Reduction In Exposure Research Articles

Methods for Risk Reduction: Training and Exercises to Pursue the Planned Evacuation

Natural and anthropic disasters produce relevant economic and environmental losses at a global level. Many countries have adopted a risk management cycle to limit these losses. Agenda 2030 defined specific Sustainable Development Goals (SDGs) and relative targets dedicated to disaster risk reduction. Planned actions can pertain to the context “before” or “after” a disastrous event. The United Nations recommend a risk-informed approach for achieving the SDGs by working on anticipation and prevention. Planning with training and exercises, referring to transport systems in emergency conditions, can limit disaster impacts and strongly support the pursuit of sustainability. This research focuses on actions and methodologies for increasing preparedness levels “before” a disastrous event, to improve the capabilities of managers and people by increasing awareness of the effects of planned actions. Transport system models (TSMs) play an important role in simulating the evacuation of people to reduce theoretical risk, thereby reducing theoretical exposure. In this work, a method is presented that allows us to investigate how this theoretical reduction can become effective, through training and exercises. The paper proposes a general framework of training and exercises for risk reduction based on a given transportation planning model. The framework supports ex ante evaluations of exposure reduction produced by an evacuation plan. The obtained results show that the effectiveness of the planned actions increases with different levels of exercise implementation. The progressive implementation of exercises contributes to achieving the risk reductions estimated at the evacuation planning stage. The TSM in the mitigation phase is the basis for the development of specific quantitative evacuation plans, that must be implemented in the preparedness phase by means of training and exercises to test the planned actions in terms of reducing the exposure risk component. Some exercises implemented worldwide verify the proposed framework by means of some empirical evidence. The results and discussions reported in this paper can be useful for researchers, decisionmakers, and society by offering a contribution to the growing knowledge about risk and the potential actions and their relative effects on reducing it.

Technical and Clinical Outcome of Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement in Abdominal Fluid Collections after Liver Transplantation: A 16-Year Retrospective Analysis of 50 Consecutive Patients.

Evaluation of the effectiveness of CT-guided drainage (CTD) placement in managing symptomatic postoperative fluid collections in liver transplant patients. The assessment included technical success, clinical outcomes, and the occurrence of complications during the peri-interventional period. Analysis spanned the years 2005 to 2020 and involved 91 drain placement sessions in 50 patients using percutaneous transabdominal or transhepatic access. Criteria for technical success (TS) included (a) achieving adequate drainage of the fluid collection and (b) the absence of peri-interventional complications necessitating minor or prolonged hospitalization. Clinical success (CS) was characterized by (a) a reduction or normalization of inflammatory blood parameters within 30 days after CTD placement and (b) the absence of a need for surgical revision within 60 days after the intervention. Inflammatory markers in terms of C-reactive protein (CRP), leukocyte count and interleukin-6, were evaluated. The dose length product (DLP) for various intervention steps was calculated. The TS rate was 93.4%. CS rates were 64.3% for CRP, 77.8% for leukocytes, and 54.5% for interleukin-6. Median time until successful decrease was 5.0 days for CRP and 3.0 days for leukocytes and interleukin-6. Surgical revision was not necessary in 94.0% of the cases. During the second half of the observation period, there was a trend (p = 0.328) towards a lower DLP for the entire intervention procedure (median: years 2013 to 2020: 623.0 mGy·cm vs. years 2005 to 2012: 811.5 mGy·cm). DLP for the CT fluoroscopy component was significantly (p = 0.001) lower in the later period (median: years 2013 to 2020: 31.0 mGy·cm vs. years 2005 to 2012: 80.5 mGy·cm). The TS rate of CT-guided drainage (CTD) placement was notably high. The CS rate ranged from fair to good. The reduction in radiation exposure over time can be attributed to advancements in CT technology and the growing expertise of interventional radiologists.

Pedicle screw placement accuracy in robot-assisted versus image-guided freehand surgery of thoraco-lumbar spine (ROBARTHRODESE): study protocol for a single-centre randomized controlled trial

BackgroundRobotic spinal surgery may result in better pedicle screw placement accuracy, and reduction in radiation exposure and length of stay, compared to freehand surgery. The purpose of this randomized controlled trial (RCT) is to compare screw placement accuracy of robot-assisted surgery with integrated 3D computer-assisted navigation versus freehand surgery with 2D fluoroscopy for arthrodesis of the thoraco-lumbar spine.MethodsThis is a single-centre evaluator-blinded RCT with a 1:1 allocation ratio. Participants (n = 300) will be randomized into two groups, robot-assisted (Mazor X Stealth Edition) versus freehand, after stratification based on the planned number of pedicle screws needed for surgery. The primary outcome is the proportion of pedicle screws placed with grade A accuracy (Gertzbein-Robbins classification) on postoperative computed tomography images. The secondary outcomes are intervention time, operation room occupancy time, length of stay, estimated blood loss, surgeon’s radiation exposure, screw fracture/loosening, superior-level facet joint violation, complication rate, reoperation rate on the same level or one level above, functional and clinical outcomes (Oswestry Disability Index, pain, Hospital Anxiety and Depression Scale, sensory and motor status) and cost-utility analysis.DiscussionThis RCT will provide insight into whether robot-assisted surgery with the newest generation spinal robot yields better pedicle screw placement accuracy than freehand surgery. Potential benefits of robot-assisted surgery include lower complication and revision rates, shorter length of stay, lower radiation exposure and reduction of economic cost of the overall care.Trial registrationClinicalTrials.gov NCT05553028. Registered on September 23, 2022

Malaria seroepidemiology in very low transmission settings in the Peruvian Amazon

Despite progress towards malaria reduction in Peru, measuring exposure in low transmission areas is crucial for achieving elimination. This study focuses on two very low transmission areas in Loreto (Peruvian Amazon) and aims to determine the relationship between malaria exposure and proximity to health facilities. Individual data was collected from 38 villages in Indiana and Belen, including geo-referenced households and blood samples for microscopy, PCR and serological analysis. A segmented linear regression model identified significant changes in seropositivity trends among different age groups. Local Getis-Ord Gi* statistic revealed clusters of households with high (hotspots) or low (coldspots) seropositivity rates. Findings from 4000 individuals showed a seropositivity level of 2.5% (95%CI: 2.0%-3.0%) for P. falciparum and 7.8% (95%CI: 7.0%-8.7%) for P. vivax, indicating recent or historical exposure. The segmented regression showed exposure reductions in the 40–50 age group (β1 = 0.043, p = 0.003) for P. vivax and the 50–60 age group (β1 = 0.005, p = 0.010) for P. falciparum. Long and extreme distance villages from Regional Hospital of Loreto exhibited higher malaria exposure compared to proximate and medium distance villages (p < 0.001). This study showed the seropositivity of malaria in two very low transmission areas and confirmed the spatial pattern of hotspots as villages become more distant.

Secondhand Smoke and Socio-Demographic Associated Factors: Results From the Vietnam Population-Based Provincial Global Adult Tobacco Survey in 2022.

Background: Secondhand smoke (SHS) has detrimental effects on community health, including coronary heart diseases, stroke, lung cancer etc. This manuscript exploited data from the Vietnam Population-based Provincial Global Adult Tobacco Survey (PGATS) in 2022 to update the prevalence of adult exposure to SHS and associated socio-demographic factors. Methods: With the sample size of 71,981 adults aged 15+ throughout 30 provinces and cities in Vietnam, data was collected using the Global Adult Tobacco Survey (GATS) questionnaire. Bivariate analysis and multivariate logistic regression modelling were performed. Results: In the past 30 days, 44.4% (95% CI: 44.0%-44.9%) adults aged 15+ exposed to SHS at home while 23.1% (95% CI: 22.6%-23.6%) exposed to SHS at work. Female exposure to SHS in the past 30 days was higher at homes but lower at indoor workplaces. Participants aged 15-24 were likely to have higher odds of SHS exposure in the past 30 days to other age groups. Those living in the urban areas had 1.15 times higher odds (95% CI: 1.08-1.22) of exposure to SHS than those in the rural areas. Current smokers tended to have 2.2 times higher odds of exposure to SHS at the indoor workplaces compared to non-smokers (95% CI: 2.05-2.37). Conclusions: The prevalence of exposure to SHS at home was still relatively high amongst the adult population. While there was a significant reduction of SHS exposure at indoor workplaces, there was a higher prevalence of women being exposed to SHS at home. The Government of Vietnam should continue to strictly implement the smoke-free environment resolution at indoor workplaces and appropriate communication campaigns to protect people, especially women from SHS exposure at homes.

Personal protection strategies for mitigating the effects of air pollution: A narrative literature review

reducing air emissions is the fundamental action necessary to mitigate the negative health effects caused by air pollution. However, increased public awareness has highlighted the need to identify protective measures that can mitigate the personal health risks associated with air pollution. examine the evidence regarding personal protection strategies capable of mitigating the health effects caused by air pollution, with a focus on healthy individuals and at-risk categories. Design: narrative review. this study examines the most effective personal protection strategies for healthy and at-risk individuals, considering children, the elderly, and individuals with cardiovascular and respiratory diseases; the examined strategies include the use of air purifiers, respiratory masks, exposure limitation, physical activity, alternative means of transportation, and environmental monitoring systems. reduction of individual exposure to air pollution, respiratory and cardiovascular outcomes, total and all-cause mortality. the evidence indicates that these measures can reduce exposure and promote well-being. For at-risk individuals, it is crucial to limit exposure during periods and in locations with high pollution levels, with an emphasis on physical activity. The use of high-efficiency air purifiers can reduce the negative effect of air pollution on individuals with respiratory and cardiovascular conditions, especially those with asthma. In healthy individuals, multiple mitigation actions have been identified, with evidence suggesting that the benefits of physical activity persist even in environments with high levels of air pollution. this narrative review provides an overview of personal strategies capable of reducing air pollution exposure and consequently mitigating its negative impact on health. These findings can support the development of recommendations and communication and prevention interventions, promoting risk reduction policies and increased awareness and engagement from both healthcare and non-healthcare networks at the local level. Although more robust systematic approaches are needed, this review serves as a useful tool for stakeholders and citizens, while also providing a simple instrument with significant communicative potential, applicable on a large scale.

A musculoskeletal multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: results of a prospective cohort study

ObjectiveTo test whether a musculoskeletal multifactorial and individualised hamstring muscle injury (HMI) risk reduction programme could reduce HMI risk in professional football.MethodsWe conducted a prospective cohort study in Finnish premier...

Analysis of respirable dust exposure data collected at a Zambian copper mine between 2017 and 2022.

Mine workers are occupationally exposed to respirable dust, which can cause irreversible lung diseases and controlling exposure concentrations to as low as reasonably practicable is, therefore, essential. To implement exposure reduction strategies and adequately manage exposure to hazardous chemicals, exposure needs to be measured and recorded according to a standard exposure management plan. This study aimed to assess the available respirable dust exposure data measured between 2017 and 2022 in various work areas and job categories at two mining shafts and a concentrator plant of a Zambian copper mine. Additionally, the monitoring program implemented at the mine was assessed for appropriateness. Descriptive data analysis was used to create an exposure matrix comprising 253 exposure measurements. Approximately 5.6% of the measured concentrations exceeded the South African time-weighted average occupational exposure limit (TWA-OEL) of 3 mg/m3. The geometric means of respirable dust exposure for shaft A, shaft B and the concentrator plant were 0.44 mg/m3, 0.44 mg/m3, and 0.68 mg/m3, respectively. The work areas with the highest maximum exposure results were the tipping area (18.0 mg/m3) at shaft A, the sump and waste bin (8.05 mg/m3) at shaft B and the screening (10.8 mg/m3), secondary crusher (14.0 mg/m3), foreign ore bin (4.43 mg/m3), and tertiary crusher (5.07 mg/m3) areas at the concentrator plant. It was found that the monitoring strategy implemented at the mine was flawed and did not collect a sufficient number of samples in each area during each year to make rigorous statistical assessment possible. This study highlights the sampling strategy's shortcomings and recommends adopting a standardized monitoring strategy, such as EN689, to improve the respirable dust monitoring program at the mine. Additionally, this strategy can be implemented across Zambia and, if implemented correctly, it has the potential to be improve exposure monitoring across the country as no standard sampling strategy is currently enforced by the Government.

Pharmacokinetics of Dacarbazine and Unesbulin and CYP1A2-Mediated Drug Interactions in Patients With Leiomyosarcoma.

Unesbulin is being investigated in combination with dacarbazine (DTIC) as a potential therapeutic agent in patients with advanced leiomyosarcoma (LMS). This paper reports the pharmacokinetics (PK) of unesbulin, DTIC, and its unreactive surrogate metabolite 5-aminoimidazole-4-carboxamide (AIC) in 29 patients with advanced LMS. Drug interactions between DTIC (and AIC) and unesbulin were evaluated. DTIC (1000 mg/m2 ) was administered to patients with LMS via 1-hour intravenous (IV) infusion on Day 1 of every 21-day (q21d) cycle. Unesbulin dispersible tablets were administered orally twice weekly (BIW), starting on Day 2 of every cycle, except for Cycle 2 (C2), where unesbulin was dosed either on Day 1 together with DTIC or on Day 2, 1 day after DTIC administration. The PK of DTIC, AIC, and unesbulin in Cycle 1 (C1) and C2 were estimated using noncompartmental analysis. DTIC and AIC were measurable immediately after the start of infusion and reached Cmax immediately or shortly after end of infusion at 1.0 and 1.4 hours (Tmax ), respectively. Coadministration of unesbulin orally at 200 mg or above with DTIC inhibited cytochrome P450 (CYP)1A2-mediated DTIC metabolism, resulting in 66.7% reduction of AIC exposures. Such inhibition could be mitigated when unesbulin was dosed the day following DTIC infusion. Repeated unesbulin dosing demonstrated evidence of clinical CYP1A2 induction and increased AIC Cmax by 69.4% and AUCinf by 57.9%. No meaningful difference in unesbulin PK was observed between C2 and C1. The combination therapy of 1000 mg/m2 IV DTIC q21d and 300 mg unesbulin BIW in a staggered regimen is well tolerated in patients with LMS.

Improved image quality in CT pulmonary angiography using deep learning-based image reconstruction

We investigated the effect of deep learning-based image reconstruction (DLIR) compared to iterative reconstruction on image quality in CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE). For 220 patients with suspected PE, CTPA studies were reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction (ASiR-V 30%, 60% and 90%) and DLIR (low, medium and high strength). Contrast-to-noise ratio (CNR) served as the primary parameter of objective image quality. Subgroup analyses were performed for normal weight, overweight and obese individuals. For patients with confirmed PE (n = 40), we further measured PE-specific CNR. Subjective image quality was assessed independently by two experienced radiologists. CNR was lowest for FBP and enhanced with increasing levels of ASiR-V and, even more with increasing strength of DLIR. High strength DLIR resulted in an additional improvement in CNR by 29–67% compared to ASiR-V 90% (p < 0.05). PE-specific CNR increased by 75% compared to ASiR-V 90% (p < 0.05). Subjective image quality was significantly higher for medium and high strength DLIR compared to all other image reconstructions (p < 0.05). In CT pulmonary angiography, DLIR significantly outperforms iterative reconstruction for increasing objective and subjective image quality. This may allow for further reductions in radiation exposure in suspected PE.

E-cigarettes and heated tobacco products impact on dental color parameters

ObjectivesAbstaining from tobacco smoking may not only improve general health, but also reduce teeth staining and restore teeth whiteness. Compared with conventional cigarettes, E-cigarettes (ECs) and heated tobacco products (HTPs) may offer substantial reduction in exposure to pigmented tar-like compounds of cigarette smoke. It is possible that improvements in dental color indices may be observed in those who have stopped smoking combustible cigarettes by switching to tar-free nicotine delivery products. MethodsThis cross-sectional study evaluated and compared dental color parameters by digital spectrophotometry among five different groups: individuals who currently smoke ; individuals who used to smoke but have quit ; individuals who have never smoked ; exclusive users of electronic cigarettes (former smokers) ; and exclusive users of heated tobacco products (former smokers) . ResultsDental whiteness in current cigarette smokers was notably worse compared with never and former smokers, (13.38 Whiteness Index for Dentistry (WID) units vs. 19.96 and 16.79 WID units). Remarkably high WID values (i.e., whiter teeth) were also observed in ECs (16.72 WID units) and HTPs users (17.82 WID units). Compared to current smokers, difference in dental whiteness for ECs and HTPs users was visually noticeable (ΔWID difference being on average > 2.90 units). The colour differences measured as delta E*(ΔE*) were all visually detectable except for the comparison between ex-smokers and ECs users for which no perceptible color difference was observed (0.415). ConclusionExclusive use of ECs and HTPs is associated with better dental color measurements than current smoking, suggesting that tar-free nicotine delivery technologies are unlikely to have negative effects on dental appearance. Clinical significanceUse of alternative nicotine delivery systems may be associated with cosmetic benefits with important implications for those smokers perceiving dental aesthetics as a significant problem. For these an oral-based narrative may be a much more significant reason to refrain from smoking than the fear of developing smoking-related diseases in future.

P352 Comparison of Radiation Dose, Image Quality, and Diagnostic Performance between Hybrid Iterative Reconstruction and Deep Learning Reconstruction for CT Enterography of IBD

Abstract Background CT enterography (CTE) is recommended as one of the preferred methods for patients with inflammatory bowel disease (IBD), especially in primary hospitals that lack MRI equipment. However, the potential risk of radiation derived from using CTE during the life-long follow-up is an important issue for these patients. This study aimed to compare the radiation dose, image quality, and diagnostic performance of CTE for IBD using hybrid iterative reconstruction (HIR) and deep learning reconstruction (DLR). Methods We prospectively collected data on low dose CTE reconstructed by HIR and DLR in patients with IBD between February 2023 and September 2023, and retrospectively enrolled IBD patients who underwent conventional dose CTE reconstructed by HIR between June 2019 and June 2022 as controls. The CTE examinations were performed within 2 weeks of bowel histologic evaluation (the reference standard of bowel inflammation). The objective and subjective image quality and the image features were evaluated by two IBD radiologists. The radiation dose, image quality, and diagnostic performance was compared between the two dose protocols. Results The preliminary study included 36 patients in the low dose group with HIR and DLR and 40 patients in the conventional dose group with HIR. There were no significant differences in demographic data of patients between the two groups (all P&amp;gt;0.05). The sensitivity, specificity, and diagnostic accuracy for detecting active inflammation were 71.4% (43.3%), 83.3% (80.0%), and 75.0% (52.5%) for the low dose group with DLR (HIR), respectively, and 84.4%, 62.5%, and 80% for the conventional dose HIR group. Low dose group with DLR resulted in significantly increased objective and subjective image quality and diagnostic confidence for active inflammation compared to low dose group with HIR (all P&amp;lt;0.05), with no inferiority to conventional dose group with HIR (all P&amp;gt;0.05). The dichotomous inter-reader reliability (k) for the entire group was 0.88. Low dose group resulted in a significant reduction in radiation exposure (mean [± SD], 2.20 ± 0.29 mSv) compared to conventional dose group (4.85 ± 1.96 mSv; P&amp;lt;0.001). Conclusion Low dose CTE with DLR significantly improved image quality compared to low dose CTE with HIR, and maintained similarly high diagnostic performance as conventional dose CTE with HIR. Importantly, the low dose CTE with DLR significantly reduced the radiation dose, improving the safety of CTE application in the life-long follow-up of patients with IBD.

Minimizing operator exposure: field data analysis of three closed transfer systems for pesticide mixing and loading

Three Closed Transfer Systems (CTS) were evaluated for their reduction of operator exposure to plant protection products during mixing and loading: the inverted extraction systems, easyFlow M and easyconnect, and the probe extraction system, GoatThroat®. Exposure data were generated for gloves, hands, head, inner and outer body dosimeters generated in 4 European countries for high rate (Sorbitol) and low rate (Xylitol) surrogate products used by 12 operators. Exposure values were compared with predicted data using the Agricultural Operator Exposure Model as a benchmark for open pour loading (used in the EFSA Guidance). The CTS types conformed with the ISO 21191 standard for CTS performance, and their potential to significantly reduce operator exposure was confirmed in this study. There was no statistical difference in potential (naked) or actual (one layer of clothing) operator exposure using both inverted CTS types; allowing these data to be pooled. The inverted CTS types resulted in higher mean protection (> 98% potential exposure and > 95% actual exposure) than GoatThroat® (> 80% potential exposure and > 95% actual exposure). These data can be used to derive reduction factors that could be used in the AOEM model for calculations involving mitigation e.g., 0.05 for inverted CTS since they reduced exposure by > 95% and 0.3 for probe extraction CTS types. All 3 CTS significantly reduced operator exposure to products during M&L. These and future CTS types which comply with ISO 21191 standards could be considered as mitigation devices. These findings will help to build confidence of farmers to use CTS routinely, resulting in safer pesticide handling.

Internal dose rate due to intake of uranium and thorium by fish from a dam reservoir associated with a uranium mine in Brazil.

Uranium mining can cause environmental impacts on non-human biota around mine sites. Because of this, the reduction in non-human biota exposure becomes an important issue. Environmental radioprotection results from the evolution of human radioprotection; it is based on dose rate to non-human biota and uses, as a biological target, and has harmful effects on populations. In the present study, a flooded impoundment created following dam construction in a uranium mine plant undergoing decommissioning was investigated. Internal dose rates due to activity concentration of natural uranium (Unat) and 232Th in omnivorous, phytophagous, and carnivorous fish species were estimated. Radionuclide activity concentrations were obtained by spectrophotometry with arsenazo III in the visible range. The dose rate contribution of 232Th was lower than that of Unat. There were no differences between the internal dose rates to studied fish species due to 232Th, but there were differences for Unat. A dose rate of 2.30·10-2µGy∙d-1 was found due to the two studied radionuclides. Although this value falls below the benchmark for harmful effects, it is important to acknowledge that the assessment did not account for other critical radionuclides from uranium mining, which also contribute to the internal dose. Moreover, the study did not assess external doses. As a result, the possibility cannot be excluded that dose rates at the study area overcome the established benchmarks for harmful effects.

Impact of Sedation Practices on Mortality in COVID-19-Associated Adult Respiratory Distress Syndrome Patients: A Multicenter Retrospective Descriptive Study.

Background: Reduction in sedation exposure is an important metric in intensive care unit (ICU) patients. However, challenges arose during the coronavirus disease-2019 (COVID-19) pandemic in adhering to this practice, driven by concerns on transmission and disease severity issues. Accordingly, diverse sedation approaches emerged, although the effect on mortality has not been studied thoroughly. Methods: Retrospective cohort study in the medical ICU of seven hospitals within a major Health System in Northeast Ohio. We included all adult patients admitted with COVID-19 requiring invasive mechanical ventilation (IMV) from March 2020 to December 2021. Results: Study included 2394 COVID-19 patients requiring IMV. Across waves, sample included 55-63% male subjects, with an average age of 61-68 years (P < 0.001), Acute Physiologic and Chronic Health Evaluation (APACHE)-III score 65.8-68.9 (P = 0.37), median IMV duration 8-10 days (P = 0.14), and median ICU duration 9.8-11.6 days (P = 0.084). Propofol remained the primary sedative (84-92%; P = 0.089). Ketamine use increased from the first (9.7%) to fourth (19%) wave (P = 0.002). Midazolam use decreased from the first (27.4%) to third (9.4%) wave (P = 0.001). Dexmedetomidine use declined from 35% to 27-28% (P = 0.002) after the first wave. A multivariable regression analysis indicated clinical variables explained 34% of the variation in hospital mortality (R2). Factors associated with higher mortality included age [aOR = 1.059 (95% CI 1.049-1.069); P < 0.001], COVID-19 wave, especially fourth wave [aOR = 2.147, (95% CI 1.370-3.365); P = 0.001], and higher number of vasopressors [aOR = 31.636, (95% CI 17.603-56.856); P < 0.001]. Addition of sedative medications to a second model led to an increase in the R2 by only 1.6% to 35.6% [aOR = 1 (95% CI 1-1); P > 0.05] for propofol, ketamine, and midazolam. Dexmedetomidine demonstrated a decrease in the odds of mortality [aOR = 0.96 (95% CI 0.94-0.97); P < 0.001]. Conclusion: Mortality in critical COVID-19 patients was mostly driven by illness severity, and the choice of sedation might have minimal impact when other factors are controlled.

Randomized trial in rural Native American homes heated with wood stoves: results from the EldersAIR study.

Residential wood burning has both practical and traditional value among many indigenous communities of the United States Mountain West, although household biomass burning also results in emissions that are harmful to health. In a household-level three-arm placebo-controlled randomized trial we tested the efficacy of portable filtration units and education interventions on improving pulmonary function and blood pressure measures among elder participants that use wood stoves for residential heating. A total of 143 participants were assigned to the Education (n=49), Filter (n=47), and Control (n=47) arms. Blood pressure and spirometry measures were collected multiple times during a per-intervention winter period and during a follow-up post-intervention winter period. Despite strong PM2.5 exposure reduction results with the Filter arm (50% lower compared to Control arm), neither this intervention nor the Education intervention translated to improvements in the selected health measures among this population with a mixture of chronic conditions. Intention to treat analysis failed to demonstrate evidence that either of the intervention arms had beneficial effects on the blood pressure or the spirometry measures. Post-hoc evaluation of effect modification for blood pressure and spirometry outcomes did not reveal any interaction influence on the outcomes according to sex, residential smoking, chronic disease history and study area.

The Impact of COVID-19 on Medical Education: A Lost Generation of Ophthalmologists?

COVID-19 had a significant impact on undergraduate medical education.There has been extensive analysis on the generic impact on medical education, but the individual impact on specialties, particularly ophthalmology, has not been widely researched. We explored the impact of COVID-19 on the undergraduate ophthalmology experience in the UK, characterising the effect on medical education and considered positive outcomes that could be implemented in future undergraduate curricula. An online-cross sectional study was performed using a 13-item questionnaire in 2023, completed by 101 participants from UK medical schools.This study was conducted through University College London, England. Statistical and qualitative analysis revealed a significant reduction in clinical exposure during the pandemic with an almost complete shift to online lecture-based teaching. This teaching style has been adapted post-pandemic, which is impacting student confidence in dealing with ophthalmic conditions and deterring them from considering ophthalmology as a career. COVID-19 has exacerbated a pre-existing gap in training medical trainees to deal with ophthalmic presentations. With an increase in the proportion of undergraduate medical education taking place online, efforts should be made to ensure students have hands-on, clinical exposure especially in practical placements, such as ophthalmology.

Chemicals Used in Plastic Materials: An Estimate of the Attributable Disease Burden and Costs in the United States.

Chemicals used in plastics have been described to contribute to disease and disability, but attributable fractions have not been quantified to assess specific contributions. Without this information, interventions proposed as part of the Global Plastics Treaty cannot be evaluated for potential benefits. To accurately inform the tradeoffs involved in the ongoing reliance on plastic production as a source of economic productivity in the United States, we calculated the attributable disease burden and cost due to chemicals used in plastic materials in 2018. We first analyzed the existing literature to identify plastic-related fractions (PRF) of disease and disability for specific polybrominated diphenylethers (PBDE), phthalates, bisphenols, and polyfluoroalkyl substances and perfluoroalkyl substances (PFAS). We then updated previously published disease burden and cost estimates for these chemicals in the United States to 2018. By uniting these data, we computed estimates of attributable disease burden and costs due to plastics in the United States. We identified PRFs of 97.5% for bisphenol A (96.25-98.75% for sensitivity analysis), 98% (96%-99%) for di-2-ethylhexylphthalate, 100% (71%-100%) for butyl phthalates and benzyl phthalates, 98% (97%-99%) for PBDE-47, and 93% (16%-96%) for PFAS. In total, we estimate $249 billion (sensitivity analysis: $226 billion-$289 billion) in plastic-attributable disease burden in 2018. The majority of these costs arose as a result of PBDE exposure, though $66.7 billion ($64.7 billion-67.3 billion) was due to phthalate exposure and $22.4 billion was due to PFAS exposure (sensitivity analysis: $3.85-$60.1 billion). Plastics contribute substantially to disease and associated social costs in the United States, accounting for 1.22% of the gross domestic product. The costs of plastic pollution will continue to accumulate as long as exposures continue at current levels. Actions through the Global Plastics Treaty and other policy initiatives will reduce these costs in proportion to the actual reductions in chemical exposures achieved.

Liquefied Petroleum Gas or Biomass Cooking and Severe Infant Pneumonia

BackgroundExposure to household air pollution is a risk factor for severe pneumonia. The effect of replacing biomass cookstoves with liquefied petroleum gas (LPG) cookstoves on the incidence of severe infant pneumonia is uncertain.MethodsWe conducted a randomized, controlled trial involving pregnant women 18 to 34 years of age and between 9 to less than 20 weeks’ gestation in India, Guatemala, Peru, and Rwanda from May 2018 through September 2021. The women were assigned to cook with unvented LPG stoves and fuel (intervention group) or to continue cooking with biomass fuel (control group). In each trial group, we monitored adherence to the use of the assigned cookstove and measured 24-hour personal exposure to fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm [PM2.5]) in the women and their offspring. The trial had four primary outcomes; the primary outcome for which data are presented in the current report was severe pneumonia in the first year of life, as identified through facility surveillance or on verbal autopsy.ResultsAmong 3200 pregnant women who had undergone randomization, 3195 remained eligible and gave birth to 3061 infants (1536 in the intervention group and 1525 in the control group). High uptake of the intervention led to a reduction in personal exposure to PM2.5 among the children, with a median exposure of 24.2 μg per cubic meter (interquartile range, 17.8 to 36.4) in the intervention group and 66.0 μg per cubic meter (interquartile range, 35.2 to 132.0) in the control group. A total of 175 episodes of severe pneumonia were identified during the first year of life, with an incidence of 5.67 cases per 100 child-years (95% confidence interval [CI], 4.55 to 7.07) in the intervention group and 6.06 cases per 100 child-years (95% CI, 4.81 to 7.62) in the control group (incidence rate ratio, 0.96; 98.75% CI, 0.64 to 1.44; P=0.81). No severe adverse events were reported to be associated with the intervention, as determined by the trial investigators.ConclusionsThe incidence of severe pneumonia among infants did not differ significantly between those whose mothers were assigned to cook with LPG stoves and fuel and those whose mothers were assigned to continue cooking with biomass stoves. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; HAPIN ClinicalTrials.gov number, NCT02944682.)

Personal care product use patterns in association with phthalate and replacement biomarkers across pregnancy

BackgroundHumans are exposed to phthalates, a class of non-persistent chemicals, through multiple products, including personal care and cosmetics. Associations between specific phthalates and product use have been inconsistent. However, determining these connections could provide avenues for exposure reduction.ObjectiveExamine the association between patterns of personal care product use and associations with phthalate and replacement biomarkers.MethodsIn the Human Placenta and Phthalates Study, 303 women were enrolled in early pregnancy and followed for up to 8 visits across gestation. At each visit, women completed a questionnaire about product use in the prior 24 hours and contributed urine samples, subsequently analyzed for 18 phthalate and replacement metabolites. At early, mid-, and late pregnancy, questionnaire responses were condensed and repeated metabolite concentrations were averaged. Latent class analysis (LCA) was used to determine groups of women with similar use patterns, and weighted associations between group membership and biomarker concentrations were assessed.ResultsLCA sorted women into groups which largely corresponded to: (1) low fragranced product use (16-23% of women); (2) fragranced product and low body wash use (22–26%); 3) fragranced product and low bar soap use (26–51%); and (4) low product use (7–34%). Monoethyl phthalate (MEP) urinary concentrations were 7–10% lower and concentrations of summed di(2-ethylhexyl) terephthalate metabolites were 15–21% lower among women in the “low fragranced product use” group compared to the population mean. Few other consistent associations between group and biomarker concentrations were noted.Impact statementPersonal care products and cosmetics are a known exposure source for phthalates and potentially represent one of the most accessible intervention targets for exposure reduction. However, in this analysis accounting for concurrent use and fragranced status of products, we did not find any use patterns that corresponded to universally lower levels.