Kuruvilla Mathew

The allergy section of the electronic health record (EHR) is ideally reviewed and updated by health care workers during routine outpatient visits, emergency room visits, inpatient hospitalizations, and surgical procedures. This EHR section has the potential to help proactively and comprehensively avoid exposures to drugs, contact irritants, foods, and other agents for which, based on an individual’s medical history and/or genetics, there is increased risk for adverse outcomes with future exposures. Because clinical decisions are made and clinical decision support is triggered based on allergy details from the EHR, the allergy module needs to provide meaningful, accurate, timely, and comprehensive allergy information. Although the allergy section of the EHR must meet these requirements to guide appropriate clinical decisions and treatment plans, current EHR allergy modules have not achieved this standard. We urge EHR vendors to collaborate with allergists to optimize and modernize allergy documentation. A work group within the Adverse Reactions to Drugs, Biologicals, and Latex Committee of the American Academy of Allergy, Asthma & Immunology was formed to create recommendations for allergy documentation in the EHR. Whereas it is recognized that the term “allergy” is often used incorrectly because most adverse drug reactions (ADRs) are not true immune-mediated hypersensitivity reactions, “allergy” in this article includes allergies and hypersensitivities as well as side effects and intolerances. Our primary objective is to provide guidance for the current state of allergy documentation in the EHR. This guidance includes clarification of the definition of specific ADR types, reconciliation of confirmed ADRs, and removal of disproved or erroneous ADRs. This document includes a proposal for the creation, education, and implementation of a drug allergy labeling system that may allow for more accurate EHR documentation for improved patient safety.

Decentralised wastewater recycling and irrigation systems have been established with industry partners in Perth urban villages. The project is now monitoring and evaluating these systems for performance and reliability to meet regulatory standards, effects on soil and vegetation, pathogen disinfection, nutrients prevented from infiltration to groundwater or infiltrated and recycled, maintenance issues of the systems and the effective amount of scheme and bore water saved in the long term. Three trial sites were established for the Premier’s Water Foundation (PWF) (Bridgewater Lifestyle Village 389 household greywater recycling; Timbers Edge Resort Village 260 houses to common greywater recycling; Banksia Tourist Village 162 park homes to common wastewater treatment) The research team continues to conduct research on other promising sites (Somerville Ecovillage with 104 houses on dry composting toilets and greywater recycling and Tuart Lakes Lifestyle Village with 415 park homes to common wastewater treatment). This paper provides an overview of the results to date from five research topics: completed are a new regulatory framework, a technical elements model, and a new water balance and efficiency rating tool. For the fourth topic, trials found that mosquito control measures are effective. Fifthly, early monitoring results for a “zero emissions nutrients” (ZEN) model for urban land developments are promising with nutrient leaching within prescribed limits.

The Solarflow was invented at The Environmental Technology Centre, Murdoch University (the Murdoch ETC) in Perth, Western Australia as part of a doctoral thesis in the early 1990s researching suitable water treatment systems for remote indigenous communities. The design has been modified since this time by its original manufacturer but full commercialisation was not achieved. The current owner Solco Pty Ltd was keen to further improve the efficiency and lower the purchase cost of the unit and engaged the Murdoch ETC to undertake further testing. The Solarflow is a self-contained solar-powered unit capable of producing 400 L/day of high quality drinking water from brackish water via reverse osmosis and requires only 120 W of photovoltaic power. This is achievable due to its innovative energy recovery system. In order to assess the unit's efficiency more accurately the latest high-rate data logging technology from the ResLab laboratory at Murdoch University was employed. This enabled quantification of the Solarflow's unique and complex waveforms of the four key parameters: voltage, current, pressure and flow. The results of this testing are presented in this paper.

Drought across swathes of Australia, highlights our need for water conservation in addition to seeking new sources of water (demand and supply-side resource options). Water conservation or efficiency improvement is currently a non-systematic process along the lines of 'if we do such and such then we will save so much water'. Such an approach is ad-hoc and only has the appearance of being 'quantitative'. We would class it as qualitative, or maybe advanced qualitative water conservation. True quantitative or structured water auditing of non-domestic water consumption is an iterative, systematic and documented process of obtaining reliable use data, validated by a closure approach. Opportunities are identified for water use reduction, water reuse, recycling and for water resource substitution. Financial assessment of savings in cost against cost of measures will provide a payback period. A water management strategy or Water Management Plan (WMP) as it is known in Victoria, Australia, is devised which is consistent with legal requirements, the enterprise's environmental policy and its movement towards sustainable development. Regulators have legislated for mandatory WMPs and audits in Victoria, but this is the only state so far to do this. Mandatory water auditing should be an uncontested choice as it can only provide a win:win situation regulation to the private sector. We argue that only the systematic process provided by structural water auditing constitutes quantitative water conservation. Further, statutory obligation for water users to engage in the water auditing process will give the broad, systematic quantitative information, and based upon which optimal water management strategies or WMPs can be devised. This will ensure a rational approach to our future water needs and the needs of our environment. It is anticipated that voluntary auditing in the arenas not mandated will increase in the long term if this is done.

Using sub-surface dripline has several advantages over sprinklers, when irrigating with treated wastewater. However, sprinklers are still preferred for landscape irrigation in Western Australia (WA). A trial funded by the Water Corporation is currently being conducted in the Town of Northam. The trial will test the effectiveness of subsurface dripline for use with reclaimed water in municipal parks and gardens. This paper describes the methodology and indicates expected outcomes. The literature reviewed suggests that although subsurface dripline has limitations, it should effectively irrigate turf if care is taken to install and manage a system properly. Like any method of effluent irrigation, consideration must be given to the impacts of nutrients, salts, pathogens, and other potentially detrimental species in the water. Local councils in WA, and elsewhere, may gain information from the results, which will be useful when evaluating the option of using dripline for wastewater irrigation.

Integrated Urban Water Management (IUWM) in land developments is becoming increasingly necessary in order to more efficiently utilise and manage water resources. Techniques including the control of stormwater runoff, increasing infiltration and providing opportunities for retention, treatment and reuse of both stormwater and wastewater, are well suited to being designed into the development rather than considered post-construction or not at all. There can be extensive capital investment by developers to implement IUWM which is often not returned in the land sales. This produces a disincentive for the developer unless the contribution is recognised and rewarded either financially or with appropriate marketing advantage. A system to rate land developments based upon IUWM has been developed that would quantifiably assess how effectively water resources would be utilised in a proposed land development. This assessment would provide a point of comparison between developments allowing property purchasers, developers, utilities and legislators to quickly compare how well the development performs in terms of IUWM, providing a mechanism for financial reward or recognition. This paper discusses the development of a model to quantifiably assess land developments for water efficient use and introduces a rating system with which land developments can be compared in terms of IUWM.

In rural Costa Rica it is widespread practice to separate greywater from blackwater (toilet water), with only the blackwater connected to a septic system. The flow of untreated greywater directly into the environment is a cause of substantial environmental contamination and poses a significant health risk Low cost reedbeds for the treatment of domestic greywater in Monteverde, Costa Rica were developed in order to achieve affordable, low maintenance systems. A range of design and installation modifications relevant to the local environment were developed in order to achieve this objective as well as to meet the national guidelines for wastewater reuse. The use of PET plastic segments was found to be a viable alternative media to gravel and its potential as a readily available material which can significantly reduce the cost of reedbeds is described. This paper summarises the experience gained from over four years in terms of the design, installation, affordability, performance and maintenance of reedbeds for greywater treatment in the mountainous tropics of Central America.

The 'H2S test' is being advanced for microbiological water quality testing where conventional coliform based methods are impractical or too expensive. It involves ambient temperature incubation of water samples with nutrient formulated to generate hydrogen sulphide when 'faecal' bacteria are present. Recently a WHO review identified several concerns including the limited number of comparative studies, formulation variability, and false positives and negatives. In response we have compared the H2S test's ability to detect and quantify faecal contamination in an aquifer impacted by septic tank leachfields with measurements obtained concurrently using conventional bacterial indicators, coliphages, faecal sterol biomarkers, Cryptosporidium and Giardia. Like these other analytes, H2S testing detected a contamination gradient ranging from high (septic liquid) to moderate (exfiltration zones), to background (e.g. domestic bores), corresponding to indicator removal + dilution by factors >106. Presence/absence tests could not distinguish between heavily and slightly contaminated waters, whereas multi-tube testing (e.g. 10 10 mL arrays) did. It was concluded that while the WHO review concerns are justified, the H2S test performance shows promise in sanitary survey work, can be improved by employing an mpn approach and has potential to aid in the protection of source water and identifying contaminated groundwater.

Integrated Urban Water Management (IUWM) seeks to extend Water Sensitive Urban Design to a total water cycle approach that includes reuse of wastewaters. This paper investigates the appropriateness of environmental technologies for application at a cluster scale in IUWM. Many environmental technologies are economically or physically unsuited to use on a municipal or unit scale. Cluster scale is a middle ground that will allow such environmental technologies to achieve full potential. The concept of cluster scale and the application of environmental technologies at this scale are discussed along with some examples of suitable technologies.