Determinants of ultrafine particles, black carbon, nitrogen dioxide, and carbon monoxide concentrations inside vehicles in the Paris area: PUF‐TAXI study

International audienceThis study presents real-time concentrations of traffic-related air pollutants during 499 trips conducted by 50 Parisian taxi drivers from PUF-TAXI project. Ultrafine particles (UFPs), black carbon (BC), and nitrogen dioxide (NO2)/carbon monoxide (CO) were measured inside vehicles by Diffusion Size Classifier Miniature(R), microAeth(R), and Gas-Pro(R), respectively, for nine hours. Vehicle/trip data characteristics were collected by questionnaires and on ambient conditions by monitoring stations. The associations between pollutant levels and their potential determinants were analyzed using generalized estimating equation model. Determinants of in-vehicle pollutants levels were identified: (1) ambient factors (meteorology and ambient pollution)-affecting BC, NO2, and CO; (2) vehicle characteristics-affecting all pollutants; and (3) trip-related driving habits-affecting UFP, BC, and CO. We highlight that commuters can, therefore, avoid high in-vehicle air pollutant concentrations mainly by (1) closing windows and activating air-conditioning under air recirculation mode in congested traffic; (2) smooth driving; and (3) maintaining cabin air filters

Short-term association of in-vehicle ultrafine particles and black carbon concentrations with respiratory health in Parisian taxi drivers

International audienceIntroduction: Professional drivers are exposed inside their vehicles to high levels of air pollutants due to the considerable time they spend close to motor vehicle emissions. Little is known about ultrafine particles (UFP) or black carbon (BC) adverse respiratory health effects compared to the regulated pollutants.Objectives: We aimed to study the short-term associations between UFP and BC concentrations inside vehicles and (1) the onset of mucosal irritation and (2) the acute changes in lung function of Parisian taxi drivers during a working day.Methods: An epidemiological study was carried out on 50 taxi drivers in Paris. UFP and BC were measured inside their vehicles with DiSCmini® and microAeth®, respectively. On the same day, the frequency and the severity of nose, eye, and throat irritations were self-reported by each participant and a spirometry test was performed before and after the work shift. Multivariate analysis was used to evaluate the associations between in-taxis UFP and BC concentrations and mucosal irritation and lung function, after adjustment for potential confounders.Results: In-taxis UFP concentrations ranged from 17.9 to 37.9 × 103 particles/cm3 and BC concentrations from 2.2 to 3.9 μg/m3, during a mean of 9 ± 2 working hours. Significant dose-response relationships were observed between in-taxis UFP concentrations and both nasal irritation and lung function. The increase of in-taxis UFP (for an interquartile range of 20 × 103 particles/cm3) was associated to an increase in nasal irritation (adjusted OR = 6.27 [95% CI: 1.02 to 38.62]) and to a reduction in forced expiratory flow at 25-75% by -7.44% [95% CI: -12.63 to -2.24], forced expiratory volume in one second by -4.46% [95% CI: -6.99 to -1.93] and forced vital capacity by -3.31% [95% CI: -5.82 to -0.80]. Such associations were not found with BC. Incident throat and eye irritations were not related to in-vehicle particles exposure; however, they were associated with outdoor air quality (estimated by the Atmo index) and in-vehicle humidity, respectively.Conclusion: To our knowledge, our study is the first to show a significant association, within a short-period of time, between in and vehicle UFP exposure and acute respiratory effects in professional drivers

Improving pediatric pharmacy services in a primarily adult emergency department

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The American Society of Health-System Pharmacists (ASHP) and Pediatric Pharmacy Advocacy Group (PPAG) guidelines for providing pediatric pharmacy services in hospitals and health systems can be used to improve medication safety wherever pediatric patients receive care, including in the emergency department (ED). The purpose of this initiative was to improve compliance with these guidelines in a primarily adult ED. METHODS: This quality improvement initiative was conducted in a level 1 trauma center ED between October 2019 and March 2020. The ASHP-PPAG guidelines were used to create practice elements applicable to the ED. An initial compliance assessment defined elements as noncompliant, partially compliant, fully compliant, or not applicable. Investigators identified interventions to improve compliance for noncompliant or partially compliant elements and then reassessed compliance following implementation. Data were expressed using descriptive statistics. This initiative was exempt from institutional review board approval. RESULTS: Ninety-three ED practice elements were identified within the 9 standards of the ASHP-PPAG guidelines. At the initial compliance assessment, the majority (59.8%) of practice elements were fully compliant; however, various service gaps were identified in 8 of the standards, and 16 interventions were implemented to improve compliance. At the final compliance assessment, there was a 19.5% increase in full compliance. Barriers to achieving full compliance included technology restrictions, time constraints, financial limitations, and influences external to pharmacy. CONCLUSION: This quality improvement initiative demonstrated that the ASHP-PPAG guidelines can be used to improve ED pediatric pharmacy services in a primarily adult institution. The initiative may serve as an example for other hospitals to improve compliance with the guidelines

Cross‐sectional study of in‐vehicle exposure to ultrafine particles and black carbon inside Lebanese taxicabs

International audienceTaxi drivers' exposure to traffic-related air pollutants inside their vehicles has been reported in different countries but not yet in Lebanon. Thus, we conducted a cross-sectional study on 20 Lebanese taxi drivers to (1) assess their exposure to ultrafine particles (UFP) and black carbon (BC) inside their vehicles and (2) identify determinants of this exposure. UFP and BC were measured using Diffusion Size Classifier Miniature (R) and microAeth (R) Model AE51, respectively, for 5 hours. Data on characteristics of vehicles and trips were collected by face-to-face interviews. Associations between pollutant levels and their determinants were analyzed by multiple linear regression. The mean of UFP count (35.2 +/- 17.6 x 10 3particles cm(-3)) and BC (5.2 +/- 1.9 mu g m(-3)) concentrations in-taxis was higher in the morning measurements compared with those in the afternoon measurements. UFP count increased in-taxis by 60% for every 10 minutes spent in blocked traffic and by 84% starting from two trips with smokers compared to trips without smokers. Conversely, UFP count decreased by 30% for every 10 minutes under both air-conditioning and air recirculation mode with windows closed. BC was not affected by any of these factors. Our findings suggest easy ways to reduce UFP exposure inside vehicles for all commuters

PROTOCOL: Measuring diet‐related consumer behaviours relevant to low‐ and middle‐income countries to advance food systems research: an evidence and gap map

International audienceThis is the protocol for a evidence and gap map. The main objective of this evidence and gap map is to provide access to a systematic overview of available indicators for diet-related consumer behaviours relevant to LMICs, to support policy makers and researchers to develop, monitor and revise food policies and programmes to leverage food systems transformations for healthier and more sustainable diets

PROTOCOL: Measuring diet-related consumer behaviours relevant to low- and middle-income countries to advance food systems research: An evidence and gap map

This is the protocol for a evidence and gap map. The main objective of this evidence and gap map is to provide access to a systematic overview of available indicators for diet‐related consumer behaviours relevant to LMICs, to support policy makers and researchers to develop, monitor and revise food policies and programmes to leverage food systems transformations for healthier and more sustainable diets

Comèl-Netherton syndrome defined as primary immunodeficiency

BACKGROUND: Mutations in SPINK5, encoding the serine protease inhibitor LEKTI, cause Comèl-Netherton syndrome, an autosomal-recessive disease characterized by congenital ichthyosis, bamboo hair, and atopic diathesis. Despite increased frequency of infections, the immunocompetence of Comèl-Netherton syndrome patients has not been extensively investigated. OBJECTIVE: To define Comèl-Netherton syndrome as a primary immunodeficiency and to explore the benefit of IVIG replacement therapy. METHODS: We enrolled nine patients with Comèl-Netherton syndrome, sequenced SPINK5, and analyzed LEKTI expression by immunohistochemistry. Immune function was assessed by measuring cognate immunity, serum cytokine-levels and natural killer cell cytotoxicity. RESULTS: All patients presented with recurrent skin infections caused predominantly by Staphylococcus aureus. All but one reported recurrent respiratory tract infections; 78% had sepsis and/or pneumonia; 67% suffered from recurrent gastroenteritis and failure to thrive. Mutations in SPINK5 – including six novel mutations- were identified in eight patients. LEKTI expression was decreased or absent in all patients. Immunologic evaluation revealed reduced memory B cells and defective responses to vaccination with Pneumovax(®) and bacteriophage phiX174, characterized by impaired antibody amplification and class-switching. Immune dysregulation was suggested by a skewed TH1-phenotype and elevated proinflammatory cytokine levels, while serum concentrations of the chemokine RANTES and NK cell cytotoxicity were decreased. Treatment with intravenous immunoglobulin substitution resulted in remarkable clinical improvement and temporarily increased NK cell cytotoxicity. CONCLUSION: These data provide new insights into the immunopathology of Comèl-Netherton syndrome and demonstrate that this multisystem disorder, characterized by lack of LEKTI expression in epithelial cells, is complicated by cognate and innate immunodeficiency that responds favorably to IVIG therapy