Air pollution disasters: liability issues in negligence associated with the provision of Personal Protective Interventions (facemasks)

Disasters may impact air quality through the generation of high levels of potentially pathogenic particulate matter (PM), for example, in a volcanic eruption. Depending on the concentrations of particles in the air, their size and composition, and the duration of exposure, high levels of PM can create significant public health issues. It has been argued that air pollution, in and of itself, is a public health crisis. One possible intervention to reduce exposure to high levels of PM during an air pollution disaster (APD) is using facemasks. However, agencies may be reluctant to recommend or distribute facemasks for community use during APDs for a variety of reasons, including concerns about liability. There has been no analysis of these concerns. This paper analyzes whether agencies may have a legal duty of care in negligence to provide warnings about the health risks associated with APDs and/or to recommend facemasks as a protective mechanism for community use to reduce exposure to PM. It is also the first to examine the potential for liability in negligence, when a decision is made to distribute facemasks for community use during an APD and the receiver alleges that they sustained a personal injury and seeks compensation

The development and process evaluation of PEER : a camp-based programme for adolescents impacted by cancer

Adolescents impacted by their own or a relative’s cancer diagnosis experience significant psychosocial needs. Residential programmes provide opportunities to address these, yet limited evaluation research and unclear reporting of therapeutic and theoretical underpinnings complicate efforts to understand programme effects. This paper reports the development and process evaluation of PEER, a four-day programme with psychosocial (acceptance and commitment therapy, self-compassion) and recreational components for adolescents impacted by their own or a parent/sibling’s cancer. Staff (N = 51) and adolescents (N = 148, 12–17 years) who attended a PEER programme participated in this evaluation. The evaluation of fidelity included measures of facilitators’ confidence to deliver content, adherence to the programme manual, quality of programme delivery, participants’ engagement, and overall satisfaction. The process evaluation included assessment of quality of life, distress, and process variables (psychological flexibility, mindfulness, self-compassion) at pre-programme, post-programme, and two-month follow-up, as well as qualitative feedback from participants and facilitators. Moderation analyses identified predictors of clinically significant improvement in psychosocial outcomes. The programme was delivered with good fidelity, and participants reported high satisfaction and engagement. Approximately 15–20% of participants experienced clinically-meaningful improvements in distress and quality of life; those who reported higher distress and lower baseline psychological flexibility, mindfulness and self-kindness experienced greater improvements. Qualitative feedback additionally evidenced the value of peer connection and support. The evaluation evidences PEER’s feasibility, acceptability and value for adolescents impacted by cancer, particularly those experiencing greater distress. Its success indicates the potential of the therapeutic approaches used, and for community organisations to develop interventions complementing services offered by healthcare systems

Evaluation of barley protein concentrate and fish protein concentrate, made from trimmings, as sustainable ingredients in Atlantic salmon (Salmo salar L.) feeds

Barley protein concentrate (BPC) was tested as a protein source in the diets of Atlantic salmon post-smolts. Fish were fed one of four experimental diets consisting of a fish meal/soya protein concentrate control (CT) along with two feeds supplemented with increasing levels of BPC replacing the more costly SPC. A fourth diet partially replaced FM in the high BPC diet with a liquid fish protein concentrate (FPC) made from fish trimmings. No significant differences were observed in terms of growth at the end of the 12-week feeding period, although the protein efficiency ratio (ggaing−1protein consumed) was significantly lower for the control compared to fish fed diets containing either BPC only or FPC and BPC. This suggests that diets containing BPC had a beneficial effect when compared to the control diet. Furthermore, the lack of any detriment to fish growth in diets containing BPC suggests there are no significant issues regarding any negative effects of potential antinutritional factors which can otherwise be the case with other plant origin products. The data presented in this study indicate that BPC and FPC are products which could be of benefit to salmon culture, and related species, in providing a valuable new raw material to the industry

Facemask use for community protection from air pollution disasters: An ethical overview and framework to guide agency decision making

Disasters involving severe air pollution episodes create a pressing public health issue. During such emergencies, there may be pressure on agencies to provide solutions to protect affected communities. One possible intervention to reduce exposure during such crises is facemasks. Ethical values need to be considered as part of any decision-making process to assess whether to provide advice on, recommend and/or distribute any public health intervention. In this paper, we use principles from public health ethics to analyse the critical ethical issues that relate to agencies providing advice on, recommending and/or distributing facemasks in air pollution disasters, given a lack of evidence of both the specific risk of some polluting events or the effectiveness of facemasks in community settings. The need for reflection on the ethical issues raised by the possible recommendation/use of facemasks to mitigate potential health issues arising from air pollution disasters is critical as communities progressively seek personal interventions to manage perceived and actual risks. This paper develops an ethical decision-making framework to assist agency deliberations. We argue that clarity around decision-making by agencies, after using this framework, may help increase trust about the intervention and solidarity within and between populations affected by these disasters and the agencies who support public health or provide assistance during disasters

Interaction of Serum- and Glucocorticoid Regulated Kinase 1 (SGK1) with the WW-Domains of Nedd4-2 Is Required for Epithelial Sodium Channel Regulation

The epithelial sodium channel (ENaC) is an integral component of the pathway for Na(+) absorption in epithelial cells. The ubiquitin ligases Nedd4 and Nedd4-2 bind to ENaC and decrease its activity. Conversely, Serum- and Glucocorticoid regulated Kinase-1 (SGK1), a downstream mediator of aldosterone, increases ENaC activity. This effect is at least partly mediated by direct interaction between SGK and Nedd4-2. SGK binds both Nedd4 and Nedd4-2, but it is only able to phosphorylate Nedd4-2. Phosphorylation of Nedd4-2 reduces its ability to bind to ENaC, due to the interaction of phosphorylated Nedd4-2 with 14-3-3 proteins, and hence increases ENaC activity. WW-domains in Nedd4-like proteins bind PY-motifs (PPXY) present in ENaC subunits, and SGK also has a PY-motif.Here we show that single or tandem WW-domains of Nedd4 and Nedd4-2 mediate binding to SGK and that different WW-domains of Nedd4 and Nedd4-2 are involved. Our data also show that WW-domains 2 and 3 of Nedd4-2 mediate the interaction with SGK in a cooperative manner, that activated SGK has increased affinity for the WW-domains of Nedd4-2 in vitro, and a greater stimulatory effect on ENaC Na(+) transport compared to wildtype SGK. Further, SGK lacking a PY motif failed to stimulate ENaC activity in the presence of Nedd4-2.Binding of Nedd4-2 WW-domains to SGK is necessary for SGK-induced ENaC activity

LA-ICP-MS analysis of late bronze age blue glass beads from Gurob, Egypt

LA-ICP-MS analysis was undertaken on 37 blue glass beads excavated from a tomb in Gurob, in the Southern Fayum region of Egypt. The tomb was undisturbed, contained the remains of seven females and two children, and dated between the reigns of Amenhotep I (1525-1504 BC) and Tuthmosis III (1479-1425 BC). The glass beads are coloured by copper and the trace element concentrations are compositionally consistent with glasses from Mesopotamia, rather than from Egypt. Therefore, these glass beads represent a rare example of Mesopotamian glass to be discovered in Egypt, in addition to being some of the earliest glass found. Gurob is known to have been the site of a ‘harem palace’ established in the reign of Tuthmosis III (1479-1425 BC), the implication being that these beads represent luxury items transported into Egypt by high-ranking foreign women, possibly in connection with the harem palace

Effectively Measuring Exercise-Related Variations in T1ρ and T2 Relaxation Times of Healthy Articular Cartilage.

BACKGROUND: Determining the compositional response of articular cartilage to dynamic joint-loading using MRI may be a more sensitive assessment of cartilage status than conventional static imaging. However, distinguishing the effects of joint-loading vs. inherent measurement variability remains difficult, as the repeatability of these quantitative methods is often not assessed or reported. PURPOSE: To assess exercise-induced changes in femoral, tibial, and patellar articular cartilage composition and compare these against measurement repeatability. STUDY TYPE: Prospective observational study. POPULATION: Phantom and 19 healthy participants. FIELD STRENGTH/SEQUENCE: 3T; 3D fat-saturated spoiled gradient recalled-echo; T1ρ - and T2 -prepared pseudosteady-state 3D fast spin echo. ASSESSMENT: The intrasessional repeatability of T1ρ and T2 relaxation mapping, with and without knee repositioning between two successive measurements, was determined in 10 knees. T1ρ and T2 relaxation mapping of nine knees was performed before and at multiple timepoints after a 5-minute repeated, joint-loading stepping activity. 3D surface models were created from patellar, femoral, and tibial articular cartilage. STATISTICAL TESTS: Repeatability was assessed using root-mean-squared-CV (RMS-CV). Using Bland-Altman analysis, thresholds defined as the smallest detectable difference (SDD) were determined from the repeatability data with knee repositioning. RESULTS: Without knee repositioning, both surface-averaged T1ρ and T2 were very repeatable on all cartilage surfaces, with RMS-CV SDD) average exercise-induced in T1ρ and T2 of femoral (-8.0% and -5.3%), lateral tibial (-6.9% and -5.9%), medial tibial (+5.8% and +2.9%), and patellar (-7.9% and +2.8%) cartilage were observed. DATA CONCLUSION: Joint-loading with a stepping activity resulted in T1ρ and T2 changes above background measurement error. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY STAGE: 1 J. MAGN. RESON. IMAGING 2020;52:1753-1764.GlaxoSmithKline National Institute of Health Research (NIHR) Cambridge Biomedical Research Centr

A pragmatic group sequential placebo controlled randomised trial to determine the effectiveness of Glyceryl trinitrate for retained placenta (GOT-IT): a study protocol

A retained placenta is diagnosed when the placenta is not delivered following delivery of the baby. It is a major cause of postpartum haemorrhage and treated by the operative procedure of manual removal of placenta (MROP).The aim of this pragmatic, randomised, placebo-controlled, double-blind UK-wide trial, with an internal pilot and nested qualitative research to adjust strategies to refine delivery of the main trial, is to determine whether sublingual glyceryl trinitrate (GTN) is (or is not) clinically and cost-effective for (medical) management of retained placenta. The primary clinical outcome is need for MROP, defined as the placenta remaining undelivered 15 min poststudy treatment and/or being required within 15 min of treatment due to safety concerns. The primary safety outcome is measured blood loss between administration of treatment and transfer to the postnatal ward or other clinical area. The primary patient-sided outcome is satisfaction with treatment and a side effect profile. The primary economic outcome is net incremental costs (or cost savings) to the National Health Service of using GTN versus standard practice. Secondary outcomes are being measured over a range of clinical and economic domains. The primary outcomes will be analysed using linear models appropriate to the distribution of each outcome. Health service costs will be compared with multiple trial outcomes in a cost-consequence analysis of GTN versus standard practice.Ethical approval has been obtained from the North-East Newcastle and North Tyneside 2 Research Ethics Committee (13/NE/0339). Dissemination plans for the trial include the Health Technology Assessment Monograph, presentation at international scientific meetings and publication in high-impact, peer-reviewed journals.ISCRTN88609453; Pre-results