Air pollution mitigation assessment to inform Cambodia's first clean air plan.

Cambodia's 16.5 million people are exposed to air pollution in excess of World Health Organisation guidelines. The Royal Government of Cambodia has regulated air pollutant emissions and concentrations since 2000, but rapid economic growth and energy consumption means air pollution continues to impact human health. In December 2021, the Ministry of Environment of Cambodia published Cambodia's first Clean Air Plan that outlines actions to reduce air pollutant emissions over the next decade. This work presents the quantitative air pollution mitigation assessment underpinning the identification and evaluation of measures included in Cambodia's Clean Air Plan. Historic emissions of particulate matter (PM2.5, black carbon, organic carbon) and gaseous (nitrogen oxides, volatile organic compounds, sulphur dioxide, ammonia, and carbon monoxide) air pollutants are quantified between 2010 and 2015, and projected to 2030 for a baseline scenario. Mitigation scenarios reflecting implementation of 14 measures included in Cambodia's Clean Air Plan were modelled, to quantify the national reduction in emissions, from which the reduction in ambient PM2.5 exposure and attributable health burdens were estimated. In 2015, the residential, transport, and waste sectors contribute the largest fraction of national total air pollutant emissions. Without emission reduction measures, air pollutant emissions could increase by between 50 and 150% in 2030 compared to 2015 levels, predominantly due to increases in transport emissions. The implementation of the 14 mitigation measures could substantially reduce emissions of all air pollutants, by between 60 and 80% in 2030 compared to the baseline. This reduction in emissions was estimated to avoid approximately 900 (95% C.I.: 530-1200) premature deaths per year in 2030 compared to the baseline scenario. In addition to improving air pollution and public health, Cambodia's Clean Air Plan could also to lead to additional benefits, including a 19% reduction in carbon dioxide emissions, simultaneously contributing to Cambodia's climate change goals.

Longitudinal Changes in Health and Fitness Measures Among State Patrol Officers by Sex.

ABSTRACT: Dawes, JJ, Lopes dos Santos, M, Kornhauser, C, Holmes, RJ, Alvar, BA, Lockie, RG, and Orr, RM. Longitudinal changes in health and fitness measures among state patrol officers by sex. J Strength Cond Res 37(4): 881-886, 2023-Research suggests that police officers lose fitness as a result of their policing vocation with occupational factors like stress, shift work, poor sleep, and poor diet all contributors to this loss The purpose of this research was to measure changes in fitness test scores of qualified police officers over a 5-year period. Archived fitness data for 523 state patrol officers ( n = 494 men; 29 women) from one agency were used for this analysis. These tests included 60-second sit-up [SU] and push-up [PU] scores (muscular endurance), vertical jump height [VJ] (lower-body power), and 20-m multistage fitness test (aerobic capacity). A series of paired-samples t-tests and effect size calculations were used to investigate mean differences in fitness tests score at the beginning and end of a 5-year period. The paired-samples t test showed significant tests score decreases among male officers over the 5-year period in VJ, PU, and V̇ o2 max , , with no differences observed in SU performance. Small effect sizes were observed in both VJ ( g = -0.20) and PU ( g = -0.27) with a trivial effect size observed in changes to V̇ o2 max ( g = -0.14). In contrast, significant improvements in performance were observed in SU performance among female officers, with a small effect size ( g = 0.38). No other significant differences were found in female measures. Whether at an organizational or individual level, annual fitness assessments for police officers can serve to educate and motivate officers regarding their personal fitness and potentially slow the negative impact of aging on health, fitness, and performance in these populations.

Drivers and distribution of global ocean heat uptake over the last half century.

Since the 1970s, the ocean has absorbed almost all of the additional energy in the Earth system due to greenhouse warming. However, sparse observations limit our knowledge of where ocean heat uptake (OHU) has occurred and where this heat is stored today. Here, we equilibrate a reanalysis-forced ocean-sea ice model, using a spin-up that improves on earlier approaches, to investigate recent OHU trends basin-by-basin and associated separately with surface wind trends, thermodynamic properties (temperature, humidity and radiation) or both. Wind and thermodynamic changes each explain ~ 50% of global OHU, while Southern Ocean forcing trends can account for almost all of the global OHU. This OHU is enabled by cool sea surface temperatures and sensible heat gain when atmospheric thermodynamic properties are held fixed, while downward longwave radiation dominates when winds are fixed. These results address long-standing limitations in multidecadal ocean-sea ice model simulations to reconcile estimates of OHU, transport and storage.

Exploring associations between physical fitness tests and a law enforcement specific Physical Ability Test using principal components analysis.

The purpose of this study was to determine relationships between components of physical fitness on performance in an occupation-specific physical ability test (PAT) for state patrol officers (women, n = 19; men, n = 256) using archived data. Physical fitness was assessed by 2.4 km run time (2.4 R), body fat % (BF), 1 min sit-up (SU), 1-min push-up (PU), the vertical jump (VJ), and the sit-and-reach test (SR). Principal components analysis (PCA) of the entire sample revealed that dynamic fitness (DF), related 2.4 R, SU, PU, VJ, & BF, explained 49% of variance in performance in the PAT. Lower back and hamstring flexibility explained a further 18% of variance. Law-enforcement agencies using a standard job-specific test to screen the occupational fitness of its members may use fitness tests to make fitness recommendations. Officers should prioritize developing aerobic fitness, muscular endurance, lower-body power, and flexibility to help meet the demands of occupational performance.

The Impact of External Loads Carried by Police Officers on Vertical Jump Performance.

The purpose of this study was to examine the impact that external loads have on vertical jump height and peak anaerobic power output (PAPw) of police officers during a vertical jump (VJ) test. Retrospective data of 47 (mean age 38.79 ± 7.97 years) police officers from a US Law Enforcement Agency (LEA) were used for analysis. VJ heights and body mass were used in the Sayers Peak Power Equation to calculate PAPw. Power-to-weight (P:W) ratios were then calculated by dividing PAPw by the officer's body mass. VJ height significantly (p < .001) decreased with load (unloaded = 49.49 ± 8.46 cm: loaded = 43.62 ± 7.68 cm). A Pearson's correlation showed a significant (p < .01) low-moderate (r = .387) relationship between absolute load (9.57 ± .94 kg) and change in PAPw, and a significant (p < .01) strong (r = .794) correlation between relative load and changes in P:W. This study supports previous research that suggests that occupational load carriage has a negative impact on VJ performance in police officers and may influence job performance, and that training programs may mitigate these negative effects.

The Impact of Formal Strength and Conditioning on the Fitness of Law Enforcement Recruits: A Retrospective Cohort Study.

Research involving law enforcement populations has suggested better fitness could enhance job task performance and reduce injuries. Academy training should lead to improvements in recruit fitness. The aim of this study was to investigate the impact of a strength and conditioning program on fitness among law enforcement recruits. Twenty-six recruits (23 males, three females) completed a 27-week academy, which incorporated 3-4 physical training sessions per week. Fitness assessment occurred during pre- (week 0), mid- (week 14), and post-testing (week 27) time points. The fitness assessments included: vertical jump, one-minute push-ups, one-minute sit-ups, posterior chain strength measured by a leg/back dynamometer, grip strength, and aerobic fitness measured by the 20-m multistage shuttle run (MSR). A repeated measures ANOVA with Bonferroni post hoc tests determined any significant changes in fitness between time points, with alpha set at p < .05. Due to the small sample size of females, statistical analysis was only conducted on male recruits. Overall, significant main effects (p < .001) were observed in all fitness assessments except for grip strength. The results detailed general improvements in fitness. However, push-up and MSR scores decreased from mid- to post-test, while sit-ups did not change. Posterior chain strength and the vertical jump improved from mid-to post-test. The data indicated that the strength and conditioning program positively influenced the fitness of recruits. An increased focus on skill-specific work in the second-half of academy may have contributed to the plateaus in muscular endurance and aerobic fitness, and improvement of lower-body strength and power.

Comparing levels of fitness of police Officers between two United States law enforcement agencies.

BACKGROUND: The general physical task demands of law enforcement may suggest that police Officers are of similar fitness levels across cities, states and countries. OBJECTIVE: To investigate whether fitness levels of police Officers from two different United States (U.S.) Law Enforcement Agencies (LEA) are similar. METHODS: Retrospective data were analysed from two LEAs (LEA1 n = 79 and LEA2 n = 319). The data for Officers included: age, mass, 1-minute push-up repetitions, 1-minute sit-up repetitions, vertical jump height, 2.4 km run time (LEA 1) and 20-meter Multi-Stage Fitness Test results (LEA 2). Independent samples t-tests were used to compare anthropometric and fitness data between LEA with significance set at 0.05. RESULTS: Officers from LEA1 weighed significantly less and performed significantly better than Officers from LEA2 on all fitness measures. When comparing male Officers alone, there was no statistical difference in age and mass; nonetheless, Officers from LEA1 significantly outperformed Officers from LEA2 on all fitness measures. CONCLUSION: While similarities / differences in job tasks performed between these two LEA are not known, the results from this study suggest differences in fitness between these two different U.S. LEA. Fitness standards and training protocols need to be developed and contextualized to each LEA's specific population and needs.

Cross-Sectional and Retrospective Cohort Analysis of the Effects of Age on Flexibility, Strength Endurance, Lower-Body Power, and Aerobic Fitness in Law Enforcement Officers.

Lockie, RG, Dawes, JJ, Kornhauser, CL, and Holmes, RJ. Cross-sectional and retrospective cohort analysis of the effects of age on flexibility, strength endurance, lower-body power, and aerobic fitness in law enforcement officers. J Strength Cond Res 33(2): 451-458, 2019-There can be a great age range in cohorts of law enforcement officers. As the tasks required of officers generally do not change with advancing age, it is important to understand how physical performance in tests that assess job-specific characteristics may be altered. Retrospective analysis of performance test data of 383 officers (362 men and 21 women) was conducted. The tests included the following: sit-and-reach to determine hamstring and lower back flexibility; maximal push-up and sit-up repetitions in 60 seconds to measure muscle endurance; vertical jump (VJ) to assess lower-body power; and 2.4-km run to ascertain aerobic capacity. Data were stratified by age into 20-29, 30-39, 40-49, and 50-59 year groups, and analyzed by sex. A 1-way analysis of variance with the Bonferroni post hoc test was used to calculate the differences between the groups. Considering the male subjects, the 40-49 and 50-59 year groups performed poorer in the VJ, sit-up test, and 2.4-km run compared with the 20-29 year group (p ≤ 0.001-0.045). For the female subjects, the 20-29 year group was superior to the 30-39 (p = 0.013) and 40-49 (p = 0.025) year groups in the push-up test. To ensure that an older officer can successfully complete occupation-specific tasks, lower-body power, abdominal strength, and aerobic training should be completed. Female officers should also attempt to maintain relative upper-body strength. Practitioners must attempt to design training programs that fit within the context of the occupational demands, and potentially using a nontraditional training design as law enforcement officers may not have the time to follow a traditional periodization model.

Biomarkers and anastomotic leakage in colorectal surgery: C-reactive protein trajectory is the gold standard.

BACKGROUND: Anastomotic leakage is a feared complication following colorectal surgery. Early prediction results in improved clinical outcome, but accurate predictive factors remain elusive. Many biomarkers have been studied with respect to diagnosis of anastomotic leakage but the concept of trajectory testing, using biomarkers, has not been assessed with regards to early diagnosis of anastomotic leak. METHODS: C-reactive protein (CRP), procalcitonin (PCT), white cell count (WCC) and gamma-glutamyl transferase were assessed for predictive utility in diagnosing anastomotic leakage with emphasis on identifying an association with change in their levels or trajectory. Levels were collected preoperatively and daily for the first 5 post-operative days on patients undergoing elective colorectal surgery, involving an anastomosis. Anastomotic leakage was defined clinically by operative or radiological intervention. Comparison was made between biomarkers and clinical anastomotic leakage, using receiver operator characteristic curves for logistic models, based on trajectory of the four biomarkers. RESULTS: A total of 197 consecutive patients were analysed. Eleven patients developed clinical anastomotic leakage. An association of biomarker trajectory with anastomotic leakage was observed for WCC, PCT and CRP, but not for gamma-glutamyl transferase. CRP was the superior biomarker based on trajectory, with area under the receiver operator curve of 0.961. CONCLUSION: This study identifies change in CRP, WCC and PCT as potential markers of anastomotic leakage following colorectal surgery and in particular highlights CRP trajectory as extremely accurate in diagnosing anastomotic leakage requiring intervention. External validation should be sought before incorporating this into routine clinical practice, given the numbers in this study.

Randomized clinical trial to assess the ideal mode of delivery for local anaesthetic abdominal wall blocks.

BACKGROUND: Adequate post-operative analgesia is essential for recovery following abdominal surgery. Abdominal wall nerve blocks have been shown to be beneficial in this respect following surgery. The purpose of this trial was to examine the efficacy of infusional versus intermittent bolus delivery of abdominal wall blocks in patients undergoing abdominal resectional gastrointestinal surgery. METHODS: A prospective randomized clinical trial, involving 120 patients undergoing gastrointestinal surgery, was undertaken across three hospitals. Insertion of abdominal wall catheters was performed and patients were randomized to receive ropivacaine 0.2% by either continuous infusion or regular intermittent bolus. The primary outcome was respiratory function, as measured by spirometry on post-operative days 1-3 and 30. Secondary outcomes were pain, mobility, return of gut function, length of hospital stay, complication rates and patient satisfaction with analgesia. RESULTS: All 120 patients were followed up to trial completion. Patients were well matched with regards to demographics. There was no difference between groups with regards to the primary outcome of post-operative respiratory function. The bolus group had improved mobility scores on post-operative day 1 (P = 0.025). There were no complications associated with blockade, and no other differences were identified between assessed outcomes. CONCLUSIONS: Continuous infusion and intermittent bolus are both safe ways of delivering abdominal wall nerve blockade, with equivalent analgesic outcomes. Bolus delivery appears to provide superior early mobility in comparison with continuous infusion.

A physical fitness profile of state highway patrol officers by gender and age.

BACKGROUND: Law enforcement officers perform physically demanding tasks that generally remain constant as they age. However, there is limited population-specific research on age, gender and normative fitness values for law enforcement officers as opposed to those of the general population. The purpose of this study was to profile the current level of fitness for highway patrol officers based on age and gender and provide percentile ranking charts unique to this population. METHODS: Retrospective data for six-hundred and thirty-one state troopers (♂ = 597; mean age = 39.52 ± 8.09 yrs; mean height = 180.72 ± 7.06 cm; mean weight = 93.66 ± 15.72 kg: ♀ = 34; mean age = 36.20 ± 8.45 years; mean height = 169.62 ± 6.65 cm; mean weight = 74.02 ± 14.91 kg) collected in 2014-2015 were provided for analysis. Data included demographic (age), anthropometric (height and weight), and select fitness (VJ, push-ups, sit ups, isometric leg/back strength, isometric grip strength and 20 m shuttle run test) information. RESULTS: There were generally significant differences between genders for all anthropometric and fitness measures, most consistently in the 30-39 age groups. While there was a general decline in push-up and shuttle run performance in female officers, these results did not reach significance. For male officers, there were significant differences between the 20-29 year-old age group and the 30-39, 40-49 and 50-59 year-old groups with the younger group performing better in VJ, push-ups, sit ups and number of shuttle runs than the older groups. There were no differences in isometric grip strength and leg back dynamometer measures between age groups. CONCLUSION: Male officers tended to be heavier, taller and perform significantly better than female officers in all measures bar sit-ups. While there appeared to be a general decline in certain physical characteristics across genders with increasing age the notable differences were between the youngest male age group (20-29 years) and all other male age groups with a potential reason being the lack of fitness requirements once typically younger cadets leave the academy. Percentile rankings for the assessed measures were found to have elements very specific to this population when compared to the general population and those provided in this paper can be used to inform future profiling and research in this population.

Physical Fitness Characteristics of High vs. Low Performers on an Occupationally Specific Physical Agility Test for Patrol Officers.

Law enforcement agencies frequently use physical ability tests (PATs) as a method of evaluating occupational performance. These tests are designed to replicate essential occupational tasks frequently performed by officers in the field. The purpose of this study was to determine whether significant relationships exist between the selected physical fitness tests and PAT performance and to determine which of these tests best differentiates between high and low PAT performers. Full-time highway patrol officers (n = 495) submitted self-reported anthropometric data (mean age = 39.6 + 7.7 years) along with fitness assessments taken from their organization's yearly fitness tests. All subjects completed a series of field-based fitness tests, as well as an occupationally specific PAT. Results of the study indicated that the selected tests accounted for almost 69% of the total variance on PAT performance. Overall, the 20-m meter multistage fitness test, 1-minute sit-up performance, and vertical jump height best predicted PAT performance. Furthermore, it was revealed that high performers were significantly more fit in all measures of dynamic fitness when compared with lower performers. No significant differences were discovered in static strength between groups. Strength and conditioning specialists should focus on developing aerobic capacity, trunk muscular endurance, and whole-body anaerobic power to improve PAT and occupational performance.

Heavy metal removal capacity of individual components of permeable reactive concrete.

Permeable reactive barriers (PRBs) are a well-known technique for groundwater remediation using industrialized reactive media such as zero-valent iron and activated carbon. Permeable reactive concrete (PRC) is an alternative reactive medium composed of relatively inexpensive materials such as cement and aggregate. A variety of multimodal, simultaneous processes drive remediation of metals from contaminated groundwater within PRC systems due to the complex heterogeneous matrix formed during cement hydration. This research investigated the influence coarse aggregate, portland cement, fly ash, and various combinations had on the removal of lead, cadmium, and zinc in solution. Absorption, adsorption, precipitation, co-precipitation, and internal diffusion of the metals are common mechanisms of removal in the hydrated cement matrix and independent of the aggregate. Local aggregates can be used as the permeable structure also possessing high metal removal capabilities, however calcareous sources of aggregate are preferred due to improved removal with low leachability. Individual adsorption isotherms were linear or curvilinear up, indicating a preferred removal process. For PRC samples, metal saturation was not reached over the range of concentrations tested. Results were then used to compare removal against activated carbon and aggregate-based PRBs by estimating material costs for the remediation of an example heavy metal contaminated Superfund site located in the Midwestern United States, Joplin, Missouri.

Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial.

INTRODUCTION: Adequate postoperative analgesia is essential for recovery following colorectal surgery. Transversus abdominis plane (TAP) blocks have been found to be beneficial in improving pain following a variety of abdominal operations. The objective of this study was to determine if TAP blocks are useful in improving postoperative recovery following laparoscopic colorectal surgery. MATERIALS AND METHODS: A prospective double-blind randomized clinical trial, involving 226 consecutive patients having laparoscopic colorectal surgery, was performed by a university colorectal surgical department. Patients were randomized to either TAP blockade using ultrasound guidance, or control, with the primary outcome being postoperative pain, as measured by analgesic consumption. Secondary outcomes assessed were pain visual analogue score (VAS), respiratory function, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction. RESULTS: A total of 142 patients were followed up to trial completion (74 controls, 68 interventions). Patients were well matched with regard to demographics. No complications occurred as a result of the intervention of TAP blockade. There was no difference between groups with regards to analgesic consumption (161 mEq morphine control vs 175 mEq morphine TAP; p = 0.596). There was no difference between the two groups with regards to the secondary outcomes of daily VAS, respiratory outcome, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction. CONCLUSION: We conclude that TAP blockade appears to be a safe intervention but confers no specific advantage following laparoscopic colorectal surgery.

Handling cases of 'medical futility'.

Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks down between those involved or reaches an impasse. This paper presents a set of practical strategies for dealing with cases of perceived medical futility at a major cancer center.