An evaluation of the supply and demand of radiation oncology medical physicists in the United States.

Background: This dissertation is a mixed methods evaluation of the radiation oncology medical physics workforce in the United States. Radiation oncology medical physicists serve a vital role in the safe treatment of patients with radiation therapy. While cancer incidence continues to rise, the pathways to board certification in radiation oncology medical physics continue to narrow causing a potential shortage of radiation oncology physicists in the United States. While there is no lack of data about the medical physics community it has scarcely been used to evaluate the current state of the workforce. In order to ensure patient safety, appropriate physics to patient staffing ratios are important and cannot be sustained without an adequate supply of qualified physicists entering the profession annually. Purpose: The purpose of this dissertation is to determine the current supply of medical physicists, develop a model to predict the future supply and demand, and evaluate the current job market based on the perceptions of recent graduates. The primary question to be addressed is that based on current data and development of a new supply and demand model, will there be enough Radiation Oncology Physicists to keep up with the supply and demand through 2030? Secondary questions include: Do the perceptions of recent Masters and PhD graduates of medical physics support the new model findings of the residency shortage? Are graduates of residency programs in high demand because of the now single pathway into the field? Methods: Quantitative methods include standard distributive methods; minimum, maximum, quartiles, mean and medians of data ranges. Qualitative methods include a five-point Likert psychometric scale and open-ended question surveys with radiation oncology medical physics graduate students, residents, and recent retirees. Mixed methods procedures include the use of Stella modeling software used for supply and demand analysis. The anonymized list of potential survey respondents was supplied and coded by the American Association of Physicists in Medicine. Subjects with personal emails for follow up responses obtained institutional Review Board approval due to potential self-identifying information. Results: Based on modeling results approximately 250 residency positions for radiation oncology medical physicists are needed. This is a growth by almost 100 positions needed urgently to meet the rising demand. Perceptions of recent graduates and residents support the modeling results that limited residency positions are leading to a surplus of graduates with no pathway to board eligibility and thus creating a limitation on the workforce making it difficult to meet the rising demand. Conclusions: While the medical physics profession is a rewarding career, there are immediate and urgent risks to the future of the medical physics workforce. The lack of residencies will lead to a deficit of almost fifteen percent by 2030 if nothing changes. There is an urgent need for a widespread evaluation of the medical physics education pathways to ensure a proper workforce moving forward while meeting the ethical obligation to students to have a pathway to certification in the profession

Characterization of Stream Turbidity in the Catskills, New York: Insights into Environmental Controls

Elevated turbidity poses a threat to water quality, which is especially problematic in unfiltered water supply systems such as New York City\u27s (NYC). The Catskills Region of New York, which supplies NYC with the majority of its drinking water, is especially prone to chronically elevated turbidity due to the erosion of glacial till in Catskill streams. Here, we characterize turbidity and streamflow in the Catskills to understand the drivers of turbidity in this region. To accomplish this, we examined over a decade\u27s worth of observed turbidity and streamflow data (2010-2022, n = 88,255) at 20 United States Geological Survey (USGS) monitoring sites. We investigated the seasonal and temporal trends in turbidity and streamflow, as well as the potential underlying causes for extreme turbidity events. Our results indicate that turbidity peaks during January through April across sites, which suggests that earlier timings of spring snow melt may contribute to elevated turbidity during these months. The turbidity baseline conditions also differ across sites, along with several sites frequently exceeding the Environmental Protection Agency (EPA) turbidity regulatory limit of 5 NTU, suggesting that certain areas of the Catskill Watershed are more susceptible to higher turbidity. Examination of extreme floods in the Catskills, such as a severe flood in December 2020 that affected the entire region, reveals that there is a characteristic process that can explain turbidity dynamics after severe flooding in this region. The December 2020 flood elevated turbidity above baseline conditions for approximately three months at several Catskill sites. There was an intermediate flood in March 2021 that could flush the easily erodible sediment that had been deposited in the channels as a result of the first flood event. However, this intermediate flood did not produce enough energy to overwhelm the system and keep turbidity above baseline conditions. Overall, our analysis proposes potential mechanisms to explain elevated turbidity events throughout the watershed and highlights the extent of the turbidity problem in the Catskills, which has important implications for water resources management of this water supply system

HUMAN SANITARY WASTES AND WASTE TREATMENT IN NEW YORK CITY

Henry Hudson first sailed toNew Yorkharbor 400 years ago. Since then,New York Cityhas both affected and been affected by water quality in greaterNew YorkHarbor. In this paper, we focus on sewers, sewerage, and sewage treatment inManhattanand their effects on theHudson River. It is clear that feedbacks among drinking water quality and quantity, population, public perceptions, regulations, and estuarine water quality exist, although their strength and character have varied over time. Early land uses damaged local water supplies found on ManhattanIsland. New Yorkthen began to exploit the large fresh water resources available to its north, which helped the City to expand more rapidly. Water availability also allowed for water carriage sanitary practices, increasing discharges of wastes through a growing sewer network into local waters. The discharge of wastes degraded water quality, affecting natural resources in the harbor. Untreated wastes led to disease from contaminated seafood, and also more generalized effects on public health. Overall, New Yorklifestyles became largely detached from its shoreline, partly due to the industrial character of the waterfront, and partly because of odors and visual blight from pollution. Growing public distaste over poor harbor water quality, especially in the early 20th century, led to some sewage treatment. More and more comprehensive treatment followed regulatory and legal actions, beginning in mid-twentieth century. Concurrently, maritime commerce declined, and the waterfront became underutilized. However, in the twenty-first century, natural resources are recovering, andNew York City citizens once again flock to the shores of theHudson River, to new and revitalized parks, new areas of development and older areas undergoing transformation, and into the harbor, now largely cleaned of its fouling from sanitary waste disposal. Today New York City public life has a much greater orientation toward the waterfront, which certainly was fostered by improved harbor water quality, and the opportunities for growth that were available with the disappearance of the City’s maritime industries. Thus, there has been a complicated relationship between the City and its rivers and harbor. One aspect has been continuing use of local water bodies as receptacles for wastes, which has benefitted those living in the City. Gaining these benefits has had continuing costs, however. Marine resources were damaged and some were lost, and quality of life on land was affected. Trying to undo the impacts, which has required great effort and much capital, has been hampered by technology decisions that appear suboptimal with the advantage of more than 100 years of hindsight. Still, modern sewage treatment, initiated by local efforts and concerns, but spurred on to completion by the forces unleashed by the great environmental awakening of the 1960s and 1970s, has made it possible for the citizens of New York to again fish, boat, and even swim in City waters

Benthic-pelagic trophic coupling in an Arctic marine food web along vertical water mass and organic matter gradients

Source at: http://doi.org/10.3354/meps12582Understanding drivers of benthic-pelagic coupling in Arctic marine ecosystems is key to identifying benthic areas that may be sensitive to climate-driven changes in hydrography and surface production. We coupled algal biomass and sedimentary characteristics with stable isotope data for 113 fishes and invertebrates in the Canadian Beaufort Sea and Amundsen Gulf to examine how trophic structure was influenced by the vertical water mass structure and organic matter input regimes, from 20 to 1000 m depths. Indices of community-level trophic diversity (isotopic niche size, 13C enrichment relative to a pelagic baseline, and δ13C isotopic range) increased from west to east, coincident with the use of more diverse dietary carbon sources among benthic functional groups. Data suggested benthic-pelagic trophic coupling was strongest in the western study region where pelagic sinking flux is relatively high, intermediate in the central region dominated by riverine inputs of terrestrial organic matter, and weakest in the east where strong pelagic grazing is known to limit sinking flux. Differences in δ13C between pelagic and benthic functional groups (up to 5.7 ‰) increased from west to east, and from the nearshore shelf to the upper slope. On the upper slope, much of the sinking organic matter may be intercepted in the water column, and dynamic hydrography likely diversifies available food sources. In waters > 750 m, there were no clear trends in benthic-pelagic coupling or community-level trophic diversity. This study represents the first description of fish and invertebrate food web structure > 200 m in the Canadian Beaufort Sea

Validity of predictive equations for 24-h urinary sodium excretion in adults aged 18–39 y1–5

Background: Collecting a 24-h urine sample is recommended for monitoring the mean population sodium intake, but implementation can be difficult. Objective: The objective was to assess the validity of published equations by using spot urinary sodium concentrations to predict 24-h sodium excretion. Design: This was a cross-sectional study, conducted from June to August 2011 in metropolitan Washington, DC, of 407 adults aged 18–39 y, 48% black, who collected each urine void in a separate container for 24 h. Four timed voids (morning, afternoon, evening, and overnight) were selected from each 24-h collection. Published equations were used to predict 24-h sodium excretion with spot urine by specimen timing and race-sex subgroups. We examined mean differences with measured 24-h sodium excretion (bias) and individual differences with the use of Bland-Altman plots. Results: Across equations and specimens, mean bias in predicting 24-h sodium excretion for all participants ranged from2267 to 1300mg (Kawasaki equation). Bias was least with International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) equations with morning (2165 mg; 95% CI: 2295, 36 mg), afternoon (290 mg; 2208, 28 mg), and evening (2120 mg; 2230, 211 mg) specimens. With overnight specimens, mean bias was least when the Tanaka (223 mg; 95% CI: 2141, 95 mg) or Mage (2145 mg; 2314, 25 mg) equations were used but was statistically significant when using the Tanaka equations among females (216 to 243 mg) and the Mage equations among races other than black (2554 to 2372 mg). Significant over- and underprediction occurred across individual sodium excretion concentrations. Conclusions: Using a single spot urine, INTERSALT equations may provide the least biased information about population mean sodium intakes among young US adults. None of the equations evaluated provided unbiased estimates of individual 24-h sodium excretion. This trial was registered at clinicaltrials.gov as NCT01631240

The PPAR-γ agonist pioglitazone modulates inflammation and induces neuroprotection in parkinsonian monkeys

<p>Abstract</p> <p>Background</p> <p>Activation of the peroxisome proliferator-activated receptor gamma (PPAR-γ) has been proposed as a possible neuroprotective strategy to slow down the progression of early Parkinson's disease (PD). Here we report preclinical data on the use of the PPAR-γ agonist pioglitazone (Actos^®; Takeda Pharmaceuticals Ltd.) in a paradigm resembling early PD in nonhuman primates.</p> <p>Methods</p> <p>Rhesus monkeys that were trained to perform a battery of behavioral tests received a single intracarotid arterial injection of 20 ml of saline containing 3 mg of the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Twenty-four hours later the monkeys were assessed using a clinical rating scale, matched accordingly to disability, randomly assigned to one of three groups [placebo (n = 5), 2.5 (n = 6) or 5 (n = 5) mg/kg of pioglitazone] and their treatments started. Three months after daily oral dosing, the animals were necropsied.</p> <p>Results</p> <p>We observed significant improvements in clinical rating score (<it>P </it>= 0.02) in the animals treated with 5 mg/kg compared to placebo. Behavioral recovery was associated with preservation of nigrostriatal dopaminergic markers, observed as higher tyrosine hydroxylase (TH) putaminal optical density (<it>P </it>= 0.011), higher stereological cell counts of TH-ir (<it>P </it>= 0.02) and vesicular monoamine transporter-2 (VMAT-2)-ir nigral neurons (<it>P </it>= 0.006). Stereological cell counts of Nissl stained nigral neurons confirmed neuroprotection (<it>P </it>= 0.017). Pioglitazone-treated monkeys also showed a dose-dependent modulation of CD68-ir inflammatory cells, that was significantly decreased for 5 mg/kg treated animals compared to placebo (<it>P </it>= 0.018). A separate experiment to assess CSF penetration of pioglitazone revealed that 5 mg/kg p.o. induced consistently higher levels than 2.5 mg/kg and 7.5 mg/kg. p.o.</p> <p>Conclusions</p> <p>Our results indicate that oral administration of pioglitazone is neuroprotective when administered early after inducing a parkinsonian syndrome in rhesus monkeys and supports the concept that PPAR-γ is a viable target against neurodegeneration.</p

Piloting co-developed behaviour change interventions to reduce exposure to air pollution and improve self-reported asthma-related health

Background Exposure to air pollution can exacerbate asthma with immediate and long-term health consequences. Behaviour changes can reduce exposure to air pollution, yet its ‘invisible’ nature often leaves individuals unaware of their exposure, complicating the identification of appropriate behaviour modifications. Moreover, making health behaviour changes can be challenging, necessitating additional support from healthcare professionals. Objective This pilot study used personal exposure monitoring, data feedback, and co-developed behaviour change interventions with individuals with asthma, with the goal of reducing personal exposure to PM2.5 and subsequently improving asthma-related health. Methods Twenty-eight participants conducted baseline exposure monitoring for one-week, simultaneously keeping asthma symptom and medication diaries (previously published in McCarron et al., 2023). Participants were then randomised into control (n = 8) or intervention (n = 9) groups. Intervention participants received PM2.5 exposure feedback and worked with researchers to co-develop behaviour change interventions based on a health behaviour change programme which they implemented during the follow-up monitoring week. Control group participants received no feedback or intervention during the study. Results All interventions focused on the home environment. Intervention group participants reduced their at-home exposure by an average of 5.7 µg/m³ over the monitoring week (−23.0 to +3.2 µg/m³), whereas the control group had a reduction of 4.7 µg/m³ (−15.6 to +0.4 µg/m³). Furthermore, intervention group participants experienced a 4.6% decrease in participant-hours with reported asthma symptoms, while the control group saw a 0.5% increase. Similarly, the intervention group’s asthma-related quality of life improved compared to the control group. Impact statement This pilot study investigated a novel behaviour change intervention, utilising personal exposure monitoring, data feedback, and co-developed interventions guided by a health behaviour change programme. The study aimed to reduce personal exposure to fine particulate matter (PM2.5) and improve self-reported asthma-related health. Conducting a randomised controlled trial with 28 participants, co-developed intervention successfully targeted exposure peaks within participants’ home microenvironments, resulting in a reduction in at-home personal exposure to PM2.5 and improving self-reported asthma-related health. The study contributes valuable insights into the environmental exposure-health relationship and highlights the potential of the intervention for individual-level decision-making to protect human health

Parkinson's disease biomarkers: perspective from the NINDS Parkinson's Disease Biomarkers Program

Biomarkers for Parkinson's disease (PD) diagnosis, prognostication and clinical trial cohort selection are an urgent need. While many promising markers have been discovered through the National Institute of Neurological Disorders and Stroke Parkinson's Disease Biomarker Program (PDBP) and other mechanisms, no single PD marker or set of markers are ready for clinical use. Here we discuss the current state of biomarker discovery for platforms relevant to PDBP. We discuss the role of the PDBP in PD biomarker identification and present guidelines to facilitate their development. These guidelines include: harmonizing procedures for biofluid acquisition and clinical assessments, replication of the most promising biomarkers, support and encouragement of publications that report negative findings, longitudinal follow-up of current cohorts including the PDBP, testing of wearable technologies to capture readouts between study visits and development of recently diagnosed (de novo) cohorts to foster identification of the earliest markers of disease onset

“I have to stay inside …”: experiences of air pollution for people with asthma

Asthma, characterized by airway inflammation, sensitization and constriction, and leading to symptoms including cough and dyspnoea, affects millions of people globally. Air pollution is a known asthma trigger, yet how it is experienced is understudied and how individuals with asthma interact with air quality information and manage exacerbation risks is unclear. This study aimed to explore how people living with asthma in Scotland, UK, experienced and managed their asthma in relation to air pollution. We explored these issues with 36 participants using semi-structured interviews. We found that self-protection measures were influenced by place and sense of control (with the home being a “safe space”), and that the perception of clean(er) air had a liberating effect on outdoor activities. We discuss how these insights could shape air quality-related health advice in future