Complications after polydioxanone threads (PDO) for facial lifting - a literature review

Introduction: The popularity of cosmetic treatments is increasing, including treatments using polydioxanone (PDO) threads. Among the various complications that PDO threads can cause are swelling, skin dimpling, paresthesia, thread visibility/palpability, infection, and thread extrusion. On the other hand, it is an alternative to surgical facelift. Purpose of work: To collect information on the complications after PDO threads for facial lifting. Summary: In the literature review, there were reported complications after PDO threads for facial lifting as edema, allergy, inflammation, infection, skin dimpling, contour irregularity, visible threads, hematoma, thread extrusion, and incomplete facial paralysis. Knowledge of complications after face lifting with PDO threads allows us to prepare for these side effects and act appropriately in the event of their occurrence, thus avoiding the long-term effects of the cosmetic procedure

Legal and Medical Aspects of the End of Human Life from the Perspective of Palliative Medicine Related to Cardiac Surgery

Despite the impressive developments in modern medicine, the healthcare system is still associated with human death. Medicine has made great strides in the treatment of many diseases. The procedures are particularly advanced in, e.g., cardiac surgery, vascular surgery, and other fields. However, despite these efforts, not all patients are cured, and the use of aggressive treatment often contributes to their suffering. This does not mean that patients should be left unattended at the end of their lives.. Palliative medicine deals with patients coming to the end of their lives, concentrating on alleviating suffering and improving quality of life. It is a medical speciality focused on a wide range of interventions, including symptom management, communication, and psychosocial and spiritual support for patients. Patients undergoing highly qualified procedures, for whom causal treatment is not possible, should have the right to such care before death. However, according to medical practice and national legal regulations, it is not always possible to provide this care, despite the anticipated death. This article presents the legal and medical aspects of the end of life from the point of view of the European and Polish healthcare systems.Piotr Jakubów: [email protected] Niedźwiecka: [email protected] Kondracka: [email protected] Turczynowicz: [email protected] Kocańda: [email protected] Malarewicz-Jakubów: [email protected] Jakubów - Medical University of Białystok, PolandKarolina Niedźwiecka - Medical University of Białystok, PolandJulia Kondracka - Medical University of Gdańsk, PolandAleksander Turczynowicz - Medical University of Białystok, PolandSzymon Kocańda - Medical University of Białystok, PolandAgnieszka Malarewicz-Jakubów - University of Bialystok, PolandAszyk P. et al., Deklaracja medycznego środowiska kardiologicznego, paliatywnego i internistycznego wskazująca na znaczenie opieki paliatywnej w kompleksowej opiece nad chorymi z niewydolnością serca, ‘Palliative Medicine in Practice’ 2018; vol. 12, no. 1, pp. 64–66.Avaaz.org, The Prague Charter, https://secure.avaaz.org/community_petitions/en/The_Prague_Charter_Relieving_suffering/.Bartko A., Pawlikowski J., Ewolucja opieki paliatywno-hospicyjnej: od terminalnie do prenatalnie, ‘Archiwum historii i filozofii medycyny’ 2016, vol. 79, pp.8–15.Boerner K., Rodriguez J., Quach E., Hendricksen M., Implementing the MOLST (Medical Orders for Life-Sustaining Treatments): Challenges Faced by Nursing Home Staff, ‘Geriatric Nursing’ 2018, vol. 39, no. 4, pp. 465–470.Bogusz H., Hospicjum – drzewo życia, Poznań 2017.Ciałkowska-Rysz A., De Walden-Gałuszko K., Medycyna Paliatywna, Warsaw 2022.Crespo-Leiro M. et al. Advanced Heart Failure: A Position Statement of the Heart Failure Association of the European Society of Cardiology. ‘European Journal of Heart Failure’ 2018, vol. 20, no. 11, pp. 1505–1535.European Commission (2022), Access to Affordable and High-Quality Long-Term Care, https://ec.europa.eu/info/law/better-regulation/have-your-say/initiatives/13190-Access-to-affordable-and-high-quality-long-term-care_en.Goldstein N.E., Morrison R.S., Evidence-Based Practice of Palliative Medicine, Philadelphia 2013.Goodlin S.J., Rich M.W. (eds.), End-of-Life Care in Cardiovascular Disease, New York 2015.Hentsch L. et al., Palliative Care Provision for People Living with Heart Failure: The Geneva Model, ‘Frontiers in Cardiovascular Medicine’ 2022, vol. 9/933977.House S.A., Schoo C., Ogilvie W.A., Advance Directives. StatPearls, https://www.statpearls.com/ArticleLibrary/viewarticle/17247.Huenchuan S., The Right to End-of-Life Palliative Care and a Dignified Death’, https://www.un.org/development/desa/ageing/wp-content/uploads/sites/24/2017/11/ECLAC-contribution.pdfKearney M., Mortally Wounded: Stories of Soul Pain, Death and Healing (3rd ed.), California 2021.Kovacs A.H., Dipchand A.I., Greutmann M., Tobler D., End-of-Life Care in Pediatric and Congenital Heart Disease, (in:) S. Goodlin, M. Rich (eds.), End-of-Life Care in Cardiovascular Disease, London 2015, pp. 136–154.Kowalik G., Idea opieki paliatywno-hospicyjnej – rys historyczny, ‘Studia Medyczne’ 2013, vol. 29, no. 2, pp. 188–194.Leeds H., Smith D., Palliative Care Involvement in Patients with Operative Mortality after Cardiac Surgery, ‘The Heart Surgery Forum’ 2020, vol. 23, no. 6, pp. E789–E792.MacDonald S., Herx L., Boyle A. (eds.), Palliative Medicine: A Case-Based Manual (4th ed.), Oxford 2022.Maciver J., Ross H.J., A Palliative Approach for Heart Failure End-of-Life Care, ‘Current Opinion in Cardiology’ 2018, vol. 33, no. 2, pp. 202–207.Maetens A., Cohen J., Harding R., A Public Health Approach to Integrate Palliative Care into a Country’s Health-Care System: Guidance as Provided by the WHO, (in:) R.D. MacLeod, L. van den Block (eds.), Textbook of Palliative Care, Cham 2020, pp. 1749–1768.Manalo M.F.C., End-of-Life Decisions about Withholding or Withdrawing Therapy: Medical, Ethical, and Religio-Cultural Considerations, ‘Palliative Care’ 2013, vol. 10, no. 7, pp. 1–5.Mullen R., The Provision of Palliative Care in Europe, https://pace.coe.int/en/files/25057.Najwyższa Izba Kontroli, Zdążyć z pomocą, https://www.nik.gov.pl/aktualnosci/opieka-paliatywna-i-hospicyjna.html.Penders Y.W.H., Bopp M., Zellweger U., Bosshard G., Continuing, Withdrawing, and Withholding Medical Treatment at the End of Life and Associated Characteristics: A Mortality Follow-back Study, ‘Journal of General Internal Medicine’ 2020, vol. 35, no. 1, pp. 126–132.Sobański P.Z. et al., Stanowisko Grupy Ekspertów Polskiego, ‘Kardiologia Polska’ 2020, vol. 3, pp. 104–117.Radbruch L., de Lima L., Lohmann D., Gwyther E., Payne S., The Prague Charter: Urging Governments to Relieve Suffering and Ensure the Right to Palliative Care, ‘Palliative Medicine’ 2013, vol. 27, no. 2, pp. 101–102.Radbruch L., Payne S., White Paper on Standards and Norms for Hpspice and Palliative Care in Europe: Part 1. Recommendations from the European Association for Palliative Care, ‘Journal of Palliative Care’ 2009, vol. 16, no. 6, pp. 278–289.Roberts N.F., The History of Hospice: A Different Kind of Health ‘Care’, ‘Forbes’ 22.06.2018, https://www.forbes.com/sites/nicolefisher/2018/06/22/the-history-of-hospice-a-different-kind-of-health-care.Schmidlin E., Palliative Care as a Human Right: What Has the Prague Charter Achieved? ‘European Journal of Palliative Care’ 2015, vol. 22, no. 3, pp. 141–143, https://www.academia.edu/12245063/Palliative_care_as_a_human_right-_what_has_the_Prague_Charter_achieved.Singh G.K., Davidson P.M., Macdonald P.S., Newton P.J., The Perspectives of Health Care Professionals on Providing End of Life Care and Palliative Care for Patients with Chronic Heart Failure: An Integrative Review, ‘Heart, Lung & Circulation’ 2019, vol. 28, no. 4, pp. 539–552.Sobanski P.Z. et al., Palliative Care for People Living with Heart Failure: European Association for Palliative Care Task Force Expert Position Statement ‘Cardiovascular Research’ 2020, vol. 116, no. 1, pp. 12–27.Sobanski P.Z., Krajnik M., Goodlin S.J., Palliative Care for People Living With Heart Disease: Does Sex Make a Difference? ‘Frontiers in Cardiovascular Medicine’ 2021, vol. 8/629752.Truby L.K., Rogers J.G., Advanced Heart Failure: Epidemiology, Diagnosis, and Therapeutic Approaches, ‘JACC Heart Failure’ 2020 vol. 8, no. 7, pp. 523–536.Vitas Healthcare, What Are the Differences and Commonalities Between Hospice and Palliative Care?, https://www.vitas.com/hospice-and-palliative-care-basics/about-palliative-care/hospice-vs-palliative-care-whats-the-difference.Vranick J., Sanghavi D.K., Torp K.D., Stanton M., Do Not Resuscitate, ‘National Library of Medicine’, https://www.ncbi.nlm.nih.gov/books/NBK470163/.Waligórska D., Opieka paliatywna i hospicyjna. Rozporządzenie Ministra Zdrowia z dnia 29 października 2013 r. w sprawie świadczeń gwarantowanych z zakresu opieki paliatywnej i hospicyjnej Dz.U. z 2013 r., poz. 1347, https://www.gov.pl/web/zdrowie/opieka-paliatywna-i-hospicyjna-w-warunkach-stacjonarnych.Zehnder A.R., Pedrosa Carrasco A.J., Etkind S.N., Factors Associated with Hospitalisations of Patients with Chronic Heart Failure Approaching the End of Life: A Systematic Review ‘Palliative Medicine’ 2022, vol. 36, no. 10, pp. 1452–1468.283537

Single nucleotide polymorphisms as predictors of treatment efficacy and adverse effects of morphine in palliative medicine — a literature review

Introduction: Pain has a significant negative impact on the quality of life of cancer patients and implies numerous clinical consequences. Moderate to severe pain is common in patients receiving palliative care. A major issue is the individual variability resulting in different degrees of response to the analgesic effects of opioids, including morphine, and to the occurrence of their adverse effects. According to one of the theories of pharmacogenomics, single nucleotide polymorphisms (SNPs) are associated with opioid metabolism. Material and methods: A literature review of the PubMed database identified 18 scientific articles concerning SNPs that affect the analgesic effects and adverse effects of morphine or other opioids, per morphine equivalent, from which additional 22 scientific articles were retrieved. Results: The review identified SNPs in the genes OPRM1 A118G, COMT rs4680, ABCB1 C3435T, IL-6, IL-8, TNF-⍺, TAOK3, HTR3B, UGT1A1/UGT1A8 and OPRM1 Arg181Cys, which were found to affect both the occurrence of potential adverse effects and the different demand in palliative care patients for a dose of morphine that will effectively relieve pain. SNPs were found to significantly affect morphine metabolism; the determination of this effect is individual-based. Most studies were conducted in small groups of individuals from ethnically diverse populations, which, if mutations are present, may significantly affect the efficacy of opioid-related SNP assays and the response of patients to the analgesic treatment administered. Conclusions: Findings raise the prospect of the use of SNPs in clinical practice as part of personalised medicine in the future.Ból nowotworowy ma poważny wpływ na jakość życia chorych i implikuje liczne kliniczne konsekwencje. Ból w stopniu od umiarkowanego do ciężkiego doświadcza większość pacjentów medycyny paliatywnej. Problem stanowi zmienność osobnicza powodująca różny stopień odpowiedzi na działanie przeciwbólowe opioidów, w tym morfiny i na wystąpienie ich efektów ubocznych. Jedną z teorii farmakogenomicznych mających na celu wyjaśnienie zmienności są polimorfizmy pojedynczych nukleotydów (SNP – single nucleotide polymorphisms) związane z metabolizmem opioidów. Przegląd literatury przeprowadzony w bazie PubMed zidentyfikował 16 artykułów naukowych dotyczących SNP wpływających na działanie przeciwbólowe i działania niepożądane morfiny bądź innych opioidów z przeliczeniem na ekwiwalent morfiny, z których dodatkowo pozyskano 22 istotne dla przeglądu artykuły naukowe. W przeglądzie zidentyfikowano SNP w genach OPRM1 A118G, COMT rs4680, ABCB1 C3435T, IL-6, IL-8, TNF⍺, TAOK3, HTR3B, UGT1A1/UGT1A8, a także OPRM1 Arg181Cys, które wykazały wpływ na zróżnicowane zapotrzebowanie pacjentów paliatywnych na dawkę morfiny skutecznie kontrolującej ból oraz na wystąpienie potencjalnych działań niepożądanych. Wykazano, że SNP istotnie wpływa na metabolizm morfiny. Określenie tego wpływu jest zależne osobniczo. W przeprowadzonej analizie większość badań opierała się na niewielkich liczebnie grupach pacjentów z różnorodnych etnicznie populacji, co w przypadku występowania mutacji może mieć istotny wpływ na skuteczność oznaczania SNP związanych z opioidami i na odpowiedź pacjentów na zastosowane leczenie przeciwbólowe. Liczba dostępnych dowodów naukowych w literaturze daje nadzieję na wykorzystanie SNP w praktyce klinicznej w przyszłości jako element medycyny spersonalizowanej

Letter to Wanda Hermann from Laura de Turczynowicz and Peter de Turczynowicz

There are two letter that arrived for Wanda Hermann from her Mother Laura de Turczynowicz and her brother Peter de Turczynowicz. The first letter from her mother, discusses the weather in California and asks about Wanda's portrait that she recently painted. The second letter from her brother Peter reads in part "Dear Wanda, I hear you have all your pictures framed which is very much better than it was, I wrote Adelaide awhile ago but she as yet has not answered. Madame just read "Nazarene" by Soleman Asch which is really very good, have you been able to get "Secret Scepter" by Francis Gerard. Hobart is going to church next Sunday with us. goodfriend was down for bridge last night his bridge is very strange. We have had "Bambi's Family" by Sauter. It has been raining quite a lot Santa Monica has 31.63 in normal 12. in it is blowing and trying to rain right now which it certainly will do before long...navy stuck it chin out a little too far with german urgeing of course...I guess Hitler does not love the Serbes not too much any way.

Spatio-temporal Indoor Human Exposures in Homes Affected by Chemical-contaminated Soil and Groundwater

INTRODUCTION: Public health problem statement: Vapour intrusion is a process that involves the migration of volatile chemicals from contaminated soil and/or groundwater into dwellings or other confined structures where inhalational exposure may occur. The process is exemplified by naturally occurring soil radon, which is considered a major risk factor for lung cancer in a number of countries. However, the extensive use of industrial chemicals and fuels over many years has left a legacy of soil and groundwater contamination potentially posing an even wider variety of disease endpoints. Volatile substances such as benzene and trichloroethylene (TCE) have also been shown to intrude into buildings from single or multiple sources off site. Limited environmental epidemiological studies have reported increased risks of cancer and non-cancer effects. Owing to the number of people potentially exposed including vulnerable subpopulations, regulatory agencies have developed frameworks for risk assessment based on environmental sampling and predictive models. These approaches, however, are based on idealized contaminant source and migration characteristics, and have been found to have limited predictive value for health risk assessment. Further research is required to provide more confidence in risk assessment outcomes. Initial literature review: In Australia, the federal enHealth’s human health risk assessment framework and a National Environment Protection Measure provide the basis for site contamination assessment. These documents, although recognizing the complexity of vapour intrusion, provide limited guidance on exposure assessment and have a focus on petroleum hydrocarbons. The human health risk assessment of vapour intrusion can be structured into three key areas: • Sub-surface fate and transport models and vapour measurement that establishes the vapour concentration at the building boundary. • Ventilation models and measurement which consider indoor air concentrations in space and over time within the building; and • Human inhalation dosimetry which considers absorbed doses over time. The peer-reviewed scientific literature on vapour intrusion over the past thirty years combined with the international regulatory documentation is extensive. However, the majority of this literature is oriented towards the initial phase of sub-surface transport to the building boundary. There has been limited focus on ventilation dynamics and less so on inhalation dosimetry. In the past five years, however, increasing attention has focused on spatial and temporal indoor air contaminant changes with one public health publication on residential indoor air spatio-temporal variability and another on linking indoor air contaminant concentrations to biological markers. In terms of considering inhalation dosimetry, however, there is as yet, no discourse on how these indoor environments may result in differing inhalation doses. This may be particularly important where high level peak doses due to environmental effects on the distribution of an indoor volatile, result in adverse pathologies. Indeed, there is some evidence, for example, in the case of TCE, for peak tissue concentrations precipitating acute neurotoxic effects. Gap in knowledge: The gaps in knowledge in vapour intrusion exposure assessment include the following: • Models of dynamic and time-dependent (non-steady state) vapour migration processes and their validation. • An understanding of spatio-temporal variability in indoor concentrations and the correlates of the variability that might lead to an evidenced-based indoor air sampling protocol. • The time dependence of absorbed dose, especially tissue concentrations, that results from time-dependent inhaled air concentrations. PURPOSE STATEMENT: Through a critical review of the literature and a series of empirical case studies, this research seeks to: • Elucidate the nature of spatial-temporal changes in indoor contaminant concentrations within houses affected by vapour intrusion and the factors that may influence those changes. • Provide an evidence base for a time-dependent vapour intrusion model with empirical evaluation, applicable to Australian conditions. • Explore the utility of biological monitoring for risk assessment in a common vapour intrusion scenario. GENERAL RESEARCH QUESTIONS: • What is the short- and long-term spatio-temporal variability of indoor air contaminants arising from vapour intrusion? • Which factors are significantly associated with indoor air concentration variability? • What is the relationship between biological monitoring data and indoor TCE concentrations? METHODS: A critical literature review and experimental case study approach were used. The experimental case studies were opportunistic and reflected real-life conditions. Case Study 1 was a termiticide treatment (including xylene) in a suspended floor home and Case Study 2 was a slab-on-ground house in a TCE-affected area. Critical literature review: Computerised searches of the published literature were conducted using the Web of Science, Scopus and PubMed. The logic grid included “vapour intrusion”; “ventilation”; “inhalation dosimetry” and “exposure”. The yields were complemented with author searching and forwards and backwards searching. The literature on vapour intrusion was critically reviewed in terms of its utility for human health risk assessment. Case Study 1 – Suspended timber floor home construction - Indoor air concentrations: The upper portion of the soil in the subfloor of a 1950’s home was treated with technical grade xylene containing m-, p- and o-xylenes as part of a termiticide treatment. Analyses were conducted of soil xylene and moisture concentrations; subfloor and indoor air xylene concentrations; and air exchange rates in the subfloor space and occupied space. Concurrent meteorological data were collected from a weather station. A published Australian non-steady state model, developed in previous national guidance, was used to estimate (and compare with) indoor air concentrations based on the empirical measurements. Case Study 2a – Concrete slab on ground home construction - Indoor air concentrations: A four-bedroom public housing property in a residential area impacted by chlorinated hydrocarbon contaminated groundwater was used over a period of 14 months to assess indoor air TCE levels. Passive TCE sampling occurred at five indoor and two outdoor locations over various time intervals. Air exchange rates were calculated at front and rear indoor sampling locations. Detailed local meteorological data were gathered from a weather station. Indoor temperature and indoor relative humidity were measured at 30 minute intervals over a 3-month period at each of five indoor air sampling locations. Soil vapour, sub-slab vapour and flux chamber measurements were carried out during one week concurrent with 6 hour passive sampling. Case Study 2b - Slab on ground home construction - Human exposure experiments: A biological monitoring pilot study was conducted with 5 volunteer adults who occupied the TCE-contaminated house for 12 hours. End-exhaled breath samples and blood samples were collected. Participants were also asked to provide urine samples at baseline, at the end of the exposure period and on three subsequent occasions. Passive indoor air sampling and surface flux testing was undertaken. Sub-slab TCE samples were also collected inside and outside the house. RESULTS: Critical literature review: Papers on vapour intrusion mainly focused on issues associated with the sub surface. These included areas such as development of one- and three-dimensional steady-state models; estimation of attenuation factors; lateral exclusion distances; factors affecting subsurface migration such as moisture levels and oxygen concentrations and reconsideration of the United States (US) Environment Protection Agency vapour intrusion database. There have, however, been some new areas of focus in the last five years, which have included the use of new real-time measurement techniques; an increased focus of the role of pressure differences on indoor air contaminant concentrations; seasonal and diurnal differences and spatio-temporal variability in homes across an affected community. One recent study examined indoor air TCE concentrations and blood TCE levels. The recent literature has increasingly examined the above-ground and indoor environment but has not further considered within building spatial differences nor a more detailed examination of short-term indoor air average concentration changes and associated influencing variables. In addition, the literature is silent on the issue of inhalation dosimetry in vapour intrusion and the potential for non-invasive methods of biological monitoring. Case Study 1– Suspended floor home construction - Indoor air concentrations: Xylene air concentrations decayed to non-detectable levels within two weeks. Subfloor xylene air concentrations were greater than living space xylene air concentrations, and the decay of the concentrations following a generally consistent pattern. Air exchange rates between the sub-floor and living space differed by up to an order of magnitude and demonstrated the influence of subfloor ventilation on vapour intrusion. Statistically significant associations were found for air exchange in the sub-floor space and locally measured minimum and average wind speed. Site-specific variables in a non-steady state model showed general consistency with measured data, but the modelling estimated a greater shorter-term initial peak with more rapid decay of xylene concentrations than those measured. Case Study 2a - Slab on ground home construction - Indoor air concentrations: Air sampling data revealed spatial and seasonal indoor TCE variations. Winter month results were up to an order of magnitude greater than summer months. Monitoring over 6-hour (h) periods demonstrated the occurrence of diurnal peaks that were not evident with a 24-h sampling regime. Moreover, the use of a continuous data logging instrument showed occasional spikes over rapid time intervals which were an order of magnitude or greater compared to the common baseline value. Air exchange measurements revealed consistent early morning declines in ventilation. Correspondingly, the highest surface TCE flux was noted during the day with the lowest occurring during the evening. Soil vapour measurements at progressive depths at the rear of the property showed high source concentrations of TCE with lower concentrations progressively up to the subslab. Using the 6-h average TCE concentration as the outcome variable, it was found that ventilation, internal temperature, barometric pressure and wind direction were significant predictor variables in a multivariate model. Ventilation had the greatest impact in the best fit model with one air change per hour predicting a 4.4 μg m⁻³ decline in the indoor TCE concentration. Assessment of model predictions showed close agreement with the dataset. Case Study 2b - Slab on ground home construction - Human exposure experiments: The pilot biological monitoring exercise yielded mixed results with most biomonitoring data below the limit of reporting (LOR) which was which was <5μg m⁻³ for breath and <0.01 μg L⁻¹ for blood. End-exhaled breath TCE concentrations were generally below 5μg m⁻³ with two results above the LOR. Composite end-exhaled breath samples for baseline and at 02:30 and 08:30 were 2.0, 1.5 and 1.2μg m⁻³ respectively. Blood concentrations were all below the level of reporting of 0.01 μg L⁻¹. While blood TCE concentrations could not be quantified in accordance with standard protocols, discrete peaks were observed on the chromatograms. CONCLUSIONS AND RECOMMENDATIONS: The recent literature has increasingly examined the above-ground and indoor environment but has not further considered within-building spatial differences nor shorttermindoor air average concentration changes and their influencing variables. In addition, the literature is silent on the issue of inhalation dosimetry in vapour intrusion and the potential for non-invasive methods of biological monitoring. Case Study 1 confirmed the influence of dwelling features and that of ventilation and meteorological variables such as wind speed for a suspended-floor dwelling. Case Study 2 captured greater resolution across all measurements and although the extent of the variables measured varied, sufficient data were captured to provide a more detailed examination of time-dependent change. Statistically significant spatial differences were observed suggesting the need to account for prevailing wind direction in worst case indoor sampling strategies. Mixed-effects regression models were consistent with the observed seasonal and diurnal differences. The two case studies provide evidence for a worst-case sampling strategy, that is, sampling in winter and during the evening and accounting for spatial variance. Overall, the results demonstrate the complexity of indoor ventilation dynamics and that spatial and temporal influences are important to understand for exposure assessment purposes. Short term, peak TCE exposure periods were observed and may be of toxicological significance based on information suggesting TCE exhibits a nonmonotonic dose-response relationship for foetal malformations. On the basis of the research the following recommendations are made: • More detailed and extensive (>1 year) longitudinal studies capturing time dependent changes in indoor air concentrations and all influencing variables including air pressure changes, should be undertaken. • A human volunteer biological monitoring study using end-exhaled breath and blood TCE analyses should be undertaken, using sensitive analytical techniques such as Selected Ion Flow Tube Mass Spectrometry. • A retrospective epidemiological study in TCE-affected areas should be conducted in Adelaide.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 201

Exposure assessment modeling for volatiles - Towards an Australian indoor vapor intrusion model

Human health risk assessment of sites contaminated by volatile hydrocarbons involves site-specific evaluations of soil or groundwater contaminants and development of Australian soil health-based investigation levels (HILs). Exposure assessment of vapors arising from subsurface sources includes the use of overseas-derived commercial models to predict indoor air concentrations. These indoor vapor intrusion models commonly consider steady-state assumptions, infinite sources, limited soil biodegradation, negligible free phase, and equilibrium partitioning into air and water phases to represent advective and diffusive processes. Regional model construct influences and input parameters affect model predictions while steady-state assumptions introduce conservatism and jointly highlight the need for Australian-specific indoor vapor intrusion assessment. An Australian non-steady-state indoor vapor intrusion model has been developed to determine cumulative indoor human doses (CIHDs) and to address these concerns by incorporating Australian experimental field data to consider mixing, dilution, ventilation, sink effects and first-order soil and air degradation. It was used to develop provisional HILs for benzene, toluene, ethylbenzene, and xylene (BTEX), naphthalene, and volatile aliphatic and aromatic total petroleum hydrocarbons (TPH) < or = EC16 fractions for crawl space dwellings. This article summarizes current state of knowledge and discusses proposed research for differing exposure scenarios based on Australian dwelling and subsurface influences, concurrent with sensitivity analyses of input parameters and in-field model validation.Leonid Turczynowicz; Neville I. Robinso

"She Trumped Her Partner's Ace"

A short story written by Laura de Turczynowicz under the nom de plume Kirsty Brandon

When the Prussians came to Poland; the experiences of an American woman during the German invasion,

Mode of access: Internet

Health risk assessment and vapor intrusion: a review and Australian perspective

Soil contamination by volatile hydrocarbons is of public health importance due to vapor intrusion and indoor inhalation exposures. These are assessed using measurement or predictive modeling and need to consider the key areas of subsurface partitioning and transport, dwelling ventilation, and receptor inhalation dosimetry. While subsurface partitioning and transport have been subject to intensive international investigation, limited consideration has been given to the latter. Building ventilation research has developed multi-zone airflow and contaminant dispersal models including AccuRate, an Australian model that examines natural ventilation modeling, roof and sub-floor ventilation, and identifies the importance of geometry and thermal factors on ventilation (the most sensitive variable) and indoor pollutant concentrations. Inhalation dosimetry has received recent attention due to concerns over child inhalation susceptibility and dose metrics. Research using coupled computational fluid dynamics (CFD) and physiologically based pharmaco-kinetic (PBPK) models has reported variance from previous animal models’ extrapolation while CFD modeling of transient lung vapor absorption suggests the significance of transient versus steady-state evaluation of volatiles absorption into tissue and blood. The transient nature of sub-surface fate and transport, ventilation, and inhalation uptake thus warrants integrated exploration and application in order to realize improvements in vapor intrusion assessments. These perspectives and Australian modeling initiatives are presented in this article.Leonid Turczynowicz, Dino Pisaniello and Terry Williamso