International Protocols Research Articles

An exploratory international survey of the assessments and interventions used by occupational therapists and physiotherapists during the hospitalization of people with Guillain-Barré syndrome.

Guillain-Barré syndrome is a rare neurological condition. Although some people make a substantial functional recovery, almost half require intensive rehabilitation. Data were collected using a cross-sectional survey which investigated the assessments and interventions used by occupational therapists and physiotherapists for people with Guillain-Barré syndrome. Seventy valid responses were received from 10 countries. The survey highlighted four factors about current practice: (i) practitioners did not identify the use of formal clinical guidelines or protocols for Guillain-Barré Syndrome treatment of the upper limb; (ii) a range of standardized and non-standardized assessment and goal-setting tools are utilized; (iii) interventions include passive and active range of motion exercises, and the prescription of upper limb/hand splints; and (iv) interdisciplinary practice is common in the intensive care unit and during acute phases of Guillain-Barré syndrome, whereas discipline-specific work is more common during rehabilitation. A range of goal-setting and assessment tools are used by occupational therapists and physiotherapists during the hospitalization of people with Guillain-Barré syndrome. The type and duration of interventions vary and may reflect the lack of international protocols for Guillain-Barré syndrome rehabilitation.

Enhanced productivity and stability of PRV in recombinant ST-Tret1 cells

Productivity and stability of Pseudorabies virus (PRV) are critical for the manufacture and storage of live attenuated pseudorabies vaccine. Trehalose is commonly used as a cryoprotectant to stabilize organisms during freezing and lyophilization. Trehalose transporter 1 (Tret1), derived from Polypedilum vanderplanki, can deliver trehalose with a reversible transporting direction. In this study, we demonstrated that productivity and stability of PRV proliferated in recombinant ST cells with stable expression of Tret1 were enhanced. As a result, a five-fold increase of intracellular trehalose amount was observed, and the significant increase of progeny viral titer was achieved in recombinant cells with the addition of 20 mM trehalose. Particularly, after storage for 8 weeks at 20 °C, the loss of viral titer was 0.8 and 1.7 lgTCID50/mL lower than the control group with or without the addition of trehalose. Additionally, the freeze-thaw resistance at −20 °C and −70 °C of PRV was significantly enhanced. Furthermore, according to standard international protocols, a series of tests, including karyotype analysis, tumorigenicity, and the ability of proliferation PRV, were conducted. Our results demonstrated that the recombinant ST cell with Tret1 is a promising cell substrate and has a high potential for producing more stable PRV for the live attenuated vaccine.

A Survey on Fluorinated Greenhouse Gases in Taiwan: Emission Trends, Regulatory Strategies, and Abatement Technologies

Fluorinated greenhouse gases (F-gases), including hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), sulfur hexafluoride (SF6), and nitrogen trifluoride (NF3), are used in a variety of applications, but they are potent greenhouse gases (GHGs). Therefore, they have been blanketed into the list of items to be phased out under international protocols or treaties. During the desk research, the updated statistics of Taiwan’s National Inventory Report (NIR) were used to analyze the trends of F-gases (i.e., HFCs, PFCs, SF6, and NF3) emissions during the period of 2000–2020. Furthermore, the regulatory strategies and measures for the reduction of the four F-gas emissions will be summarized to be in accordance with the national and international regulations. With the rapid development in the electronics industry, the total F-gas emissions indicate a significant increase from 2462 kilotons of carbon dioxide equivalents (CO2eq) in 2000 to the peak value (i.e., 12,643 kilotons) of CO2eq in 2004. However, it sharply decreased from 10,284 kilotons of CO2eq in 2005 to 3906 kilotons of CO2eq in 2020 due to the ongoing efforts of the regulatory requirements and the industry’s voluntary reduction in time sequence. It was also found that the most commonly used method for controlling the emissions of F-gases from the semiconductor and optoelectronic industries in Taiwan is based on the thermal destruction-local scrubbing method.

Maternal diet and interactions with nutritional evaluation during pregnancy.

This narrative review aims to describe the knowledge regarding nutritional evaluation and monitoring in pregnant women. We discuss care provided by non-specialists in nutrition, regarding dietary information and risks during pregnancy, from a theoretical or conceptual viewpoint. A narrative review was conducted following a literature search when scientific databases were investigated, including SciELO, LILACS, Medline, PubMed, theses, government reports, books, and chapters in books. Finally, the material was fully read, categorized, and critically analyzed. National and international protocols of prenatal nutritional care were included and discussed. Different protocols describe the complexity of evaluating and monitoring nutrition among pregnant women during the prenatal period according to each country. The understanding of social conditions and eating habits has an important role in providing nutritional advice during pregnancy. The lack of dietitians in care overwhelms the healthcare workers and characterizes a missed opportunity. Therefore, it is important to consider rapid support tools that can track adverse nutritional status, and ways to recommend a diet that meets eating habit dynamics, according to the reality of each public health system.

Radiation dosimetry for quality control of silicon wafer using electron beam

Dosimetry studies using electron beams were performed with energies of up to 3 MeV, 2mA with various trolley speeds on the silicon wafer. The silicon wafer came with diameters of 152.4 and 203.2 mm with a thickness of 0.5 mm. The irradiations were performed by utilising the EPS 3000 Cockcroft-Walton type 3.0 MeV, 90 kwatts electron beam (EB) accelerator. Plastic film dosimeter, cellulose triacetate (CTA) was used as a dosimeter with a UV-vis spectrophotometer as the readout system. The dose setting in this investigation was ~100 kGy for 152.4 mm diameter and ~160 kGy for 203.2 mm diameter, which was based on the requirements of the customer. The acceptable dose value was set (± 10%) for better performance of the silicon wafer. It was important to comply with the international standards protocol for dosimeters in radiation processing dosimetry. The results showed that the dose and temperature decreased with increasing the speed. The optimum dose for both diameter of wafers when irradiate at electron beam current of 2 mA and the voltage of 3 MeV is at speed of 0.89 m/min. Based on these studies, it was found that it is important to control the speed of the trolley as it affects the irradiation conditions (e.g., temperature and dose measurements).

Analysis of pharmaceutical supply of breast cancer patients

The aim: to conduct a clinical and economic analysis of the state of pharmaceutical support for patients with breast cancer in women. Materials and methods. During the research, data from the National List of Essential Medicines, the 14th State Formulary of Medicines, the Ukrainian clinical protocol, the clinical protocols of Great Britain and the United States of America for the treatment of breast cancer, and a depersonalized database of drug prescriptions were used. The research used such methods as clinical-economic, organizational-economic, mathematical-statistical, graphic, grouping and generalization. Research results. It was established that 46 schemes of schemes for the treatment of breast cancer are presented in Ukrainian and international clinical protocols (Great Britain, USA). In all three protocols, there were 5 regimens for the treatment of breast cancer, such as CMF (Cyclophosphamide, Methotrexat, Fluorouracil), AC (Doxorubicin, Cyclophosphamide), DC (Docetaxel, Cyclophosphamide), TC (Trastuzumab, Capecitabin), EC (Epirubicin, Cyclophosphamide). Analysis of the pharmaceutical component in the protocols for individual drugs showed that they included 23 drugs according to the INN, which belong to the group of antineoplastic drugs. The Ukrainian clinical protocol includes 17 drugs, the British protocol – 14 drugs, and the American one – 15 drugs. The frequency analysis of antineoplastic drugs included in the Ukrainian clinical protocol revealed the TOP-3 in terms of drug prescription frequency: L01A A01 Cyclophosphamide (Ki=0.037), L01C D02 Docetaxel (Ki=0.029), L01D B01 Doxorubicin (Ki=0.026). The largest number of prescribed drugs are vital drugs – 61.96 %, the smallest share – essential drugs – 2.17 %, and the share of non-essential drugs is 35.87 %. The ABC analysis made it possible to determine the group of the most expensive drugs in the treatment of breast cancer - these are antineoplastic and immunomodulating agents. The total expenses for this group amounted to UAH 772,459.96, which according to the US dollar exchange rate of the National Bank of Ukraine at the end of August 2022 was USD 21,122.77. According to the analysis of the matrix of the integrated ABC-VEN-frequency analysis, it was established that the largest number of prescriptions belonged to the group of less expensive and vital drugs (B/V) – 7 drugs (48.73 % of the total amount. At the same time, the largest amount of expenses is observed in for the A/V group – UAH 772,459.96 (52.83 % of all costs directed to the pharmaceutical support of patients). The results of the structural analysis of the group of the most expensive drugs showed that the highest costs were characteristic of L01CD02 Docetaxel (UAH 1166,531.31; 39.81 % of the total cost in the group), and the lowest – for L01DB01 Doxorubicin – UAH 63,694.14 (5.46 %, respectively). Conclusions. According to the results of the conducted research, it was established that the largest costs fall on the group of essential drugs (1047735.07 UAH, 71.65 % of all costs). This determines the need for further pharmacoeconomic calculations of breast cancer treatment to optimize the costs of antineoplastic drugs

Agglomeration Behavior and Fate of Food-Grade Titanium Dioxide in Human Gastrointestinal Digestion and in the Lysosomal Environment.

In the present study, we addressed the knowledge gaps regarding the agglomeration behavior and fate of food-grade titanium dioxide (E 171) in human gastrointestinal digestion (GID). After thorough multi-technique physicochemical characterization including TEM, single-particle ICP-MS (spICP-MS), CLS, VSSA determination and ELS, the GI fate of E 171 was studied by applying the in vitro GID approach established for the regulatory risk assessment of nanomaterials in Europe, using a standardized international protocol. GI fate was investigated in fasted conditions, relevant to E 171 use in food supplements and medicines, and in fed conditions, with both a model food and E 171-containing food samples. TiO2 constituent particles were resistant to GI dissolution, and thus, their stability in lysosomal fluid was investigated. The biopersistence of the material in lysosomal fluid highlighted its potential for bioaccumulation. For characterizing the agglomeration degree in the small intestinal phase, spICP-MS represented an ideal analytical tool to overcome the limitations of earlier studies. We demonstrated that, after simulated GID, in the small intestine, E 171 (at concentrations reflecting human exposure) is present with a dispersion degree similar to that obtained when dispersing the material in water by means of high-energy sonication (i.e., ≥70% of particles <250 nm).

A generic theory of change-based framework with core indicators for monitoring the effectiveness of large-scale food fortification programs in low- and middle-income countries.

Large-scale food fortification (LSFF) programs are widely implemented in low- and middle-income countries (LMIC) to alleviate micronutrient deficiencies. However, these programs may not achieve the desired impact due to poor design or bottlenecks in program implementation. Monitoring and evaluation (M&E) frameworks and a set of agreed indicators can help to benchmark progress and to strengthen the evidence-base of effectiveness in a standardized way. We aimed to formulate recommendations towards core indicators for evaluating the effectiveness of LSFF programs with their associated metrics, methods, and tools (IMMT). For this, we used a multi-method iterative approach, including a mapping review of the literature, semi-structured interviews with international experts, compilation of a generic Theory of Change (ToC) framework for LSFF program delivery, and selection of IMMT for M&E of LSFF programs at key stages along the ToC delivery framework. Lastly, we conducted exploratory, qualitative interviews with key informants in Nigeria to explore experiences and perceptions related to the implementation of LSFF programs in Nigeria's context, and their opinion towards the proposed set of core IMMT. The literature search resulted in 14 published and 15 grey literature documents, from which we extracted a total of 41 indicators. Based on the available literature and interviews with international experts, we mapped a ToC delivery framework and selected nine core indicators at the output, outcome and impact level for M&E of the effectiveness of LSFF programs. Key informants in Nigeria revealed that the main bottlenecks for implementation of the proposed IMMT are related to the lack of technical capacity, equipment, laboratory infrastructure, and financial resources. In conclusion, we propose a set of nine core indicators for enabling comprehensive M&E of the effectiveness of LSFF programs in LMIC. This proposed set of core indicators can be used for further evaluation, harmonization and integration in national and international protocols for M&E of LSFF programs.

Slower clozapine titration than the official Japanese protocol led to fewer inflammatory adverse effects: A retrospective chart review of seven hospitals

BackgroundHigher frequencies of inflammatory adverse effects of clozapine have been reported in Japan. As the international titration protocol for Asians has set slower dose titration than the Japanese package insert, we hypothesized that a dose titration speed slower than the recommendation of the guideline would be associated with fewer inflammatory-related adverse events. MethodsThe medical records of all 272 patients who were first started on clozapine at seven hospitals between 2009 and 2023 were studied retrospectively. Of those, 241 were included in the analysis. The patients were divided into two groups regarding whether the titration speed was faster or slower than the guideline for Asians. The incidence of inflammatory adverse events with clozapine was compared between the groups. ResultsThe frequency of inflammatory adverse events was 34 % (37/110) in the faster titration group and 13 % (17/131) in the slower titration group, and a significant difference was observed by Fisher exact test (odds ratio 3.38; 95 % confidence interval 1.71–6.91; p < 0.001). Serious adverse effects, fever for more than five days, and clozapine discontinuation were significantly more frequent in the faster titration group. Logistic regression analysis indicated significantly more inflammatory adverse events in the faster titration group (adjusted odds ratio 4.01; 95 % confidence interval 2.02–7.87; p < 0.001) considering age, sex, body mass index, concomitant valproic acid, and smoking as confounding factors. ConclusionClozapine-induced inflammatory adverse events were less frequent in Japanese individuals when a titration rate was more gradual than the protocol recommended in the Japanese package insert.

Listening to Students: The Experiences of Disabled Students of Learning in a Selected University in Zimbabwe

Disability is one of the most neglected forms of diversity, which usually results in the different forms of discrimination at community level. Nonetheless, more institutions of higher education are making an effort toward creating more inclusive settings for the students and staff. This study examined the lived experiences of the students with disabilities in an institution of higher education in Zimbabwe. Student experiences and disability are the main themes in this study. This study is phenomenological research that was carried out with a questionnaire survey which was conducted among seven participants. This was triangulated by interviews that involved two participants. Overall results showed that physical disability is the most prevalent amongst the students in the institution considered for the study. Moreover, the disabled students faced challenges at home and in their life at university, which affected them psychologically. In addition, while the students were conscious of the existing international and national protocols that promote their welfare, they were not well aware of those embedded within their university policies. Results also reveal that the disabled students suffered socially from stigma and negligence from their able-bodied counterparts and staff. Further, they had limited access to some of the physical structures that lacked ramps and lifts. To promote full participation of the disabled students in academic life, the institution is expected to formulate and implement a binding disability policy that promotes diversity and inclusive education. In addition, infrastructure, especially the old structures need to be refurbished with the disabled in mind.

Strategic Intelligence Analysis of the Threat of Weapons of Mass Destruction Proliferation: Potential Vulnerability of Indonesia’s National Security

This study addresses the issue of the proliferation of weapons of mass destruction, which includes the possession of chemical weapons, biological weapons, and nuclear weapons. The international community endeavors to mitigate the dangers posed by the trade in weapons of mass destruction. Changes in technology have contributed to a shift in the sources of funding for weapons of mass destruction. Financial institutions are susceptible to being utilized as a conduit for money laundering and the financing of the proliferation of weapons of mass destruction. There are a variety of transactional options available for money laundering and the financing of weapons of mass destruction by criminals. Financial institutions must therefore adhere to international protocols to prevent the proliferation of weapons of mass destruction. Interviews and documentation studies are used to collect qualitative data for this study.

Климатическая повестка США как возможность социально-политической трансформации американского общества

The article’s introduction includes a justification of the climate policy’s dependence and socioeconomic transformation in American society. The research’s purpose is to substantiate that the climate crisis is a complex infrastructural issue that requires solutions from all institutions and spheres of American society to achieve sustainable development and leadership. The article’s materials consist of international treaties, laws, and protocols that are adopted by the US Congress, the US government’s orders and plans, US politicians’ speeches and correspondence, research articles and monographs by famous scientists from various countries, the political practice’s analysis of the presidential administration of J. Biden in the conditions of fulfilling the obligations assumed by the United States under the Paris Climate Agreement, as well as new social and economic problems related to the hydrocarbons’ use. The article analyzes the Environmental Protection Agency’s activities and the supporters’ and opponents’ actions regarding the use of fossil fuels. The methodology is based on the principles of scientific historical research; a rationalistic approach is used as a methodological approach, and two special historical methods are used as research methods: systemic and genetic. The study’s results were updated plans and actions by the American government to address the climate agenda for the 2016–2020 period. As a result, the article’s author comes to several conclusions, which are that the struggle for a fair energy transition during the 2016–2022 period made American society more polarized and divided taken the measures according to ideas and actions. The so-called BIPOC community began to play a special role in this movement as the main force in a period of change and as a hope for the creation of a more fair society in America. The Inflation Reduction Act (2022) created the conditions for American society’s consolidation. The changes should be expected in 2023 as visible trends in socio-political modernization after the adoption of this law: for example, in healthcare, greater availability of medicines and lower prices for them, especially for insulin-dependent people; greater availability for more citizens in the health insurance sphere; reduction of citizens’ costs for electricity and energy efficiency of household appliances; reduction of taxes for low- and medium-income citizens; a tangible reduction in harmful pollution from fossil fuels; and the expected reduction in cancer diseases among Americans.

Actuación forense con enfoque en derechos humanos – una asignatura pendiente en la medicina forense española

Forensic medicine has historically played a leading role in the defense of the fundamental human rights as an essential tool at the service of the Administration of Justice in fighting against impunity as a denial of the right of the victim. In recent years, especially promoted by the International Committee of the Red Cross (ICRC), the concept of ‘humanitarian forensic action’ has been developed, as opposed or complementary to criminal investigation, focused on alleviating human suffering and protecting the dignity of victims of armed conflicts and other catastrophic events. That type of investigations demands specialized education under the perspective of multidisciplinarity of forensic work, in the proper application of international protocols and guidelines (Istanbul, Minnesota) and the recognition of the rights of victims and families. Development of training programs and specific plans and procedures focused on human rights for Medicolegal Institutes in Spain, particularly in those areas where progress has already been made with the publication of guides and protocols is a necessity in the commitment of forensic medicine with victims and their families, will benefit our advisory function to Justice Administration, and will provide us with the necessary skills to collaborate with other national and international entities.

A multi-dimensional reality: Carol Lally Shields.

A multi-dimensional reality: Carol Lally Shields.

The Aga Khan Development Network’s (AKDN) approach to supply chain carbon foot printing for healthcare providers

Very few examples of footprints exist for lower-middle-income countries and none for low-income countries. Where footprints do exist, they suggest that healthcare in LMICs is more carbon intensive per unit of expenditure than in high-income or upper-middle-income countries. At the same time, delivery of global commitments on Universal Health Coverage implies that healthcare provision in low and middle-income countries (LMICs) must grow more rapidly than anywhere else in the word.There has been little or no access to appropriate, comprehensive but affordable support to enable operations in LMICs to calculate full Scope 1,2 and 3 footprints. Without this it has been challenging for operations in LMICs to effectively target actions to reduce their emissions.With this in mind this paper sets out to demonstrate an approach to carbon foot printing healthcare in LMICs that is sufficiently robust to support targeted action, while using tools, resources and data that are freely accessible in all countries.This paper describes and discusses a 4-tiered ‘hybrid’ approach, developed using the international Greenhouse Gas Protocol. The approach was used successfully by staff to generate carbon footprints for healthcare organisations in 8 LMICs in South and Central Asia and East Africa. The organisations covered all fall within the Aga Khan Development Network (AKDN); specifically, the Aga Khan Health Services (AKHS) and the Aga Khan Universities (AKU)The principles discussed in this paper, have been used to build a comprehensive carbon management tool in Microsoft Excel. The use of the approach and the tool has enabled AKDN healthcare providers to effectively, baseline, target and structure their carbon reduction activity.This work has had to pragmatically balance accuracy with deliverability in an LMIC context. While footprinting for Scope 1 and 2 has followed standard protocols, proxy data has been used to generate high level supply chain footprints, this has then been refined with data from suppliers.The tool and its accompanying guide are published and available, free to use, from AKDN to support other healthcare organisations in footprinting and reducing their own carbon emissions.

Preface

The emerging pest and disease incursions in coconut growing countries result in great economic yield losses and negative impact to the industry, biodiversity loss, and disrupted native and agricultural system.Repeated use of the same active ingredient of pesticide to control pests and diseases could lead to pest and disease resistance. The inevitable effect of climate change, other environmental factors, and the destruction of natural enemies could trigger the incursion and migration of devastating pests and diseases. The massive planting and replanting could create homogeneity in coconut farms, predisposing these to disease infection and pest infestation. The concurrent reported outbreaks of Brontispa in Southeast Asia, Coconut Rhinoceros Beetle, Guam type (CRB-G) in Guam, and Asia-Pacic countries, Coconut Scale Insect in the Philippines, Lethal Yellowing in Jamaica, and Mexico, Bogia Coconut Syndrome in Papua New Guinea, Sexava, Rhyncophorus in Indonesia, and the recognition of the need to develop international biosecurity protocols for safe germplasm exchange have prompted the International Coconut Community (ICC) to hold the 1st IPM symposium.We know that pests and diseases reduced the ability of the industry to fully benefit from the market opportunities. In the face of this situation ICC Sessions and Ministerial meetings as the highest authority and the ICC recommended the ICC Secretariat to convene an IPM symposium to help countries overcome low coconut production due to pests and diseases.The general objective of the symposium is to establish an international IPM network system and synergy to protect the coconut producers & industries and conserve the coconut genetic resources and diversity from the adverse impact of pests and diseases through expertise and experience sharing.The specific objectives of the symposium are:1. To bring together key members of the scientific community for an interactive discussion on emerging issues and advances related to IPM, that will help enhance and develop IPM extension and research on invasive coconut pests and diseases2. To craft ecologically sound, science-based, and sustainable pest and disease management approaches based on IPM practices across countries.3. To create an international platform/network among coconut growing countries to strengthen the development of IPM strategies, pest and disease risk assessment, and inter-country collaborations that will address the research gaps and challenges of managing invasive pests/diseases losses and negative impact on the industry, biodiversity loss, and disrupted native and agricultural system.List of Editor-in-Chief, Managing Editor, Associate Editor, Scientific Committee of IPM Symposium Proceedings are available in this Pdf.

Efficacy and safety of Lianhua Qingwen capsules combined with standard of care in the treatment of adult patients with mild to moderate COVID-19 (FLOSAN): protocol for a randomized, double-blind, international multicenter clinical trial.

Effective anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) drugs are not only the next defense after vaccines but also the key part of establishing a multi-tiered coronavirus disease 2019 (COVID-19) prevention and control system. Previous studies had indicated that Lianhua Qingwen (LHQW) capsules could be an efficacious Chinese patent drug for treating mild to moderate COVID-19. However, pharmacoeconomic evaluations are lacking, and few trials have been conducted in other countries or regions to evaluate the efficacy and safety of LHQW treatment. So, this study aims to explore the clinical efficacy, safety, and economy of LHQW for treating adult patients with mild to moderate COVID-19. This is a randomized, double-blind, placebo-controlled, international multicenter clinical trial protocol. A total of 860 eligible subjects are randomized at a 1:1 ratio into the LHQW or placebo group to receive two-week treatment and follow-up visits on days 0, 3, 7, 10, and 14. Clinical symptoms, patient compliance, adverse effects, cost scale, and other indicators are recorded. The primary outcomes will be the measured median time to sustained improvement or resolution of the nine major symptoms during the 14-day observation period. Secondary outcomes regarding clinical efficacy will be evaluated in detail on the basis of clinical symptoms (especially body temperature, gastrointestinal symptoms, smell loss, and taste loss), viral nucleic acid, imaging (CT/chest X-ray), the incidence of severe/critical illness, mortality, and inflammatory factors. Moreover, we will assess health care cost, health utility, and incremental cost-effectiveness ratio (ICER) for economic evaluation. This is the first international multicenter randomized controlled trial (RCT) of Chinese patent medicine for the treatment of early COVID-19 in accordance with WHO guidelines on COVID-19 management. This study will help clarify the potential efficacy and cost-effectiveness of LHQW in the treatment of mild to moderate COVID-19, facilitating decision-making by healthcare workers. This study is registered at the Chinese Clinical Trial Registry, with registration number: ChiCTR2200056727 (date of first registration: 11/02/2022).

Microplastics ingestions by wild and aquaculture marine bivalves: A systematic review on field investigation study

Plastics degradation has resulted in a major threat to marine organisms, including bivalves. Thirty-three peer-reviewed papers have been reviewed to understand the geographical spread of microplastics ingestion by marine bivalves, characteristics of microplastics ingested, and limitation of microplastics analysis globallly. Only studies on microplastics investigation in marine bivalves from wild and aquaculture area were selected. Marine bivalves are reported to accumulate microplastics from all marine environment compartments. High proximity area with intensive human activities is suggested to increase the uptake of microplastics by the bivalves. Microfibers and fragments are the common types of microplastics ingested by the bivalves around the world, with various sizes (0.45µm – &lt;45mm) and number of particles per individual (20 – ~175 particles/individual). However, there is uncertainty when comparing the findings from one study to another due to the absence of international standard protocol and microplastics data base. Therefore, this limitation should be addressed prior to monitoring microplastics accumulation in marine bivalves.

Promoting enforcement of non-lead hunting ammunition regulations and compliance in Europe and North America.

The direct regulation of lead ammunition in North America and Europe has been mainly for hunting in wetlands. Little support among hunters and the ammunition makers exists for further regulation despite suitable lead substitutes and much education about the known risks to wildlife and human health from ingested lead. In the absence of personnel to detect use of lead ammunition and enforce regulations, hunter compliance is low. Identification of non-lead ammunition using existing electronic technology and an international protocol on the identification of non-lead rifle bullets is proposed to aid enforcement. An explicit definition of the chemical composition of lead substitutes is required in European Union legislation together with a more enforceable distinction between 'possession during hunting' and 'ownership' of lead ammunition. A more transdisciplinary regulatory approach to transitioning to non-lead ammunition is advised. It comprises widespread public health advisories, setting a maximum allowable lead level in commercial game meats in EU legislation, and public communication that emphasizes the benefits of non-lead ammunition use to all categories of wildlife and the public perception of hunting, whether in North America or Europe.

The rate of occupational noise-induced hearing loss among male workers in Israel and implication on hearing surveillance frequency.

To investigate the annual rate of NIHL in Israel, a modern economy with relatively low industrial hazardous noise exposure. To review international protocols of hearing surveillance. To recommend an effective, efficient, hearing screening frequency protocol. A historical cohort study was conducted. Audiometric surveillance data from the Jerusalem occupational medicine registry of male employees in various industries from 2006 to 2017 were used. Mean individual annual threshold shifts simulating 1-8 checkup interval years were calculated. Joinpoint regression analysis was used to assess the interval in which the slope of the calculated ATS variability moderates significantly. A total of 263 noise-exposed workers and 93 workers in the comparison group produced 1913 audiograms for analysis. Among the noise-exposed workers, using the 1-4kHz average, threshold shifts stabilized from 3years onwards at around 1dB per year in all age groups and 0.83dB in the stratum younger than 50years. No enhanced decline was detected in the first years of exposure. Although most countries conduct annual hearing surveillance, hearing threshold shifts of noise-exposed workers become more accurate and show less variability when calculated at 3-year checkup intervals onwards than shorter intervals. Since margins of errors of the test method are much larger than the annual shift found, screening schedule that enables each subsequent test to identify a real deterioration in hearing is necessary. Triennial audiometric screening would be a better surveillance frequency for noise-exposed workers younger than 50years of age in the category of 85-95 dBLAeq,8h without other known risk factors.