Introduction: Prescription drug monitoring programs (PDMPs) are one strategy established to curb the prescription opioid abuse epidemic. Prescriber use mandates has emerged as a promising practice to increase PDMPs impact on prescription opioid abuse; however, evidence of its effectiveness has not yet been established. Kentucky was the first state to implement comprehensive prescriber use mandates in July 2012. Objective: To assess the relationship between prescriber use mandates policy and emergency department (ED) visits related to prescription opioid poisoning among adults in Kentucky and North Carolina. Secondary aim: to evaluate the economic impact of prescriber use mandates in Kentucky. Methods: A controlled, pre-post study design. Data from the State Emergency Department Databases (SEDD) and the State Inpatient databases (SID) were used to identify prescription opioid poisoning ED visits among those ≥ 12 years old. Prevalence rate were estimated. Prescription opioid poisoning ED visits were characterized based on sociodemographic and clinical characteristics. Logistic regression was applied to compare occurrences of prescription opioid poisoning ED visits pre and post prescriber use mandates in Kentucky, and between Kentucky and North Carolina for the period 2011 to 2014. A cost of illness framework was applied to estimate direct medical costs associated with prescription opioid poisoning ED visits. The economic impact of prescriber use mandates was quantified based on logistic regression coefficient for the interaction term (state*time to implementation). Results: There were 7,419 and 12,598 prescription opioid poisoning -related ED visits in Kentucky and North Carolina, respectively. Young and Middle age, male gender, white, having one or more chronic conditions, and psychiatric conditions (such as depression and drug abuse) were significantly associated with prescription opioid poisoning ED visits (p-value<0.05). The odds of having a prescription opioid poisoning ED visit in Kentucky were significantly lower compared to North Carolina in 2012, 2013, and 2014 compared to 2011 (OR = 0.9, 0.7, and 0.7 respectively). The total estimated direct medical costs were $13.77 and $24.37 million in Kentucky and North Carolina, respectively. In Kentucky, the economic impact of prescriber use mandates was estimated at - $2.3 million. Conclusion: Prescriber use mandates is effective in reducing prescription opioid poisoning ED visits, and its economic impact is considerable.

Maintaining due diligence on safety practices at the workplace of battery technicians is the most cost-effective intervention against lead-related hazards. The safety practice on lead poisoning in Nigeria is below average, and the compliance level is far from the expected target of 90%. Using Dejoy's workplace self-protective behavior theory, this study investigated multilevel factors that influence safety practices on lead poisoning and compared the rate of utilization of personal protective equipment by battery technicians in the organized and roadside settings. The study was a quantitative, cross-sectional survey design, and a multistage and systematic sampling technique was used to select 293 adult battery technicians aged 18 years and above. Hypotheses were tested with chi-square and multivariate logistic regressions at the significant level of p < 0.05 and 95% confidence interval. The outcome of the safety practice status of battery technicians is 20%, and the rate of utilization of personal protective equipment is 18% in Lagos, Nigeria. Findings revealed that workplace conditions, blood lead levels, knowledge, education, and the rate of utilization of personal protective equipment are predictors of the safety practice status of battery technicians. There was no significant difference between battery technicians in the organized and roadside setting considering the perceived risk of lead poisoning and utilization of personal protective equipment. The positive social change implications of this study include recommendations for battery technicians to use the evolved alternative safety approaches to reduce lead-related hazards. Public health professional and policymakers should invest resources towards reducing the impact of lead poisoning on battery technicians at the workplace.

Lead is a global health hazard and reducing environmental exposures to lead is becoming increasingly important as negative health impacts are documented at lower levels of exposure. Soils, an important source of lead exposure in children, represent a largely untested reservoir of accumulated past and present lead contamination retained in the surface. Concentrations of soil lead are very spatially heterogeneous, however, and testing is required to identify whether site-specific soils present a hazard. In this dissertation I outline the several ways to increase testing and awareness about soil-lead contamination to provide individuals with the information needed to prevent exposure to soil lead. Chapter one presents a new field procedure for use by the general public to screen soils for hazardous levels of lead that is based on determining bioaccessible lead. Chapter two describes the delineation of soil-lead hotspots in four mining-impacted towns in Peru and reveals that parents using the field procedure identified a hotspot missed by previous testing. In this study, we find child blood lead information is associated with parent cleanliness, which may represent a pathway for child exposure to dust and soil lead, although no associations are seen directly with soil lead concentrations. In chapter three, Peruvian high school students use the field procedure in their science classes to identify hotspots of soil lead and share this information with their community. Finally, chapter four highlights that extremely elevated concentrations of soil lead are not limited to far-off mining communities but are also present locally in New York City. Soil core data collected does not reveal a single source or blanket atmospheric inputs, but rather highlights the variability of deposition that requires widespread testing.

Les jeunes enfants sont les plus exposés au plomb et les plus sensibles à ses effets sur la santé, notamment sur le développement. Une enquête d’imprégnation sur 3831 enfants vivant en France a permis d’établir la moyenne géométrique des expositions au plomb à 14,9 (+/- 0,5) µg/L de sang avec 76000 enfants au-delà du seuil d’intervention obligatoire de 50µg/L. Les critères actuels de dépistage se sont avérés peu aptes à repérer ces enfants surexposés et de nouveaux critères sont proposés. En complément, une enquête environnementale avec mesures de plomb dans le logement a été réalisée dans 484 logements. Les poussières au sol des habitations et l’eau du robinet sont des facteurs important de surexposition, ainsi que l’utilisation de vaisselle et cosmétiques traditionnels. Les politiques de prévention doivent être poursuivies compte tenu de la persistance de sources d’exposition et de la toxicité même à faible dose. / Young children are most exposed to lead and the most susceptible to its health effects, notably on development. A nationwide representative survey on 3831 children in France has established the geometric mean of lead exposures at 14.9 (+/- 0.5) µg/L of blood with 76000 children beyond the mandatory action level of 50μg / L. The current screening criteria have proved insufficient to identify these overexposed children and new ones are proposed. In addition, an environmental investigation with lead measurements in housing was performed in 484 homes. Household floor dust and tap water are major factors of overexposure, and also the use of traditional dishes and cosmetics. Prevention policies must be pursued in light of the continuing sources of exposure and toxicity even at low doses.

Harmful algal blooms (HABs, or "red tides") of the brevetoxin-producing dinoflagellate Karenia brevis occur periodically along Florida's Gulf coast. Mass mortalities of marine birds have long been associated with these blooms, yet there are few data documenting the accumulation of brevetoxins (PbTx) in the tissues of birds. Post-mortem evaluations were performed on 185 birds representing 22 species collected from October 2001 through May 2006 during red tide and non-red tide events to quantify their body burdens of brevetoxins. A variety of tissues and organs were selected for brevetoxin analysis including blood, brain, heart, fat, stomach or gut contents, intestinal contents or digestive tract, muscle, lung, liver or viscera, kidney, gonads, gallbladder and spleen. Brevetoxin levels in avian tissues ranged from K. brevis which may amass in various tissues of the body. As a consequence, the birds may exhibit acute brevetoxicosis during red tide events or show chronic accumulation effects during non-red tide events.

Catalytic combustion is an environmentally friendlytechnique to combust fuels in e.g. gas turbines. Introducing acatalyst into the combustion chamber of a gas turbine allowscombustion outside the normal flammability limits. Hence, theadiabatic flame temperature may be lowered below the thresholdtemperature for thermal NOXformation while maintaining a stable combustion.However, several challenges are connected to the application ofcatalytic combustion in gas turbines. The first part of thisthesis reviews the use of catalytic combustion in gas turbines.The influence of the fuel has been studied and compared overdifferent catalyst materials. The material section is divided into two parts. The firstconcerns bimetallic palladium catalysts. These catalysts showeda more stable activity compared to their pure palladiumcounterparts for methane combustion. This was verified both byusing an annular reactor at ambient pressure and a pilot-scalereactor at elevated pressures and flows closely resembling theones found in a gas turbine combustor. The second part concerns high-temperature materials, whichmay be used either as active or washcoat materials. A novelgroup of materials for catalysis, i.e. garnets, has beensynthesised and tested in combustion of methane, a low-heatingvalue gas and diesel fuel. The garnets showed some interestingabilities especially for combustion of low-heating value, LHV,gas. Two other materials were also studied, i.e. spinels andhexaaluminates, both showed very promising thermal stabilityand the substituted hexaaluminates also showed a good catalyticactivity. Finally, deactivation of the catalyst materials was studied.In this part the sulphur poisoning of palladium, platinum andthe above-mentioned complex metal oxides has been studied forcombustion of a LHV gas. Platinum and surprisingly the garnetwere least deactivated. Palladium was severely affected formethane combustion while the other washcoat materials were mostaffected for carbon monoxide and hydrogen. <b>Keywords:</b>catalytic combustion, catalyst materials,palladium, platinum, bimetallic, garnet, spinel, hexaaluminate,deactivation, sulphur, poisoning, diesel, methane,hydrocarbons

Lead is a serious developmental neurotoxin with the capacity to interrupt brain development and impair functioning. Since at least 1930 numerous case studies in American, Canadian and Australian literature have identified lead based paint in the home as a source of poisoning for young children; and since at least 1990 evidence has shown that it is the lead dust from deteriorating paint in older homes and renovating activities that is the primary source of chronic exposure for young children today. Not much is known about the extent of childhood lead poisoning in Canada. Gaps in our understanding include a lack of national survey data on childhood blood lead levels and an absence of reliable data to determine the era of housing that poses the greatest risk. This thesis posits that despite this paucity of research knowledge there is evidence to suggest that populations of vulnerable children continue to be harmed by exposure to historic sources of lead, such as lead-based paint found in older housing stock. This thesis examines the evidence to support this contention by critically analyzing the Canadian public health response to the issue of childhood lead poisoning. Specific attention is paid to discourse corresponding to lead-based paint, the putative major pathway of exposure for children ages 1 to 5 years. Using Foucault’s genealogical/archaeological approach, as elaborated upon by Rawlinson (1987) this thesis discusses the socio-political and economical processes that shaped health care knowledge regarding childhood lead poisoning in Canada and influenced the way knowledge was produced and used by health care providers and policy makers. The analysis is assisted via a comparison of Canadian public health discourse with American discourse, with an emphasis on discourse appearing in the post leaded gasoline era (1990-2008). The strength of a Foucauldian archaeological/genealogical analysis for nursing research and particularly for this analysis is in its focus on discourse, surfaces of emergence, transformations, mutations, contingencies, events, recognition of power/knowledge strategies, descriptions of discipline technologies and consequences, and suggested possibilities of resistance. This thesis proposes that surveillance data constituted both a product and acatalyst of the dominant view on childhood lead poisoning occurring from residential sources and posits that a lack of Canadian context specific surveillance data was the major “policing” factor limiting Canadian public health discourse. Further, privileged access to blood lead survey data maintained the view that childhood lead poisoning was a problem of the past or an American problem. Third, tensions among Canada’s two federal agencies which hold primary responsibility for lead, health and housing resulted in a weakened response whereby, to date, no legislation exists to protect vulnerable populations of Canadian children from exposure to historic sources of lead in residential dwellings.

Lead is a serious developmental neurotoxin with the capacity to interrupt brain development and impair functioning. Since at least 1930 numerous case studies in American, Canadian and Australian literature have identified lead based paint in the home as a source of poisoning for young children; and since at least 1990 evidence has shown that it is the lead dust from deteriorating paint in older homes and renovating activities that is the primary source of chronic exposure for young children today. Not much is known about the extent of childhood lead poisoning in Canada. Gaps in our understanding include a lack of national survey data on childhood blood lead levels and an absence of reliable data to determine the era of housing that poses the greatest risk. This thesis posits that despite this paucity of research knowledge there is evidence to suggest that populations of vulnerable children continue to be harmed by exposure to historic sources of lead, such as lead-based paint found in older housing stock. This thesis examines the evidence to support this contention by critically analyzing the Canadian public health response to the issue of childhood lead poisoning. Specific attention is paid to discourse corresponding to lead-based paint, the putative major pathway of exposure for children ages 1 to 5 years. Using Foucault’s genealogical/archaeological approach, as elaborated upon by Rawlinson (1987) this thesis discusses the socio-political and economical processes that shaped health care knowledge regarding childhood lead poisoning in Canada and influenced the way knowledge was produced and used by health care providers and policy makers. The analysis is assisted via a comparison of Canadian public health discourse with American discourse, with an emphasis on discourse appearing in the post leaded gasoline era (1990-2008). The strength of a Foucauldian archaeological/genealogical analysis for nursing research and particularly for this analysis is in its focus on discourse, surfaces of emergence, transformations, mutations, contingencies, events, recognition of power/knowledge strategies, descriptions of discipline technologies and consequences, and suggested possibilities of resistance. This thesis proposes that surveillance data constituted both a product and acatalyst of the dominant view on childhood lead poisoning occurring from residential sources and posits that a lack of Canadian context specific surveillance data was the major “policing” factor limiting Canadian public health discourse. Further, privileged access to blood lead survey data maintained the view that childhood lead poisoning was a problem of the past or an American problem. Third, tensions among Canada’s two federal agencies which hold primary responsibility for lead, health and housing resulted in a weakened response whereby, to date, no legislation exists to protect vulnerable populations of Canadian children from exposure to historic sources of lead in residential dwellings.

Polymer electrolyte membrane (PEM) fuel cells are promising alternative green power source for mobile, portable and stationary applications. However, their cost, durability, and performance are impacted by their sensitivity to impurities in fuel stream. Carbon monoxide (CO), an impurity commonly present in the hydrogen gas produced from hydrocarbon fuels, is known to have a significant degrading effect on PEM fuel cell performance because CO has a strong affinity to the platinum-based catalyst. At present, most studies in literature are limited to either experimental or simplified-dimensional analysis/modeling. In this thesis research, a three-dimensional (3D) multiphase PEM fuel cell model with the CO poisoning and O2 bleeding is developed based on the conservation laws for mass, momentum, energy, and species, and implemented in the commercial software Fluent (6.3.26) through the user-defined functions. Numerical simulations are conducted to simulate a single PEM fuel cell including flow channels, gas diffusion layers, catalyst layers, and PEM. The simulation results are compared with experimental data favorably. The result shows that the reaction rate of hydrogen in the anode catalyst layer is higher near the membrane layer, decreasing towards the gas diffusion layer (GDL) interface, and the reaction rate in general is higher in the inlet region and decreases towards the exit region of the flow channel. It means that the outlet of anode catalyst layer next to the flow channel and GDL has suffered the most significant poisoning effect. The result helps optimize the design of anode catalyst layer by embedding more platinum on the most poisoned area to increase available surface for hydrogen adsorption; similarly, reducing platinum loading on the less poisoned area. The fuel cell performance can be almost fully recovered when switching the anode fuel mixture to pure hydrogen, though it takes a long period of time. The reaction rate of hydrogen decreases significantly along the flow channel when impurity mixture is provided; while there is little change along the channel for pure hydrogen fuel. Adding oxygen into the anode fuel mixture can mitigate CO poisoning, but there is a time delay when the oxygen is introduced into the anode stream and when the performance starts to recover. It is observed that at the beginning of oxygen introduced in the anode stream the recovery rate in the region adjacent to the channel outlet is faster than the rate in the region close to the inlet. This difference in the recovery rate gradually becomes smaller over time. In addition, the influence of CO poisoning and oxygen bleeding on multi-phase water is investigated. The influence on dissolved water is only clearly seen in the anode catalyst layer next to the land area. Finally, response to sudden load changes is simulated by changing cell voltage. It is found that the overshoot and undershoot are more significant at high current densities.

No description available.