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Frontiers in Cardiovascular Medicine 2022Over the last decades, the implementation of new technology in cardiac pacemakers and defibrillators as well as the increasing life expectancy have been associated with... (Review)
Review
Over the last decades, the implementation of new technology in cardiac pacemakers and defibrillators as well as the increasing life expectancy have been associated with a higher incidence of transvenous lead complications over time. Variable degrees of venous stenosis at the level of the subclavian vein, the innominate trunk and the superior vena cava are reported in up to 50% of implanted patients. Importantly, the number of implanted leads seems to be the main risk factor for such complications. Extraction of abandoned or dysfunctional leads is a potential solution to overcome venous stenosis in case of device upgrades requiring additional leads, but also, in addition to venous angioplasty and stenting, to reduce symptoms related to the venous stenosis itself, i.e., the superior vena cava syndrome. This review explores the role of transvenous lead extraction procedures as therapeutical option in case of central venous disorders related to transvenous cardiac leads. We also describe the different extraction techniques available and other clinical indications for lead extractions such as lead infections. Finally, we discuss the alternative therapeutic options for cardiac stimulation or defibrillation in case of chronic venous occlusions that preclude the implant of conventional transvenous cardiac devices.
PubMed: 35282352
DOI: 10.3389/fcvm.2022.783576 -
Environmental Research May 2022Communities around Kabwe, Zambia are exposed to lead due to deposits from an old lead (Pb) and zinc (Zn) mining site. Children are particularly more vulnerable than...
BACKGROUND
Communities around Kabwe, Zambia are exposed to lead due to deposits from an old lead (Pb) and zinc (Zn) mining site. Children are particularly more vulnerable than adults, presenting with greatest risk of health complications. They have increased oral uptake due to their hand to mouth activities. Spatial analysis of childhood lead exposure is useful in identifying specific areas with highest risk of pollution. The objective of the current study was to use a geospatial approach to investigate spatial clustering and hotspots of blood lead levels in children within Kabwe.
METHODS
We analysed existing data on blood lead levels (BLL) for 362 children below the age of 15 from Kabwe town. We used spatial autocorrelation methods involving the global Moran's I and local Getis-Ord Gi*statistic in ArcMap 10.5.1, to test for spatial dependency among the blood lead levels in children using the household geolocations.
RESULTS
BLL in children from Kabwe are spatially autocorrelated with a Moran's Index of 0.62 (p < 0.001). We found distinct hotspots (mean 51.9 μg/dL) in communities close to the old lead and zinc-mining site, lying on its western side. Whereas coldspots (mean 7 μg/dL) where observed in areas distant to the mine and traced on the eastern side. This pattern suggests a possible association between observed BLL and distance from the abandoned lead and zinc mine, and prevailing winds.
CONCLUSION
Using geocoded data for households, we found clustering of childhood blood lead and identified distinct hotspot areas with high lead levels for Kabwe town. The geospatial approach used is especially valuable in resource-constrained settings like Zambia, where the precise identification of high risk locations allows for the initiation of targeted remedial and treatment programs.
Topics: Adult; Child; Cluster Analysis; Humans; Lead; Mining; Spatial Analysis; Zambia
PubMed: 34979123
DOI: 10.1016/j.envres.2021.112646 -
Heart Rhythm Nov 2020No comparative study of outcomes in Riata and Sprint Fidelis leads undergoing lead extraction (LE), lead abandonment (LA), and generator change only (GC) has been... (Comparative Study)
Comparative Study
BACKGROUND
No comparative study of outcomes in Riata and Sprint Fidelis leads undergoing lead extraction (LE), lead abandonment (LA), and generator change only (GC) has been published.
OBJECTIVES
Determine outcomes (major complications [MC]; death, extended hospitalization, or rehospitalization within 60 days [RH]; lead malfunction) of LE, LA, and GC for recalled leads.
METHODS
Retrospective, multicenter, comparative study.
RESULTS
A total of 298 LE, 85 LA, and 310 GC were performed. In the clinical setting of a lead intervention, there was no difference in a composite of MC, death, RH, lead revision, inappropriate shocks, or device infection between LE and LA groups (15% vs 22%, P = .140). In the clinical setting of a device at elective replacement interval (ERI), there were significantly more acute events at 60 days (MC, death, and RH) in the LE and LA groups at 15.4% (4) and 15.4% (4), and this was significantly (P = .017) higher than the GC group at 5.1% (16). There was no difference (P = 1.000) in the composite of MC, death, RH, lead malfunction, lead revisions, device infections, or inappropriate shocks between LE, LA, and GC groups at 15.4% (4), 15.4% (4), and 17.4% (54), respectively. Following generator change, 14 of 175 Fidelis leads and 3 of 135 Riata leads failed over a total of 12,714 months of follow-up.
CONCLUSIONS
The failure rate of recalled leads was substantially lower compared to previous reports. It may be prudent to perform generator change only when the device is at ERI, especially when the recalled lead has historical performance that likely outweighs the risks of extraction/abandonment.
Topics: Aged; Defibrillators, Implantable; Device Removal; Disease Management; Equipment Design; Female; Follow-Up Studies; Humans; Male; Medical Device Recalls; Middle Aged; Retrospective Studies; Time Factors
PubMed: 32512178
DOI: 10.1016/j.hrthm.2020.06.004 -
Journal of Pediatric Surgery Feb 2024Birth Defects are accountable for the substantial surgical burden of disease worldwide. It can bring upon death, chronic illness, disability [physical or mental or... (Review)
Review
Birth Defects are accountable for the substantial surgical burden of disease worldwide. It can bring upon death, chronic illness, disability [physical or mental or both], financial burden, social stigma, abandonment, feticide and Infanticide. Availing timely and safe surgery can minimize the potential fatalities and sufferings caused by birth defects. Yet surgery is not treated as essential for the management of birth defects, especially in lower middle-income countries. It causes potentially correctable conditions to exacerbate, which can lead to death or lifelong disabilities. Surgical care cannot only correct birth defects but also can avert potential Disability Adjusted Life Years (DALYs) and financial burden. Furthermore, surgical correction facilitates social inclusion. Such transformation can be equated to "Revising Destiny". A "whole of society" approach focused on surgical care is instrumental for addressing the health, financial, and social implications of birth defects. LEVEL OF EVIDENCE V: Expert Opinion.
Topics: Humans; Quality-Adjusted Life Years; Disabled Persons; Global Health; Chronic Disease; Cost of Illness
PubMed: 37953161
DOI: 10.1016/j.jpedsurg.2023.10.006 -
The Science of the Total Environment Feb 2024The 160-year history of oil and gas drilling in the United States has left a legacy of unplugged orphaned and abandoned wells, some of which are leaking methane and... (Review)
Review
The 160-year history of oil and gas drilling in the United States has left a legacy of unplugged orphaned and abandoned wells, some of which are leaking methane and other hazardous chemicals into the environment. The locations of around 120,000 documented orphaned wells are currently known with the number of undocumented orphaned wells possibly ranging towards a million. The bulk of methane emissions originate from only 10 % of orphaned and abandoned wells, while the remaining wells have undetectable emissions. Understanding the sources of methane emissions from orphaned wells is key to estimating emission rates and prioritizing plugging. In this article, we identify key studies reporting methane emission measurements from orphaned and abandoned wells in the published literature and analyze previously published isotopic methane data to categorize the sources of methane emissions. Three primary geologic sources provide methane to a leaking well that can migrate from geologic formations into or along the wellbore to contaminate groundwater, the surface environment, and the atmosphere. These geologic sources of methane are petroleum (oil and gas) sourced reservoirs, coal seams, and methanogenesis occurring in and around the wellbore. Thermogenic petroleum gas reservoirs are associated with the highest emission rates measured to date. The next highest rates are from coalbed methane sources, while biogenic sources are the lowest based on the publicly available measured emissions data. Well conditions that could potentially enable methane transport include decay of the wellhead and surface infrastructure, wellbore deterioration from corrosive fluids in the subsurface, delamination of the casing and cement, damage from seismicity, and new fracture networks created by hydraulic fracturing of newly drilled neighboring wells. With an understanding of these geologic sources and well conditions, we can (1) better identify areas where high-emitting wells are likely to be present, (2) improve emission rate estimates from orphaned and abandoned wells, and (3) better prioritize wells for plugging. SYNOPSIS: Understanding the geologic sources of methane emissions from orphaned and abandoned wells and wellbore conditions that lead to methane release can significantly improve emissions estimates and aid in prioritizing which wells to plug.
PubMed: 38151133
DOI: 10.1016/j.scitotenv.2023.169584 -
Journal of Environmental Quality Nov 2020Atmospheric deposition samples were collected over 15 mo at several locations near an operating smelter and an abandoned Pb smelter to investigate the contribution of Pb...
Atmospheric deposition samples were collected over 15 mo at several locations near an operating smelter and an abandoned Pb smelter to investigate the contribution of Pb smelting to depositional fluxes and potential local air quality degradation. Samples were analyzed for As, Cd, Cu, Pb, and Zn and subjected to scanning electron microscopy (SEM)-energy dispersive spectroscopy (EDS). Concentrations of Cd and Pb at both sites were greater than at the control site (p < .05), and significant correlations existed between Cd and Pb concentrations at both sites (p < .05). Monthly depositional flux variations at both sites were similar, with greater deposition during cold and dry periods. Heavy metal(loid)s deposition during these periods was correlated with wind speed. Greater Cd depositional flux differences were found between the smelter and control sites compared with other elements. The SEM images suggested that some particles at the operating smelter site were from Pb smelting material. However, most particles at both sites had no characteristics of smelting, suggesting reactions occurred between the smelter-emitted particles and soil components. The EDS results indicated that atmospheric deposition from both sites had lower Pb concentrations than smelting material or ash. The main atmospheric deposition source at the operating and abandoned sites was likely from the resuspension of heavy metal(loid)-enriched soil particles. Greater risk of air pollution from historical Pb smelting facilities exists years after closing down. Reducing soil wind erosional losses may help reduce heavy metal(loid)s dispersion across environments.
Topics: Arsenic; Cadmium; China; Copper; Environmental Monitoring; Lead; Metals, Heavy; Soil Pollutants; Zinc
PubMed: 33107090
DOI: 10.1002/jeq2.20151 -
Environmental Science and Pollution... Nov 2022Enterprises of fuel and energy complex are the main sources of carcinogenic and mutagenic potentially toxic elements (PTEs). Their particulate and gaseous emissions,...
Enterprises of fuel and energy complex are the main sources of carcinogenic and mutagenic potentially toxic elements (PTEs). Their particulate and gaseous emissions, wastes, and effluents enforce migration processes of PTEs in atmosphere, soil, and then in water bodies, creating a danger to the functioning of aquatic ecosystems. Vulnerable objects include water bodies with slow water exchange, due to the accumulation of PTEs in the bottom sediments and the threat of secondary contamination. Among them it is necessary to note cooling ponds of thermal power plants (TPP). In this study, the ecological and geochemical state of components of "water-suspended sediments-bottom sediments" aquatic system is assessed on the example of the Gusinoye Lake (the Republic of Buryatia), which is used as cooling pond for the largest in the region TPP, burning brown coal from local deposits. The Gusinoye Lake is the second largest lake in Buryatia after the Baikal Lake and a valuable source of water supply, place of recreation, and fish breeding. To study the distribution of PTEs in the waters of the lake, a network of 19 monitoring stations was deployed in the summer of 2019. In contrast to the previous researches, detailed studies of the central deep-water part of the lake were carried out. As a result, data on the concentration of PTEs in the dissolved and suspended forms and also in bottom sediments was obtained. To study the balance of chemicals in the lake, its main tributaries were surveyed, as well as the drainage channel of TPP. For the first time, for the Lake Gusinoye, bulk concentrations of As, Cd, Pb, Zn, Co, Mo, Cu, Sb, Cr, V, Mn, Sr, and Ag were determined using the inductively coupled plasma mass spectrometry. The highest concentrations of dissolved PTEs in the lake water are confined to the mouths of tributaries in the northern part of the lake. Dissolved Sr, Mo, and Cu in the lake exceed maximum permissible concentrations (MPCs) for fishery. The maximum concentrations of Sr and Cu are almost 3 MPCs and that of Mo is 22 MPCs near the TPP. The suspended sediments of the Gusinoye Lake are depleted of all studied PTEs as compared to the regional clarkes (natural abundances) of the lithosphere. Mn has the highest concentrations in the suspension, and its maximum concentration was due to the surface runoff from the solid waste landfill and an abandoned coal mine. Concentrations of Cu, Zn, Sr, Mo, and Pb in bottom sediments are higher than in suspended sediments, thus indicating the accumulation of pollutants. The maximum intensity of accumulation is characteristic of the deep central basin of the lake and its eastern part, where Sr, Ag, and Mo accumulate most intensively near the coal field. The main sources of PTE pollution are concentrated in the northern and northeastern parts of the lake catchment area. Significant amount of dissolved Mo, Sr, and As enter the lake with the waters of quarries and mines of the coal fields, the solid waste landfill of the town of Gusinoozyorsk, and northern rivers-tributaries, draining the dumps of the large Zagustaj coal field.
Topics: Lakes; Metals, Heavy; Environmental Monitoring; Solid Waste; Ecosystem; Cadmium; Lead; Soil; Soil Pollutants; Coal; Water; Risk Assessment; Geologic Sediments
PubMed: 35680743
DOI: 10.1007/s11356-022-18848-1 -
Journal of Orthopaedics 2021Hand amputation significantly challenges one's independence in carrying out daily activities. With the UK and Italy recoding circa 5200 and 3500 upper limb (UL)... (Review)
Review
INTRODUCTION
Hand amputation significantly challenges one's independence in carrying out daily activities. With the UK and Italy recoding circa 5200 and 3500 upper limb (UL) amputations (ULAs) yearly, respectively, and about 541,000 Americans losing ULs in 2005, incidence victims constitute a considerable proportion of our population and should be adequately supported. The use of upper limb prosthesis (ULP) offers amputees a new opportunity of living a quality life - but poses challenges on the physically and psychologically traumatised. With reports that up to 20% of adult UL amputees choose not to use a prosthesis, roughly 26% of adults and 45% of children and adolescents are dissatisfied with their devices and abandon them with reasons of poor solution to basic needs, a review of ULP for suitability has become crucial.
OBJECTIVES
These include, to review UL prosthetic technology (PT), the materials used in the manufacturing of ULP, challenges in research and development of ULP, and to advise on the suitability of different devices to the needs of amputees.
METHODS
They involve an extensive review of relevant literature and application of statistics to analyse data obtained from literature.
RESULTS
ULAs are characterised to show affected bones in seven types of amputations. The characterisation depicts key causes of incidences that lead to amputations while advising on device suitability. PT is classified in terms of cost, nature, functions/operations of each type of device while providing the design challenges. Users' opinions on PT materials are analysed and used to suggest new materials for the next generation of the devices. R&D challenges hindering future developments of PT is reviewed and results used to identify characteristics for the next generation of the technology.
CONCLUSIONS
To increase user satisfaction and reduce device abandonment, amputees need useful information on the trend in PT and engineers need information about device field performance for improvements. The use of better performing ULP will improve users' everyday lives.
PubMed: 33442223
DOI: 10.1016/j.jor.2020.12.009 -
The Science of the Total Environment Jun 2023Arbuscular mycorrhizal fungi were recovered from soil samples from the naturally radioactive soil at the long-abandoned South Terras uranium mine in Cornwall, UK....
Arbuscular mycorrhizal fungi were recovered from soil samples from the naturally radioactive soil at the long-abandoned South Terras uranium mine in Cornwall, UK. Species of Rhizophagus, Claroideoglomus, Paraglomus, Septoglomus, and Ambispora were recovered, and pot cultures from all except Ambispora were established. Cultures were identified to species level using morphological observation and rRNA gene sequencing combined with phylogenetic analysis. These cultures were used in pot experiments designed with a compartmentalised system to assess the contribution of fungal hyphae to the accumulation of essential elements, such as copper and zinc, and non-essential elements, such as lead, arsenic, thorium, and uranium into root and shoot tissues of Plantago lanceolata. The results indicated that none of the treatments had any positive or negative impact on shoot and root biomass. However, Rhizophagus irregularis treatments showed higher accumulation of copper and zinc in shoots, while R. irregularis and Septoglomus constrictum enhanced arsenic accumulation in roots. Moreover, R. irregularis increased uranium concentration in roots and shoots of the P. lanceolata plant. This study provides useful insight into fungal-plant interactions that determine metal and radionuclide transfer from soil into the biosphere at contaminated sites such as mine workings.
Topics: Mycorrhizae; Uranium; Plant Roots; Copper; Arsenic; Soil; Phylogeny; Soil Pollutants; Plants; Zinc; Glomeromycota
PubMed: 36906011
DOI: 10.1016/j.scitotenv.2023.162781 -
Disability and Rehabilitation Jun 2017Conceptualizations of risk in seniors' rehabilitation emphasize potential physical injury, functional independence and cost containment, shifting rehabilitation from...
PURPOSE
Conceptualizations of risk in seniors' rehabilitation emphasize potential physical injury, functional independence and cost containment, shifting rehabilitation from other considerations essential to promoting a satisfying life. In a two-day multidisciplinary planning meeting we critically examined and discussed alternatives to dominant conceptualizations.
METHOD
Invitees reflected on conceptualizations of risk in stroke rehabilitation and low vision rehabilitation, identified and explored positive and negative implications and generated alternative perspectives to support rehabilitation approaches related to living a good life.
RESULTS
Current risk conceptualizations help focus rehabilitation teamwork and make this work publically recognizable and valued. However, they also lead to practice that is depersonalized, decontextualized and restrictive. Further research and practice development initiatives should include the voices of clinicians and seniors to more adequately support meaningfully living, and foster safe spaces for seniors and clinicians to speak candidly, comprehensively and respectfully about risk. To ensure that seniors' rehabilitation targets a satisfying life as defined by seniors, increased focus on the environment and more explicit examination of how cost containment concerns are driving services is also necessary.
CONCLUSION
This work reinforced current concerns about conceptualizations of risk in seniors' rehabilitation and generated ways forward that re-focus rehabilitation more on promoting a satisfying life. Implications for rehabilitation In seniors' rehabilitation, considerations of risk focus on physical injury, functional dependence and cost containment. Focus on provider-defined risk of physical injury limits examination of patient goals and patients' histories of judging and dealing with risk. Focus on functional dependence and cost containment may lead to practice that is depersonalized and decontextualized. Abandonment of ableist and ageist thinking and an explicit focus on person-centered definitions of risk and a satisfying life are recommended.
Topics: Aged; Aging; Humans; Quality of Life; Risk Assessment; Risk Factors; Stroke Rehabilitation; Vision, Low
PubMed: 27291255
DOI: 10.1080/09638288.2016.1192227