Greater Chicago Research Articles

Fish and Federalism: How the Asian Carp Litigation Highlights a Deficiency in the Federal Common Law Displacement Analysis

In response to the growing threat posed by the progress of Asian carp up the Mississippi River toward the Great Lakes, and with increased frustration with the federal response to the imminent problem, in 2010, five Great Lakes states sued the Army Corps of Engineers and the Metropolitan Water Reclamation District of Greater Chicago to force a more desirable and potentially more effective strategy to prevent the Asian carp from infiltrating the Great Lakes: closing the Chicago locks. This Note examines the federal common law displacement analysis through the lens of the Asian carp litigation. Both the Federal District Court for the Northern District of Illinois and the United States Court of Appeals for the Seventh Circuit denied the plaintiff States’ request for a preliminary injunction, but allowed the plaintiffs to proceed with their federal common law claim against the Army Corps of Engineers. While both the district court and court of appeals correctly determined that the plaintiff States’ federal common law nuisance claim was not displaced by congressional action and could thus continue to the merits stage, both courts failed to recognize the important and fundamental federalist function, i.e., exercising their sovereign function, that the states were performing in bringing their suit.

Caring behaviors can make a difference

The other day, a patient approached me with a concerned expression on her face. When I asked if I could help, she asked if she could talk to me privately. I directed her to one of our patient consultation areas and sat down to talk with her. She was concerned about her husband who has several chronic medical conditions including pain. She wanted my opinion regarding his medication regimen and advice about his pain meds. The other day, a patient approached me with a concerned expression on her face. When I asked if I could help, she asked if she could talk to me privately. I directed her to one of our patient consultation areas and sat down to talk with her. She was concerned about her husband who has several chronic medical conditions including pain. She wanted my opinion regarding his medication regimen and advice about his pain meds. Although this scenario is common in many pharmacies, it caused me to pause and think about my value to her and her husband. She said that she had switched to our pharmacy 6 years ago because she believed I was a caring and knowledgeable pharmacist. To be honest, I do not remember my early interactions with her or her husband, but something I said or did must have made a difference in their lives. ■Patients react positively to pharmacists who demonstrate empathy and care.■Good pharmacy leaders create a culture of caring within their practice. ■Patients react positively to pharmacists who demonstrate empathy and care.■Good pharmacy leaders create a culture of caring within their practice. Questions came to my mind. How do our patients perceive us? Why did they choose our practice instead of other pharmacies? I remembered the adage, “People don’t care how much you know until they know how much you care.” Perhaps it is the caring aspects of our behaviors that affect patients’ preferences for one pharmacist or pharmacy over another. I reviewed the literature to see what has been studied about caring behaviors of pharmacists and came across an interesting article published in the Journal of the American Pharmacists Association that provided me with some answers to my questions. ■The study observed caring pharmacists (as determined by their pharmacy managers) and identified caring behaviors demonstrated during interactions with patients.■Observation and interviews were used to assess caring attitudes of pharmacists who practiced in cor- porately owned community pharmacies in greater Chicago.■The following four categories of caring behaviors emerged:•Physical behaviors: pharmacists’ body language and reflection•Relationship behaviors: pharmacists’ interactions with patients•Task behaviors (nonpharmacy): helping patients find items or explaining their costs/receipts•Task behaviors (pharmacy): pharmacists’ counseling and education of patients■The pharmacy manager was essential in creating the caring culture of the pharmacy. This made a difference in how the pharmacy staff interacted or related to their patients.■Mentors were a powerful influence in developing caring pharmacists.■Caring pharmacists treated their patients holistically. They knew many of their patients by their first names. Patients were treated as individuals.■Caring pharmacists enabled their patients to take control of their health. As pharmacists make strides in reengineering their practices to provide medication therapy management (MTM) services, we must remember that patients respond favorably to pharmacists who demonstrate empathy and care. MTM services are just that—ser- vices. They alone do not provide care. Patients judge the quality of MTM services by the outward behaviors demonstrated by pharmacists during the MTM session. It is the patients’ perceptions that become their reality. They need to experience the caring behaviors of pharmacists in order to know that pharmacists do care about their health and that the pharmacists see them as unique individuals. Comprehensive MTM services focus on the entire patient— all medications and medical conditions. MTM is a great vehicle for pharmacists to demonstrate care to patients. Comprehensive MTM services focus on the entire patient—all medications and medical conditions. The Medication Action Plan provides patients with their own road map to achieve optimal benefits of their medications. By working with MTM pharmacists, patients are better-informed consumers of medications and are in more control of their medications and health outcomes. Last, pharmacy managers and supervisors should set an example for the rest of the staff. Good leaders create a culture of caring within their practice so that staff knows what is expected of them when interacting with patients. As more pharmacies and providers provide MTM services, patients will have a variety of choices for care. I am betting that they will choose those who they believe are the most caring.

Citizen science on a local scale: the Plants of Concern program

Plants of Concern, a program administered by the Chicago Botanic Garden, relies on citizen scientists to monitor rare plant populations in the greater Chicago, Illinois, region. Over 650 volunteers monitor 990 populations of 233 endangered, threatened, and rare plant species. Volunteers attend a day‐long workshop to learn a variety of monitoring techniques and also receive one‐on‐one mentoring in the field to help them apply the appropriate methodology for the species and sites they choose to monitor.

Development of a comprehensive plan for utilization of digester gas moves towards energy self-sufficiency in Chicago, USA

The Metropolitan Water Reclamation District (MWRD) of Greater Chicago's Stickney Water Reclamation Plant (SWRP) anaerobically digests approximately 430 dry tons per day (dtpd) (390 dry metric tons per day) of solids and produces 3.4 million ft(3)/day (96 thousand m(3)/day) of biogas from the anaerobic digesters, making it one of the largest municipal digester gas complexes in the world. Installation of new treatment processes, as well as future increases in flows and loads to the plant, are expected to significantly increase production of biologically degradable sludge and biogas. This paper presents a comprehensive planning study that was completed to identify and evaluate alternatives for utilization of this biogas. The best, sustainable approach was identified, taking into consideration economics, social impacts, and environmental impacts. The model results indicate that the most economically favorable scenario involves installing a cogeneration facility to produce electricity on-site, and operating it in conjunction with the plant's existing boilers to satisfy the heating needs of the plant. This scenario also provides the greatest reduction in GHG offsets at the power plants.

Wild Birds as Sentinels for Multiple Zoonotic Pathogens Along an Urban to Rural Gradient in Greater Chicago, Illinois

Wild birds are important in the maintenance and transmission of many zoonotic pathogens. With increasing urbanization and the resulting emergence of zoonotic diseases, it is critical to understand the relationships among birds, vectors, zoonotic pathogens, and the urban landscape. Here, we use wild birds as sentinels across a gradient of urbanization to understand the relative risk of diseases caused by three types of zoonotic pathogens: Salmonella pathogens, mosquito-borne West Nile virus (WNV) and tick-borne pathogens, including the agents of Lyme disease and human anaplasmosis. Wild birds were captured using mist nets at five sites throughout greater Chicago, Illinois, and blood, faecal and ectoparasite samples were collected for diagnostic testing. A total of 289 birds were captured across all sites. A total of 2.8% of birds harboured Ixodes scapularis--the blacklegged tick--of which 54.5% were infected with the agent of Lyme disease, and none were infected with the agent of human anaplasmosis. All infested birds were from a single site that was relatively less urban. A single bird, captured at the only field site in which supplemental bird feeding was practised within the mist netting zone, was infected with Salmonella enterica subspecies enterica. While no birds harboured WNV in their blood, 3.5% of birds were seropositive, and birds from more urban sites had higher exposure to the virus than those from less urban sites. Our results demonstrate the presence of multiple bird-borne zoonotic pathogens across a gradient of urbanization and provide an assessment of potential public health risks to the high-density human populations within the area.

A Case-Control Study of Severe Physical Abuse of Older Adults

To characterize the severity and outcome of traumatic injuries suffered by victims of elder abuse, describe the characteristics of the perpetrators, and identify risk factors associated with severe traumatic elder abuse. Case-control study. Two Level I trauma units in the greater Chicago, Illinois, metropolitan area. Forty-one cases of elder abuse resulting in severe traumatic injury were identified between 1999 and 2006. Controls were randomly selected from the list of elderly patients in the trauma registry (N=123). Elder abuse was defined according to the Illinois Elder Abuse and Neglect Act. In this study, 85% of the perpetrators were family members or intimate partners. In the final multivariable logistic regression model, victims of severe traumatic elder abuse were more likely to be female, to have a neurological or mental disorder, and to abuse drugs or alcohol. This is the first clinical case-control study detailing clinical outcomes and evaluating risk factors of persons suffering severe physical abuse. Of elderly trauma victims, those who are physically abused have more-severe injuries than their nonabused counterparts. More research is needed to better evaluate risk factors of physical abuse and effective interventions.

Integrating Core Wastewater Business Processes – Lessons Learned from Metropolitan Water Reclamation District of Greater Chicago

Integrating Core Wastewater Business Processes – Lessons Learned from Metropolitan Water Reclamation District of Greater Chicago

Assessing Surface Water Quality and Its Relation with Urban Land Cover Changes in the Lake Calumet Area, Greater Chicago

Urban land use and land cover change significantly affect spatial and temporal patterns of runoff, which in turn impacts surface water quality. With the exponential growth in urban areas over the past three decades, changes in land use and land cover to cater for the growth of cities has been a conspicuous spectacle in urban spaces. The main goal of this study was to assess the impacts of land cover change on runoff and surface water quality using a partial area hydrology framework. The study employed ArcHydro GIS extension and a modified version of Long-Term Hydrologic and Nonpoint Source Pollution model (L-THIA-NPS) in estimating runoff and nonpoint source pollutant concentration around Lake Calumet between 1992 and 2001. Data employed include National Land Cover Data set, rainfall data, digital elevation model (DEM), Soil Survey Geographic (SSURGO) data, and The United States Environmental Protection Agency's STORET (storage and retrieval) water quality data. The model was able to predict surface water quality reasonably well over the study period. Sensitivity analysis facilitated a manual calibration of the model. Model validation was executed by comparing simulated results following calibration and observed water quality data for the study area. The study demonstrates that the level of concentration of nonpoint source pollutants in surface water within an urban watershed heavily depends on the spatiotemporal variations in areas that contribute towards runoff compared to the spatial extent of change in major land use/land cover.

Four Years of Surveillance Cultures at a Long-Term Acute Care Hospital

To characterize the degree of colonization with multidrug-resistant organisms (MDROs) among patients admitted to a long-term acute care hospital. Ecologic study. A 70-bed long-term acute care hospital (a hospital within a hospital) in the greater Chicago area. As part of an infection control initiative, specimens were collected from all consecutively admitted patients for culture of MDROs within 72 hours of admission. Cultures from July 28, 2005, through November 1, 2008, were analyzed on the basis of the bodily site from which the isolate was recovered and the organisms identified. If MDROs were yielded by culture of specimens that were obtained from 24 hours to 30 days after collection of the patient's original set of specimens, these MDROs were removed from the analysis. In addition, repeat rectal swab samples were collected for culture at 2 weeks after admission for all consecutive patients admitted from January 1 through March 31, 2007. A total of 1,739 patients with a total of 5,198 specimens met entry criteria. Of the corresponding 5,198 surveillance cultures, 1,580 (30%) were positive for MDROs. Of the 1,739 patients, 947 (54%) had a culture-positive specimen recovered from any site. Vancomycin-resistant Enterococcus was the organism most commonly isolated in cultures of rectal swab samples (in 38% of such cultures) and wounds (in 18% of such cultures). The rate of rectal carriage of vancomycin-resistant Enterococcus increased from 29% in 2005 to 44% in 2008.

Improvising Chicago

Aldo Rossi's The Architecture of the City articulates how civic space intersects with collective agency: "One can say that the city itself is the collective memory of its people, and like memory it is associated with objects and places [. . .] The collective memory participates in the actual transformation of space in the works of the collective, a transformation that is always conditioned by whatever material realities oppose it" (130). Rossi's contention—that the development, or "transformation," of urban space is accomplished by a collective deploying memory in its struggle with material reality—is the scene of Stuart Dybek's southside Chicago in, The Coast of Chicago. Where this short story cycle deals with musical improvisation it dramatizes Rossi's contention by showing how memory not only resists "material realities"—in this case the demolition of southside neighborhoods initiated by Mayor Daley—and not only preserves ethnicity—especially the Polish and Chicano diasporas Dybek writes about—but also enables what Thomas S. Gladsky has called "a trans-ethnic urban America [. . .] a diverse cultural landscape where ethnicity transcends national origins but remains vital" (117). Dybek's ethnic self is a processual subjectivity, improvisatory rather than definitive, "based [less] on national origins [than] on a shared sense of ethnicity as a condition of Americanness" (Gladsky 115). In the story "Blight" characters inhabit a neighborhood where "the city was tearing down buildings for urban renewal and tearing up streets for a new expressway, and everywhere one looked there were signs in front of the rubble reading: sorry for the inconvenience / another improvement / for a greater Chicago / Richard J. Daley, Mayor" (44). Yet it is this demolition of monuments, this assault on what Rossi calls "the Locus" ("a relationship between a [. . .] specific location and the buildings that are in it" 103), this demonstration of the materiality of civic space that allows the characters to reawaken to the transformative potential of community: "It was the route we usually took to the viaduct, but since blight had been declared we were trying to see our surroundings from a new perspective" (45). Awakening to "new perspectives" as a result of civic "improvement" Dybek's characters cast off a determinate subjectivity and realize the action of the collective in the determination of civic reality. When the characters go to the viaduct off Douglas Park and begin improvising a "blues" by "slamming an aerial or board or chain off the girders, making the echoes collide and ring [. . .] clonk[ing] empty bottles and beer cans [. . .] shouting and screaming like [. . .] Howlin' Wolf" (48) they are joined by "a train [. . .] booming overhead like part of the song" (48)and by "a gang of black kids" at the other end of the viaduct who "stood harmonizing from bass through falsetto just like the Coasters, so sweetly that though at first [the characters] tried outshouting them, [they] finally shut up and listened, except for Pepper keeping the beat" (48). The fragments of the city are used to enable collectivity, to remember what the city is for. The attempt of civic authority to wrest memory from its inhabitants by making it impermanent, fragmentary, demolished, is precisely what restores agency by giving way to a subjectivity that is the scene of salvage. In this way communities become aware of their ability to define landscape, to alter "perspective" and take possession of space, to regard ethnicity as a common instrument, as if out of material destruction it might be possible to make of memory something more powerful than memorization, defying institutional permanence—civic or ethnic—for a community that is elastic, responsive, aware of its relationships with and within the spaces it inhabits.

Prevention of Bloodstream Infections by Use of Daily Chlorhexidine Baths for Patients at a Long-Term Acute Care Hospital

To evaluate the effect of bathing patients with 2% chlorhexidine on the rates of central vascular catheter (CVC)-associated bloodstream infection (BSI) at a long-term acute care hospital (LTACH). Quasi-experimental study. A 70-bed LTACH in the greater Chicago area. All consecutive patients admitted to the LTACH during the period from February 2006 to February 2008. For patients at the LTACH, daily 2% chlorhexidine baths were instituted during the period from September 2006 until May 2007 (ie, the intervention period). A preintervention period (in which patients were given daily soap-and-water baths) and a postintervention period (in which patients were given daily nonmedicated baths and weekly 2% chlorhexidine baths) were also observed. The rates of CVC-associated BSI and ventilator-associated pneumonia were analyzed for the intervention period and for the pre- and postintervention periods. The rates of CVC-associated BSI were 9.5, 3.8, and 6.4 cases per 1,000 CVC-days during the preintervention, intervention, and postintervention periods, respectively. By the end of the intervention period, there was a net reduction of 99% in the CVC-associated BSI rate. No changes were seen in the rates of ventilator-associated pneumonia during the preintervention and intervention periods. Daily chlorhexidine baths appeared to be an effective intervention to reduce rates of CVC-associated BSI in an LTACH.

Neighborhood geographical factors and the presence of advanced community pharmacy practice sites in Greater Chicago.

To determine the availability of experiential learning opportunities in culturally diverse areas and to identify opportunities and barriers to attract and sustain sites for the University of Illinois at Chicago College of Pharmacy. Utilizing variables of census tract income, racial/ethnicity composition and crime index, data analyses included descriptive statistics and multivariate logistic regression. Faculty members involved in experiential education were interviewed to identify other factors influencing site placement and selection for community-based advanced pharmacy practice experiences (APPEs). Median family income and Asian population were significantly higher and black population was significantly lower in census tracts with community APPE sites than in census tracts without APPE sites (p < 0.05). No significant differences were found in the population variables of white and Latino populations and crime index. The Asian population variable was the only significant predictor of an APPE site (p = 0.0148) when controlling for other variables. Distance from the College, pharmacy staffing issues, goodwill, influence of district and corporate managers, and strategic initiatives were critical considerations in site establishment and overall sustainability. Advanced community pharmacy practice sites were fairly well distributed across metropolitan Chicago, indicating that exposure to diverse populations during the advanced community practice experiences parallels with strategic College objectives of expanding and diversifying experiential sites to enhance pharmacy students' abilities to meet emerging patient care challenges and opportunities.

Assessing Breast Cancer Risk and Providing Treatment Recommendations: Immediate Impact of an Educational Session

The widespread availability of information regarding advancements in breast cancer care has heightened public awareness about risk and prevention, but there is limited knowledge as to the translation of these evolving advancements into physician practice patterns. The purpose of this study was to: (a) determine current practice patterns/treatment recommendations for evaluating patients at high-risk for breast cancer and (b) measure the immediate effect of an educational session on new knowledge acquired for high-risk patients. Five thousand and one health care provider surveys were sent to physicians in the greater Chicago area. The survey inquired about practice patterns and offered an opportunity to attend an educational session utilizing our "Spectrum of Care Options" framework. To evaluate session effectiveness, pre and post-tests were administered to participants. Of 767 survey respondents, 78 attended an educational session, 64 completed a pre and post-test, and 65 completed program evaluations. Pretest scores averaged 67.1% correct (range = 29-100%, SD = 15.8%) while post-test scores averaged 80.3% correct (range = 59-100%, SD = 11.0%), p < 0.0001. Participants rated the following on a 1-5 (poor to excellent) Likert scale (average scores): presentations 4.74, instructional materials 4.58, usefulness to practice 4.60, new knowledge gained 4.71, and likelihood of changing practice 4.49. Primary care physicians and surgeons are interested in identifying and treating high-risk patients, but may lack sufficient state-of-the art knowledge to do so. An educational session providing information on this subject, based on Spectrum of Care Options, significantly improved their knowledge and may influence their future practices.

Sustainable Technology for Achieving Very Low Nitrogen and Phosphorus Effluent Levels

This project addresses the successful nitrogen and phosphorus removal technologies being implemented at existing wastewater treatment plants (WWTPs), some key challenges and knowledge gaps in implementing technologies, research needs to improve the existing methods and technologies to achieve low total nitrogen (TN) and total phosphorus (TP) effluents (TN <5 mg/L and TP< 0.5 mg/L). Technology and cost assessment of successful technologies for TN and TP removal on a sustainable basis was accomplished by using a “threshold limit” approach to categorize technologies for different effluent TN and TP limits based on desired criteria. Membrane-based process applications were selected among advanced treatment processes for N and P removal from wastewater at pilot and lab scale technology demonstration studies. The investigations included membrane bioreactor application for N and P removal from wastewater, centrate treatment, and to achieve simultaneous nitrification and denitrification. The results indicated membrane based applications are attractive methods for achieving low TN and TP effluents, but supplementary chemical addition is needed depending on the wastewater characteristics. Full scale implementation of step feed BNR with chemical P removal was demonstrated as a successful technology transfer application at John Egan Wastewater Reclamation Plant of Metropolitan Water Reclamation District of Greater Chicago (MWRDGC). This title belongs to WERF Research Report Series . ISBN: 9781843397892 (eBook)

Does Preventive Care Save Money?

n engl j med 358;26 www.nejm.org june 26, 2008 2847 As mentioned by Myrianthefs et al. and Lima et al., acinetobacter can manifest as wound infections. As we noted, in one series of patients affected by a natural disaster, 20% of wounds were infected with acinetobacter; acinetobacter was also a common cause of infected wounds in the battlefield and burn injuries. Our experience in the greater Chicago area is that acinetobacter detected in wounds more frequently tends to be a contaminant than an actual pathogen. Nevertheless, in the majority of settings, the most common presentations are respiratory, urinary, and blood infections. L. Silvia Munoz-Price, M.D.

Sixty-five-year old final clarifier performance rivals that of modern designs

The Stickney plant of the Metropolitan Wastewater Reclamation District of Greater Chicago (MWRDGC), one of the largest wastewater treatment plants in the world, treats an average dry weather flow of 22 m3/s and a sustained wet weather flow of 52 m3/s that can peak to 63 m3/s. Most of the inner city of Chicago has combined sewers, and in order to reduce pollution through combined sewer overflows (CSO), the 175 km Tunnel and Reservoir Plan (TARP) tunnels, up to 9.1 m in diameter, were constructed to receive and convey CSO to a reservoir from where it will be pumped to the Stickney treatment plant. Pumping back storm flows will result in sustained wet weather flows over periods of weeks. Much of the success of the plant will depend on the ability of 96 circular final clarifiers to produce an effluent of acceptable quality. The nitrifying activated sludge plant is arranged in a plug-flow configuration, and some denitrification takes place as a result of the high oxygen demand in the first pass of the four-pass aeration basins that have a length to width ratio of 18:1. The SVI of the mixed liquor varies between 60 and 80 ml/g. The final clarifiers, which were designed by the District's design office in 1938, have functioned for more than 65 years without major changes and are still producing very high-quality effluent. This paper will discuss the design and operation of these final clarifiers and compare the design with more modern design practices.

IT Strategic Planning: Creating the Path for a Sustainable Business A Case Study from the MWRD of Greater Chicago

IT Strategic Planning: Creating the Path for a Sustainable Business A Case Study from the MWRD of Greater Chicago

Stream Response to Phosphorus Reduction at the Metropolitan Water Reclamation District of Greater Chicago's John E. Egan Plant

Stream Response to Phosphorus Reduction at the Metropolitan Water Reclamation District of Greater Chicago's John E. Egan Plant

Asthma morbidity and treatment in the Chicago metropolitan area: one decade after national guidelines

A number of studies have demonstrated disproportionate hospitalization and mortality rates in US urban areas. Yet, no published population-based studies have examined the burden of asthma on the residents of a particular urban area known to be at high risk for poor asthma outcomes. To examine asthma morbidity and medical care in a population-based sample of adults and children with asthma residing in the greater Chicago, IL, metropolitan area and to explore social and demographic influences on morbidity and treatment. A telephone survey of adults living in the Chicago metropolitan area was conducted from November 1999 through December 2000. The final sample included 152 adults and children with active asthma. Emergency department visits and hospitalizations for asthma in the previous year were reported by 25.7% and 6.6% of respondents, respectively. Of current medication users, 32.2% reported current regular use of controller medications. After adjusting for age, sex, income, education, and reported current pharmacotherapy, compared with white individuals, African American individuals remained 6.3 times more likely to have experienced an emergency department visit and 12.3 times more likely to have been hospitalized. These findings suggest that poorly controlled asthma remains a prevalent problem for persons with asthma in this metropolitan area and that a large gap remains between the goals of asthma therapy and appropriate treatment as defined by the National Asthma Education and Prevention Program. The reasons for disparate treatment and health outcomes by race/ethnicity and income need further study and intervention.

Are Electronic Conferences a Solution in Search of an Urban Problem?

This article briefly reviews initiatives that have attempted to create communities of educators using Web-based, electronic conferencing. The authors critically analyze the advocacy for electronic communication as a medium for bringing educators together across time and distance with an emphasis on what is known about urban schools, access to Internet connections, and teachers’workloads. Although not a research report, the analysis is grounded in 4 years of ongoing research and development of the Novice Teacher Support E-mentoring Project and in the evaluation of the expansion of this concept to institutions in the Greater Chicago area. The authors raise questions about the role of technology and the intensification of expectations of urban educators.