Geoffrey I. Scott

Background: Children with Down syndrome often have co-occurring physical conditions affecting well-being, and respiratory issues remain a leading cause of hospitalization and death among people with Down syndrome. Parents of children with Down syndrome experience stressors associated with respiratory illness and challenges navigating healthcare access. No prior qualitative study has examined parental perspectives on respiratory health specifically among children with Down syndrome. Identifying parental concerns can help in the development of strategies to mitigate respiratory ailments in children with Down syndrome. Methods: One-hour, semi-structured interviews were conducted among 24 families of children with Down syndrome to understand respiratory concerns. Findings were identified through codebook thematic analysis. Results: The themes identified included persistent concerns about respiratory health, repeated impact from acute and chronic respiratory issues, a rapid and unexpected decline in health during respiratory illness, insurance coverage concerns, and a lack of confidence in assessing air quality which could impact respiratory health. Conclusions: Insights gained from interviews of parents of children with Down syndrome can help policy makers identify opportunities to prevent and mitigate respiratory health problems. Findings underscore the importance of clinician responsiveness to parental concern about rapid deterioration and suggest that insurance coverage policies for this high-risk population warrant further research and policy consideration.

Epidemiological studies have reported a strong association between liver injury and incidences of hepatocellular carcinoma in sections of humans globally. Several preclinical studies have shown a strong link between cyanotoxin exposure and the development of nonalcoholic steatohepatitis, a precursor of hepatocellular carcinoma. Among the emerging threats from cyanotoxins, new evidence shows cylindrospermopsin release in freshwater lakes. A known hepatotoxin in higher concentrations, we examined the possible role of cylindrospermopsin in causing host gut dysbiosis and its association with liver pathology in a mouse model of toxico-pharmacokinetics and hepatic pathology. The results showed that oral exposure to cylindrospermopsin caused decreased diversity of gut bacteria phyla accompanied by an increased abundance of Clostridioides difficile and decreased abundance of probiotic flora such as Roseburia, Akkermanssia, and Bacteroides thetaiotamicron, a signature most often associated with intestinal and hepatic pathology and underlying gastrointestinal disease. The altered gut dysbiosis was also associated with increased Claudin2 protein in the intestinal lumen, a marker of gut leaching and endotoxemia. The study of liver pathology showed marked liver inflammation, the release of damage-associated molecular patterns, and activation of toll-like receptors, a hallmark of consistent and progressive liver damage. Hepatic pathology was also linked to increased Kupffer cell activation and stellate cell activation, markers of progressive liver damage often linked to the development of liver fibrosis and carcinoma. In conclusion, the present study provides additional evidence of cylindrospermopsin-linked progressive liver pathology that may be very well-linked to gut dysbiosis, though definitive evidence involving this link needs to be studied further.

Monitoring programs have traditionally monitored legacy contaminants but are shifting focus to Contaminants of Emerging Concern (CECs). CECs present many challenges for monitoring and assessment, because measurement methods don't always exist nor have toxicological studies been fully conducted to place results in proper context. Also some CECs affect metabolic pathways to produce adverse outcomes that are not assessed through traditional toxicological evaluations. Antibiotics are CECs that pose significant environmental risks including development of both toxic effects at high doses and antibiotic resistance at doses well below the Minimum Inhibitory Concentration (MIC) which kill bacteria and have been found in nearly half of all sites monitored in the US. Antimicrobial resistance has generally been attributed to the use of antibiotics in medicine for humans and livestock as well as aquaculture operations. The objective of this study was to assess the extent and magnitude of antibiotics in the environment and estimate their potential hazards in the environment. Antibiotics concentrations were measured in a number of monitoring studies which included Waste Water Treatment Plants (WWTP) effluent, surface waters, sediments and biota. A number of studies reported levels of Antibiotic Resistant Microbes (ARM) in surface waters and some studies found specific ARM genes (e.g. the blaM-1 gene) in E. coli which may pose additional environmental risk. High levels of this gene were found to survive WWTP disinfection and accumulated in sediment at levels 100-1000 times higher than in the sewerage effluent, posing potential risks for gene transfer to other bacteria.in aquatic and marine ecosystems. Antibiotic risk assessment approaches were developed based on the use of MICs and MIC Ratios [High (Antibiotic Resistant)/Low (Antibiotic Sensitive) MIC] for each antibiotic indicating the range of bacterial adaptability to each antibiotic to help define the No Observable Effect Concentration (NOEC) for each antibiotic which were compared to maximum Measured Exposure Concentrations (MEC) in the environment to predict individual environmental risks. Four antibiotics had high MEC/NOEC and high MIC ratios and were identified as higher risks for concern based upon this approach, but only Triclosan had MEC/NOEC ratios >1 and was recommended for monitoring in future studies.

Rapid population growth in the southeastern US coastal zone has led to suburban and urban areas intertwined with estuarine ecosystems, reshaping the landscape ecology. Stakeholders identified residential pesticides as a major concern within developed coastal areas. Pesticide safety is regulated through label standards at the federal level, making it difficult to ensure safe practices at the community level. The goal of this study is to provide a guide of geophysical characteristics and climatic variables for better timing and specificity of pesticide applications. Using a Geographic Information System (GIS) to generate a series of map overlays, a visual guide was developed for pesticide application. We housed the guide on an online, interactive platform, as well as in a smart-phone Application, where users view the various data overlays for a particular property. The online guide allows quick access to site specific information pertinent to pesticide application, creating a process driven by stakeholder’s priorities rather than by enforcement efforts. El rápido crecimiento demográfico en la zona costera del sudeste de Estados Unidos ha llevado la remodelación de la ecología del paisaje debido al entrelazo de las áreas suburbanas y urbanas con los ecosistemas estuarinos. Las partes interesadas identificaron pesticidas residenciales como una de las principales preocupaciones dentro de las áreas costeras desarrolladas. Seguridad de los pesticidas está regulada a través de normas de etiqueta en el nivel federal, por lo que es difícil garantizar las prácticas de seguridad en el ámbito comunitario. El objetivo de este estudio es proporcionar una guía de las características geofísicas y las variables climáticas para una mejor sincronización y la especificidad de las aplicaciones de pesticidas. El uso de un Sistema de Información Geográfica (SIG) para generar una serie de superposiciones de mapa, una guía visual fue desarrollado para la aplicación de plaguicidas. Alojamos la guía en una línea y en una aplicación de teléfono con una plataforma interactiva donde los usuarios ven las diversas superposiciones de datos para una propiedad particular. La guía en línea permite un acceso rápido a la información del sitio específico pertinente para la aplicación de plaguicidas, criando un proceso impulsado por las prioridades de las partes interesadas y no por los esfuerzos de aplicación.

Multiple Antibiotic Resistance (MAR) analysis and regression modeling techniques were used to identify surface water areas impacted by fecal pollution from human sources, and to determine the effects of land use on fecal pollution in Murrells Inlet, a small, urbanized, high-salinity estuary located between Myrtle Beach and Georgetown, South Carolina, MAR analysis was performed to identify areas in the estuary that are impacted by human-source fecal pollution. Additionally, regression analysis was performed to determine if an association exists between land use and fecal coliform densities over the ten-year period from 1989 to 1998. Land-use variables were derived using Geographic Information System (GIS) techniques and were used in the regression analysis. MAR analyses were conducted by comparing the frequency and patterns of antibiotic resistance found in Escherichia coli isolates derived from surface water samples and from sewage sources in the Murrells Inlet sewage collection system. The MAR results suggest that the majority of the fecal pollution detected in the Murrells Inlet estuary may be from non-human sources, including fecal coliforms isolated from areas in close proximity to high densities of active septic tanks. A MAR Index, which measures the frequency of antibiotic resistance, was calculated for each of twenty-three water samples and nine sewage samples. The antibiotic resistance pattern comparisons were performed using cluster analysis. Although the MAR indices indicated that several surface water sites had potential human-source contamination, the cluster analysis suggests that only one sampling site had MAR patterns that were similar to those found in the sewage samples. This site was in close proximity to several large pleasure boats as well as a sewage collection system lift station, but was not near areas with active septic tanks. The results of the regression analysis also suggest that sewage sources and rainfall runoff from urbanized areas may contribute to fecal pollution in the estuary.