluent; c) the variable contribution of hospital effluents to the PPCP loads into the WWTP influents (contribution ranging between 1% (WS-2) and 59% (WS-3); d) the PPCP load reduction after treatment for all WS reaching more than 95% for WS using activated sludge processes (WS-2 and WS-4), with inflow above 6500m(3) d(-1), and having a lower percentage of hospital effluent in theWWTP influent; e) the relevance of four therapeutical categories for the PPCP load inWWTP effluents (analgesics, antidiabetics, antiepileptics and psychoanaleptics); and f) the risk quotients calculated using screening-level Predicted Non Effect Concentration indicate thatWWTP effluents contain 33 PPCPs with potential medium to high ecological risk. To our knowledge no other monitoring investigation published in the scientific literature uses direct-injection methods to cover as many PPCPs and therapeutical categories in different types of WS. (C) 2015 Elsevier B.V. All rights reserved.

Summary Increased need for water and projected declines in precipitation due to climate change could leave waterways increasingly dominated by wastewater effluent. Understanding how components of wastewater influence fish populations is necessary for effective conservation and management. Despite research demonstrating effects of oestrogens, such as 17α‐ethynylestradiol (EE2), on fish physiology and population failure, the generality of population responses is uncertain and the underlying mechanisms affecting population declines are unknown. EE2 is the steroid oestrogen in human contraceptive pills and has been measured up to 11 ng L−1 in the environment. We identify disrupted population dynamics due to direct and transgenerational effects on survival and fecundity. We conducted a year‐long study on three generations of fathead minnows Pimephales promelas Rafinesque in aquatic mesocosms and laboratory aquaria. We added environmentally relevant concentrations of EE2 daily using a static renewal, which approximates a pulsed exposure that fish experience in natural systems. EE2 (3·2 ng L−1) reduced F0 male survival to 17% (48% lower than controls) and juvenile production by 40% compared to controls. F1 fish continuously exposed to EE2 failed to reproduce, and reproduction of the F1 transferred to clean water was 70–99% less than controls. F2 larval survival, exposed only as germ cells in their parents, was reduced by 51–97% compared to controls. The indirect effect on F2 survival suggests the possibility of transgenerational effects of EE2. Synthesis and applications. Our results suggest that fish populations exposed to environmentally relevant 17α‐ethynylestradiol (EE2) concentrations may not recover from exposure. Management of short‐lived highly fecund fishes should be prioritized to protect fish from the embryo through gonadal differentiation. Reducing effluent will not be possible in many situations; hence, conservation of breeding and rearing habitat in unpolluted tributaries or reaches is needed. Additionally, resource managers could enhance habitat connectivity in rivers to facilitate immigration. Finally, investment in advanced wastewater processing technology should improve removal of bioactive chemicals such as EE2. Our results provide a baseline for regulatory agencies to consider when assessing the ecological effects of environmental oestrogens, and our approach to evaluating population‐level effects could be widely applied to other contaminants.