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Environmental Geochemistry and Health Feb 2024An evaluation of the pollution, distribution, and mobility of arsenic and heavy metals in spoil heaps and soils surrounding the abandoned Carmina lead-zinc mine...
An evaluation of the pollution, distribution, and mobility of arsenic and heavy metals in spoil heaps and soils surrounding the abandoned Carmina lead-zinc mine (Asturias, northern Spain) was carried out. Fractionation of arsenic was performed by an arsenic-specific sequential extraction method; while, heavy metal fractionations was carried out using the protocol of the Bureau Community of Reference (BCR) (now renamed Standards, Measurements and Testing Programme). Arsenic appeared predominantly associated with amorphous iron oxyhydroxides. Among the heavy metals, lead and zinc showed high availability since significant amounts were extracted in the nonresidual fractions; whereas, chromium, copper and nickel showed very low availability, indicating their lithogenic origins. The results showed that the extractability of heavy metals in soils is influenced mainly by the presence of iron and manganese oxides as well as by pH and Eh. Multiple pollution indices, including the enrichment factor (EF), geoaccumulation index (Igeo), ecological risk index (Er) and potential ecological risk index (PERI), were used to assess the degree of soil pollution in the mine area. All results showed that lead was the key factor causing the pollution and ecological risk in the studied area, and copper, zinc and arsenic also had significant contributions. Notably, the sites at higher risk coincided with those with high availability of arsenic and heavy metals. This study provides an integrative approach that serves as a powerful tool to evaluate the metal pollution status and potential threats to the local environment of abandoned mining areas, and the results are useful for making management decisions in these areas.
Topics: Arsenic; Soil; Copper; Spain; Soil Pollutants; Metals, Heavy; Zinc; Environmental Monitoring; Iron; Risk Assessment
PubMed: 38367139
DOI: 10.1007/s10653-023-01848-6 -
Annales Pharmaceutiques Francaises May 2024In a context of heparin shortage, we studied the wasted quantities in three intensive care units (ICU) of a university hospital where two electric syringe pump (ESP)... (Observational Study)
Observational Study
OBJECTIVES
In a context of heparin shortage, we studied the wasted quantities in three intensive care units (ICU) of a university hospital where two electric syringe pump (ESP) heparin protocols coexist (20,000UI/48mL used in the cardiology ICU and 25,000UI/50mL use in the medical and surgical ICUs).
METHOD
We performed a prospective observational study of patients treated with heparin ESP. We collected the information recorded in the prescription software connected to the ESP (dosage, start time, infusion rate, interruption times, date and time of end of treatment). We observed the ESPs, noted the time of start written on the label and the quantity remaining, and questioned nurses about the constraints that lead for changing the ESPs.
RESULTS
Between 23/03/23 and 19/05/23, 164 vials of 25,000UI/5mL were used. The wasted quantity was equivalent 42 vials: 18 vials (43%) of treatment stopped, nurses practices such as changing the ESP in advance 6 vials (14%), application of the rule "discard the ESP 24hours after preparation" 9 vials (21.5%) and 9 vials (21.5%) corresponding to the 45mL discarded for the 45 ESP prepared in the cardiology ICU.
CONCLUSION
More than a quarter of the heparin purchased is wasted. The results should lead to policy decisions concerning the medications supply chain, i.e. abandoning the 20,000UI/48mL protocol, supply of ready to use heparin syringes by industry or by the pharmacy. It is essential that these data be fed back to nurses' teams, in order to gather their suggestions before considering any changes of their practices.
Topics: Humans; Heparin; Hospitals, University; Intensive Care Units; Pharmacy; Prospective Studies
PubMed: 38340805
DOI: 10.1016/j.pharma.2024.02.002 -
Journal of Clinical Medicine Jan 2024VDD (atrial sensing, ventricular sensing/pacing) leads are relatively rarely implanted; therefore, experience in their extraction is very limited. We aimed to...
VDD (atrial sensing, ventricular sensing/pacing) leads are relatively rarely implanted; therefore, experience in their extraction is very limited. We aimed to investigate whether VDD lead removal may be a risk factor for the increased complexity of transvenous lead extraction (TLE) or major complications. We retrospectively analyzed 3808 TLE procedures (including 103 patients with VDD leads). If TLE included VDD lead removal, procedure duration (lead dilation time) was prolonged, complicated extractions were slightly more common, and more advanced tools were required. This is partly due to longer implant duration (in patients with VDD systems-135.2 months; systems without VDD leads-109.3 months; < 0.001), more frequent presence of abandoned leads (all systems containing VDD leads-22.33% and all systems without VDD leads-10.77%), and partly to the younger age of patients with VDD leads (51.74 vs. 57.72 years; < 0.001, in the remaining patients) at the time of system implantation. VDD lead extraction does not increase the risk of major complications (1.94 vs. 2.34%; = 0.905). The extraction of VDD leads may be considered a risk factor for increased procedure complexity, but not for major complications. However, this is not a direct result of VDD lead extraction but specific characteristics of the patients with VDD leads. Operator skill and team experience combined with special custom maneuvers can enable favorable results to be achieved despite the specific design of VDD leads, even with older VDD lead models.
PubMed: 38337494
DOI: 10.3390/jcm13030800 -
Diabetes & Metabolic Syndrome Feb 2024Prior authorization (PA) is a utilization management strategy used by health plans to ensure affordable, cost-effective care; however, PA may lead to therapy... (Observational Study)
Observational Study
BACKGROUND
Prior authorization (PA) is a utilization management strategy used by health plans to ensure affordable, cost-effective care; however, PA may lead to therapy delay/abandonment and exacerbate health disparities. The purpose of this observational study was to assess the clinical outcomes and any health disparities associated with PA for diabetes mellitus (DM) medications.
MATERIALS AND METHODS
This was a cohort study of US adult patients from health plans with integrated and non-integrated system providers who were prescribed a DM medication that required a PA. Patients were categorized into three groups: received the requested DM medication (PA Med) or a new, alternative DM medication (DM Med), or did not receive the requested or new DM medication (No Med). The primary outcome was change in hemoglobin A1c (HbA1c). Adjusted and unadjusted analyses were performed. Patient characteristics associated with the No Med group were identified, also, with multivariable logistic regression modeling.
RESULTS
6305 patients were included: 2434, 1323, and 2548 in the PA Med, DM Med, and No Med groups, respectively. Patients in the PA Med (-0.9 %) and DM Med (-1.0 %) groups had statistically significantly greater reductions in HbA1c compared to the No Med group (-0.4 %) in both unadjusted and adjusted analyses (all p < 0.05). Patients who were Hispanic/Latino, had a non-integrated system prescriber, and had a higher burden of chronic disease were statistically significantly associated with the No Med group.
CONCLUSIONS
Receiving a new DM medication following PA was associated with better clinical outcomes but health disparities were present in the PA process.
Topics: Adult; Humans; Cohort Studies; Prior Authorization; Glycated Hemoglobin; Diabetes Mellitus; Health Inequities
PubMed: 38310735
DOI: 10.1016/j.dsx.2024.102954 -
The Science of the Total Environment Mar 2024Heavy metal composite pollution is widespread in the surrounding environment of tailings ponds in arid and semi-arid regions, leading to the abandonment of substantial...
Evaluation of heavy metal speciation distribution in soil and the accumulation characteristics in wild plants: A study on naturally aged abandoned farmland adjacent to tailings.
Heavy metal composite pollution is widespread in the surrounding environment of tailings ponds in arid and semi-arid regions, leading to the abandonment of substantial agricultural land. This study investigates the speciation distribution and plant accumulation characteristics of heavy metals in abandoned farmland with different durations of natural aging. The aim is to comprehend the local heavy metal behavior pattern in the soil-plant system and offer insights for environmental remediation. Our findings reveal that Cd stands out as the primary heavy metal pollutant in this area. The mobility ranking of heavy metals is Cd > Pb > Zn > Cu, with Cd and Pb mobility decreasing along the basin. Notably, active Pb exhibits a higher affinity for soil binding compared to other metals. The predominant plant species in the region are primarily small shrubs, herbaceous plants, and semi-shrubs that demonstrate tolerance to drought and salt. Most plant samples showed elevated levels of Cd, Pb, and Zn, surpassing the maximum tolerance levels for dietary minerals in livestock. This elevated metal content poses potential threats to the health of local livestock and wildlife, yet it is also considered a potential for phytoremediation. Selected dominant plant species from the current study include Kalidium foliatum & gracile which shows potential as a Cd accumulator and indicator. Neotrinia splendens and Reaumuria songarica demonstrate potential as Cd excluders, with the latter exhibiting higher tolerance to Cd (62.9 mg/kg). Additionally, our observations indicate that different plant parts exhibit distinct responses to heavy metals, and Zn synergistically influences the aerial part accumulation of Cd. This study holds significant importance in understanding the complex behavior patterns of multi-metal pollutants in the natural environment. The identification of native plants with remediation potential is valuable for phytoremediation of environment pollution in mining area.
Topics: Soil; Cadmium; Farms; Lead; Soil Pollutants; Metals, Heavy; Plants; Environmental Pollutants; China; Environmental Monitoring
PubMed: 38309366
DOI: 10.1016/j.scitotenv.2024.170594 -
JACC. Case Reports Jan 2024Transvenous lead extraction has been increasingly recognized as a safe and effective method of lead extraction, but there are only few references for extracting leads...
Transvenous lead extraction has been increasingly recognized as a safe and effective method of lead extraction, but there are only few references for extracting leads migrating outside the heart. We present a successful extraction of a fractured pacemaker lead from the spermatic vein using several approaches and multiple tools.
PubMed: 38264307
DOI: 10.1016/j.jaccas.2023.102160 -
Social Science & Medicine (1982) Feb 2024Understanding the shifting nature of structural racism historically and across institutions is vital for effective action towards racial health equity. While public...
Understanding the shifting nature of structural racism historically and across institutions is vital for effective action towards racial health equity. While public health research on structural racism is rapidly increasing, most studies are missing the interdependence of policies and institutional practices over time that shape power imbalances and lead to entrenched health inequities. Here, we discuss Ruth Wilson Gilmore's concept of organized abandonment - the intentional disinvestment in communities which, in turn, creates opportunities for extraction, revenue generation, and carceral enforcement to fill the cracks of a compromised social infrastructure - to encourage action-oriented public health research that is grounded in history and an understanding of racial capitalism. We present a case example using publicly-available data on redlining, gentrification and policing in Seattle, Washington. We mapped the intersections of redlining and gentrification and estimated their neighborhood-level association with police activity using Bayesian spatial Poisson regression models. We found that histories of racist housing policies like redlining and processes of gentrification are interdependent and shape contemporary neighborhood racial and economic segregation and police activity. Compared to structurally advantaged neighborhoods, police stops were higher in neighborhoods that were 1) historically disinvested (i.e. redlined) and remain low-income and structurally disadvantaged and 2) formerly industrial and business districts that were not redlined and are now gentrified. Notably, we found that policing practices were significantly more intensive in neighborhoods that were both high redlined and gentrified. Together, these findings illustrate how the place-based racialized processes of dispossession, displacement and policing are deeply intertwined to maintain racial capitalism. Our findings also highlight the importance of examining multiple racialized processes simultaneously to fill critical gaps in the existing literature that are necessary for sustainable solutions to address structural racism.
Topics: Humans; Bayes Theorem; Capitalism; Public Health; Racism; Systemic Racism
PubMed: 38237286
DOI: 10.1016/j.socscimed.2024.116576 -
PLoS Computational Biology Jan 2024The 2022 FIFA World Cup was the first major multi-continental sporting Mass Gathering Event (MGE) of the post COVID-19 era to allow foreign spectators. Such large-scale...
The 2022 FIFA World Cup was the first major multi-continental sporting Mass Gathering Event (MGE) of the post COVID-19 era to allow foreign spectators. Such large-scale MGEs can potentially lead to outbreaks of infectious disease and contribute to the global dissemination of such pathogens. Here we adapt previous work and create a generalisable model framework for assessing the use of disease control strategies at such events, in terms of reducing infections and hospitalisations. This framework utilises a combination of meta-populations based on clusters of people and their vaccination status, Ordinary Differential Equation integration between fixed time events, and Latin Hypercube sampling. We use the FIFA 2022 World Cup as a case study for this framework (modelling each match as independent 7 day MGEs). Pre-travel screenings of visitors were found to have little effect in reducing COVID-19 infections and hospitalisations. With pre-match screenings of spectators and match staff being more effective. Rapid Antigen (RA) screenings 0.5 days before match day performed similarly to RT-PCR screenings 1.5 days before match day. Combinations of pre-travel and pre-match testing led to improvements. However, a policy of ensuring that all visitors had a COVID-19 vaccination (second or booster dose) within a few months before departure proved to be much more efficacious. The State of Qatar abandoned all COVID-19 related travel testing and vaccination requirements over the period of the World Cup. Our work suggests that the State of Qatar may have been correct in abandoning the pre-travel testing of visitors. However, there was a spike in COVID-19 cases and hospitalisations within Qatar over the World Cup. Given our findings and the spike in cases, we suggest a policy requiring visitors to have had a recent COVID-19 vaccination should have been in place to reduce cases and hospitalisations.
Topics: Humans; Mass Gatherings; COVID-19 Vaccines; COVID-19; Soccer; Sports
PubMed: 38236838
DOI: 10.1371/journal.pcbi.1011018 -
Sensors (Basel, Switzerland) Dec 2023Lower limb exoskeletons and orthoses have been increasingly used to assist the user during gait rehabilitation through torque transmission and motor stability. However,...
Lower limb exoskeletons and orthoses have been increasingly used to assist the user during gait rehabilitation through torque transmission and motor stability. However, the physical human-robot interface (HRi) has not been properly addressed. Current orthoses lead to spurious forces at the HRi that cause adverse effects and high abandonment rates. This study aims to assess and compare, in a holistic approach, human-robot joint misalignment and gait kinematics in three fixation designs of ankle-foot orthoses (AFOs). These are AFOs with a frontal shin guard (F-AFO), lateral shin guard (L-AFO), and the ankle modulus of the H2 exoskeleton (H2-AFO). An experimental protocol was implemented to assess misalignment, fixation displacement, pressure interactions, user-perceived comfort, and gait kinematics during walking with the three AFOs. The F-AFO showed reduced vertical misalignment (peak of 1.37 ± 0.90 cm, -value < 0.05), interactions (median pressures of 0.39-3.12 kPa), and higher user-perceived comfort (-value < 0.05) when compared to H2-AFO (peak misalignment of 2.95 ± 0.64 and pressures ranging from 3.19 to 19.78 kPa). F-AFO also improves the L-AFO in pressure (median pressures ranging from 8.64 to 10.83 kPa) and comfort (-value < 0.05). All AFOs significantly modified hip joint angle regarding control gait (-value < 0.01), while the H2-AFO also affected knee joint angle (-value < 0.01) and gait spatiotemporal parameters (-value < 0.05). Overall, findings indicate that an AFO with a frontal shin guard and a sports shoe is effective at reducing misalignment and pressure at the HRI, increasing comfort with slight changes in gait kinematics.
Topics: Humans; Biomechanical Phenomena; Ankle; Foot Orthoses; Robotics; Gait
PubMed: 38203110
DOI: 10.3390/s24010246 -
Environmental Pollution (Barking, Essex... Mar 2024Mountaintop removal coal mining leaves a legacy of disturbed landscapes and abandoned infrastructure with clear impacts on water resources; however, the intensity and...
Mountaintop removal coal mining leaves a legacy of disturbed landscapes and abandoned infrastructure with clear impacts on water resources; however, the intensity and persistence of this water pollution remains poorly characterized. Here we examined the downstream impacts of over a century of coal mining in the Crowsnest Pass (Alberta, Canada). Water samples were collected downstream of two historical coal mines: Tent Mountain and Grassy Mountain. Tent Mountain hosts a partially reclaimed surface mine that closed in 1983. Selenium concentrations downstream of Tent Mountain reached 185 μg/L in a lake below the mine spoil pile, and up to 23 μg/L in Crowsnest Creek, which drains the lake and the mine property. Further downstream, a well-dated sediment core from Crowsnest Lake records increases in sediment, selenium, lead, carbon, nitrogen, and polycyclic aromatic compounds that closely tracked the history of mining at Tent Mountain. In contrast, episodic discharge of mine water from abandoned underground adits at Grassy Mountain drive periodic (but short-term) increases in iron, various metals, and suspended sediment. These results underscore the lasting downstream impacts of abandoned and even reclaimed coal mines.
Topics: Coal Mining; Ecosystem; Environmental Monitoring; Selenium; Water Pollutants, Chemical; Mining; Water; Alberta; Coal
PubMed: 38195024
DOI: 10.1016/j.envpol.2024.123328