Common Exposure Research Articles

HoneyCar: A Framework to Configure Honeypot Vulnerabilities on the Internet of Vehicles

The Internet of Vehicles (IoV), whereby interconnected vehicles that communicate with each other and with road infrastructure on a common network, has promising socio-economic benefits but also poses new cyber-physical threats. To protect these entities and learn about adversaries, data on attackers can be realistically gathered using decoy systems like honeypots. Admittedly, honeypots introduces a trade-off between the level of honeypot-attacker interactions and incurred overheads and costs for implementing and monitoring these systems. Deception through honeypots can be achieved by strategically configuring the honeypots to represent components of the IoV to engage attackers and collect cyber threat intelligence. Here, we present HoneyCar, a novel decision support framework for honeypot deception in IoV. HoneyCar benefits from the repository of known vulnerabilities of the autonomous and connected vehicles found in the Common Vulnerabilities and Exposure (CVE) database to compute optimal honeypot configuration strategies. The adversarial interaction is modelled as a repeated imperfect-information zero-sum game where the IoV network administrator strategically chooses a set of vulnerabilities to offer in a honeypot and a strategic attacker chooses a vulnerability to exploit under uncertainty. Our investigation examines two different versions of the game, with and without the re-configuration cost, to empower the network administrator to determine optimal honeypot investment strategies given a budget. We show the feasibility of this approach in a case study that consists of the vulnerabilities in autonomous and connected vehicles gathered from the CVE database and data extracted from the Common Vulnerability Scoring System (CVSS).

Road salt is more toxic to wood frog embryos from polluted ponds

Organisms that rely on aquatic habitats in roaded landscapes face a growing array of consequences from pollution, especially due to freshwater salinization. Critically, these consequences can vary from population to population depending on exposure histories and evolutionary responses. Prior studies using transplant and common garden experiments have found that aquatic-stage wood frogs (Rana sylvatica) from roadside populations are less fit in the wild and more sensitive to road salt than their counterparts from woodland populations away from roads. While this pattern is consistent with local maladaptation, unresolved insights into the timing and duration of these effects leave open the possibility that negative outcomes are countered during development. Here, we asked whether the survival disadvantage of roadside wood frogs is stage-specific, and whether this disadvantage reverses before metamorphosis. We used a common garden road salt exposure experiment and a field-based reciprocal transplant experiment to examine differences in survival across life-history stage and with respect to population type. In each experimental context, roadside embryos showed a survival disadvantage relative to woodland embryos, and this disadvantage was not reversed prior to metamorphosis. We also found that salt exposure delayed metamorphosis more strongly for roadside than woodland populations. Together, these results suggest that local maladaptation in aquatic-stage wood frogs is driven by embryonic sensitivity to salt and that roadside populations are further compromised by delayed developmental rates. Future studies should consider which embryonic traits fail to adapt to salt toxicity, and how those traits might correlate with terrestrial trait variation.

Determination Of Arsenic In Minor Cereals (Barley, Foxtail Millet, Proso-Millet, Finger- Millet, Pearl -Millet, Buckwheat. Oat, Quinoa And Sorghum) In Gazipur, Bangladesh

Cereal grains are the most important source of the world’s total food and also the major accumulator of toxic arsenic. Arsenic distributes in the environment via contaminated ground water which is used as drinking water and irrigated in the crop field. Chronic arsenic toxicity can be lethal for liver, kidney, bladder, lung, skin. Skin hyperpigmentation and hyperkeratosis are common exposure related phenotypes. Therefore, it's high time to produce ideal cereals that must contain a lower amount of arsenic and ensure safety for all kinds of lives. Ensuring safe food is one of the objectives of sustainable development goal-2 (SDG-2). With this view in mind, the Plant Breeding Division of BARI currently working with nine minor kinds of cereal included Barley, Foxtail millet, Proso-millet, Finger-millet, Pearl-millet, Buckwheat, Oat, Quinoa, and BARI-Sorghum 1 were undertaken for biochemical analysis of arsenic on their leaves. The biochemical analysis of these nine kinds of minor cerealsshowed negligible amount of arsenic on leaves. Further analysis in other location in Bangladesh might bring the overall picture of arsenic uptake in minor cereals.

Analysis of Consumer Exposure Cases for Alcohol-Based Disinfectant and Hand Sanitizer Use against Coronavirus Disease 2019 (COVID-19).

The development and distribution of vaccines and treatments as well as the use of disinfectants and hand sanitizers to cope with coronavirus disease 2019 (COVID-19) infection has increased rapidly. As the use of disinfectants and hand sanitizers increased, the number of unintended exposures to these substances also increased. A total of 8016 cases of toxic exposure to disinfectants and hand sanitizers were reported to the American Association of Poison Control Centers (AAPCC) from 1 January 2017 to 30 May 2021. The cases have been characterized by substance, sex, patient age, exposure reason and site, treatments received, and outcomes. The number of exposures correlates closely to the rise of COVID-19 cases, rising significantly in March 2020. About half of the total cases involved children less than 10 years old and 97% of those exposures per year were unintentional. In addition, the most common exposure site was the patient’s own residence. Over-exposure to disinfectants and hand sanitizers can cause symptoms such as burning and irritation of the eyes, nose, and throat, coughing, chest tightness, headache, choking, and, in severe cases, death.

Maternal Common Cold or Fever During Pregnancy and the Risk of Orofacial Clefts in the Offspring: A Systematic Review and Meta-analysis.

The common cold and/or an associated fever during pregnancy have/has been suspected to harm the developing fetus. We sought possible correlations between a maternal common cold or fever during pregnancy and the risk of orofacial clefts in the offspring. We systematically searched PubMed and Embase using appropriate keywords, and we checked the reference lists of retrieved articles. We used random-effects models to estimate overall relative risks. Incidence of orofacial clefts. We included 13 case-control studies. Modest but statistically significant associations were found between a maternal common cold and cleft lip with or without a cleft palate (CL/CP) (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.66–2.83) and a cleft palate only (CPO) (OR 3.08; 95% CI 1.5–6.34). Furthermore, maternal fever was also associated with an increased risk of CL/CP (OR 1.91, 95% CI 1.3–2.8) and CPO (OR 1.48, 95% CI 0.83–2.63) in the offspring. Further analyses of maternal influenza (alone) yielded similar results. Although evidence of heterogeneity should be carefully evaluated, our findings suggest that maternal common cold or fever during pregnancy may be associated with a greater risk of CL/CP or CPO in the offspring. Future cohort studies using valid assessments of maternal common cold exposure during pregnancy that consider the severity of fever are needed to clarify the contribution of maternal common cold or fever status to the risk of orofacial clefts in children.

Targeted walking training of patients in the early recovery period of cerebral stroke (preliminary research)

Background: Currently, training of the gait function for patients with cerebral stroke using the biofeedback technology is an independent, effective, and promising method. The most common training and exposure parameters are the gait speed, cycle length, and cadence. However, the application of basic and more complex types of selective training using wearable sensor technology is rare due to the technological complexity of their use for biofeedback.
 Aims: To study the possibility of using the biofeedback training technology with a targeted effect on one of the basic parameters characterizing the symmetry of walking, the duration of the support period, in patients in the early recovery period of cerebral stroke.
 Methods: We examined 12 patients who underwent a course of biofeedback training to harmonize the period of support during the early recovery period of hemispheric cerebral stroke in the middle cerebral artery basin. The biomechanics of voluntary walking was investigated before and after the training. The spatio-temporal parameters of walking, kinematics of movements in the hip, knee, and ankle joints, and the maximum EMG amplitudes of the main muscle groups responsible for walking were recorded. The classical clinical scales were also used. The biofeedback training on a treadmill consisted of 10 sessions; the duration of the support period was the training parameter.
 Results. As a result of the treatment, a significant improvement was noted according to the UpGo clinical scale and Hausers walking index. The differences in the trained support phase after the treatment are not significant and demonstrate positive changes. The kinematics of movements in the joints also demonstrates relatively small, but significant changes for the knee joint. For the hip joint, no dynamics in the parameters values is observed; the joint function does not change significantly, and the amplitude asymmetry remains unchanged. For the knee joint, the greatest dynamics is observed for the main swing amplitude and its phase.
 Conclusion: The study has shown that the purposeful biofeedback training of the gait function using the support period to reduce the functional asymmetry in this parameter, and also has a positive effect on other gait parameters.

418. Low Frequency of Healthcare Worker Infections Following Occupational Exposures to COVID-19

BackgroundData on occupational acquisition of COVID-19 in healthcare settings are limited. Contact tracing efforts are high resource investments. MethodsDuke Health developed robust COVID-19 contact tracing methods as part of a comprehensive prevention program. We prospectively collected data on HCW exposures and monitored for development of symptomatic (SYX) and asymptomatic (ASYX) COVID-19 infection after documented high-, medium, and low-risk exposures. HCWs were required to self-report exposures or were identified through contact tracing as potentially exposed to COVID-19 positive HCWs, patients or visitors. Contact tracers interviewed exposed HCWs and assessed the risk of exposure as high-, medium-, or low-risk based on CDC guidance (Table 1). Testing was recommended at 6 days after high- or medium-risk exposures and was provided upon HCW request following low-risk exposures. Our vaccination campaign began in 12/2020. Results12,916 HCWs registered in the contact tracing database. From March 2020-May 2021, we identified 6,606 occupational exposures (0.51 exposures/HCW). The highest incidence of workplace exposures per number of HCWs in each job category was among respiratory therapists (RT) (0.95 exposures/RT), nursing assistants (NA) (0.79 exposures/NA), and physicians (0.64 exposures/physician). The most common exposure risk level was medium (51.4%), followed by low (35.5%), and then high (13.1%). A total of 260 (2%) HCW had positive tests/conversions; 28 (10.8%) were ASYX at the time of testing. High-risk exposures had a significantly greater number of post-exposure infections compared to medium- and low-risk exposures (12.5% vs. 4.2%, vs. 0.4%; p < 0.001). The rate of SYX infection following exposure to a fellow HCW (179/3,198; 5.6%) was higher than that following exposure to a patient (81/3,408; 2.4%; p< 0.001). ConclusionConversion following exposure to COVID-19 in the healthcare setting with appropriate protective equipment was low. Incomplete testing of all exposed individuals was a limitation and our data may under-estimate the true conversion rate. Our findings support our local practice of not quarantining HCWs following non-household exposures. Limiting contact tracing to only high or medium risk exposures may best utilize limited personnel resources. Disclosures Rebekah W. Moehring, MD, MPH, UpToDate, Inc. (Other Financial or Material Support, Author Royalties)

A Strong Evidence Outbreak of Salmonella Enteritidis in Central Italy Linked to the Consumption of Contaminated Raw Sheep Milk Cheese.

Salmonellosis is the second most commonly reported gastrointestinal infection in humans after campylobacteriosis, and an important cause of foodborne outbreaks in the EU/EEA. The vast majority (72.4%) of the salmonellosis foodborne outbreaks reported in EU in 2019 were caused by Salmonella Enteritidis, even if their total number due to this serovar decreased. In spring 2020, a foodborne outbreak of S. Enteritidis occurred in the Marche region (Central Italy), involving 85 people. The common exposure source was a cheese, pecorino “primo sale”, produced with raw sheep milk. The cheese batches were produced by two local dairies, with a livestock production facility, also including a sheep farm, being part of one dairy. Bacteriological analysis of samples collected allowed the detection of S. Enteritidis in animal faeces, environmental samples, raw-milk bulk tanks and milk taken from single animals. These data confirm that, despite the scarce scientific evidence, S. Enteritidis can infect sheep and be shed into the animals’ milk. Hence, this is a real risk for public health when unpasteurized milk is used in production of such cheese. The present paper describes the results of the investigations conducted to clarify this outbreak.

Concentrated Commonalities and Systemic Risk in China’s Banking System: A Contagion Network Approach

Chinese banking system has seen increasing convergence in exposures to different asset types. This concentrated commonalities have far reaching implications on systemic financial risk. By subdividing banks' assets on their balance sheets into 20 types, we construct a bipartite financial network using China's data in 2019 and 2020. A linear model is proposed to measure each bank's systemic importance (SI) and indirect vulnerability (IV), and the contagion strength between pair-wise banks (C), with respect to exogenous shocks originated from different sectors of the real economy. Results show that (1) concentrated common exposure to mortgage is demonstrated to be the most significant source of systemic vulnerability; (2) the derived contagion network shows the property of ``small world, which plays an important role in generating systemic risk, amplified non-linearly by multi-rounds of contagion; (3) Agricultural Bank of China along with seven other banks are identified as systemic important, Guangdong Development Bank as well as five other regional banks are suggested to be vulnerable, and Postal Savings Bank of China and China Construction Bank are critical nodes in transmitting risks. These findings contribute to more efficient and preciser macro prudential regulations.

Swimming Pool-Related Outbreak of a Rare gp60 Subtype of Cryptosporidium hominis, England, October 2016

In October 2016, Public Health England was initially notified of four cases of cryptosporidiosis among users of two swimming pools. We investigated to identify further cases, the outbreak source, and ensure the implementation of appropriate control measures. Probable primary cases had diarrhoea and reported swimming in the pools 1–12 days prior to illness; confirmed cases were verified by the reference laboratory. Secondary cases had contact with primary cases 1–12 days prior to illness. We identified twenty-two cases: eleven were primary (eight confirmed) and eleven were secondary (five confirmed). Four cases were infected with C. parvum (different gp60 subtypes); all were primary and swam at two pools. Seven primary and secondary cases were infected with C. hominis gp60 subtype IdA16, and all were associated one pool. Failings in pool water treatment and management were identified that likely contributed to the load on the filters and their efficiency. Our investigation identified a complex outbreak, with secondary transmission, involving exposures to two swimming pools. C. hominis IdA16 is rare; it has been isolated from only three previous UK cases. We hypothesize that C. hominis cases arose from a common exposure, and the C. parvum cases were likely sporadic. This investigation highlights the value of integrating epidemiology and microbiology to investigate clusters of Cryptosporidium cases, defining the extent of the outbreak and the likely transmission pathways.

Glial cell-derived neurotrophic factor decrease may mediate learning, memory and behavior impairments in rats after neonatal surgery

Patients who have surgery during the first few years of their lives may have an increased risk of behavioral abnormality. Our previous study has shown a role of glial cell-derived neurotrophic factor (GDNF) in neonatal surgery-induced learning and memory impairment in rats. This study was designed to determine whether neonatal surgery induced hyperactive behavior in addition to learning and memory impairment and whether GDNF played a role in these changes. Postnatal day 7 male and female Sprague-Dawley rats were subjected to right common carotid arterial exposure under sevoflurane anesthesia. Their learning, memory and behavior were tested from 23 days after the surgery. GDNF was injected intracerebroventricularly at the end of surgery. Surgery reduced GDNF expression in the hippocampus. Surgery impaired learning and memory and induced a hyperactive behavior as assessed by Barnes maze, fear conditioning and open field tests. In addition, surgery reduced dendritic arborization and spine density. The effects were attenuated by GDNF injection. These results suggest that surgery induces a hyperactive behavior pattern, impairment of learning and memory, and neuronal microstructural damage later in the lives in rats. GDNF reduction may mediate these surgical effects.

Enhancing the use of exposure science across EU chemical policies as part of the European Exposure Science Strategy 2020–2030

BackgroundA scientific framework on exposure science will boost the multiuse of exposure knowledge across EU chemicals-related policies and improve risk assessment, risk management and communication across EU safety, security and sustainability domains.ObjectiveTo stimulate public and private actors to align and strengthen the cross-policy adoption of exposure assessment data, methods and tools across EU legislation.MethodsBy mapping and analysing the EU regulatory landscape making use of exposure information, policy and research challenges and key areas of action are identified and translated into opportunities enhancing policy and scientific efficiency.ResultsIdentified key areas of actions are to develop a common scientific exposure assessment framework, supported by baseline acceptance criteria and a shared knowledge base enhancing exchangeability and acceptability of exposure knowledge within and across EU chemicals-related policies. Furthermore, such framework will improve communication and management across EU chemical safety, security and sustainability policies comprising sourcing, manufacturing and global trade of goods and waste management. In support of building such a common framework and its effective use in policy and industry, exposure science innovation needs to be better embedded along the whole policymaking cycle, and be integrated into companies’ safety and sustainability management systems. This will help to systemically improve regulatory risk management practices.SignificanceThis paper constitutes an important step towards the implementation of the EU Green Deal and its underlying policy strategies, such as the Chemicals Strategy for Sustainability.

Long-Term Exposures to Urban Noise and Blood Pressure Levels and Control Among Older Adults.

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Mental health problems among healthcare workers involved with the COVID-19 outbreak.

Objective:The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers’ mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems.Methods:A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19.Results:The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001).Conclusion:The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.

ACUTE PULMONARY HISTOPLASMOSIS: A DIAGNOSTIC DILEMMA DURING COVID-19 PANDEMIC

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute histoplasmosis is usually a concern in immunocompromised individuals. In immunocompetent patients, histoplasmosis is generally mild or asymptomatic unless there is inhalation of a large inoculum. Below, we present a case of severe acute pulmonary histoplasmosis in an otherwise healthy, immunocompetent person and discuss the diagnostic challenges it presented during the COVID-19 pandemic. CASE PRESENTATION: A 30-year-old non-smoking Caucasian man with hypertension presented to our hospital with 1 week duration of headache, dyspnea, productive cough and high fever. He was admitted with a provisional diagnosis of COVID-19 pneumonia and started on dexamethasone and empiric antibiotics. He had elevated inflammatory markers. Chest x-ray showed diffuse bilateral interstitial and alveolar opacities. CT chest demonstrated numerous clustered ground glass nodular opacities bilaterally with mediastinal and hilar adenopathy. Subsequently, RT-PCR for SARS-CoV2 returned negative. The patient continued to deteriorate clinically over the next few days. Repeat imaging showed diffuse micronodules with mediastinal adenopathy. Upon further questioning, the patient recalled demolishing a chimney at his parents' house in Michigan 2 weeks prior to admission. The differential diagnosis was broadened to include acute hypersensitivity pneumonitis and fungal infection. BAL, transbronchial biopsies and EBUS-TBNA was performed while escalating steroids. The lung biopsy confirmed Histoplasma. Urine Histoplasma antigen returned positive. The patient was treated with itraconazole with an overlap of steroids for 2 weeks upon discharge. He was readmitted within a week with worsening hypoxia and worsening infiltrates on lung imaging. He was then treated with liposomal amphotericin with gradual clinical improvement. Follow-up 1 month post discharge revealed complete clinical and radiologic resolution. DISCUSSION: Viral pneumonia and acute pulmonary histoplasmosis have overlapping clinical and radiologic features which can make diagnosis challenging. COVID-19 pneumonia typically presents with peripheral ground glass opacities with or without superimposed consolidations. Invasive fungal pneumonia can have a similar appearance on CT usually with additional findings of hilar and mediastinal adenopathy. CONCLUSIONS: This case highlights the challenges involved in diagnosing acute pulmonary histoplasmosis in an immunocompetent individual in the midst of the pandemic. Clinicians should always maintain a wide differential diagnosis to avoid diagnostic delay. REFERENCE #1: Staffolani, S., Buonfrate, D., Angheben, A., Gobbi, F., Giorli, G., Guerriero, M., Barchiesi, F. (2018). Acute histoplasmosis in immunocompetent travelers: A systematic review of literature. BMC Infectious Diseases, 18(1). doi:10.1186/s12879-018-3476-z REFERENCE #2: Duzgun, S. A., Durhan, G., Demirkazik, F. B., Akpinar, M. G., & Ariyurek, O. M. (2020). COVID-19 pneumonia: the great radiological mimicker. Insights into imaging, 11(1), 118. https://doi.org/10.1186/s13244-020-00933-z REFERENCE #3: Klein, M., Khan, M., Salinas, J. L., & Sanchez, R. (2019). Disseminated pulmonary histoplasmosis in immunocompetent patients: A common epidemiological exposure. BMJ Case Reports, 12(3). doi:10.1136/bcr-2018-227994 DISCLOSURES: No relevant relationships by Joseph Arguinchona, source=Web Response No relevant relationships by Michael Kaster, source=Web Response No relevant relationships by Muazzam Mirza, source=Web Response No relevant relationships by Anusha Pinjala, source=Web Response no disclosure on file for Venketraman Sahasranaman;

A construction for the prediction of noise-induced annoyance in the presence of auditory masking

There is a large amount of evidence to suggest that people’s reactions to annoying sounds are moderated by the presence of other background sounds. One of the mechanisms of this moderation is auditory masking: when the annoying sound simply cannot be heard over the background. This presentation outlines a construction for computing a predictor of annoyance in the presence of masking. The construction is demonstrated by producing an augmentation of the common sound exposure level noise metric using one-third octave band data sampled at 2 Hz. These data allow an estimation of the probability of masking within each band at each time step. The acoustic energy within a masked band can be ‘discounted’ by this estimation before being summed in the usual equal-energy way and with the typical A-weighting corrections. In this way, backgrounds that only provide partial masking in frequency and time will produce predictions of annoyance that fall between the unmasked sound exposure value and negative infinity (the result if there was a certainty of complete masking). The application of this concept to the noise of multirotor air vehicles is discussed.

Diesel Engine Exhaust Exposure in the Ontario Civil Infrastructure Construction Industry.

Diesel engine exhaust (DEE) is a known lung carcinogen and a common occupational exposure in Canada. The use of diesel-powered equipment in the construction industry is particularly widespread, but little is known about DEE exposures in this work setting. The objective of this study was to determine exposure levels and identify and characterize key determinants of DEE exposure at construction sites in Ontario. Elemental carbon (EC, a surrogate of DEE exposure) measurements were collected at seven civil infrastructure construction worksites and one trades training facility in Ontario using NIOSH method 5040. Full-shift personal air samples were collected using a constant-flow pump and SKC aluminium cyclone with quartz fibre filters in a 37-mm cassette. Exposures were compared with published health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03 µg m-3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5 µg m-3 respirable EC). Mixed-effects linear regression was used to identify determinants of EC exposure. In total, 149 EC samples were collected, ranging from <0.25 to 52.58 µg m-3 with a geometric mean (GM) of 3.71 µg m-3 [geometric standard deviation (GSD) = 3.32]. Overall, 41.6% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 90.6% exceeded the DECOS limit. Underground workers (GM = 13.20 µg m-3, GSD = 1.83) had exposures approximately four times higher than below grade workers (GM = 3.56 µg m-3, GSD = 1.94) and nine times higher than above ground workers (GM = 1.49 µg m-3, GSD = 1.75). Training facility exposures were similar to above ground workers (GM = 1.86 µg m-3, GSD = 4.12); however, exposures were highly variable. Work setting and enclosed cabins were identified as the key determinants of exposure in the final model (adjusted R2 = 0.72, P < 0.001). The highest DEE exposures were observed in underground workplaces and when using unenclosed cabins. This study provides data on current DEE exposure in Canadian construction workers. Most exposures were above recommended health-based limits, albeit in other jurisdictions, signifying a need to further reduce DEE levels in construction. These results can inform a hazard reduction strategy including targeted intervention/control measures to reduce DEE exposure and the burden of occupational lung cancer.

Improving Medical Student Recruitment into Plastic Surgery: A Survey of Orphaned Medical Students

This study was undertaken to measure the concerns of students whose medical schools do not have a plastic surgery training program to help educators better understand their perspectives. This is essential to improve plastic surgery education for almost 50% of students in the United States at institutions without a residency program. An anonymous survey was distributed to the clerkship directors of the applicable medical schools. They were then asked to forward this survey to their student body. The survey was divided as follows: demographics; exposure to plastic surgery; mentorship; suggestions for improvement; perceived impact on matching. We received 265 responses from 16 unique institutions. About 38% consider themselves underrepresented in medicine. The most common initial professional exposure to plastic surgery was shadowing (20%). About 10% reported exposure to plastic surgery in their school curriculum. About 51% reported having no professional exposure to plastic surgery. About 89% did not identify a mentor. All students applying to away rotations reported difficulties facilitating these sub-internships. About 64% felt extremely concerned about matching. Students from schools without plastic surgery training programs are at a disadvantage. The academic community needs to support these students to achieve a more diverse field. All students should be given an introduction to plastic surgery as part of their curriculum, and they should be encouraged to explore a career in plastic surgery as a realistic option. If 1 perceives themselves as non-competitive due to institutional shortcomings, this will translate into a non-competitive applicant and discourage our specialty's serious pursuit by almost half the country's medical students.

Intrauterine drug exposure as a risk factor for cerebral palsy.

To determine whether infants with intrauterine drug exposure (IUDE) are similarly at risk for cerebral palsy (CP) as other high-risk populations, whether CP classification differs based on IUDE status, and describe the association of CP with specific substances among exposed infants. This was a retrospective analysis of infants in a high-risk follow-up program (n=5578) between January 2014 and February 2018 with a history of IUDE or who received a CP diagnosis. CP rates were compared using two-sample z-tests. CP classification was assessed using Fisher's exact, Cochran-Armitage, and Wilcoxon rank-sum tests. Models for CP risk were assessed using multivariable logistic regression. Among all infants with IUDE (n=1086), 53.8% were male with a mean (SD) birth gestational age of 36.8 (3.6) weeks. Among unexposed infants with CP (n=259), 54.4% were male with a mean (SD) birth gestational age of 29.9 (5.7) weeks. Opioids were the most common exposure (93.7%) of all infants with IUDE. The CP rate in the IUDE (5.2%) and unexposed (5.7%) high-risk populations were not significantly different (p=0.168), nor were there differences in CP typology, topography, or severity between exposed (n=57) and unexposed (n=259) infants (all p>0.05). In patients with IUDE and after controlling for established CP risk factors, the observed odds of CP varied among substances. We suggest that IUDE should be considered a 'newborn-detectable risk' in the guidelines for the early detection of CP.

Next-Generation Intestinal Toxicity Model of Human Embryonic Stem Cell-Derived Enterocyte-Like Cells.

The gastrointestinal tract is the most common exposure route of xenobiotics, and intestinal toxicity can result in systemic toxicity in most cases. It is important to develop intestinal toxicity assays mimicking the human system; thus, stem cells are rapidly being developed as new paradigms of toxicity assessment. In this study, we established human embryonic stem cell (hESC)-derived enterocyte-like cells (ELCs) and compared them to existing in vivo and in vitro models. We found that hESC-ELCs and the in vivo model showed transcriptomically similar expression patterns of a total of 10,020 genes than the commercialized cell lines. Besides, we treated the hESC-ELCs, in vivo rats, Caco-2 cells, and Hutu-80 cells with quarter log units of lethal dose 50 or lethal concentration 50 of eight drugs—chloramphenicol, cycloheximide, cytarabine, diclofenac, fluorouracil, indomethacin, methotrexate, and oxytetracycline—and then subsequently analyzed the biomolecular markers and morphological changes. While the four models showed similar tendencies in general toxicological reaction, hESC-ELCs showed a stronger correlation with the in vivo model than the immortalized cell lines. These results indicate that hESC-ELCs can serve as a next-generation intestinal toxicity model.