Reduction In Exposure Research Articles

Papel de enfermería en el cateterismo cardiaco derecho. Ventajas del acceso venoso periférico

IntroductionPulmonary hypertension (PH) is a serious disease that requires early diagnosis to achieve a better patient prognosis. Right heart catheterization (RHC) has become the main diagnostic test for this disease, measuring the pressures from the right heart chambers invasively, using a catheter placed through venous access. Nursing performance has an important role in RHC through peripheral venous access due to its well-done skills for canalization and knowledge about the management and care of these accesses. RHC performed through peripheral venous access provide advantages over those performed through central venous access. ObjectiveTo analyze the benefits from RHC through peripheral venous access compared to those performed through central venous access, as well as highlighting the role of nursing during this type of procedures. MethodA retrospective, descriptive, and observational study was performed for patients who underwent RHC in our center between January 2019 to January 2023. We analyzed clinical characteristics, access, fluoroscopy parameters, periprocedural complications, and hospital admissions. ResultA total of 115 patients were included. The average age was 65±12 years, with 58.1% of females. Risk stratification of PH was the reason for conducting RHC in 82.9%. The anterocubital veins became the main approach (72.2%), performed by hemodynamics nurses, while the central venous ones composed the rest (27.8%), which were done by cardiology specialized doctors. We observed a significant reduction in radiation dose in RHC via anterocubital route compared to central venous access (4.4Gycm2 vs 12.5Gycm2 [IQR: 4.5]; P<.001), and it does also in fluoroscopy times (2.3minutes vs 4.6minutes [IQR: 2.6]; P<.001). No complications were recorded, independently of the approach. Patients who underwent a scheduled catheterization were discharged more frequently on the same day of the procedure whether a peripheral approach was performed (77.2%, 44 of 57 patients), in comparison with the central one (28.6%) (P=.001). ConclusionsThe RHC is an essential tool for the diagnosis of PH, achieving nursing such an important role for those performed by peripheral venous access. Peripheral venous access provides benefits and advantages like the reduction of radiation exposure and scan times, reduced hospital stay. All this could bring greater comfort, safety and better quality of care to the patient.

Assessing PM2.5 exposure bias towards deprived areas in England using a new indicator

In many countries higher concentrations of harmful air pollutants coincide with more deprived areas of society, where prevalence of health impacts associated with air pollution are greater. However, the impact of policies aimed at mitigating air pollution on the bias in exposure across deprivation groups rarely feature in policy development.We introduce the Indicator of Exposure Bias (IoEB) to the UK Integrated Assessment Model to quantify this bias, providing a method for comparing different scenarios and sectors. We analyse the bias in exposure to PM2.5 concentrations across deprivation levels within England currently and for future scenarios, and by sectors. While England's Index of Multiple Deprivation (IMD) and the Health domain are used as measures of deprivation here, the indicator can be applied to any pair of spatial socio-economic status and environmental exposure metrics.An IoEB of 0.88 µg.m−3 was calculated for the 2018 baseline, indicating a bias in exposures towards more deprived areas ranked using the IMD. All future scenarios considered here lead to reductions in population exposure and a reduction in the bias towards more deprived areas, with the greatest reduction of 59 % achieved by focusing on urban sources of primary PM2.5. The total bias in exposure towards more deprived areas is mitigated by an opposite bias for the transboundary contribution, therefore the bias in exposure of total PM2.5 does not accurately reflect that associated to UK anthropogenic emissions. The bias varies significantly between sectors, with non-industrial combustion and road transport the greatest contributors.Reaching England's 2040 PM2.5 exposure target is likely to deliver substantially greater health benefits for the more deprived members of society than the less deprived, reducing health inequality. The bias is sensitive to the measure of deprivation used, demonstrated using the Health domain.

Non-communicable airway disease and air pollution in three African Countries: Benin, Cameroon and The Gambia.

Air pollution exposure can increase the risk of development and exacerbation of chronic airway disease (CAD). We set out to assess CAD patients in Benin, Cameroon and The Gambia and to compare their measured exposures to air pollution. We recruited patients with a diagnosis of CAD from four clinics in the three countries. We collected epidemiological, spirometric and home air pollution data. Of the 98 adults recruited, 56 were men; the mean age was 51.6 years (standard deviation ±17.5). Most (69%) patients resided in cities and ever smoking was highest in Cameroon (23.0%). Cough, wheeze and shortness of breath were reported across the countries. A diagnosis of asthma was present in 74.0%; 16.3% had chronic obstructive pulmonary disease and 4.1% had chronic bronchitis. Prevalence of airflow obstruction was respectively 77.1%, 54.0% and 64.0% in Benin, Cameroon, and Gambia. Across the sites, 18.0% reported >5 exacerbations. The median home particulate matter less than 2.5 μm in diameter (PM2.5) was respectively 13.0 μg/m3, 5.0 μg/m3 and 4.4 μg/m3. The median home carbon monoxide (CO) exposures were respectively 1.6 parts per million (ppm), 0.3 ppm and 0.4 ppm. Home PM2.5 differed significantly between the three countries (P < 0.001) while home CO did not. Based on these results, preventive programmes should focus on ensuring proper spirometric diagnosis, good disease control and reduction in air pollution exposure.

Trends in prenatal prescription opioid use among Medicaid beneficiaries in Wisconsin, 2010-2019.

To examine changes in prenatal opioid prescription exposure following new guidelines and policies. Cohort study of all (262,284) Wisconsin Medicaid-insured live births 2010-2019. Prenatal exposures were classified as analgesic, short term, and chronic (90+ days), and medications used to treat opioid use disorder (MOUD). We describe overall and stratified temporal trends and used linear probability models with interaction terms to test their significance. We found 42,437 (16.2%) infants with prenatal exposure; most (90.5%) reflected analgesic opioids. From 2010 to 2019, overall exposure declined 12.8 percentage points (95% CI = 12.1-13.1). Reductions were observed across maternal demographic groups and in both rural and urban settings, though the extent varied. There was a small reduction in chronic analgesic exposure and a concurrent increase in MOUD. Broad and sustained declines in prenatal prescription opioid exposure occurred over the decade, with little change in the percentage of infants chronically exposed.

Significant Reduction of Unequal Population Exposure to Climate Extremes by Achieving the Carbon Neutrality

AbstractClimate extremes, such as hot temperature and heavy precipitation events, have devastating effects on human societies. As the planet gets warmer, they have become more intense and more frequent. To avoid irreversible damages from climate extremes, many countries have committed to achieving net‐zero anthropogenic carbon emissions, or carbon neutrality, by the 2050s. Here, we quantify the impact of carbon neutrality on population exposure to climate extremes using multi‐model projections from the Coupled Model Intercomparison Project Phase 6 (CMIP6) Shared Socioeconomic Pathway (SSP)1‐1.9 and SSP3‐7.0 scenarios. It is found that the increasing population exposure to hot‐temperature and heavy‐precipitation extremes under SSP3‐7.0 scenario can be substantially reduced by 87%–98% in the late 21st century by achieving the carbon neutrality based on SSP1‐1.9 scenario. The benefits of carbon neutrality are particularly pronounced in Africa and Asia. The potential benefits of carbon neutrality are also significant in North America, Europe, and Oceania, where a reduction in climate extremes is more than twice as important as population decline in reducing population exposure to climate extremes. These results provide important scientific support for ongoing efforts to achieve net‐zero carbon emissions by the 2050s to reduce potential climate risk and its inequity across continents.

Digital variance angiography in patients undergoing lower limb arterial recanalization: cost-effectiveness analysis within the English healthcare setting.

Aim: Digital variance angiography (DVA) is a recently developed image processing method capable of improving image quality compared with the traditionally used digital subtraction angiography (DSA), among patients undergoing lower limb x-ray angiography. This study aims to explore the potential cost-effectiveness of DVA from an English National Health Service perspective. Materials & methods: A two-part economic model, consisting of a decision tree and a Markov model, was developed to consider the costs and health outcomes associated with the use of DVA as part of current practice imaging, compared with x-ray angiography using standard DSA. The model explored the impact of DVA on the development of acute kidney injury (AKI), chronic kidney disease and radiation-induced cancer over a lifetime horizon. Both deterministic and probabilistic analyses were performed to assess the cost per quality-adjusted life-year (QALY). Results: Base-case results indicate that DVA results in cost savings of £309 per patient, with QALYs also improving (+0.025) over a lifetime. As shown in sensitivity analysis, a key driver of model results is the relative risk (RR) reduction of contrast-associated acute kidney injury associated with use of DVA. The intervention also decreases the risk of carcinoma over a lifetime. Scenario analyses show that cost savings range from £310 to £553, with QALY gains ranging from 0.048 to 0.109 per patient. Conclusion: The use of DVA could result in a decrease in costs and an increase in QALYs over a lifetime, compared with existing imaging practice. The potential for this technology to offer an economically viable alternative to existing image processing methods, through a reduction in contrast media volume and radiation exposure, has been demonstrated.

Exposure to Smoke From Wildfire, Prescribed, and Agricultural Burns Among At-Risk Populations Across Washington, Oregon, and California.

Wildfires, prescribed burns, and agricultural burns all impact ambient air quality across the Western U.S.; however, little is known about how communities across the region are differentially exposed to smoke from each of these fire types. To address this gap, we quantify smoke exposure stemming from wildfire, prescribed, and agricultural burns across Washington, Oregon, and California from 2014 to 2020 using a fire type-specific biomass burning emissions inventory and the GEOS-Chem chemical transport model. We examine fire type-specific PM2.5 concentration by race/ethnicity, socioeconomic status, and in relation to the Center for Disease Control's Social Vulnerability Index. Overall, population-weightedPM2.5 concentrations are greater from wildfires than from prescribed and from agricultural burns. While we found limited evidence of exposure disparities among sub-groups across the full study area, we did observe disproportionately higher exposures to wildfire-specific PM2.5 exposures among Native communities in all three states and, in California, higher agricultural burn-specific PM2.5 exposures among lower socioeconomic groups. We also identified, for all three states, areas of significant spatial clustering of smoke exposures from all fire types and increased social vulnerability. These results provide a first look at the differential contributions of smoke from wildfires, prescribed burns, and agricultural burns to PM2.5 exposures among demographic subgroups, which can be used to inform more tailored exposure reduction strategies across sources.

Reducing heat exposure from personal cooling strategies to green city construction in China's tropical city

With rapid industrialization and urbanization, the risk of summer heat exposure for urban dwellers has increased. The use of air conditioners (ACs) has become the most common personal cooling strategy, but further increasing fossil fuel consumption. As sustainable and affordable cooling strategies, urban parks can reduce heat exposure and substitute a part of air conditioners use. This study evaluates the heat exposure reduction from personal cooling to urban parks based on satellite images, questionnaire surveys, and network analysis in Liuzhou, one tropical city in China. We found that residents with lower income had a higher risk of heat exposure. Among the respondents, 85 % of residents chose to use ACs to alleviate high temperatures in summer, and 81.8 % among them were willing to access park cooling area (PCA) to cool off instead of using ACs. About one third parks could serve as potential alternatives (with temperatures <28 °C) to air conditioning, reducing carbon emissions by 175.93 tons per day during the hot summer and offsetting 2.5 % of urban fossil fuel carbon emissions. The design of parks should give more consideration to elder people and provide a good cooling platform for various social income groups. Future planning should also focus on accessibility to enable residents to fully utilize the parks. Building parks within 34.10 ha would provide a more efficient use of land. This research guides sustainable, high-quality growth in industrial cities and might contribute to promotion of low-carbon cities and social equity.

A spatial approach to assessing PM2.5 exposure level of a brickmaking community in South Africa

ABSTRACT Globally, particulate matter with an aerodynamic diameter of 2.5 µm or less poses a significant threat to human health. The first step in quantifying human health impacts caused by exposure to PM2.5 pollution is exposure assessment. Population-weighted exposure level (PWEL) estimation is one of the methods that provides a more precise exposure assessment since it incorporates the spatiotemporal distribution of population with the pollution concentration estimate. In this study, PM2.5 exposure levels in the local communities around brickmaking industries were investigated, using the population census data of the study area and 1-year data from nine PM2.5 monitoring stations installed in and around the brickmaking industries. The observed PM2.5 data was spatially interpolated using inverse distance weight (IDW). Data on PM2.5 levels across the study area were classified based on the World Health Organization interim target (IT) guidelines and the South African National ambient air quality standard (NAAQS). An annual PM2.5 population weighted exposure level of 27.6 µg/m3 was estimated for the study area. However, seasonal exposure levels of 28.9, 37.6, 26.5, and 20.7 µg/m3 were estimated for the autumn, winter, spring, and summer seasons, respectively. This implies that local communities around the brick kiln in the Vhembe District are exposed to high levels of PM2.5, especially in winter. The PM2.5 levels in the brickmaking industries as well as its other sources in the Vhembe District, therefore, need to be lowered. Findings from population exposure level to pollutants can provide valuable data for formulating policies and recommendations on exposure reduction and public health protection. Implications: PM2.5 concentration in any given environment has high spatial and temporal variability due to the presence of diffused sources in the environment. Using ambient air concentrations to directly estimate population exposure without taking into consideration the disproportionate spatial and temporal distribution of the pollutant and the population may not yield accurate results on human exposure levels. It is, therefore, important to assess the aggregated PM2.5 exposure of a populace within a given area. This study therefore examines the PM2.5 population-weighted-exposure level of the host communities of the brickmaking industry in Vhembe District, South Africa.

Abstract 7165: Clinical population pharmacokinetic (popPK) analysis of NBF-006, a novel siRNA inhibitor of glutathione-S-transferase P (GSTP) encapsulated in a lipid nano particle (LNP), for treatment of advanced non-small cell lung cancer (NSCLC)

Abstract GSTP has an important role in detoxification and antioxidative damage response. Additionally, GSTP has a chaperone function that regulates multiple oncogenic pathways such as KRAS and JNK. Since alternative pathways could compensate for the inhibition of a single kinase, targeting multiple pathways could lead to more effective therapy. NBF-006 is a drug product comprised of GSTP siRNA encapsulated within a novel LNP. It is designed to deliver siRNA to localized and metastatic lung tumors. Unlike other well-established drug modalities, there is a general need for increased understanding of the PK of RNA therapeutics. For NBF-006, we present popPK analysis of patients who have undergone treatment in a Phase I (a/b) clinical study. A primary goal of popPK modeling is to identify PK parameters and sources of variability in a population. Other goals include correlating drug exposures with administered doses through identification of predictive covariates in a target population and establishing whether fixed dosing as opposed to weight-based dosing can be utilized in future clinical studies. Ultimately this analysis will help to inform decision-making for dosing regimens in future clinical trial designs and to better predict PK variability across populations. A total of 48 advanced NSCLC (N=38), pancreatic (N=5), or colorectal cancer (N=5) patients received 4 doses (QW) of NBF-006 by infusion at 0.15, 0.3, 0.6, 1.2 or 1.6 mg/kg followed by a 2-week rest period. In all studies, serial blood samples were collected at weeks 1 and 4. Plasma concentrations of siRNA were determined by hybridization ELISA. PopPK analysis was performed to characterize NBF-006 PK and to explore intrinsic and extrinsic covariate effects that could affect NBF-006 exposure. The analysis included 695 quantifiable PK observations. A popPK model with two-compartment disposition and linear elimination adequately described the PK profile of NBF-006. Exploratory data analysis of dose-normalized PK profiles suggested that exposure increased proportionally with increasing dose from 0.15 to 1.6 mg/kg. Little to no apparent accumulation nor exposure reduction was observed between weeks 1 and 4. The impact of individual patient covariates, including body weight, baseline ALT, sex, KRAS mutation, cancer type and race, was assessed on PK parameters. None of the covariates evaluated had a significant effect on NBF-006 clearance or central distribution volume (Vc) in the model. Vc showed a slight positive trend with higher body weight, but was not statistically significant. A popPK model was successfully developed for NBF-006. No covariates were identified that impact NBF-006 exposure. The lack of a relationship of exposure with body weight suggests the potential to use fixed dosing in future clinical studies. Citation Format: Michael P. Hall, Zhihong O'Brien, Xi Chen, Angelean Hendrix, Stacy Brenes-Coto, Sonya Zabludoff. Clinical population pharmacokinetic (popPK) analysis of NBF-006, a novel siRNA inhibitor of glutathione-S-transferase P (GSTP) encapsulated in a lipid nano particle (LNP), for treatment of advanced non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7165.

Experimental assessment of the exposure to airborne exhaled contaminants using general and personalised ventilation systems in a hospital room

Ensuring good indoor air quality is critical in hospitals. An environment free from airborne particles can prevent the spread of various diseases and improve patient health. In this study, the efficiency of a personalised ventilation supply system (PSS) and personalised ventilation extraction system (PES) for diluting and removing contaminants exhaled by a patient in a hospital bed was evaluated. These systems, which were integrated into the head and foot of a hospital bed, were combined with three general ventilation strategies in the room. Fifteen ventilation strategies were analysed experimentally. Two breathing thermal manikins (BTMs) were used to simulate a patient and health worker in a hospital. The breathing of each BTM was controlled by the patient (source) generating particles that can increase the risk of infection in a healthy person (target). Experimental results show that using a PES combined with general ventilation of the room reduces the exposure of the target manikin compared to general ventilation strategies alone. However, no marked improvement was observed when the PSS was activated. The reduction in exposure to the target manikin was considerable when the PES was located at the foot of the hospital bed, which is the preferred option for integrating personalised systems in a hospital bed.

The hair tales of women of color in Northern Manhattan: a qualitative analysis.

Exposure to endocrine disrupting chemicals (EDCs), such as phthalates, can negatively impact maternal and child health, contributing to impaired fetal growth, preterm birth, and pregnancy complications, as well as increased downstream risks of cardiometabolic disease and breast cancer. Notably, women of color (WOC) are the largest consumers of personal care products, which are a common source of EDC exposure. The Let's Reclaim Our Ancestral Roots (Let's R.O.A.R) Pilot Study developed an educational intervention delivered during pregnancy to promote reduced use of phthalate-containing hair care products (HCPs). This mixed-methods study included: (1) a quantitative analysis and (2) a qualitative analysis of the educational sessions and the semi-structured focus groups to evaluate the factors that influenced the hair care practices and product choices of WOC at various stages of life, including their current pregnancy (hereafter referred to as the hair journey). During the sessions, participants learned about EDCs (with a focus on phthalates), the unequal burden of exposure for WOC, adverse implications of exposure, and exposure reduction strategies. Focus group sessions provided insight into participants' hair journeys from childhood to the current pregnancy and explored factors during their hair product selection process. All sessions were transcribed and imported into NVivo Version 12 for coding and thematic analysis. A total of 46 individuals were enrolled in the study, and 31 participated in an educational session. This current work synthesizes the qualitative analysis of this study. We identified two important life stages (before and after gaining agency over hair care practices and product choices) and three dominant themes related to HCP use: (1) products that impacted the hair journey, which involved all mentions of hair products, (2) factors that influenced the hair journey, which included individuals or entities that shaped participants' hair experiences, and (3) the relationship between hair and sense of self, where sense of self was defined as the alignment of one's inner and outer beauty. The themes intersected and impacted the participants' hair journey. Cultural integration was a sub-theme that overlapped within the dominant themes and participants discussed the effect of traditions on their hair experiences.

Toxicokinetics of homosalate in humans after dermal application: applicability of oral-route data for exposure assessment by human biomonitoring

Homosalate (HMS) is a UV filter used in sunscreens and personal care products as a mixture of cis- and trans-isomers. Systemic absorption after sunscreen use has been demonstrated in humans, and concerns have been raised about possible endocrine activity of HMS, making a general population exposure assessment desirable. In a previous study, it was shown that the oral bioavailability of cis-HMS (cHMS) is lower than that of trans-HMS (tHMS) by a factor of 10, calling for a separate evaluation of both isomers in exposure and risk assessment. The aim of the current study is the investigation of HMS toxicokinetics after dermal exposure. Four volunteers applied a commercial sunscreen containing 10% HMS to their whole body under regular-use conditions (18–40 mg HMS (kg bw)−1). Parent HMS isomers and hydroxylated and carboxylic acid metabolites were quantified using authentic standards and isotope dilution analysis. Further metabolites were investigated semi-quantitatively. Elimination was delayed and slower compared to the oral route, and terminal elimination half-times were around 24 h. After dermal exposure, the bioavailability of cHMS was a factor of 2 lower than that of tHMS. However, metabolite ratios in relation to the respective parent isomer were very similar to the oral route, supporting the applicability of the oral-route urinary excretion fractions for dermal-route exposure assessments. Exemplary calculations of intake doses showed margins of safety between 11 and 92 (depending on the approach) after single whole-body sunscreen application. Human biomonitoring can reliably quantify oral and dermal HMS exposures and support the monitoring of exposure reduction measures.

Health benefits to the pediatric population from reduction of ambient particulate matter in Krakow, Poland

There have been few assessments of the health benefits to children of policies aimed at curbing fossil fuel-related air pollution. This has resulted in a lack of awareness regarding their positive impact on the health of this vulnerable population. We estimated the pediatric health benefits of policies targeting coal burning in one of Europe’s most polluted cities, Kraków, Poland. We combined available data on child health outcomes, related concentration-response functions, childhood population counts, and concentrations of PM2.5 and PM10 based on city-wide air monitoring in Kraków. Two exposure reduction scenarios were examined. First, we used the observed decrease in air pollutant concentrations between 2010 and 2019. Second, we hypothesized a reduction to the annual World Health Organization (WHO) air quality guideline values issued in 2005. Between 2010 and 2019, the mean annual air pollution levels in Kraków decreased for both PM2.5 and PM10. Annual average PM2.5 concentrations declined by 39.1%, reaching 23.3 μg m−3; PM10 dropped by 39.2% to 34.6 μg m−3. These reductions in air pollution can be linked to numerous actions undertaken at local and national levels. We estimate that the forgone benefits in 2010 from not having achieved the PM levels observed in 2019 (on an annual basis) included: 505 (35.7%) fewer incident cases of asthma in the 1–14 age group, 81 fewer preterm births (16.8% decrease), 52 fewer cases of low birth weight (12.3% decrease), and 59 avoided asthma hospitalizations in 0–18 year olds. Compliance with the 2005 WHO PM2.5 guidelines in 2010 would have avoided 780 incident asthma cases in the 1–14 age group (54.5% decrease), 138 preterm births (28.3% decrease), and 90 cases of low birth weight (21.2% reduction) and 219 (54.2%) fewer asthma hospitalizations in 0–18 year olds. Large health benefits were also estimated for PM10 in both scenarios. This study estimated substantial health benefits for children in Kraków, which were largely attributable to clean air policies that restrict the use of coal and other solid fuels. Kraków provides a model for other cities in Europe and beyond that are affected by coal pollution and have high rates of preterm birth, low birth weight, and respiratory illness.

Multiple Myeloma and Occupational Risk Factors: A Narrative Review.

Multiple Myeloma (MM) is a neoplastic hematologic disorder caused by the excessive proliferation of plasma cells and leads to bone lesions, anemia, and kidney failure. No definite etiology has been proposed for MM, but several environmental and genetic risk factors have been implicated so far. Exposure to pesticides, benzene, and organic solvents like methyl chloride have been considered a potential risk factor. Asbestos, ionizing radiation, and wood dust exposure have also been associated with MM. As MM is a relatively rare condition, the number of studies is insufficient, and in many studies, only a few study participants recall exposure to any agents. Therefore, establishing a definite risk factor is cumbersome and further studies with large study samples are needed. By recognizing these occupational risk factors, clinicians can encourage employees to reduce their exposure as more as possible and implement precautionary measures. In this review, we highlighted the current research on the potential association between occupational exposures and MM. Because of these studies, new regulations with the goal of occupational exposure reduction are anticipated in the future.

Opportunities and Challenges Associated with the Uptake of Residential Clean Fuel Usage.

Almost 3 billion people worldwide use solid fuel for cooking and heating. This review examines (i) household energy practices and infrastructures and their influence on fuel usage in different contexts; (ii) barriers in adoption of household clean energy technologies and uses in diverse settings and population groups and (iii) potential air pollution exposure reduction in homes through using processed fuel. Population health burden from solid fuel combustion-derived particulate air pollution has been estimated in several low- and middle-income countries. However, such studies have not been carried out in high income countries (e.g., UK). Irrespective of the region, fuel prices are the most dominant factor influencing the choice of fuel. Laboratory studies suggest processed fuel - pellets and briquettes - reduce particulate matter emissions by 70-80% and can be a promising alternative. Adoption of clean fuels for domestic energy needs facilitates progress towards five of the UN Sustainable Development Goals (SDGs). There is evidence that a variety of factors, including cost savings, encourage and hinder such uptake. These factors include price fluctuations, expenses, and the usage of clean fuels. Due to their distinct development scenarios, more expansive policy frameworks, and political economies of energy, these determinants are localized in character and differ significantly amongst economies. Therefore, in order to create innovative plans for the adoption of clean fuel use, strategies centred on local settings must be developed while keeping broad socio-technical and socio-economic issues in mind. Solid fuel processing - pelletization and briquetting - have the potential to reach Liquefied Petroleum Gas (LPG)-like emissions, and could be a potential strategy to mitigate exposure to household air pollution.

Comparison of Low-Dose Computed Tomography Versus Conventional-Dose Computed Tomography in the Evaluation of Distal Radius Fractures.

Distal radius fractures (DRFs) are common upper extremity fractures and often require surgical fixation when they are intraarticular. Preoperative computed tomography (CT) has emerged as a surgical planning tool to evaluate intraarticular DRFs. Although CT affords additional details, patients receive higher radiation doses than standard radiographs. We aim to develop a low-dose CT (LDCT) protocol, relative to the institutional standard-dose CT wrist for intraarticular DRFs although providing adequate detail for surgical decision-making. A single-institution prospective study was conducted on patients with intraarticular DRFs who underwent closed reduction and below-elbow splinting who otherwise would undergo wrist CT. Observations were defined as total measurements taken, with each view undergoing 44 measurements. Patients underwent 2 scans with a standard dose and a 10× dose reduction. Articular step and gap measurements were recorded in the sagittal and coronal images. A total of 11 patients were enrolled (7 women and 4 men). The mean age was 55 years (SD = 20.1). There were a total of 4 reviewers: 1 attending surgeon, 2 resident physicians, and 1 student. When comparing LDCT and conventional-dose CT (CDCT), there were no significant differences in step and gap measurements across all reviewers. This study demonstrated that LDCT provides comparable imaging quality for surgical planning as a CDCT without significant diagnostic decay in the setting of DRFs. This comes with the added benefit of a 10-fold reduction in radiation exposure. These results suggest that LDCT is an opportunity to reduce effective radiation in patients although providing beneficial preoperative imaging.

Predictors of smoking exposure in non-smoking adolescents in Indonesia

Exposure to secondhand smoke is one of the leading causes of death for non-smokers worldwide. The prevalence of exposure to secondhand smoke is higher among adolescents. Research on predictors of secondhand smoke exposure in adolescents is still rarely conducted in Indonesia. This study aimed to analyze the predictors of exposure to secondhand smoke among non-smoking adolescents in Indonesia. This study used data from the Global Youth Tobacco Survey (GYTS) Indonesia 2019 with a cross-sectional design. A total of 7,594 adolescents aged 13 to 15 were selected using purposive sampling. The dependent variables were exposure to secondhand smoke at home and in public. The independent variables included age, gender, smoking parents, smoking friends, and knowledge of the dangers of secondhand smoke. Data were analyzed using STATA with inferential tests, namely chi-square and logistic regression. The prevalence of adolescents exposed to secondhand smoke at home and in public was 49.57% and 71.86%, respectively. At-home exposure was significantly associated with smoking parents [AOR=3.50, 95% CI=2.97 to 4.12], smoking friends [AOR=1.50, 95% CI=1.30 to 1.73], and knowledge of the dangers of secondhand smoke [AOR=2.11, 95% CI=1.52 to 2.93]. Public exposure was associated with ages 13-15 [AOR=1.32, 95% CI=1.10 to 1.58] and older than 15 [AOR=1.77, 95% CI=1.39 to 2.25], male gender [AOR=1.31, 95% CI=1.11 to 1.53], smoking parents [AOR=1.58, 95% CI=1.36 to 1.84], smoking friends [AOR=2.16, 95% CI=1.85 to 2.53], and knowledge of secondhand smoke dangers [AOR=2.84, 95% CI=2.15 to 3.75]. Adolescents’ exposure to secondhand smoke in public spaces is higher in prevalence and has more associated factors compared to exposure at home. Exposure reductions require comprehensive actions from authorities by strictly implementing and expanding non-smoking areas covered by existing regulations. Also, family and school management should be involved in prevention efforts.

Study on the Mechanism of the Adrenaline-Evoked Procoagulant Response in Human Platelets.

Adrenaline has recently been found to trigger phosphatidylserine (PS) exposure on blood platelets, resulting in amplification of the coagulation process, but the mechanism is only fragmentarily established. Using a panel of platelet receptors' antagonists and modulators of signaling pathways, we evaluated the importance of these in adrenaline-evoked PS exposure by flow cytometry. Calcium and sodium ion influx into platelet cytosol, after adrenaline treatment, was examined by fluorimetric measurements. We found a strong reduction in PS exposure after blocking of sodium and calcium ion influx via Na+/H+ exchanger (NHE) and Na+/Ca2+ exchanger (NCX), respectively. ADP receptor antagonists produced a moderate inhibitory effect. Substantial limitation of PS exposure was observed in the presence of GPIIb/IIIa antagonist, phosphoinositide-3 kinase (PI3-K) inhibitors, or prostaglandin E1, a cyclic adenosine monophosphate (cAMP)-elevating agent. We demonstrated that adrenaline may develop a procoagulant response in human platelets with the substantial role of ion exchangers (NHE and NCX), secreted ADP, GPIIb/IIIa-dependent outside-in signaling, and PI3-K. Inhibition of the above mechanisms and increasing cytosolic cAMP seem to be the most efficient procedures to control adrenaline-evoked PS exposure in human platelets.

TEACHING THE HIERARCHY WITHIN VARIOUS APPROACHES TO SAFETY

This paper highlights examples of approaches to safety and illustrates how these approaches influence the implementation of the hierarchy of controls. The hierarchy of controls emphasizes the elimination or reduction of exposure to hazards by using the most effective controls in a hierarchical order. The five control measures, from most to least effective, are: elimination, substitution, engineering controls, administrative controls, and personal protective equipment (PPE). Undergraduate engineering students should be well informed about the hierarchy of controls, the order in which the controls are applied, and be able to justify why they applied a particular level of control. Teaching a hierarchical approach to safety also benefits undergraduate engineering students after they graduate. It is concluded that the educational training provided to an undergraduate engineering student should ensure that the hierarchy of controls is explained, and its application reinforced with engineering-specific examples throughout the undergraduate years.