Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant

Background Exposure to metal working fluid (MWF) has been associated with outbreaks of EAA in the US, with bacterial contamination of MWF being a possible cause, but was uncommon in the UK. Twelve workers developed extrinsic allergic alveolitis (EAA) in a car engine manufacturing plant in the UK, presenting clinically between December 2003 and May 2004. This paper reports the subsequent epidemiological investigation of the whole workforce. This had three aims:- • To measure the extent of the outbreak by identifying other workers who may have developed EAA or other work-related respiratory diseases. • To provide case-detection so that those affected can be treated. • To provide epidemiological data to identify the cause of the outbreak. Methods The outbreak was investigated in a three-phase cross-sectional survey of the workforce. Phase I A respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004. Phase II 481 employees with at least one respiratory symptom on screening and 50 asymptomatic controls were invited for investigation at the factory in June 2004. This included a questionnaire, spirometry and clinical opinion. 454/481(94.4%) responded along with 48/50(96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF). Phase III 162 employees were seen at the Birmingham Occupational Lung Disease clinic. 198 employees returned PEF records, including 141 of the 162 who attended for clinical investigation. Case definitions for diagnoses were agreed. Results 87 workers (10.4% of workforce) met case definitions for occupational lung disease, comprising EAA(19), occupational asthma(74) and humidifier fever(7). 12 workers had more than one diagnosis. The peak onset of work-related breathlessness was Spring 2003. The proportion of workers affected was higher for those using metal working fluid (MWF) from a large sump(27.3%) compared with working all over the manufacturing area (7.9%) (OR=4.39,p<0.001). Two workers had positive specific provocation tests to the used but not the unused MWF solution. Conclusions Extensive investigation of the outbreak of EAA detected a large number of affected workers, not only with EAA but also occupational asthma. This is the largest reported outbreak in Europe. Mist from used MWF is the likely cause. In workplaces using MWF, there is a need to carry out risk assessments, to monitor and maintain fluid quality, to control mist and to carry out respiratory health surveillance

Crowdsourcing digital health measures to predict Parkinson's disease severity: the Parkinson's Disease Digital Biomarker DREAM Challenge

Consumer wearables and sensors are a rich source of data about patients' daily disease and symptom burden, particularly in the case of movement disorders like Parkinson's disease (PD). However, interpreting these complex data into so-called digital biomarkers requires complicated analytical approaches, and validating these biomarkers requires sufficient data and unbiased evaluation methods. Here we describe the use of crowdsourcing to specifically evaluate and benchmark features derived from accelerometer and gyroscope data in two different datasets to predict the presence of PD and severity of three PD symptoms: tremor, dyskinesia, and bradykinesia. Forty teams from around the world submitted features, and achieved drastically improved predictive performance for PD status (best AUROC = 0.87), as well as tremor- (best AUPR = 0.75), dyskinesia- (best AUPR = 0.48) and bradykinesia-severity (best AUPR = 0.95)

Ambient particulate air pollution and daily mortality in 652 cities

BACKGROUND : The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias. METHODS : We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration–response curves from each city were pooled to allow global estimates to be derived. RESULTS : On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration–response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations. CONCLUSIONS : Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies.The National Natural Science Foundation of China and othershttp://www.nejm.orgam2020Geography, Geoinformatics and Meteorolog

Old-growth forest loss and secondary forest recovery across Amazonian countries

There is growing recognition of the potential of large-scale forest restoration in the Amazon as a 'nature-based solution' to climate change. However, our knowledge of forest loss and recovery beyond Brazil is limited, and carbon emissions and accumulation have not been estimated for the whole biome. Combining a 33 year land cover dataset with estimates of above-ground biomass and carbon sequestration rates, we evaluate forest loss and recovery across nine Amazonian countries and at a local scale. We also estimate the role of secondary forests in offsetting old-growth deforestation emissions and explore the temporal trends in forest loss and recovery. We find secondary forests across the biome to have offset just 9.7% of carbon emissions from old-growth deforestation, despite occupying 28.8% of deforested land. However, these numbers varied between countries ranging from 9.0% in Brazil to 23.8% in Guyana for carbon offsetting, and 24.8% in Brazil to 56.9% in Ecuador for forest area recovery. We reveal a strong, negative spatial relationship between old-growth forest loss and recovery by secondary forests, showing that regions with the greatest potential for large-scale restoration are also those that currently have the lowest recovery (e.g. Brazil dominates deforestation and emissions but has the lowest recovery). In addition, a temporal analysis of the regions that were >80% deforested in 1997 shows a continued decline in overall forest cover. Our findings identify three important challenges: (a) incentivising large-scale restoration in highly deforested regions, (b) protecting secondary forests without disadvantaging landowners who depend on farm-fallow systems, and (c) preventing further deforestation. Combatting all these successfully is essential to ensuring that the Amazon biome achieves its potential in mitigating anthropogenic climate change

The associations between seventh grade Finnish students’ motivational climate, perceived competence, self-determined motivation, and fundamental movement skills

The aim of the study was to investigate the relationships between motivational climate, perceived competence, self-determined motivation towards physical education (PE) and the fundamental movement skills of Finnish secondary school students. A sample of 370 seventh-grade PE students (girls n = 189; boys n = 181; mean age = 13.08; SD = 0.25) completed measures pertaining to motivational climates, perceived competence, regulation of motivation, and fundamental movement skills. Path analysis revealed results generally consistent with the theoretical tenets of the self-determination and the achievement goal theories by demonstrating that a task-involving motivational climate influenced perceived competence, which in turn affected more self-determined motivation towards PE. Furthermore, results revealed that this motivational sequence was associated with increased balance skill. A sequence consisting of task-involving climate, intrinsically regulated motivation, and balance skills was also observed. Additionally, the results indicated that task-involving motivational climate influenced perceived competence, in turn influencing manipulative and locomotor skills. Finally, an ego-involving climate was found to be a marginally positive predictor of manipulative skills

The impact of building recirculation rates on secondary organic aerosols generated by indoor chemistry

10.1016/j.atmosenv.2006.05.087Atmospheric Environment41255213-5223AENV