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.

The World Health Organization estimates that globally one billion people are without access to safe water and two billion people without adequate sanitation. The health consequence of such a situation is very serious and demands urgent appropriate action.

The centralised system, which is still promoted all over the world, will not help in providing water and sanitation for all as it depends on huge financial and technological resources that are often not available. The International Conference on Decentralised Water and Wastewater Systems held in Fremantle, Western Australia in July 2006 (organised by the Environmental Technology Centre at Murdoch University) promoted decentralised systems as a means of solving this problem. All the papers submitted at the conference underwent a review process. This book brings together a selection of papers presented at the conference.

Perth, Western Australia’s largest city is under increasing pressure to implement a more sustainable means of water supply and use. The coastal city is expanding rapidly in both population and geographical size (EPA, 2005), while annual rainfall is variable and gradually decreasing (WC, 2005). On top of the supply issues Perth is continuing to implement a centralised approach to wastewater sanitation, which combines many wastewater streams before treatment and disposal to ocean outfall (EPA, 2005). This creates an open cycle system that has many sustainability issues including inefficient use of potable water supplies, loss of freshwater resources and nutrients, pollution of the receiving water bodies, as well as the need for high energy infrastructure (Ho and Anda, 2004). In response to Perth’s water supply concerns the Western Australian Government implemented a State Water Strategy in February 2003. Part of this strategy was to create a Premiers Water Foundation to support research and development projects that investigate water conservation and reuse. A project titled “Demonstration of Decentralised Wastewater Recycling in Urban Villages” was funded by the foundation and aims to achieve a number of demonstration projects and research studies. This technical report is the second of three reports within Premiers Water Foundation project and is focused on technical requirements associated with decentralised wastewater recycling. The aim of the research study is to investigate the technical requirements and technologies (technical elements) associated with the successful implementation of an urban village wastewater recycling system within the PMR, for which a model can be formulated to create reliable management systems and improved protection of public health and the environment.