University of Vermont

Stormwater runoff is a significant contributor of phosphorus (P) loading to waterbodies around the world. Green stormwater infrastructure (GSI) that uses filtration media, such as bioretention, can effectively retain suspended solids and associated particulate P, but is commonly less effective for soluble P retention. The addition of aluminum-based drinking water treatment residuals (DWTRs) may increase P-sorbing capacity of GSI media, though guidance is needed for material selection and to reduce risk of potential contamination. This study examined the P removal capacities of DWTRs (n=11) from drinking water treatment plants in the New England region (northeastern USA). DWTRs were compared for P-sorption potential using batch isotherm and column experiments and characterized for several material properties as well as arsenic leaching and per and polyfluoroalkyl substances (PFAS) content. Results indicate that P retention capacity of DWTRs is generally high (>1,000 mg P kg-1) but varies by approximately one order of magnitude. Lower DWTR bulk density and greater oxalate-extractable Al + Fe were correlated with greater P retention in column experiments. Our findings also indicate that the potential for significant arsenic leaching is low. PFAS were detected in 36% of DWTRs, often at low levels near the method detection limit, with three DWTRs having higher levels of certain PFAS. The addition of DWTRs to GSI is promising for enhanced soluble P removal on a decadal scale (10-90 years), but additional research on As, PFAS, and other contaminants should be pursued prior to use, especially in areas with known or suspected source water contamination. Achieving effective long-term P removal requires selecting DWTRs with favorable material properties (e.g., drier, lower bulk density, greater oxalate-extractable Al + Fe), and mixture with sand at up to 10% DWTR by volume and potentially higher if proven to not impede hydraulic conductivity. Field monitoring of DWTR-enhanced infrastructure at multiple time points postinstallation (e.g., years 1, 5, 10, 20, and 30) is needed to confirm P removal longevity over expected infrastructure lifespans.

Blood pressure (BP) measurement in both acute care and outpatient settings is essential, as conditions like hypertension and hypotension are common and often asymptomatic until organ damage occurs. These conditions significantly increase the risk of morbidity and mortality but can be effectively managed through early detection and treatment. For decades, cuff-based devices have dominated non-invasive BP monitoring; however, they are often bulky, inconvenient, and limited to intermittent measurements. In recent years, machine learning (ML) and artificial intelligence (AI)-based approaches for BP estimation from non-invasive physiological signals-such as electrocardiography (ECG) and photoplethysmography (PPG)-have generated considerable interest. These innovations promise to enable continuous, cuff-less BP monitoring, expanding the reach of BP assessment into wearable devices and facilitating more dynamic, patient-centered care. This review provides a comprehensive overview of the evolution of non-invasive BP measurement technologies, with particular emphasis on emerging AI-driven methods and trends shaping the development of continuous and wearable solutions. While these technologies offer new opportunities for continuous monitoring and patient engagement, this review focuses on their conceptual and technological development rather than detailed performance evaluation or clinical validation.

More than 25 years ago, Pellegrino and Relman noted the increasing commercialization of the learned professions, anticipating what many physicians are increasingly experiencing today: an impairment of their ability to practice in accordance with standards of medical ethics and professionalism. These hurdles to the physician's ability to do right by the patient contribute to what leaders in medicine and the American College of Physicians have called deprofessionalization. An example is the use of the term provider to describe physicians and other health professionals. The use of this terminology has been reviewed in medical journal articles but has not been adequately explored as a matter of ethics and professionalism. Through that lens, this paper examines the trends, significance, and implications for patients, physicians, and health care of the use of the term provider.

Deer keds (Diptera: Hippoboscidae: Lipopteninae) are blood-feeding ectoparasitic flies that usually feed on deer and other Cervidae but sometimes bite humans. Two species are found in eastern North America: introduced European deer keds (Lipoptena cervi L.) and native Neotropical deer keds (L. mazamae Rondani). While historically dismissed as potential vectors of diseases, half a dozen tick-borne pathogens, including species pathogenic to humans, have been sequenced from deer keds over the last 15 years. In response to growing concerns that deer keds may transmit pathogens, efforts have been made recently to determine the distribution of deer keds in North America. Herein, we present new state records for Illinois, Kentucky, Michigan, and Nebraska, as well as 146 new county records from these and other states. We also discuss the relationship of hippoboscids to CO2-baited mosquito traps and review the impact of the community science platforms iNaturalist.org and BugGuide.net.

Most palliative care (PC) physicians will change jobs over the course of their career, yet few supports exist to guide them through this often unfamiliar process. Job transitions frequently elicit stress and uncertainty, as individuals balance personal and professional priorities, navigate complex negotiations, and assume the inherent risks of pursuing new opportunities. Yet, when approached intentionally, a job transition can also be a transformative process that allows for self-discovery, cultivation of new skills and connections, and reshaping of one's professional identity. This article, written by a team of PC physicians who have made job transitions themselves, offers 10 tips for navigating this professional step successfully. With emphases on authentic communication, skilled mentorship, relationship building, and exploration of local culture-the article offers practical advice to help PC physicians navigate a job transition confidently, while staying grounded in their personal values and the work they find most meaningful.

We compared freshwater ecosystem management of the Yuba River, in California, USA, and the Noce River in the Province of Trento, Italy to examine how cultural and political practices can shape freshwater ecosystem management strategies within similar geographical and hydrologic contexts. Specifically, we compared climate, land-use history, flow regulation, restoration approaches, and associated challenges and successes. The Yuba and Noce catchments both have Mediterranean climates, runoff sourced by rainfall and glacial or snowmelt, and developed water supply resources for agriculture, municipal water supply, recreation, and power generation. Both rivers have long histories of human modification, including damming in the 20th century to accommodate escalating energy demand and intensive agriculture. Dam releases for power generation on the Noce River result in hydropeaking, altering the eco-morphodynamics and limiting biodiversity. Water supply storage, diversion for agricultural use, and gravel extraction on the Yuba River results in highly altered flow regimes and degraded instream habitat. Contrasts between the rivers’ respective regulatory frameworks and their intended goals yield different management actions. In the Yuba, the US Endangered Species Act drives targeted restoration for species-specific recovery, limiting broader holistic protections for the aquatic ecosystem. Whereas in the Noce, the European Union Water Framework Directive mandates broad ecosystem benchmarks be met, with restoration focused on improving habitat, biodiversity, and water quality. However, the top-down approach may limit stakeholder involvement. Recently, success in coalition building among California water managers, academic institutions, conservation groups, and private landowners has led to reconnecting floodplain habitats and providing environmental flows for native salmonids. Implementing alternative hydropower generation schemes in the Noce has led to improved aquatic biodiversity metrics and increased recreation opportunities. As climate change exacerbates impacted river functions worldwide, comparison of freshwater ecosystem management between international catchments offers potential new solutions for sustaining essential ecosystem services.