Circumstances Of Exposure Research Articles

Video playback, affective witnessing, and the mobility of trauma: Video evidence of violent crime in the criminal justice system

In today's technologically mediated society, video is increasingly relied upon as an objective and reliable source of evidence in the investigation and prosecution of violent crimes. The now pervasive presence of violent video in the criminal justice system, however, presents new challenges for understanding repeated work-related exposure to and witnessing of potentially traumatic material and its impacts. Thus, this project seeks to qualitatively examine the relational affective processes that occur among criminal justice professionals when violent crimes are captured on video. We present four key categories organized around the circumstances of exposure and its impacts: 1) playback in the investigative and pre-trial process; 2) sharing videos among colleagues; 3) playing videos for victims, witnesses, and families and; 4) transmission in the broader public. Findings suggest this work involves deeply embodied processes where video evidence of violent crime enables a virtual presence at scenes and an emotional proximity to events through new forms of witnessing. These affective experiences are one relational dynamic that keeps witnessing active, thus expanding the mobility of trauma, its reach and potential impacts.

Integrated multi-biomarker responses in Mozambique tilapia, Oreochromis mossambicus under acute and chronic Diazinon® exposures

ABSTRACT The pesticide ecosystem impacts are very diverse, and depending on their persistence could exert their intrinsic toxicity within an acute to a chronic timeframe. This study examined the toxic effects of Diazinon on haematological and biochemical endpoints in Oreochromis mossambicus after chronic exposure. After a prior range fining test, fishes were exposed to predetermined diazinon concentrations (T1-0.906 mg/L) and (T2-1.812 mg/L) and sampled after 28 days for toxicity endpoints. In Diazinon-exposed fish, haemoglobin content, Total Red Blood Cells, Total White Blood Cells, and MCH levels were substantially lower (p < 0.05) than in the control fish group. The total blood glucose concentrations in treated fish were substantially greater (p < 0.05) than in the control group, whereas serum protein concentrations were significantly lower (p < 0.05). Observation for most biomarkers revealed patterns of decreasing values with increasing toxicant concentration and exposure duration. The integrated indices (IBR and BRI) indexes were used to provide visual and understandable depictions of toxicity effects and emphasised the relativity of biomarkers in terms of sensitivity and magnitude or severity of responses under graded toxicant exposures. In acute and chronic diazinon exposure circumstances, the analysed metrics show significant impairment to Oreochromis mossambicus.

Advances in Design and Development of High-Performance Super Alloys for Extreme Environments

This study centres on the current progressions in the domain of superalloy design and development, with a particular emphasis on their customization to endure the demanding conditions of highly challenging settings. The manuscript emphasises the importance of superalloys in diverse sectors, including aerospace, energy, and manufacturing, where materials are exposed to elevated temperatures and corrosive environments. The primary aims of this research encompass the investigation of innovative alloy compositions, techniques for microstructural engineering, and advanced methods of processing. The objective is to augment the mechanical strength, creep resistance, corrosion resistance, and overall durability of superalloys under circumstances of severe exposure. The manuscript emphasises the intricate nature of the problems encountered in this endeavour, highlighting the need of striking a balance between different material qualities in order to get the most favourable performance. In addition, the manuscript provides a concise overview of the paper’s methodology, which involves the use of sophisticated tools for characterising materials, computer modelling, and experimental verification. The potential of these novel high-performance superalloys to bring about a paradigm shift in industries that heavily rely on materials with the ability to endure severe circumstances is considerable. Superalloys offer enhanced qualities that can be advantageous in many applications, including as aerospace components, gas turbines, and petrochemical equipment.

Quantitative Assessment of Asbestos Fibers in Normal and Pathological Peritoneal Tissue-A Scoping Review.

Peritoneal tissue is the second most affected site by malignant mesothelioma linked to asbestos exposure. This scoping review aims to summarize the findings of the studies in which asbestos fibers in the peritoneum were quantified by electron microscopy, occasionally associated with spectroscopy, both in neoplastic and non-neoplastic tissue. The 9 studies selected comprised 62 cases, out of whom 100 samples were analyzed. Asbestos fibers were detected in 58 samples (58%). In addition, 28 cases had diagnosis of peritoneal mesothelioma. For 32 cases, a lung tumor sample was available: 28/32 samples analyzed presented asbestos fibers; 18/32 reported amphiboles with a range from not detected to 14.2 million fibers per gram of dry tissue (mfgdt); 18/32 reported chrysotile, with a range of 0 to 90 mfgdt. The studies were heterogeneous for type of samples, analytical technology, and circumstances of exposure to asbestos. To evaluate asbestos fibers in the peritoneum and to better understand the association between asbestos exposure and malignant peritoneal mesothelioma, it is desirable that the search for asbestos fibers becomes a routine process every time peritoneal tissue is accessible.

Comparison of agreement in asthmagen exposure assessments between rule-based automatic algorithms and a job exposure matrix in healthcare workers in Australia and Bhutan

Background:Assessment of occupational exposures is an integral component of population-based studies investigating the epidemiology of occupational diseases. However, all the available methods for exposure assessment have been developed, tested and used in high-income countries. Except for a few studies examining pesticide exposures, there is limited research on whether these methods are appropriate for assessing exposure in LMICs. The aim of this study is to compare a task-specific algorithm-based method (OccIDEAS) to a job-specific matrix method (OAsJEM) in the assessment of asthmagen exposures among healthcare workers in a high-income country and a low- and middle- income country (LMIC) to determine an appropriate assessment method for use in LMICs for future research.Methods:Data were obtained from a national cross-sectional survey of occupational asthmagens exposure in Australia and a cross-sectional survey of occupational chemical exposure among Bhutanese healthcare workers. Exposure was assessed using OccIDEAS and the OAsJEM. Prevalence of exposure to asthmagens and inter-rater agreement were calculated.Results:In Australia, the prevalence was higher for a majority of agents when assessed by OccIDEAS than by the OAsJEM (13 versus 3). OccIDEAS identified exposures to a greater number of agents (16 versus 7). The agreement as indicated by κ (Cohen’s Kappa coefficient) for six of the seven agents assessed was poor to fair (0.02 to 0.37). In Bhutan, the prevalence of exposure assessed by OccIDEAS was higher for four of the seven agents and κ was poor for all the four agents assessed (-0.06 to 0.13). The OAsJEM overestimated exposures to high-level disinfectants by assigning exposures to all participants from 10 (Bhutan) and 12 (Australia) ISCO-88 codes; whereas OccIDEAS assigned exposures to varying proportions of participants from these ISCO-codes.Conclusion:There was poor to fair agreement in the assessment of asthmagen exposure in healthcare workers between the two methods. The OAsJEM overestimated the prevalence of certain exposures. As compared to the OAsJEM, OccIDEAS appeared to be more appropriate for evaluating cross-country exposures to asthmagens in healthcare workers due to its inherent quality of assessing task-based determinants and its versatility in being adaptable for use in different countries with different exposure circumstances.

Analysis of qualification for post-exposure prophylaxis against rabies in children in Poland

ABSTRACT Background Rabies is a fatal disease caused by the rabies virus, usually transmitted by a bite by an infected animal. Because there is no effective treatment, prophylaxis is crucial. The aim of the study was to analyse the circumstances of exposure, characterise the animals that were a potential source of infection and evaluate the frequency of post-exposure prophylaxis in children. Methods This was a retrospective analysis of the medical records of 494 children who had been bitten, scratched or salivated on by an animal and were seen consecutively between 2015 and 2019 in the Department of Paediatric Infectious Diseases, Medical University of Warsaw. Results The study group was children aged 10 months to 17 years 11 months. The animals most commonly involved were dogs (347/494, 70.24%), cats (81/494 (16.40%) and squirrels (10/494, 2.02%). The contact was mainly with tame but unfamiliar animals (359/494, 72.67%, p < 0.001). The most common type of exposure was a bite (457/494, 92.51%). Surgical wound care was required most often after exposure in a town (64/90, 71.11%). A total of 412 children (80.83%) received post-exposure vaccination, including 333/412 using the Essen regimen. In 13/412 cases, the vaccination schedule (3.16%) was not completed because of an absence of signs of disease during veterinary observation of the animal. Anti-rabies immunoglobulin was administered to 13/412 (3.16%). Conclusion Most children who are referred after being bitten by an animal require post-exposure prophylaxis. Children are usually bitten by tame dogs with which they are unfamiliar, mostly on the hand. Surgical wound care is needed more often for urban patients than others.

A multi-analyte LC-MS/MS method for the determination of 57 pharmaceuticals and illicit drugs in plasma, and its application to poisoning cases

The diagnostic methods in an emergency scenario must be simple, fast, and efficient to provide an effectiveness and efficient treatment, thus reducing the consequences of exposure. Considering the sample analysis, the protein precipitation combined with LC-MS/MS has been shown to be a good strategy for the simultaneous determination of compounds of toxicological interest, such as medicines and drugs of abuse. In this study, a rapid and simple multi-analyte method was developed and validated for the quantification of 57 pharmaceuticals and illicit drugs in plasma samples. Sample pre-treatment consists of protein precipitation of 50 µL of the sample with 240 µL of organic solvent mixture (MeOH:ACN, 3:1, v/v), centrifugation, and injection into the LC-MS/MS, with a chromatographic run time of 7 min. The method was validated considering lower limit of quantification (LLOQ), interferences, linearity, precision, accuracy, dilution integrity, carryover, and matrix effect. The LLOQs ranged from 5 to 20 ng/mL and all analytes were linear (r2>0.99) in the tested concentration ranges. The method proved to be precise and accurate, presenting QC concentrations for all analytes within acceptable limits by the guideline used (CV % ≤20 % and bias ± 20 %). The developed method was successfully applied in 470 plasma samples of real cases of poisoning. A total of 80 % of the samples were positive for at least one substance, with acetaminophen (32.1 %), diazepam (25.1 %), and lidocaine (18.9 %) being the most detected. The most prevalent exposure circumstance among the cases was suicide attempt. The most frequent age groups were young adults between 20 and 29 years old and children under 5 years old. The methodology developed proved to be efficient in the simultaneous determination of 57 substances of toxicological interest, contributing to a correct diagnosis and, consequently, to the most appropriate management and treatment of the intoxicated patient. Furthermore, it is possible to observe the most commonly involved toxic agents in the Rio Grande do Sul, southern Brazil, helping to trace a profile of the poisoning patient, important in toxicovigilance actions.

Poisoning in older adults: characterization of exposures reported to the Dutch Poisons Information Center

Introduction: The annual number of patients > 65 years old about whom the Dutch Poisons Information Center (DPIC) was consulted has more than doubled in the last decade. We aimed to gain insight in the type and circumstances of exposures reported to the DPIC involving older patients, in order to help prevent future poisonings. Methods: Enquiries to the DPIC involving patients > 65 years old were prospectively included from January 2019 to June 2019. Data were collected on patient characteristics (e.g., age, gender, and living situation) and exposure characteristics (e.g., type and exposure scenario). Results: In the first half of 2019, the DPIC was consulted about 1051 patients > 65 years old. The median age of the patients was 77 years old (range: 66–104 years) and women were over-represented (61%). A total of 1650 different substances were reported, 1213 pharmaceutical exposures (74%) and 437 non-pharmaceutical exposures (26%), mostly household products (n = 162). Most pharmaceutical exposures involved cardiovascular agents (n = 367, 30%), central and peripheral nervous system agents (n = 354, 29%), and analgesics (n = 152, 13%). In 71% of the patients exposed to pharmaceuticals, the drugs were taken unintentionally (n = 471), frequently caused by medication errors made by the patients themselves (n = 357, 76%). Most common scenarios included inadvertently taken/given a double (n = 140, 30%) or more than double (n = 94, 20%) dose or the wrong medication (n = 124, 26%). The most common scenario for unintentional exposure to non-pharmaceuticals was “mistook product for food/drink” (n = 122, 37%). Conclusions: The majority of intoxications in older adults are accidental and often involve medication errors. Unintentional poisoning is often preventable. If patients are cognitively impaired, potentially harmful substances should be kept out of their reach and medication should only be administered under direct supervision. Clear labelling, simplified drug regimens and the use of automatic medication dispensers could reduce the risk of medication errors in older patients.

Reconstructing historical exposure to asbestos: the validation of 'educated guesses'.

In both the epidemiological and legal context, the causal attribution of asbestos-related lung diseases requires retrospective exposure assessment (REA). To assess the correlation between the retrospective assessment of occupational and anthropogenic environmental exposure to asbestos and its content in the lung tissue. Based on the available exposure information, a team of occupational physicians retrospectively assessed cumulative exposure to asbestos in 24 subjects who died of asbestos-related diseases. The asbestos lung content was analysed using analytical scanning electron microscope (SEM-EDS). The Log10 asbestos fibre count in the autoptic samples was predicted as a function of the Log10 estimated cumulative exposure using univariate regression analysis. The median count of asbestos fibres by grams of dry weight (ff/gdw) in the lung tissue was 81 339 (range 0-2 135 849.06); it was 287 144 (range 0-2 135 849.06) among the occupationally exposed, and 29 671 (range 0-116 891) among the subjects who only had anthropogenic environmental and/or household exposure. Amphiboles, and particularly amosite (52%) and crocidolite (43%), were detected in all the study subjects. Chrysotile was not detected in any of the samples. Overall, the retrospective estimate of lifetime cumulative exposure to asbestos showed a moderate correlation with the total asbestos fibre count in the autoptic lung, with the regression model explaining 38-55% of the total variance. Detailed information on occupational, environmental and household exposure circumstances would be indispensable for experienced industrial hygienists and/or occupational physicians to reliably assess past exposure to amphiboles or mixed types of asbestos.

Retrospective study of poisoned patients admitted to a hospital’s pediatric intensive care unit in Chile

Pediatric poisoning is a public health problem worldwide. The objective of this study was to establish the characteristics of pediatric cases of poisoning seen at the pediatric intensive care unit (PICU) of a hospital in Chile. The medical records of patients diagnosed with poisoning and admitted to the PICU between 2013 and 2017 were reviewed. A total of 105 cases were identified, who account for 3% of all admissions recorded in the study period. Patients' median age was 10 years. In total, 73.3% of cases were female patients; 51% of cases were associated with intentional poisoning; and 83% were caused by drug exposure. The most common drugs identified were antidepressants (11.2%) and non-steroidal anti-inflammatory drugs (10.7%). Intake was the most frequent route of exposure (93%). The average length of stay in the PICU was 1.3 days. One patient required intubation and another required hemodialysis in the PICU. Statistically significant relationships were established between patient sex and the circumstance of exposure and between the patient's psychiatric condition and the number of toxic substances ingested. Most poisoning cases seen at the PICU were intentional and occurred in female patients, who had a psychiatric condition. The most common drugs identified were antidepressants and non-steroidal anti-inflammatory drugs.

Subfertile patients underestimate their risk factors of reprotoxic exposure

BackgroundExposure of men and women to environmental reprotoxic agents is associated with impaired fertility and pregnancy rates after assisted reproductive treatment (ART). Nevertheless, such exposures are generally not systematically assessed in current practice before ART and subfertile men are generally less explored than women. Our objective was to study subfertile men and women’s level of knowledge about reprotoxic agents, their perception of their own risk factors and the correlation between perceived and identified circumstances of exposure.ResultsIn our public university hospital, 390 subfertile patients (185 men and 185 women) requiring assisted reproduction technique (ART) treatment, completed a self-report questionnaire before consultation, in order to assess patients’ knowledge of reprotoxic exposures, sources of information about them and perception of their own circumstances of exposure. Then a standardized questionnaire was used by the physician during the consultation to estimate domestic, environmental and occupational risk factors of reprotoxic exposures (RFRE). We compared the patients’ perception of exposure with the estimated RFRE.The reprotoxic agents knowledge score of patients was 61%. Their main sources of information were the media (40%), the internet (22%) and gynecologists (15%). The standardized questionnaire identified RFRE in 265/390 patients (68%); risk factor was statistically more frequent in men (77%) than in women (59%) (p < 0.05). In total, 141 of the 265 patients with identified RFRE (53%) were aware of their risk factor of reprotoxic exposure.ConclusionWe identified risk factors of reprotoxic exposures in the majority of subfertile patients, more frequently in men than in women, and half of patients were not aware of their exposures. Patients’ main sources of information were extra medical. Efforts should be made to inform patients, especially men, about potential reprotoxic exposure and to enhance medical training about reprotoxic agents, as recommended by international guidelines. The detection and correction of environmental exposures in subfertile men could improve their fecundity, but also their general health, which has been shown to be poorer than health of fertile men.

A review of the circumstances and health-seeking behaviours associated with bat exposures in high-income countries.

Human–bat interactions are now the source of the majority of locally acquired human lyssavirus infections in many high‐income countries without hematophagous or ‘vampire’ bat species. This study aims to identify the most common types and circumstances of bat exposures occurring among members of the general public in high‐income countries with no hematophagous bats, and to describe the health‐seeking behaviours associated with exposures in these settings. We conducted a scoping review of relevant academic and grey literature on bat exposures and confirmed bat lyssavirus infections among members of the general public in Australia, Canada, the United States and high‐income European countries from 1996 to 2019. Case studies and population‐based studies were included for analysis, and findings were extracted and synthesized by the literature type and geographic region. A total of 63 publications were identified, including: 47 case studies and 16 population‐based studies. Overall, most exposures in Australia and Europe were intentionally initiated by humans and involved attempts to handle, touch or help a bat. In North America, however, household exposures were more common and predominantly involved a bat being found in a room or area where a person had slept. Studies also showed that a proportion of bat exposures in high‐income countries go unreported in the absence of a public health investigation and are therefore unlikely to receive prompt treatment. The results of this review suggest that the most effective strategies for preventing bat exposures vary between regions and that health‐seeking behaviours following bat exposures could be improved in high‐income settings.

Multigenerational Insecticide Hormesis Enhances Fitness Traits in a Key Egg Parasitoid, Trichogramma chilonis Ishii

Hormesis for the intractable pests can be dreadful, but for natural enemies of pests, it is a puissant strategy in optimizing their mass rearing. We report multigenerational stimulatory effects of widely used insecticide, imidacloprid, on the demographic traits of an important egg parasitoid Trichogramma chilonis Ishii. The study investigated the consequences of sublethal (LC5), low lethal (LC30), and median lethal (LC50) concentrations, as well as a control, for five continuous generations (F1 to F5). The initial bioassay experiments revealed imidacloprid exhibiting the highest toxicity for the parasitoid with a LC50 of 2 µg·L−1, whereas LC5 and LC30 were 0.07 µg·L−1 and 0.6 µg·L−1, respectively. Among biological traits, compared to the F1 individuals, a substantial increase in the fecundity of T. chilonis was observed in the F5 individuals by 54.92% and 46.81% when exposed to LC5 and LC30, respectively (p &lt; 0.00001). Further, there was a significant enhancement in the adult longevity as well as oviposition days of the F5 individuals at both these concentrations. Considering the population traits, along with gross reproductive rate (GRR), net reproductive rate (R0) was also enhanced by both LC5 and LC30 in F5 individuals than F1; whereas the intrinsic rate of increase (r) and finite rate of increase (λ) were enhanced only at LC30 upon comparing with control. On the other hand, LC50 exposure to T. chilonis did not result in notable differences in biological or population traits when compared across generations (F1 and F5). Low and sublethal concentrations of imidacloprid did not have a major influence on demographic traits of T. chilonis at initial generations of exposure but can induce hormetic effects in the subsequent generations. Overall, imidacloprid-induced hormesis stimulating the development of T. chilonis might be helpful under circumstances of mild exposure of imidacloprid in fields and could be leveraged for its mass rearing.

Seniors and single-use detergent sacs (SUDS): a review of the National Poison Data System from 2012 to 2020

Introduction Exposure to single-use detergent sacs (SUDS), or laundry pods, have declined in the pediatric population between 2015 and 2018. Older adult exposures are less well described, and it is unclear if there is an increased risk of unintentional exposure to SUDS in older adults, especially in those with dementia. This study aims to review SUDS exposures in adults greater than 60-year-old between 2012 and 2020. Methods Using the National Poison Data System (NPDS), a query was performed for cases involving an acute single substance exposure with substance coded as “laundry detergent unit dose” (Generic code: 0201181, 0201182, and 0201183) in adults greater than 60-years-old between January 1, 2012 and December 31, 2020. Exclusion criteria included unknown age, age less than 60 years, any multi-substance exposure, and chronic or acute-on-chronic acuity. The distribution of cases was analyzed for demographics, exposure circumstances, management, clinical effects, and medical outcome. Results SUDS exposure reported to NPDS increased from 46 cases in 2012 to 219 cases in 2020. Among the 1289 total reported cases, 94.9% (n = 1223) were unintentional exposures with an average age of 75-year-old. The majority of exposures occurred in females (69%, n = 883). More than 1 exposure route was reported in 90 cases (7%), and the most common route of exposure was ingestion (64.9%, n = 836). Major effects were identified in 1% (n = 13) of exposures, and 0.5% (n = 7) of cases resulted in death. Conclusions Despite a declining incidence of pediatric SUDS exposure, older adult exposures have increased over 400% between 2012 and 2020.

Exposures to psycholeptics, psychoanaleptics, and cardiovascular drugs reported to the PIC erfurt during heat waves from 2003 to 2018

Psycholeptics, psychoanaleptics, and cardiovascular drugs alter individual tolerance to extreme heat. To explore the influence of heat waves on their toxicity in acute overdose, we retrospectively analyzed all human exposures to psycholeptics and psychoanaleptics (PLAexp) as well as cardiovascular drugs (CVDexp) registered by the Poisons Information Center (PIC) Erfurt between June to September of the years 2003 to 2018 for frequency, age groups, sex, circumstances of exposure, and symptom severity. The results of the non-heat years (NHY) 2004–2005 and 2007–2014 (average air temperature June-September 16.2 °C) were compared to the results of the heat years (HY) 2003, 2006 and 2015–2018 (average air temperature June-September 17.5 °C). In total, 13,191 cases (HY 5,117; NHY 8,074) of PLAexp and 2,960 cases (HY 1,168; NHY 1,792) of CVDexp were registered. During HY, accidental PLAexp (11.2% versus 9.7%) and CVDexp (40.6% versus 36.8%) were more often seen. Severe symptoms were less frequent in PLAexp (4.4% versus 6.3%) and CVDexp (3.3% versus 4.9%). Although in HY, no higher rates of moderate or severe PLAexp and CVDexp were detected than in NHY, patients with these medications should be observed carefully during heat waves because of affected body’s usual cooling mechanisms.

Performance of bond strength between ultra-high-performance concrete and concrete substrates (concrete screed and self-compacted concrete): An experimental study

Ultra-high-performance concrete (UHPC) is one of the contemporary overlay materials for repairing and retrofitting of reinforced concrete (RC) members. It possesses excellent compressive and tensile strength, as well as long durability. Nevertheless, the bonding performance between the overlay interface (UHPC) and the substrate concrete must be adequate under various loading, curing, and exposure circumstances. Therefore, this research examined, experimentally, the interfacial bonding behavior of UHPC overlay and two distinct substrates, namely concrete screed (CS) and self-compacted concrete (SCC). Four parameters impacting bond strength behavior, including three different substrate surface preparations, curing conditions, exposure environments, and testing techniques, were used to fulfill the goal of this study. The tests findings revealed that the substrate surface preparation and the exposure conditions had significant effects on the bond behavior of both UHPC-SC and UHPC-SCC while curing conditions seemed not to have any significant effects. The highest bond strength was obtained for specimens having sandblasted substrate preparation technique regardless of the bond test method. However, specimens tested under the bi-surface shear strength technique exhibited high bonding strength with the drill holes substrate preparation technique due to the presence of drilled holes that were being filled with UHPC. The splitting tensile test is a reliable test technique to examine the impact of repeated cyclic exposure samples. As a result of this, a substantial reduction in bond strength of nearly 32%, 55%, and 26% of the UHPC-SCC and 31.84%, 51.5%, and 41.42% for UHPC-SC interfaces for as-cast (AC), drilling hole (DH), and sandblasting (SB) substrate surface preparations, respectively, were obtained. ANOVA was carried out and found to be aligned with the experimental findings.

COPD in Firefighters: A Specific Event-Related Condition Rather than a Common Occupational Respiratory Disorder.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Smoking remains the most important risk factor, but occupational exposures may play an essential role as well. Firefighters are among occupations regularly exposed to a variety of irritative inhalational products, and they may be expected to develop respiratory health problems because of such an occupational exposure. To better understand and characterize this relationship, we performed an extensive search of the scientific literature, and we identified two major research areas: firefighters exposed to wildland fire smoke and firefighters involved in the World Trade Centre disaster-related operations. Most of the studies did not report a significant increase in COPD diagnosis in firefighters. An accelerated rate of decline in lung function was seen, a short time after major exposure events. This is the reason for an increased rate of exacerbations observed in individuals already diagnosed with obstructive respiratory disorders. A limited number of studies not covering these specific circumstances of exposure were found. They reported long-term morbidity and mortality data, and the results are controversial. Major confounding factors for most of the studies were the “healthy worker effect” and the lack of useful data regarding smoking habits. Efforts should be made in the future to better characterize specific biomarkers for the progression of COPD; to establish exposure limits; and to implement preventive strategies like rotation of workers, smoking cessation programs, and long-term monitoring programs for respiratory disorders.

Шестидесятилетие пилотируемых космических полётов в свете основных принципов обеспечения радиационной безопасности. Основные принципы в российских пилотируемых полётах. Часть 2 (в порядке дискуссии)

This article is the second of two interrelated ones, in which, in order to discuss from the point of view the basic principles of ensuring radiation safety, the 60-year evolution of the regulation of radiation safety of space flights (RSSF) and radiation safety in ground conditions is compared. The first article is devoted to the analysis of the implementation of basic principles in the recom-mendations of the ICRP and in Russian legislation. It is recognized that the principles played a positive methodological role, but at present the inclusion of their wording in legal and regulatory documents seems unnecessary to the author. In this article, a detailed analysis of documents regulating the RSSF and the implementation of the basic principles in them is carried out. It is concluded that the concept of risk is more fully used in relation to RSSF and even standards have been adopted for its calculation. It is argued that the arguments proposed to reduce dose limits for near-Earth flights contradict basic principles. The need for such a reduction is denied. It is proposed to carry out the planned changes of FL of RSP and NRS in relation to various conditions and circumstances of exposure, including to allocate RSSF in FL RSP as a special area of regulation.

An observational study of cannabis exposures reported to the Poison Information Helpline of the Western Cape

ABSTRACT Background: Cannabis has been decriminalised for private use in South Africa in September 2018. This act may potentially lead to an increase of undesirable effects from cannabis exposures. Objectives: To describe the demographics and characteristics of reported cannabis exposure cases from June 2015 to June 2019. Methods: This was a retrospective, observational, cross-sectional study of reported cannabis exposures reported to the Poisons Information Helpline of the Western Cape (PIHWC). Data included: demographics; circumstances of exposure; route of exposure; symptom profile and changes in the number of reports made to the PIHWC from June 2015 to June 2019. Results: A total of 106 database entries were identified. The most common age groups were 20–59 years old (52.8%) followed by under 12 years old (27.3%). There was a threefold increase in cases reported during the period 06/2018 – 06/2019, compared the period 06/2015 – 06/2016. Accidental overuse (40.6%), substance abuse (26.4%) and intentional self-harm (19.8%) were the most reported circumstances of exposure. The most common route of exposure was oral (66.0%) followed by inhalation (26.4%). Central nervous system (75.5%) and gastrointestinal (20.8%) symptoms were commonly reported. Central nervous system symptoms were more commonly reported in children 12 years and younger (p=0.001) compared to those over 12 years. Conclusion: During the study period undesired effects of cannabis were commonly reported after accidental exposures and oral ingestions. Children 12 years and younger are more likely to report neurological symptoms.

Physical Examination and Clinical Course of Poisoning and Drug Overdose

Poisoning refers to the development of dose-related adverse effects following exposure to drugs, chemicals, or other xenobiotics. To paraphrase Paracelsus, the dose creates the poison. Although most poisons have predictable dose-related effects, individual responses to a given dose may vary due to inhibition in the presence of other xenobiotics, genetic polymorphism, enzymatic induction, or acquired tolerance. Poisoning may be local (e.g. lungs, skin, eyes) or systemic depending on the route of exposure, the physical and chemical properties of the poison, and its mechanism of action. The reversibility and severity of poisoning also depend on the functional reserve of the target organ or individual which is influenced by preexisting disease and age. The history should include the route, duration, time, and circumstances (surrounding events, location, and intent) of exposure; the amount and name of each chemical, drug, or ingredient involved; the severity of symptoms, time of onset, nature of symptoms; the time and type of first-aid measures given; and the medical and psychiatric history. In most cases, the patient is unaware of exposure, confused, comatose, or unable or unwilling to admit to one. Suspicious circumstances include unexplained sudden disease in a previously healthy person or a group of healthy people; a history of psychiatric problems (especially depression); current changes in health, social relationships, economic status, or the onset of disease during work with chemicals or after ingestion of drink (especially ethanol), food, or medications. When patients become sick soon after arriving from a foreign country or being arrested for criminal activity, “body packing” or “body stuffing” (ingesting or concealing illicit drugs in a body cavity) should be suspected. Relevant information may be available from friends, paramedics, family, police, pharmacists, physicians, and employers, who should be queried regarding the patient’s, behavioral changes, habits, hobbies, available medications, and antecedent events. Patients have to be asked explicitly concerning their prescribed drugs and recreational medication use. Drugs previously considered “illicit” such as cannabinoids are now legal in many places and prescribed for therapeutic purposes. A search of belongings, clothes, and places of discovery may unveil a suicide note or a container of chemicals or drugs. Without an apparent history in a patient clinically suspected to be poisoned, all drugs available anywhere in the patient’s home or belongings should be considered as possible agents, including drugs for pets. The label on chemical products or the imprint code on drugs may be used to identify the potential toxicity of a suspected poison by consulting the manufacturer, a reference text, a computerized database, or a regional poison information center (800-222-1222). However, poisoning can mimic other illnesses, the correct diagnosis can usually be established by the history, physical examination, routine and toxicologic laboratory evaluations, and characteristic clinical course.