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Methods and devices for evaluating environmental remediation progress and population health

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This dissertation critically evaluated methodologies and devices for assessing and protecting the health of human populations, with particular emphasis on groundwater remediation and the use of wastewater-based epidemiology (WBE) to inform population health. A meta-analysis and assessment of laboratory-scale treatability studies for removing chlorinated solvents from groundwater found that sediment…

This dissertation critically evaluated methodologies and devices for assessing and protecting the health of human populations, with particular emphasis on groundwater remediation and the use of wastewater-based epidemiology (WBE) to inform population health. A meta-analysis and assessment of laboratory-scale treatability studies for removing chlorinated solvents from groundwater found that sediment microcosms operated as continuous-flow columns are preferable to batch bottles when seeking to emulate with high fidelity the complex conditions prevailing in the subsurface in contaminated aquifers (Chapter 2). Compared to monitoring at the field-scale, use of column microcosms also showed (i) improved chemical speciation, and (ii) qualitative predictability of field parameters (Chapter 3). Monitoring of glucocorticoid hormones in wastewater of a university campus showed (i) elevated stress levels particularly at the start of the semester, (ii) on weekdays relative to weekend days (p = 0.05) (161 ± 42 μg d-1 per person, 122 ± 54 μg d-1 per person; p ≤ 0.05), and (iii) a positive association between levels of stress hormones and nicotine (rs: 0.49) and caffeine (0.63) consumption in this student population (Chapter 4). Also, (i) alcohol consumption determined by WBE was in line with literature estimates for this young sub-population (11.3 ± 7.5 g d-1 per person vs. 10.1 ± 0.8 g d-1 per person), whereas caffeine and nicotine uses were below (114 ± 49 g d-1 per person, 178 ± 19 g d-1 per person; 627 ± 219 g d-1 per person, 927 ± 243 g d-1 per person). The introduction of a novel continuous in situ sampler to WBE brought noted benefits relative to traditional time-integrated sampling, including (i) a higher sample coverage (93% vs. 3%), (ii) an ability to captured short-term analyte pulses (e.g., heroin, fentanyl, norbuprenorphine, and methadone), and (iii) an overall higher mass capture for drugs of abuse like morphine, fentanyl, methamphetamine, amphetamine, and the opioid antagonist metabolite norbuprenorphine (p ≤ 0.01). Methods and devices developed in this work are poised to find applications in the remediation sector and in human health assessments.
ContributorsDriver, Erin Michelle (Author) / Halden, Rolf (Thesis advisor) / Conroy-Ben, Otakuye (Committee member) / Kavazanjian, Edward (Committee member) / Krajmalnik-Brown, Rosa (Committee member) / Arizona State University (Publisher)
Created2018

Provider Satisfaction with Chronic Opioid Therapy (COT) Delivery after EHR Transition at a Community Internal Medicine Clinic

Description

With the recent rise in opioid overdose and death1<br/><br/>, chronic opioid therapy (COT) programs using<br/>Center of Disease Control (CDC) guidelines have been implemented across the United States8<br/>.<br/>Primary care clinicians at Mayo Clinic initiated a COT program in September of 2017, during the<br/>use of Cerner Electronic Health Record (EHR) system. Study…

With the recent rise in opioid overdose and death1<br/><br/>, chronic opioid therapy (COT) programs using<br/>Center of Disease Control (CDC) guidelines have been implemented across the United States8<br/>.<br/>Primary care clinicians at Mayo Clinic initiated a COT program in September of 2017, during the<br/>use of Cerner Electronic Health Record (EHR) system. Study metrics included provider<br/>satisfaction and perceptions regarding opioid prescription. Mayo Clinic transitioned its EHR<br/>system from Cerner to Epic in October 2018. This study aims to understand if provider perceptions<br/>about COT changed after the EHR transition and the reasons underlying those perceptions.
ContributorsPonnapalli, Sravya (Author) / Murcko, Anita (Thesis director) / Wallace, Mark (Committee member) / College of Health Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
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Analysis of uncertainty in water management and wastewater-based population health assessments

Description
Uncertainty is inherent in predictive decision-making, both with respect to forecasting plausible future conditions based on a historic record, and with respect to backcasting likely upstream states from downstream observations. In the first chapter, I evaluated the status of current water resources management policy in the United States (U.S.) with…

Uncertainty is inherent in predictive decision-making, both with respect to forecasting plausible future conditions based on a historic record, and with respect to backcasting likely upstream states from downstream observations. In the first chapter, I evaluated the status of current water resources management policy in the United States (U.S.) with respect to its integration of projective uncertainty into state-level flooding, drought, supply and demand, and climate guidance. I found uncertainty largely absent and discussed only qualitatively rather than quantitatively. In the second chapter, I turned to uncertainty in the interpretation of downstream observations as indicators of upstream behaviors in the field of Wastewater-Based Epidemiology (WBE), which has made possible the near real-time, yet anonymous, monitoring of public health via measurements of biomarkers excreted to wastewater. I found globally, seasonality of air and soil temperature causes biomarker degradation to vary up to 13-fold over the course of a year, constituting part of the background processes WBE must address, or detrend, prior to decision-making. To determine whether the seasonal change in degradation rates was introducing previously unaccounted for uncertainty with respect to differences in observed summertime and winter-time populations, I evaluated demographic indicators recorded by the Census Bureau for correlation with their distance from all major wastewater treatment plants across the U.S. The analysis identified statistically significant correlation for household income, education attainment, unemployment, military service, and the absence of health insurance. Finally, the model was applied to a city-wide case study to test whether temperature could explain some of the trends observed in monthly observations of two opiate compounds. Modeling suggests some of the monthly changes were attributed to natural temperature fluctuation rather than to trends in the substances’ consumption, and that uncertainty regarding discharge location can dominate even relative observed differences in opiate detections. In summary, my work has found temperature an important modulator of WBE results, influencing both the type of populations observed and the likelihood of upstream behaviors disproportionally magnified or obscured, particularly for the more labile biomarkers. There exists significant potential for improving the understanding of empirical observations via numerical modeling and the application of spatial analysis tools.
ContributorsHart, Olga (Author) / Halden, Rolf (Thesis advisor) / Mascaro, Giuseppe (Committee member) / Renaut, Rosemary (Committee member) / Nelson, Keith (Committee member) / Arizona State University (Publisher)
Created2019
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Monitoring the Rise of Methamphetamine use Amidst the Opioid Epidemic in Two U.S. Cities via Wastewater-based Epidemiology

Description

The combined use of methamphetamine and opioids has been reported to be on the rise throughout the United States (U.S.). However, our knowledge of this phenomenon is largely based upon reported overdoses and overdose-related deaths, law enforcement seizures, and drug treatment records; data that are often slow, restricted, and only…

The combined use of methamphetamine and opioids has been reported to be on the rise throughout the United States (U.S.). However, our knowledge of this phenomenon is largely based upon reported overdoses and overdose-related deaths, law enforcement seizures, and drug treatment records; data that are often slow, restricted, and only track a portion of the population participating in drug consumption activities. As an alternative, wastewater-based epidemiology (WBE) has the capability to track licit and illicit drug trends within an entire community, at a low cost and in near real-time, while providing anonymity to those contributing to the sewer shed. In this study, wastewater was collected from two Midwestern U.S. cities (2017-2019) and analyzed for the prevalence of methamphetamine and the opioids oxycodone, codeine, fentanyl, tramadol, hydrocodone, and hydromorphone. Monthly 24-hour time-weighted composite samples (n = 48) from each city were analyzed using isotope dilution liquid chromatography tandem mass spectrometry. Results showed that methamphetamine and total opioid consumption (milligram morphine equivalents) in City 1 were strongly correlated only in 2017 (Spearman rank order correlation coefficient, ρ = 0.78), the relationship driven by fentanyl, hydrocodone, and hydromorphone. For City 2, methamphetamine and total opioid consumption were strongly positively correlated during the entire study (ρ = 0.54), with the correlations driven by hydrocodone and hydromorphone. In both cities, hydrocodone and hydromorphone mass loads were highly correlated, suggesting a parent and metabolite relationship. WBE provides important insights into licit and illicit drug consumption patterns in near real-time as they evolve; important information for community stakeholders in municipalities across the U.S.
ContributorsClick, Kathleen Grace (Author) / Halden, Rolf (Thesis director) / Gushgari, Adam (Committee member) / Driver, Erin (Committee member) / School of Life Sciences (Contributor) / School of Human Evolution & Social Change (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
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Narcotics Consumption Trends at a Southwestern U.S. University Campus in 2017-2018 Tracked By Wastewater-Based Epidemiology

Description
Current methods measuring the consumption of prescription and illicit drugs are often hampered by innate limitations, the data is slow and often restricted, which can impact the relevance and robustness of the associated data. Here, wastewater-based epidemiology (WBE) was applied as an alternative metric to measure trends in the consumption…

Current methods measuring the consumption of prescription and illicit drugs are often hampered by innate limitations, the data is slow and often restricted, which can impact the relevance and robustness of the associated data. Here, wastewater-based epidemiology (WBE) was applied as an alternative metric to measure trends in the consumption of twelve narcotics within a collegiate setting from January 2018 to May 2018 at a Southwestern U.S. university. The present follow-up study was designed to identify potential changes in the consumption patterns of prescription and illicit drugs as the academic year progressed. Samples were collected from two sites that capture nearly 100% of campus-generated wastewater. Seven consecutive 24-hour composite raw wastewater samples were collected each month (n = 68) from both locations. The study identified the average consumption of select narcotics, in units of mg/day/1000 persons in the following order: cocaine (528 ± 266), heroin (404 ± 315), methylphenidate (343 ± 396), amphetamine (308 ±105), ecstasy (MDMA; 114 ± 198), oxycodone (57 ± 28), methadone (58 ± 73), and codeine (84 ± 40). The consumption of oxycodone, methadone, heroin, and cocaine were identified as statistically lower in the Spring 2018 semester compared to the Fall 2017. Universities may need to increase drug education for the fall semester to lower the consumption of drugs in that semester. Data from this research encompasses both human health and the built environment by evaluating public health through collection of municipal wastewater, allowing public health officials rapid and robust narcotic consumption data while maintaining the anonymity of the students, faculty, and staff.
ContributorsCarlson, Alyssa Rose (Author) / Halden, Rolf (Thesis director) / Gushgari, Adam (Committee member) / School of Human Evolution & Social Change (Contributor) / Chemical Engineering Program (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
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The Relationship between Wastewater Toxic Substances and Alzheimer’s disease

Description
Alzheimer’s disease (AD) is a neurodegenerative disease resulting in loss of cognitive function and is not considered part of the typical aging process. Recently, research is being conducted to study environmental effects on AD because the exact molecular mechanisms behind AD are not known. The associations between various toxins and…

Alzheimer’s disease (AD) is a neurodegenerative disease resulting in loss of cognitive function and is not considered part of the typical aging process. Recently, research is being conducted to study environmental effects on AD because the exact molecular mechanisms behind AD are not known. The associations between various toxins and AD have been mixed and unclear. In order to better understand the role of the environment and toxic substances on AD, we conducted a literature review and geospatial analysis of environmental, specifically wastewater, contaminants that have biological plausibility for increasing risk of development or exacerbation of AD. This literature review assisted us in selecting 10 wastewater toxic substances that displayed a mixed or one-sided relationship with the symptoms or prevalence of Alzheimer’s for our data analysis. We utilized data of toxic substances in wastewater treatment plants and compared them to the crude rate of AD in the different Census regions of the United States to test for possible linear relationships. Using data from the Targeted National Sewage Sludge Survey (TNSSS) and the Centers for Disease Control and Prevention (CDC), we developed an application using R Shiny to allow users to interactively visualize both datasets as choropleths of the United States and understand the importance of this area of research. Pearson’s correlation coefficient was calculated resulting in arsenic and cadmium displaying positive linear correlations with AD. Other analytes from this statistical analysis demonstrated mixed correlations with AD. This application and data analysis serve as a model in the methodology for further geospatial analysis on AD. Further data analysis and visualization at a lower level in terms of scope is necessary for more accurate and reliable evidence of a causal relationship between the wastewater substance analytes and AD.
GitHub Repository: https://github.com/komal-agrawal/AD_GIS.git
ContributorsAgrawal, Komal (Author) / Scotch, Matthew (Thesis director) / Halden, Rolf (Committee member) / College of Health Solutions (Contributor, Contributor) / Barrett, The Honors College (Contributor)
Created2019-05