The Department of Veterans' Affairs Depleted Uranium Cohort in the Time of COVID-19: Translating a Traditional Surveillance Protocol to a Telehealth Platform.

OBJECTIVE: In 2021, 37 members of a cohort of depleted uranium-exposed Gulf War I veterans were evaluated using a protocol tailored to accommodate COVID-19 safety practices on a telehealth platform. METHODS: Individual elements of the legacy protocol were reviewed for urgency and feasibility of inclusion in a modified, telehealth platform. RESULTS: The redesigned protocol included a participant readiness for telehealth assessment, nurse and physician telehealth visits, collection of usual health questionnaires, and urine collections for exposure monitoring for uranium and other fragment-related metal measures. CONCLUSIONS: Despite some limitations in scope, the telehealth platform permitted a visual "visit" with surveillance participants who expressed a high comfort level with the format. The telehealth platform has apparent utility for occupational surveillance and should be explored as a standard approach for surveillance outside of public health emergencies.

Poor Sleep Quality and Other Risk Factors for Unemployment Among Patients on Opioid Agonist Treatment.

Purpose: Patients with opioid use disorder (OUD) face high rates of unemployment, putting them at higher risk of treatment nonadherence and poor outcomes, including overdose death. The objective of this study was to investigate sleep quality and its association with other biopsychosocial risk factors for unemployment in patients receiving opioid agonist treatment (OAT) for OUD. Methods: Using a cross-sectional survey design, participants from 3 OAT programs for OUD completed questionnaires to measure sleep quality (Pittsburgh Sleep Quality Index [PSQI]); pain disability; catastrophic thinking; injustice experience; quality of life; and self-assessed disability. Spearman's rank correlation was used to test for associations between sleep quality and other study variables. Results: Thirty-eight participants completed the study, with mean age 45.6 ± 10.9 years, 27 (71.1%) males, and 16 (42.1%) reporting a high school diploma/equivalent certification as the highest level of academic attainment. Poor sleep quality (defined as PSQI > 5) was identified in 29 participants (76.3%) and was positively correlated with pain disability (r = 0.657, P < .01), self-assessed disability (r = 0.640, P < .001), symptom catastrophizing (r = 0.499, P < .001), and injustice experience (r = 0.642, P < .001), and negatively correlated with quality of life (r = -0.623, P < .001). Conclusions: There was a high prevalence of poor sleep quality in patients with OUD on OAT and this was associated with multiple known risk factors for unemployment. These findings warrant the consideration of regular screening for sleep problems and the inclusion of sleep-related interventions to improve sleep quality, decrease the unemployment rate, and enhance the recovery process for individuals with OUD undergoing OAT.

Lipid distribution on ethnic hairs by Fourier transform infrared synchrotron spectroscopy.

BACKGROUND: A synchrotron-based Fourier transform infrared micro-spectrometer (µ-FTIR) allows the spatial determination of lipids across the different layers of ethnic hairs and differentiates between the lipid order arrangement and quantity. MATERIALS AND METHODS: The three ethnic fibers were delipidized, the lipid extracts were characterized, and the delipidized fibers were studied by dynamic vapor sorption experiments (DVS) and FTIR-synchrotron techniques. RESULTS: The average spectra from the different hair regions exhibited the most intense CH2 sym peaks on the medulla, followed by those from the cuticle and cortex for all hairs of different ethnicities. Differences in the lipid fraction of the three hair types have been observed, and they can explain some barrier properties. African virgin hair was demonstrated to have more lipids mainly in the medulla, which implies an important hydrophobicity with low hysteresis between absorption and desorption water vapor processes. In addition, these lipids are highly disordered, mainly in the cuticle, which can be related to its high water vapor diffusion. Asian and Caucasian virgin hairs presented a similar lipid order in all regions, with similar diffusion coefficients. Results indicate that the higher order of the lipid bilayer hinders water permeation kinetics in some way. CONCLUSION: The differences in the presence and organization of the lipids in the different regions of the African hair can account for its differentiation with regards to moisturization and swelling from the other types of fibers.

Surveillance of Depleted Uranium-exposed Gulf War Veterans: More Evidence for Bone Effects.

ABSTRACT: Gulf War I veterans who were victims of depleted uranium (DU) "friendly-fire" incidents have undergone longitudinal health surveillance since 1994. During the spring of 2019, 36 members of the cohort were evaluated with a monitoring protocol including exposure assessment for total and isotopic uranium concentrations in urine and a comprehensive review of health outcomes, including measures of bone metabolism and bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained depleted uranium (DU) shrapnel fragments. In addition, a measure of bone resorption, N-telopeptide, showed a statistically significant increase in those in the high DU subgroup, a finding consistent with a statistically significant decrease in bone mass also observed in this high DU subgroup compared to the low DU subgroup. After more than 25 y since first exposure to DU, an aging cohort of military veterans continues to show few U-related health effects in known target organs of U toxicity. The new finding of impaired BMD in the high DU subgroup has now been detected in two consecutive surveillance visits. While this is a biologically plausible uranium effect, it is not reflected in other measures of bone metabolism in the full cohort, which have largely been within normal limits. However, ongoing accrual of the U burden from fragment absorption over time and the effect of aging further impairing BMD suggest the need for future surveillance assessments of this cohort.

Cleaning and Disinfection Perceptions and Use Practices Among Elastomeric Respirator Users in Health care.

BACKGROUND: Reusable elastomeric respirator use in health care may represent one solution to address N95 respirator shortages experienced during infectious disease outbreaks, but cleaning and disinfection requirements may limit their utility. Evidence of respirator cleaning and disinfection behaviors and practices by health care workers may inform guidance on reusable respirator use. METHODS: Medical system elastomeric respirator users were surveyed about respirator cleaning and disinfection practices and perceptions via an electronic survey. Respondents were subsequently classified based on reported compliance with their assigned respirator use. To explore whether respirator cleaning and disinfection issues affected compliance with assigned device use, responses were compared between user groups and adjusted for covariates. RESULTS: A total of 432 of 2,024 (21%) eligible elastomeric respirator users completed the survey. Most (>90%) reported that their respirator was clean, but only 52% reported that they always disinfect their respirators after use according to the hospital's expected practice. Only 40 respondents (9%) reported regularly cleaning the respirator with soap and water, in accordance with manufacturer recommendations. Reporting of suboptimal decontamination practice was not associated with assigned device compliance, however, except among providers and respiratory therapists. CONCLUSION/APPLICATION TO PRACTICE: Although perceptions of cleanliness and adherence to expected decontamination practices during routine use did not appear to influence compliance with assigned respirator use overall, this did predict compliance among providers and respiratory therapists, both of whom have nonfixed workstations. Practical and effective strategies to assure easy access to and availability of clean reusable respiratory protective devices are needed to facilitate their use in health care respiratory protection programs.

Self-reported impact of respirator use on health care worker ability to perform patient care.

In a study of 1,152 health care workers surveyed prior to the COVID-19 pandemic, most disagreed that respiratory protective equipment use interferes with patient care but reported that it would affect respirator use compliance if it did. A patient's fear reaction variably influenced self-reported health care worker compliance with respirator use. Strategies to improve protective equipment design may remove potential barriers to respirator use and allow better health care worker-patient relationships.

Ethnic hair: Thermoanalytical and spectroscopic differences.

BACKGROUND: The aim of this study is to characterize and detect the possible differences among the hair of three different ethnicities: African, Asiatic and Caucasian. MATERIALS AND METHODS: The differences in water adsorption/desorption behaviour of hairs were studied using a thermogravimetric balance and compared with the analysis of the lipid distribution and order using synchrotron-based Fourier transform infrared microspectroscopy. Besides, the thermal thermogravimetry (TG) and differential scanning calorimetry (DSC) analyses on human hair were executed. RESULTS: Differences in the diffusion coefficients were evidenced. African hair exhibited increased permeability. Caucasian hair displayed a higher water absorption capability with increasing humidity but with a slow diffusion rate. The Asian fibre appeared to be more resistant to hydration changes. The spectroscopic analysis showed notable differences in the cuticle lipids. The African cuticle exhibited more lipids with a lower order bilayer. The outmost layer of Caucasian fibres contained more ordered lipids, and the Asian fibres show a very low level of lipids on the cuticle region. The DSC results indicate no difference in the thermal stability and TG showed higher water content in the Caucasian fibre and a possible lower cysteine disulphide bond content in the African hair matrix. CONCLUSION: The triple approach demonstrated the permeability differences among the ethnic fibres and their correlation with the properties of their cuticle lipids. These differences could have particular relevance to the hair care cosmetic market.

Effect of propylene glycol on the skin penetration of drugs.

Propylene glycol (PG) has been used in formulations as a co-solvent and/or to enhance drug permeation through the skin from topical preparations. Two skin in vitro permeation approaches are used to determine the effect of PG on drug penetration. The in vitro Skin-PAMPA was performed using 24 actives applied in aqueous buffer or PG. PG modulates permeability by increasing or diminishing it in the compounds with poor or high permeability, respectively. Percutaneous absorption using pigskin on Franz diffusion cells was performed on seven actives and their commercial formulations. The commercial formulations evaluated tend to have a lower permeability than their corresponding PG solutions but maintain the compound distribution in the different strata: stratum corneum, epidermis and dermis. The results indicate the enhancer properties of PG for all compounds, especially for the hydrophilic ones. Additionally, the Synchrotron-Based Fourier Transform Infrared microspectroscopy technique is applied to study the penetration of PG and the molecular changes that the vehicle may promote in the different skin layers. Results showed an increase of the areas under the curve indicating the higher amount of lipids in the deeper layers and altering the lipidic order of the bilayer structure to a more disordered lipid structure.

Storage and Availability of Elastomeric Respirators in Health Care.

Use of reusable respirators, such as elastomeric half-face respirators (EHFRs), may serve as one solution to combating the problem of N95 respirator shortages experienced during infectious disease emergencies. To clarify whether logistical issues like respirator storage and availability are barriers to implementation of healthcare respiratory protection strategies that include EHFRs, this study aimed to evaluate the availability, storage, and respirator and filter replacement practices of EHFRs used in healthcare settings under routine use. Healthcare workers using EHFRs were surveyed about their use practices. To explore whether issues related to storage and availability of EHFRs affected compliance with assigned respirator use, responses were compared between concordant users and EHFR users who were assigned to use EHFRs but currently use different respirators ("discordant users"). Most concordant EHFR users reported that their respirator was always available when needed (63.8%). Almost two-thirds of concordant but only half of discordant users reported storing their EHFRs conveniently in the patient care area (p = <0.001). Among mobile workers, discordant users had higher odds (aOR = 3.2, 95% CI [1.4,7.5]) of reporting that their respirator was not stored in the patient care area, suggesting that storage location has a significant impact on compliance with expected practice, particularly in this group. Storage and access are barriers to optimal elastomeric respirator use in healthcare. Strategies to assure ready availability and storage of respirators will permit EHFR inclusion in pandemic and routine respiratory protection programs.

External lipid function in ethnic hairs.

OBJECTIVE: The main aim of this study is to characterize the external lipids of different ethnic hairs and to study the contribution of the exogenous lipids on their physicochemical properties. METHODS: On the extraction procedure, sebaceous lipids from the exterior of the fiber are removed. The influence of those free lipids on the hair properties, such as contact angle, mechanical characteristics, and sorption of water, will be evaluated to determine permeation characteristics of the keratin fibers. Relationship with lipid order was also determined by infrared spectroscopy (IR). RESULTS: Lipid extraction indicates the greatest amount of total lipids for African hair. Caucasian lipid extracts present the higher melting point and phase transition temperatures. This could be related to higher hydration and lower diffusion coefficient of the Caucasian fibers. A decrease in moisture was found in the lipid-extracted fibers. This diminution of the maximum water regain in all cases could be due to a higher water desorption. IR results indicate that Caucasian and moreover African native fibers present the most quantity of lipids, and the similar frequency of all fibers indicates a lamellar/orthorhombic order arrangement. CONCLUSION: The hexane/tert-butanol extraction was demonstrated to modify not only cuticular but also cortex lipids. Exogenous lipid depletion in all fibers indicates a less water content and higher water desorption. However, lipid depleted Caucasian fibers presents an increase in the lipid order which could be related to the different saturation of the lipid extract and its improvement in breaking tenacity.

Lipid loses and barrier function modifications of the brown-to-white hair transition.

BACKGROUND: The main objective of this study was to determine the lipid profile of brown and white Caucasian hair fibres and the effects of lipids on the properties of fibres. MATERIALS AND METHODS: To determine the structures of white and brown hair lipid bilayers, cross sections of fibres of both hair types were examined using synchrotron-based µ-FTIR mapping. Dynamic vapour sorption (DVS) analyses were also performed to determine the differences in the barrier function of both fibres. RESULTS: Spatial identification of lipids showed that a great amount of lipids was present in the medulla of fibres of both hair types, but important differences were also observed between cuticles of the different fibres. The cuticle of a white hair fibre showed a significant decrease in its lipid content, but did not show differences in the lateral packing order with respect to the cuticle of a brown hair fibre. The cortex and medulla of the white hair fibre also exhibited a significant decrease in its lipid content but with a higher lateral packing order than brown hair. Using DVS analysis, it was found that the water dynamics of white hair fibres differed from those of brown hair fibres, showing a decrease in their total capacity to absorb water and an increase in the velocity of the exchange of water with the environment. CONCLUSION: The results of both techniques demonstrated a high correlation between the characteristics of the lipids located in the cuticle and the water dynamics of the fibres.

User acceptance of reusable respirators in health care.

BACKGROUND: Inclusion of reusable respirators, such as elastomeric half-face respirators (EHFRs) and powered air-purifying respirators (PAPRs), in hospital respiratory protection inventories may represent 1 solution to the problem of N95 respirator shortages experienced during pandemics. User acceptance of these devices is 1 potential barrier to implementing such a strategy in respiratory protection programs. METHODS: To assess user attitudes toward various respirators, health care workers enrolled in respiratory protection programs in a medical system using EHFRs, N95s, and PAPRs and completed an online questionnaire that addressed attitudes, beliefs, and respirator preferences under different risk scenarios. Responses were compared between user groups. RESULTS: Of 1,152 participants, 53% currently used N95s, 24% used EHFRs, and 23% used PAPRs. N95 users rated their respirators more favorably compared with EHFR and PAPR users (P < .001) regarding comfort and communication, however, EHFR users rated their respirators much more highly regarding sense of protection (P < .001). For all user groups, reusable respirators were significantly more likely (odds ratios 2.3-7.7) to be preferred over N95 filtering facepiece respirators in higher risk scenarios compared to "usual circumstance" scenarios. CONCLUSIONS: Despite somewhat less favorable ratings on comfort and communication, experienced EHFR and PAPR users still prefer reusable respirators over N95s in certain higher risk scenarios. This suggests that reusable respirators are an acceptable alternative to N95 respirators in health care and offer 1 viable solution to prevent pandemic-generated respirator shortages.

High throughput quantitative volatile profiling of melons with silicone rod extraction - thermal desorption - GC-MS for plant breeding line selection.

Volatile compounds determine the aroma of fruits, giving their unique flavor characteristics. The aim of many plant breeding projects is to improve the consumers' flavor experience when eating fresh produce. Large scale breeding trials produce thousands of samples which need volatile profiling amongst other phenotypes. Despite this interest, current methods have limitations: sampling unsuitable for field conditions, high cost and the inherent issue of highly variable data, which can hinder interpretation. We introduced a simple and robust sampling methodology based on silicone rod extraction, thermal desorption gas chromatography - mass spectrometry (GC-MS) to address these issues. We used differentiated calibration standards to generate quantitative data for metabolites of varying abundance. The method was used to profile 327 melons with high sensitivity (0.05-10 ng/mL, compound dependent), good reproducibility (7%) and differentiate melon varieties based on their volatile profile. The data were then used for line selection for a desired flavor profile.

Surveillance results and bone effects in the Gulf War depleted uranium-exposed cohort.

A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored in a clinical surveillance program since 1993. During the spring of 2017, 42 members of the cohort were evaluated with a protocol which includes exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes including measures of bone metabolism, and for participants >50 years, bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained DU shrapnel fragments. Only the mean serum estradiol concentration, a marker of bone metabolism, was found to be significantly different for lower-vs- higher urine U (uU) cohort sub-groups. For the first time, a significant deficit in BMD was observed in the over age 50, high uU sub-group. After more than 25 years since first exposure to DU, an aging cohort of military veterans continues to exhibit few U-related adverse health effects in known target organs of U toxicity. The new finding of reduced BMD in older cohort members, while biologically plausible, was not suggested by other measures of bone metabolism in the full (all ages) cohort, as these were predominantly within normal limits over time. Only estradiol was recently found to display a difference as a function of uU grouping. As BMD is further impacted by aging and the U-burden from fragment absorption accrues in this cohort, a U effect may be clarified in future surveillance visits.

In vitro penetration through the skin layers of topically applied glucocorticoids.

Corticoids are actives widely used in the treatment of skin diseases. This work aims to study the penetration of 3 corticoids (betamethasone, clobetasol, and flurandrenolide), their relationship with their Log D values and the effects of the vehicles. The 3 compounds were applied on a Franz-type diffusion cell in propylene glycol solution and their respective commercial creams and ointments. The active amounts found in the stratum corneum, epidermal, and dermal layers of the skin were investigated. Their diffusions were greatly affected by the formulation; moreover higher amounts of substance in the epidermis and dermis were detected in ointments than in creams. The enhancement effect of propylene glycol was also observed. The differences between the 3 substances could be related to their lipophilicity, molecular structure, and molecular weight. The more hydrophobic compounds (clobetasol and betamethasone) are present in higher amounts in the epidermis and dermis, while the hydrophilic compound (flurandrenolide) is mostly present in the receptor fluid.

Impulse oscillometry measurement of distal airways obstruction in depleted uranium-exposed Gulf War veterans.

INTRODUCTION: A cohort of Gulf War I veterans who sustained exposure to depleted uranium undergoes biennial surveillance for potential uranium-related health effects. We performed impulse oscillometry and hypothesized that veterans with higher uranium body burdens would have more obstructive abnormalities than those with lower burdens. METHODS: We compared pulmonary function of veterans in high versus low urine uranium groups by evaluating spirometry and oscillometry values. RESULTS: Overall mean spirometry and oscillometry resistance values fell within the normal ranges. There were no significant differences between the high and low uranium groups for any parameters. However, more veterans were classified as having obstruction by oscillometry (42%) than spirometry (8%). CONCLUSIONS: While oscillometry identified more veterans as obstructed, obstruction was not uranium-related. However, the added sensitivity of this method implies a benefit in wider surveillance of exposed cohorts and holds promise in identifying abnormalities in areas of the lung historically described as silent.

Qualitative Analysis of Origins and Evolution of an Elastomeric Respirator-based Hospital Respiratory Protection Program.

Elastomeric respirators (elastomerics) may serve as one alternative to disposable N95 respirator use in healthcare. We explored factors which drove elastomeric adoption and continued use in a large academic medical center. We conducted semi-structured and focus group interviews in 2015 with a) 11 leadership key informants (KIs) with involvement in the respiratory protection program (RPP) when elastomerics were introduced and b) 11 healthcare workers (HCWs) recruited from hospital departments assigned to use elastomerics. Interview transcripts and responses were open-coded to capture emergent themes, which were collapsed into broader categories and iteratively refined. Factors identified by leadership KIs as influencing elastomeric adoption included: 1) N95 shortages during 2009's H1N1 influenza pandemic and 2) the presence of trained, certified safety professionals who were familiar with respiratory protection requirements. Factors identified as influencing ongoing use of elastomerics included: 1) cleaning/decontamination practices, 2) storage, 3) safety culture, 4) HCW respirator knowledge, and 5) risk perception. HCW users expressed dissatisfaction related to breathing, communication and cleaning of elastomerics. Other themes included convenience use of N95s rather than assigned elastomerics, despite perceptions that elastomerics are more protective. Through semi-structured and focus group interviews, we learned that 1) leadership introduced elastomerics due to necessity but now face challenges related to ongoing use, and 2) HCWs were not satisfied with elastomerics for routine care and preferentially used N95s because they were conveniently available at point of use. Although the impetus behind incorporation of elastomerics was clear, the most complex themes related to sustainability of this form of RPP. These themes were used to inform a broader questionnaire and will address the utility of elastomerics as a feasible and acceptable practical alternative to N95s in healthcare.

The U.S. Department of Veterans' Affairs depleted uranium exposed cohort at 25 Years: Longitudinal surveillance results.

BACKGROUND: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored for health changes in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. METHODS: During the spring of 2015, an in-patient clinical surveillance protocol was performed on 36 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. RESULTS: On-going mobilization of U from embedded fragments is evidenced by elevated urine U concentrations. The DU isotopic signature is observed principally in participants possessing embedded fragments. Those with only an inhalation exposure have lower urine U concentration and a natural isotopic signature. CONCLUSIONS: At 25 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As U body burden continues to accrue from in-situ mobilization from metal fragment depots, and increases with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort.

Biologic monitoring and surveillance results for the department of veterans affairs' depleted uranium cohort: Lessons learned from sustained exposure over two decades.

BACKGROUND: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly fire incidents have been monitored in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. METHODS: An in-patient clinical surveillance protocol was performed on 35 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. RESULTS: Although urine U concentrations continue to be elevated in this group, illustrating on-going in situ mobilization of U from embedded fragments, no consistent U-related health effects have been observed. CONCLUSIONS: Now more than 20 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As tissue concentrations continue to accrue with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort.

Chromosomal effects of non-alkylating drug exposure in oncology personnel.

Therapy-related leukemia has been a recognized sequela of cancer treatment for decades with "signature" abnormalities of chromosomes 5, 7, and 11 observed in treated patients. Risk to oncology personnel handling anti-cancer agents has also been documented by non-specific measures of genotoxicity in blood and urine. Using chromosomal markers applied in clinical practice, we previously demonstrated in oncology workers, a dose-related increase in abnormalities of chromosomes 5 and 7, known to be targets of alkylating agent exposure. In the analysis presented here, we extended that work to also assess damage resulting from non-alkylating drug exposure. Peripheral blood lymphocytes from oncology personnel (N = 63) and non-exposed controls (N = 46) was collected and examined using the fluorescent in situ hybridization technique with probes for targets on chromosomes 5, 7, and 11. Participants recorded drug handling events over a 6 week period. Important co-variates were considered. Examining chromosomal outcomes as a function of drug handling frequency, we employed Poisson Regression to obtain incident rate ratios (IRRs) for selected drug handling frequencies. We found a dose-related increase in the IRR for aberrations in all three chromosomes 5, 7, and 11, reaching statistical significance for chromosome 5, as a function of non-alkylating drug handling. This suggests that the targeting of chromosome 5 is not limited to alkylating agent exposure, as some recent evidence in treated patients has also shown. Thus, the pattern of insult observed in treated patients appears to extend to oncology personnel exposed in the workplace.