Use Of Protective Gear Research Articles

Epidemiology and trends of adult ice hockey injuries presenting to United States emergency departments: A ten-year analysis from 2007–2016

PurposeThe adult population is under-represented in existing ice hockey injury studies, despite the number of United States (US) adult ice hockey players increasing from 103,533 in 2007 to 180,400 in 2016 (74%). This study establishes trends in demographics, injury location, and injury type for adult ice hockey players (≥19 years old) in the United States. MethodsThe National Electronic Injury Surveillance System (NEISS) was queried for all ice hockey injuries from January 1, 2007 to December 31, 2016. Cases under age 19 were excluded. Each injury's narrative text field was reviewed to determine mechanism of injury. ResultsA total of 1,653 patients, representing an estimated 68,786 ice-hockey related injuries, presented to NEISS-participating US EDs. The most commonly injured body parts were the face (n = 12,432, 18.1%), head (n = 10,201, 14.8%), shoulder (n = 9,654, 14.0%) and ankle (n = 5,389, 7.8%). The most common diagnoses made were laceration (n = 18,153, 26.4%), strain/sprain (n = 12,202, 17.7%), fracture (n = 10,079, 14.7%), contusion (n = 9,283, 13.5%) and concussion (n = 4,794, 7.0%). The most common mechanisms of injury were falling (n = 11,786, 18.7%), puck contact (n = 10,544, 15.3%) and player contact (n = 9,449, 13.7%). Concussions increased from 46 in 2007 to 928 in 2016 (R2 = 0.8, β = 0.9, p < 0.001). Females (n = 1,852, 32%) had a higher proportion of head injuries than males (n = 8,349, 13.3%) (IPR = 2.4, p < 0.0001). The 50+ year old cohort showed a significant increase in injuries during the study period (n = 146 vs. 982, R2 = 0.75, β = 0.87, p = 0.001). ConclusionsDespite changing trends in age and sex-related demographics, the majority of injuries in this population may be preventable with adequate enforcement of protective gear use. Increased education amongst players, coaches, trainers, orthopaedic surgeons and primary care physicians should be encouraged to minimize injuries.

Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review.

Personal protective equipment has become an important and emotive subject during the current coronavirus disease 2019 epidemic. Coronavirus disease 2019 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately 1 metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain. Contact, droplet and airborne transmission are each relevant during airway manoeuvres in infected patients, particularly during tracheal intubation. Personal protective equipment is an important component, but only one part, of a system protecting staff and other patients from coronavirus disease 2019 cross-infection. Appropriate use significantly reduces risk of viral transmission. Personal protective equipment should logically be matched to the potential mode of viral transmission occurring during patient care - contact, droplet or airborne. Recommendations from international organisations are broadly consistent, but equipment use is not. Only airborne precautions include a fitted high-filtration mask, and this should be reserved for aerosol generating procedures. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.

Factors Affecting Radiation Protection Behaviors among Emergency Room Nurses

Purpose This study aimed to examine factors affecting radiation protective behaviors among emergency room nurses by assessing knowledge, attitude, and environment for radiation protection. Methods The study employed a cross-sectional design. Subjects were a convenience sample of 129 nurses working in emergency rooms of three general hospitals. Data were collected using self-report questionnaires and analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple regression. Results The more the nurses received radiation safety education (t=2.26, p=.026), used protective gear (t=4.40, p<.001), and took health screenings (t=2.65, p=.009), the higher their levels of radiation protection behavior. There were significant relations between radiation protective behaviors and attitude (r=.27, p=.002), and radiation protective behaviors and environment for radiation protection (r=.55, p<.001). The factors affecting radiation protective behaviors were protective environment (β=.53, p<.001), protective attitude (β=.32, p<.001), and the use of protective gear (β=.24, p=.002). Conclusions The government, hospital administrators, and radiation protection-related organization should adopt the following measures to protect emergency room nurses from radiation: research and development of shield instrument, medical examination for emergency room nurses, protocol development of radiation protection behaviors, extension of education chances of radiation protection, and encouraging the use of protective equipment. Key Words: Emergency nursing, Radiography, Radiation protection 주요어: 응급실 간호, ë°©ì‚¬ì„ ì´¬ì˜, ë°©ì‚¬ì„ ë°©ì–´

Characterization of Facial Trauma Associated with Standing Electric Scooter Injuries

Abstract This case series describes 34 patients presenting with facial injuries after standing electric scooter use at two academic emergency departments, 6/2018-5/2019. The severity of injuries highlights this important emerging health risk and policy implications.

Skin cancer on Instagram: implications for adolescents and young adults.

Given the popularity and reach of Instagram among American adolescents and young adults (AYA), the well-known influence of social media on the behaviors of youth, and the rising rates of melanoma in this age group, this study sought to examine and describe the content of a sample of Instagram posts related to skin cancer. At three different times, a search of Instagram was conducted using #skincancer as the hashtag. Descriptive analyses of Instagram characteristics and content was performed. Overall, content focused on prevention (33.3%), skin cancer treatment (29.3%) and preventive measures such as using sunscreen and protective gear (29.3%). Nearly one-quarter discussed the ABCDEs (Asymmetrical; Borders are irregular; Color is not even; Diameter is large; Evolving) of screening and detection. Instagram postings that covered skin cancer prevention (n = 50, 33.3%) more often discussed the role of sun exposure in the development of skin cancer (28.0% vs. 10.0%, p = 0.005) and use of sunscreen and protective gear (62.0% vs. 13.0%, p < 0.001). The findings of this study indicate that a considerable portion of the Instagram posts included in this study focused on prevention. Thus, indicating that Instagram could be used to promote health, particularly among AYA.

Impact of the COVID-19 Pandemic on Neurosurgical Practice in India: Results of an Anonymized National Survey.

The COVID-19 pandemic has created an unprecedented challenge for medical professionals throughout the world to tackle the rapidly changing scenario. The objective of this survey was to analyze the change in neurosurgical practice in India following the COVID-19 outbreak and assess its impact on practising neurosurgeons. Between May 7th and 23rd, 2020, a validated questionnaire was circulated amongst practising neurosurgeons across the country by social media and e-mails, regarding changes in the patterns of patients seen, adaptations made in their practice, effect on surgeries performed, financial burden, and impact on their personal lives. The responses were kept anonymous and were analyzed for correlations between the changes observed and independent factors such as hospital affiliations, teaching professions, and neurosurgical experience. Our survey showed a drastic fall in the number of neurosurgical patients seen in the outpatient department (OPD) as well as the number of surgeries performed. A drop of 76.25% was seen in OPD patients (P = 0.000) and that of 70.59% in surgeries performed (P = 0.000). There was no uniformity among the neurosurgeons in the number of COVID-19 tests being done before elective/emergency surgery and in the use of protective gear while examining patients. Private practitioners were more affected financially as compared to those in the government sector. The pandemic has affected the research work of 53.23% of all respondents, with those in the teaching profession (70.96%) more affected than those in the non-teaching profession (24.67%). Evidence-based policies, screening COVID-19 tests with better sensitivity, and better-quality personal protective equipment kits in adequate numbers are required to protect our medical professionals from COVID-19. Mental health issues among neurosurgeons may also be an issue, this being a high risk speciality and should be closely watched for.

IADVL Position Statement and Recommendations on Post Lockdown Dermatology Practice Amidst the Covid -19 Pandemic (IADVL Academy and IADVL Executive Committee).

IADVL Position Statement and Recommendations on Post Lockdown Dermatology Practice Amidst the Covid -19 Pandemic (IADVL Academy and IADVL Executive Committee).

Motorcycle extremity injuries in South-East Nigeria: A multicenter study

Background: Motorcycle extremity injuries are an important public health concern in developing countries though under-reported. This study aimed to determine the pattern of motorcycle extremity injuries and identify the potential areas to facilitate preventive strategies and improved outcomes. Patients and Methods: This was a prospective study of all the patients with motorcycle injuries that visited emergency rooms of three Nigerian tertiary hospitals from February 1, 2015, to July 31, 2016. Results: Of the 587 patients with motorcycle injuries, 393 (67%) of them sustained extremity injuries. The male: female ratio was 2.3:1; the age range was 1.25–80 years with a mean of 30 ± 14 years. Motorcycle collisions with motor vehicles were the topmost mechanism of injury. The lower extremity was the most common site involved. Fractures, abrasions and lacerations were the three top injuries sustained. One hundred and seventeen (29.8%) of them were multiply injured patients. Traumatic brain injury (TBI) (23.7%) was the most common associated injury. None of the victims wore a crash helmet or extremity protective gear at the time of injury. The mean injury-hospital arrival interval was 84 h and delayed presentation to the hospital correlated with the presence of extremity fractures. The mortality rate was 2%, and TBI was involved in 87.5% of the mortalities. Conclusion: In this study, extremity injury is an important component of injury associated with motorcycle road traffic accidents. This calls for preventive strategies based on the observed pattern, and the use of extremity protective gear by motorcyclist

Mortality in Different Mountain Sports Activities Primarily Practiced in the Winter Season-A Narrative Review.

Annually, millions of people engage in mountain sports activities all over the world. These activities are associated with health benefits, but concurrently with a risk for injury and death. Knowledge on death rates is considered important for the categorization of high-risk sports in literature and for the development of effective preventive measures. The death risk has been reported to vary across different mountain sports primarily practiced in the summer season. To complete the spectrum, the aim of the present review is to compare mortality rates across different mountain sports activities primarily practiced in winter. A comprehensive literature search was performed on the death risk (mortality) during such activities, i.e., alpine (downhill) skiing, snowboarding, cross-country skiing, ski touring, and sledging. With the exception of ski touring (4.4 deaths per 1 million exposure days), the mortality risk was low across different winter sports, with small activity-specific variation (0.3–0.8 deaths per 1 million exposure days). Traumatic (e.g., falls) and non-traumatic (e.g., cardiac death) incidents and avalanche burial in ski tourers were the predominant causes of death. Preventive measures include the improvement of sport-specific skills and fitness, the use of protective gear, well-targeted and intensive training programs concerning avalanche hazards, and sports-medical counseling for elderly and those with pre-existing diseases.

A pilot survey of Southeastern firefighters: Safety practices, use of protective gear, and injury

IntroThere were over 60 firefighter line of duty deaths and roughly 30,000 injuries in the United States in 2016. Modern thermoprotective gear has reduced the risks firefighters face from both thermal and inhalation injury, but must be used properly to be effective. The purpose of this study is to examine gear use and associated injury in firefighters. MethodsSurveys were distributed with questions about demographics, gear usage, and maintenance practices. If previously injured, firefighters described the injury, treatment, and recovery. ResultsOf the 50 surveys distributed, 37 were returned (72%). A majority of respondents (70%) reported wearing incomplete gear. Those who reported injury were more likely to have omitted gear (81% vs 45%). For all respondents, the items most commonly omitted were hood (58%), gloves (22%), and earflaps (22%). Regular cleaning of gear was not practiced by 39% of burned respondents and 46% had not had their gear sized within 2 years. Serious burns were reported by 41% of respondents. Mean burn size was 7% total body surface area (TBSA), and 11% reported self-treating their burns, including 63.5% who continued to work despite suffering a 2nd or 3rd degree burn injury. Only 17% were treated at a burn center, and this group missed anywhere from two shifts to 8 months of work. ConclusionsFirefighters risk injury by omitting gear and not adhering to National Fire Protection Association (NFPA) guidelines on gear sizing, maintenance, and station wear. Firefighters also frequently self-treat serious burns despite unique considerations regarding re-injury. National trends related to gear use and injury risk should be studied further, and standards should be developed for ensuring safe return to work.

Non-targeted GC/MS analysis of exhaled breath samples: Exploring human biomarkers of exogenous exposure and endogenous response from professional firefighting activity

ABSTRACTA non-targeted analysis workflow was applied to analyze exhaled breath samples collected from firefighters pre- and post-structural fire suppression. Breath samples from firefighters functioning in attack and search positions were examined for target and non-target compounds in automated thermal desorption-GC/MS (ATD-GC/MS) selected ion monitoring (SIM)/scan mode and reviewed for prominent chemicals. Targeted chemicals included products of combustion such as benzene, toluene, xylenes, and polycyclic aromatic hydrocarbons (PAH) that serve as a standard assessment of exposure. Sixty unique chemical features representative of exogenous chemicals and endogenous compounds, including single-ring aromatics, polynuclear aromatic hydrocarbons, volatile sulfur-containing compounds, aldehydes, alkanes, and alkenes were identified using the non-targeted analysis workflow. Fifty-seven out of 60 non-targeted features changed by at least 50% from pre- to post-fire suppression activity in at least one subject, and 7 non-targeted features were found to exhibit significantly increased or decreased concentrations for all subjects as a group. This study is important for (1) alerting the firefighter community to potential new exposures, (2) expanding the current targeted list of toxicants, and (3) finding biomarkers of response to firefighting activity as reflected by changes in endogenous compounds. Data demonstrate that there are non-targeted compounds in firefighters’ breath that are indicative of environmental exposure despite the use of protective gear, and this information may be further utilized to improve the effectiveness of personal protective equipment.

Medición de niveles de colinesterasas eritrocitarias en agricultores usuarios de plaguicidas y en practicantes de agroecología, San Cristóbal, Medellín, Colombia

Objective: To analyze erythrocyte cholinesterase values as biomarkers of exposure to pesticides (organophosphates and carbamates) and their possible effects on their users and agroecology practitioners’ health in the village of San Cristobal, Medellin, Colombia. Methodology: Cross-sectional study in which a sample of 40 farmers was measured to see the presence of this biomarker. The measurement was then compared to demographic information, description of agricultural practices, and clinical examinations. Results: Depending on the erythrocyte cholinesterase levels in subjects who use or do not use pesticides, results showed a significant value in those who do not use them (p = 0.042). Results between women using pesticides modifying cholinesterase levels and those not using them were not statistically significant (p > 0.05). On the contrary, results in men were significant (p < 0.032). However, no statistically significant differences in erythrocyte cholinesterase levels were found between the groups of pesticide users and agroecology practitioners. An important finding was a deficient use of personal protective gear and poor technical supervision of proper use of pesticides. No symptoms associated with pesticide poisoning were found at the moment of data collection. Conclusions: Pesticides users inhibiting cholinesterase presented lower cholinesterase erythrocyte levels compared to those who practiced agroecology. The use of protection gear was poor. Therefore, this population should improve protection measures and promote more health and environmentally friendly agricultural practices, such as agroecology.

Risky riders: A comparison of personality theories on motorcyclist riding behaviour

ObjectiveFew studies have investigated the association between broad personality traits and motorcycle rider behaviours. Typically, studies have focused on specific variables such as Sensation Seeking and Aggression. This study extends the literature by investigating the trait facets of the Big Five and the Reinforcement Sensitivity Theory (RST). MethodAn internet-based questionnaire comprised of traditional (Sensation Seeking, Aggression) and novel (Big Five, Reinforcement Sensitivity Theory) personality scales, and the Motorcycle Rider Behaviour Questionnaire (MRBQ) were posted on various motorcycle internet forums. ResultsA North American sample of 550 motorcyclists completed the survey. Four separate hierarchical regression analyses were conducted with each personality theory entered step-by-step to predict the four riding behaviours from the MRBQ (errors, speeding, stunts, protective gear use) as the criterion variables. Consistent with previous literature the traditionally used personality traits, Sensation Seeking, and Aggression, were strongly associated with riding errors, speeding, and especially performing stunts. The addition of the Big Five facets contributed negligibly to riding behaviours with the greatest explained variance accounting for errors. The addition of the Reinforcement Sensitivity Theory was especially useful in accounting for motorcycle riding errors, and the use of protective gear. ConclusionAlthough research on personality theories and riding behaviour typically use more narrow trait scales this study demonstrates that physiologically-based, broader, measures such as the Reinforcement Sensitivity Theory have a strong association with riding behaviours. Future research would benefit from the inclusion of such measures.

Are electric scooters promoted on social media with safety in mind? A case study on Bird's Instagram.

Electric scooter (e-scooter) companies are growing in popularity across the United States looking to take advantage of the rideshare economy by providing an independent alternative to cars and bicycles. While e-scooter transportation could reduce emissions, and automobile congestion in local areas, powered two-wheeler drivers are extremely vulnerable to road risks. News reports of e-scooter crashes and fatalities have started to accumulate. Earlier research has demonstrated that the ways in which companies promote and demonstrate use of their product or service through social media influences consumer behavior. In the U.S. in 2018, this study examined the official Instagram account of Bird, the e-scooter market share leader with over 66,000 followers, to determine how much it emphasized safety in its posts. All posts to Bird's official Instagram account were collected from 22 September 2017 to 9 November 2018 (n = 324) and rules for coding content were developed. Among all posts, 69.14% contained a person visible with a Bird e-scooter, 6.17% contained persons wearing protective gear, 6.79% had protective gear somewhere in the post, and 1.54% of posts mentioned protective gear in the comment box. About 69.44% of the posts were reposts, and among reposts, 7.11% had persons wearing protective gear. Posts to Bird's official Instagram rarely showed e-scooters being used with protective gear. Photos of customers' experiences with Bird, via reposts, rarely featured protective gear potentially normalizing these behaviors among customers. Public health practitioners may need to establish interventions to promote use of protective gear while operating escooters.

Pigs, pooches and pasteurisation: The changing face of brucellosis in Australia

Brucellosis, also known as undulant, Mediterranean or Malta fever, is a systemic infection that causes fever, sweats, arthralgias and myalgias. A globally important disease, brucellosis is re-emerging in Australia in association with feral pig hunting activities. This article aims to provide clinicians with an overview of brucellosis, covering epidemiology, clinical features, diagnosis, management and prevention. Brucellosis should be suspected in all patients with non-specific, flu-like illness who fall into one of the major risk groups (feral pig hunters, overseas travellers and migrants). Depression is common and often severe, relative to other symptoms. Early diagnosis and treatment are important for preventing complications, which include osteoarticular, genitourinary or, more rarely, neurological or cardiovascular diseases. Diagnosing acute infections is&nbsp;based on serology and blood cultures; imaging and biopsy may be required for diagnosis of focal infections. Dual therapy with doxycycline and gentamicin is the recommended treatment. Relapse occurs in up to 10% of patients. Prevention is achieved through the use of protective gear during hunting and avoidance of unpasteurised dairy products in countries where occur in animals.

Biomarkers of hepato-renal damage of fuel filling station attendants using or abstaining from use of protective gears

Different gears (e.g. overall, mask, gloves) are being used for protective purposes by fuel filling station attendants (FFSA) in Nigeria. Whether they can adequately protect susceptible organs like liver and kidney remains largely undetermined. The aim of the study is to compare the biochemical parameters of hepato-renal axis in FFSA that abstained from and that used protective gears in the course of daily duty. Materials and Methods: The study population was grouped into three; GROUP A was made up of ten adult male FFSA who have used the protective measures consistently in the course of dispensing petroleum products. GROUP B was composed of 40 FFSA who did not use protective gears. GROUP C was the control group made up of thirty male adults not exposed to petroleum products. The minimum period of exposure for FFSA recruited for the study was 5 years. Information on worker safety was obtained through administered questionnaire concerning the use of self-protective equipment as a routine safety protocol for personal protection. Serum was utilized to assess biochemical indices of hepato-renal functions. Statistical differences were determined using Student’s t test and analysis of variance. p&lt; 0.05 was considered significant.Results: Both GROUP A and GROUP B showed activities or levels of ALP, AST, ALT, creatinine, urea, albumin, and total protein that were significantly different compared with control (GROUP C), suggestive of hepatic damage.Conclusion: Data obtained from this study suggest that the three available protective gears used by FFSA in GROUP B did not significantly reduce exposure.

A study of 200 skull fracture cases following vehicular accidents in the City of Guwahati: The gateway to North-East India

Introduction: Gradual increase in a number of vehicular accidents globally becomes a matter of concern, and adequate policies are required to reduce such incidents. This study was conducted in Guwahati city, the gateway to North-East India, to know the various factors related to such incidents associated with fractures of skull. Materials and Methods: A total of 200 cases were selected randomly over a period of 1 year. It was a cross-sectional study and data were collected from police, relatives of the deceased, and hospital records in an especially designed pro forma (questionnaire). Results obtained were tabulated and analyzed accordingly. Results: Results showed that almost 90% (89.5%) of the victims were male and 20–29 years was the most common age group involved. Fissured fracture was the most common skull fracture found in our study (56%), and temporal bone was involved in 56% of the cases. Occupants of two-wheelers were found more vulnerable to skull fracture. About 46% of the victims died before they could reach hospital, and in 71% of the cases, rural people were involved. Conclusion: Immediate and timely first-aid measure along with setting up of tertiary health-care centers in rural areas is absolutely necessary to prevent death due to vehicular accidents as the majority of the victims died before they could reach a well-equipped hospital. Public awareness about the use of protective gears, use of footpaths, and also safe usage of mobile phones while using roads would be of great help in reducing such incidents.

Self-Reported Symptoms and Pesticide Use among Farm Workers in Arusha, Northern Tanzania: A Cross Sectional Study

The objective of the study was to describe self-reported health symptoms, the use of personal protective gear and clothing and poor safety procedures when applying pesticides among farm workers. A total of 128 adult farm workers were interviewed using a structured questionnaire during the farming season. The commonly used pesticides included profenofos, mancozeb, chlorpyrifos, cypermethrin, deltamethrin, permethrin, lambda-cyhalothrin, endosulfan and carbosulfan. The majority (>90%) of farm workers used no personal protective clothing while handling pesticides. More than one-third of farm workers ate and drank without washing their hands following pesticide handling, while a smaller number smoked or chewed gum. Wearing special boots during pesticide application was found to reduce the risk of skin rash (OR = 0.2, 95% CI: 0.06–0.66), whereas smoking when applying pesticides increased the risk of chest pain occurrence (OR = 4.0, 95% CI: 1.14–15.43), as well as forgetfulness (OR = 4.0, 95% CI: 1.30–14.02). Chewing gum and eating when applying pesticides was associated with diarrhoea (OR = 11.0, 95% CI: 1.80–6.84 and OR = 7.0, 95% CI: 1.27–3.67 respectively). The increased self-reported prevalence of post-exposure adverse health effects among farm workers was associated with poor use of personal protective clothing and poor safety practices during pesticide use and handling. These data indicate the need for improved availability and use of protective equipment, and training in crop and pest management practices to prevent risky behavioursand for safer and sustainable vegetable production.

Olecranon Bursitis in a Military Population: Epidemiology and Evidence for Prolonged Morbidity in Combat Recruits.

Olecranon bursitis (OB) is a benign but disturbing condition that may adversely affect a military recruit's combat preparedness. This study was designed to assess incidence, risk factors, and associated medical burden of OB in the Israel Defense Forces. This is a retrospective study drawing on medical records of all Israel Defense Forces soldiers diagnosed as having OB between 2005 and 2015. OB was classified as septic and noninfectious. Crude incidence rates and duty-specific incidence rates were calculated. Medical burden was defined by the number of physician visits, referrals to orthopedic specialist consultations, duration of symptoms, and duration of pharmaceutical treatment. Demographic and occupational information (age, sex, height, weight, socioeconomic status, country of origin, type of military service, time of presentation to medical services) was used to identify risk factors for septic bursitis and longer duration of symptoms. Statistical analysis was performed in R statistical software. Risk factors were evaluated using the Chi-square test for categorical variables and Pearson correlation coefficients were used for continuous variables. The study was approved by the Israeli Defense Force IRB. A total of 2,692 soldiers were diagnosed with OB during the study period. The crude annual incidence rate of OB was 29/100,000 person-years (PY). Combat duty had an incidence of 97/100,000 PY, and noncombat duties had an incidence of 12/10,000 PY (p < 0.001). Female incidence (8.4/100,000 PY) was similar to male incidence (11/100,000 PY) in administrative duties (p = 0.54). More cases were diagnosed during summer and autumn than in other seasons (p = 0.016). Septic bursitis constituted 24% of all cases, was more frequent in combat soldiers (32%), and on average presented earlier in service than noninfectious OB (13 vs. 17 weeks since recruitment). The mean duration of symptoms was estimated at 17.58 weeks, with a mean of 1.75 physician visits per soldier. About 19% received a specialist referral. Origin from the former USSR was associated with a higher duration of symptoms (p = 0.012). Type of military service was the principal risk factor for OB, as indicated by a higher incidence of the disorder among combat compared to noncombat units, possibly the result of field training without protective gear and repetitive trauma to elbows. The greater number of diagnoses of OB during summer and autumn, when training is more intensive, support that explanation. Sex did not affect incidence of OB in administrative units. The medical burden appears to be relatively low, since most of the soldiers had only one physician visit. OB is highly prevalent in military compared to civilian populations. Outdoor training involving crawling is a probable explanation for the much higher rates among combat units and increased number of diagnoses during warm summer and autumn months. Prevention by use of protective gear seems to be the most promising intervention.

Target virus log10 reduction values determined for two reclaimed wastewater irrigation scenarios in Japan based on tolerable annual disease burden

Multiple-barriers are widely employed for managing microbial risks in water reuse, in which different types of wastewater treatment units (biological treatment, disinfection, etc.) and health protection measures (use of personal protective gear, vegetable washing, etc.) are combined to achieve a performance target value of log10 reduction (LR) of viruses. The LR virus target value needs to be calculated based on the data obtained from monitoring the viruses of concern and the water reuse scheme in the context of the countries/regions where water reuse is implemented. In this study, we calculated the virus LR target values under two exposure scenarios for reclaimed wastewater irrigation in Japan, using the concentrations of indigenous viruses in untreated wastewater and a defined tolerable annual disease burden (10−4 or 10−6 disability-adjusted life years per person per year (DALYpppy)). Three genogroups of norovirus (norovirus genogroup I (NoV GI), geogroup II (NoV GII), and genogroup IV (NoV GIV)) in untreated wastewater were quantified as model viruses using reverse transcription-microfluidic quantitative PCR, and only NoV GII was present in quantifiable concentration. The probabilistic distribution of NoV GII concentration in untreated wastewater was then estimated from its concentration dataset, and used to calculate the LR target values of NoV GII for wastewater treatment. When an accidental ingestion of reclaimed wastewater by Japanese farmers was assumed, the NoV GII LR target values corresponding to the tolerable annual disease burden of 10−6 DALYpppy were 3.2, 4.4, and 5.7 at 95, 99, and 99.9%tile, respectively. These percentile values, defined as “reliability,” represent the cumulative probability of NoV GII concentration distribution in untreated wastewater below the corresponding tolerable annual disease burden after wastewater reclamation. An approximate 1-log10 difference of LR target values was observed between 10−4 and 10−6 DALYpppy. The LR target values were influenced mostly by the change in the logarithmic standard deviation (SD) values of NoV GII concentration in untreated wastewater and the reliability values, which highlights the importance of accurately determining the probabilistic distribution of reference virus concentrations in source water for water reuse.