Low-dose daylight exposure induces nitric oxide release and maintains cell viability in vitro.

Any potential positive effects conferred via sunlight exposure have to be carefully balanced against carcinogenic effects. Here we provide evidence UK sunlight exposure upregulates the cardio protectant nitric oxide (NO) within in vitro skin cell lines with negligible increases in DNA damage and cell death at 1 SED, when compared against unexposed samples. The whole of the ultraviolet A (UV-A) spectrum appears to be responsible for NO release, with efficiency higher at exposures closer to shorter UV-A wavelengths and decreasing with wavelength increases. These results support further in vivo work, which could be of benefit for demographics such as the elderly (that exhibit a natural decline in NO bioavailability).

Post-exposure persistence of nitric oxide upregulation in skin cells irradiated by UV-A.

Evidence suggests that exposure to UV-A radiation can liberate nitric oxide from skin cells eliciting vasodilation in-vivo. However, the duration of nitric oxide release in skin cells after UV exposure is not well studied, with emphasis on UV-B mediated iNOS upregulation. The current study demonstrated persistence of nitric oxide release in a dark reaction after moderate UV-A exposure, peaking around 48 h post exposure; this effect was shown in keratinocytes, fibroblasts and endothelial cells from neonatal donors and keratinocytes from aged donors and confirmed the hypothesis that UV-A exposure appeared to upregulate cNOS alongside iNOS. Release of nitric oxide in the skin cells induced by a moderate exposure to UV-A in sunlight may be especially beneficial for some demographic groups such as the elderly, hypertensive patients or those with impaired nitric oxide function, not only during exposure but many hours and days after that.

Assessment of the Light Exposures of Shift-working Nurses in London and Dortmund in Relation to Recommendations for Sleep and Circadian Health.

Shift work causes disruption to circadian physiological processes in the human body, and desynchronization from the natural day-and-night rhythm. Circadian disruption is thought to explain the associations between shift work and various long-term diseases; light is an unrivalled synchronizer (or Zeitgeber) of circadian processes and inappropriate light exposure plausibly plays a critical role in the development of health impairments. As published measurement data on the actual light environments encountered by shift workers are sparse, nurses working in two hospitals in London (UK) and Dortmund (Germany) wore light-logging dosimetry devices to measure personal light exposures continuously over a week in three different seasons. The study identifies and quantifies several of the characteristics of light exposure related to different working patterns in winter, spring, and summer, and quantifies interindividual variations. These data enable informed design of light exposure interventions or changes to shifts to reduce unwanted effects of disruptive light exposure profiles.

Impact of COVID-19 Lockdown on Sun Exposure of UK Office Workers.

The impact of lockdown due to the COVID-19 pandemic in April-June 2020 on UV exposure of office workers was assessed using an online survey on time spent outdoors and environmental data for different locations in the UK. Without the need for commuting and with the flexibility of homeworking, weekday time spent outdoors was higher in the 2020 lockdown than in the same period in 2017. The weekday erythema effective radiant exposure was higher in 2020 due to an additional 45 min outdoors in the late afternoon that was not observed in 2017 and high UV levels due to extremely sunny weather in spring. The lockdown did not impact the frequency of time spent outdoors around midday, which was still governed by work commitments, and at the weekends, no difference between 2020 and 2017 was observed. In 2020, responders felt that time outdoors was very important for their health and well-being.

Global verification of a model for determining daylight photodynamic therapy dose.

Daylight photodynamic therapy is an effective treatment for actinic keratoses and relies on a minimum PpIX-effective light exposure dose being delivered during treatment. As such, daylight dosimetry is an important aspect of this treatment. Relatively simple measurements of illuminance may be converted to PpIX-effective irradiance, and subsequently exposure dose, via a conversion model (the O'Mahoney model). This model has been verified against spectral irradiance data from the UK, however the accuracy of the model has not been determined outside the UK. In this work, we test the O'Mahoney model against spectral irradiance measurements from several global locations to within bounds of a median deviation of ±10 %. The median percentage deviations are shown to be independent of location latitude and longitude. The model can be used confidently to determine PpIX-effective irradiance from illuminance measurements irrespective of location and can be widely implemented as an effective and low-cost means of accurately measuring effective light exposure for this important treatment.

Survey of Home-Use UV Disinfection Products†.

The COVID-19 pandemic provided a commercial opportunity for traders marketing a range of ultraviolet (UV) radiation products for home-use disinfection. Due to concerns about the efficacy of such products and the potential for harmful levels of UV exposure to people, a range of products were purchased from on-line trading platforms. Spectral irradiance measurements were carried out to determine whether the products could be effective against the SARS-CoV-2 virus and whether they were likely to exceed internationally agreed exposure limits. It was concluded that many of the devices were not effective and many of those that were potentially effective presented a risk to users.

Impact of High Solar UV Radiant Exposures in Spring 2020 on SARS-CoV-2 Viral Inactivation in the UK†.

Potential for SARS-CoV-2 viral inactivation by solar UV radiation in outdoor spaces in the UK has been assessed. Average erythema effective and UV-A daily radiant exposures per month were higher (statistically significant, P < 0.05) in spring 2020 in comparison with spring 2015-2019 across most of the UK, while irradiance generally appeared to be in the normal expected range of 2015-2019. It was found that these higher radiant exposures may have increased the potential for SARS-CoV-2 viral inactivation outdoors in April and May 2020. Assessment of the 6-year period 2015-2020 in the UK found that for 50-60% of the year, that is most of October to March, solar UV is unlikely to have a significant (at least 90% inactivation) impact on viral inactivation outdoors. Minimum times to reach 90% and 99% inactivation in the UK are of the order of tens of minutes and of the order of hours, respectively. However, these times are best case scenarios and should be treated with caution.

SmartPDT®: Smartphone enabled real-time dosimetry via satellite observation for daylight photodynamic therapy.

BACKGROUND: Actinic keratosis (AK) affects one quarter of over 60  year olds in Europe with the risk of transforming into invasive squamous cell carcinoma. Daylight photodynamic therapy (dPDT) is an effective and patient preferred treatment that uses sunlight to clear AK. Currently, there is no standardised method for measuring the light received during treatment. METHODS: SmartPDT® is a smartphone-based application and web-portal, developed by siHealth Ltd, enabling remote delivery of dPDT. It uses satellite imagery and computational algorithms to provide real-time determination of exposure to PpIX-effective solar radiation ("light dose"). The application also provides forecast of expected radiant exposures for 24- and 48-hs prior to the treatment period. Validation of the real-time and forecasted radiant exposure algorithms was performed against direct ground-based measurement under all weather conditions in Chilton, UK. RESULTS: Agreement between direct ground measurements and satellite-determined radiant exposure for 2-h treatment was excellent at -0.1 % ± 5.1 % (mean ±â€¯standard deviation). There was also excellent agreement between weather forecasted radiant exposure and ground measurement, 1.8 % ± 17.7 % at 24-hs and 1.6 % ± 25.2 % at 48-hs. Relative Root Mean Square of the Error (RMSEr) demonstrated that agreement improved as time to treatment reduced (RMSEr = 22.5 % (48 -hs), 11.2 % (24-hs), 5.2 % (real-time)). CONCLUSION: Agreement between satellite-determined, weather-forecasted and ground-measured radiant exposure was better than any existing published literature for dPDT. The SmartPDT® application and web-portal has excellent potential to assist with remote delivery of dPDT, an important factor in reducing risk in an elderly patient population during the Covid-19 pandemic.

In-Flight UV-A Exposure of Commercial Airline Pilots.

INTRODUCTION: Understanding UV exposure is essential for the assessment of its contribution to the occupational risk of pilots developing ocular and skin pathologies. The objective of this observational study was to measure the UV exposure of pilots flying between the United Kingdom and a range of destinations at three different seasons.METHODS: The in-flight UV exposure of pilots was measured on 322 Monarch Airlines short-haul flights on the Airbus A321-231 and Airbus A320-214 to 31 destinations, mostly in Europe, from 4 UK airports in September 2016-August 2017. The erythema effective and UV-A doses were compared with the ICNIRP guidance and typical recreational weekend exposure of UK office workers.RESULTS: The erythema effective radiant doses did not exceed 0.1 SED. For most of the flights, the UV-A exposure was also low. On 27 single sector flights, UV-A exposure could have exceeded the ICNIRP guidance if eye protection was not used.DISCUSSION: The UV exposure in a cockpit is mostly governed by the presence of direct sunlight and the duration of a flight. The average monthly exposures were low and significantly below weekend recreational exposures of UK office workers over a similar period. To assess the contribution of occupational UV exposure to the risk of developing sun-related ocular and cutaneous pathologies, it is important to consider the accumulative flight time, destinations, and UV attenuation of aircraft windshields. Additionally, leisure and recreational outdoor time needs to be considered before meaningful overall risk analysis can be undertaken.Baczynska KA, Brown S, Chorley AC, O'Hagan JB, Khazova M, Lyachev A, Wittlich M. In-flight UV-A exposure of commercial airline pilots. Aerosp Med Hum Perform. 2020; 91(6):501-510.

Measuring Daylight: A Review of Dosimetry in Daylight Photodynamic Therapy.

Successful daylight photodynamic therapy (DPDT) relies on the interaction of light, photosensitisers and oxygen. Therefore, the 'dose' of light that a patient receives during treatment is a clinically relevant quantity, with a minimum dose for effective treatment recommended in the literature. However, there are many different light measurement methods used in the published literature, which may lead to confusion surrounding reliable and traceable dose measurement in DPDT, and what the most appropriate method of light measurement in DPDT might be. Furthermore, for the majority of practitioners who do not carry out any formal dosimetry and for the patients receiving DPDT, building confidence in the evidence supporting this important treatment option is of key importance. This review seeks to clarify the methodology of DPDT and discusses the literature relating to DPDT dosimetry.

Method for Measurements of Terrestrial Ultraviolet Radiation on Inclined Surfaces in Personal Dosimetry Field Studies.

Understanding personal ultraviolet radiation (UVR) exposure is essential for the evaluation of the health risks and benefits; however, personal dosimetry could be challenging in large-scale or/and long-term population studies. Alternatively, personal exposure could be simulated using three-dimensional models and lifestyle surveys together with data on a body position with respect to the sun. These models require a real-time input on local environmental UVR. The main challenge in using this method is retrieval of the diffuse irradiance as it requires an often-expensive tracking of solar position. In this study, a hypothesis that UVR measured on a vertical plane in the north direction can be used in the UK as a proxy for diffuse radiation was tested against direct measurements and compared with models based on solar tracker data in Chilton, UK, (51.57°N) in June-July 2018. The statistical analysis over 17 days under all weather conditions showed that for 45° and 90° tilted surfaces the proposed method performed as well as the best of the models based on solar tracker data. A proposed system could offer a portable and low-cost alternative to measurements of diffuse radiation by solar tracking radiometers for spatial distribution of terrestrial erythema effective UVR in population field studies.

Ultraviolet radiation exposure during daylight Photodynamic Therapy.

BACKGROUND: Daylight photodynamic therapy (dPDT) is an effective treatment for field-change actinic keratoses (AK), with similar efficacy to conventional PDT but lower patient pain scores. Whilst AK occur consequent to chronic solar ultraviolet (UV) exposure, paradoxically solar visible radiation is used during PDT. OBJECTIVES: To investigate the nature and levels of UV exposure, both erythemal UV and UVA, occurring during dPDT. METHODS: Four years of solar erythemally effective UV (UVE) irradiance, UVA irradiance and illuminance data were obtained from Pubic Health England for 12 locations. For a standard 2 h treatment period, the data were converted into standard erythemal doses (SEDs), UVA dose and protoporphyrin-IX (PpIX)-weighted dose from UVE irradiance, UVA irradiance and illuminance respectively. These three parameters were compared ascertaining the UV exposure received during dPDT. RESULTS: Analysis of UV exposure during dPDT showed a UK maximum average UVE exposure of 8.2 SED at Camborne (PpIX dose 23.4 J cm-2). Treatment earlier in the day reduces average UV exposure (Camborne 5.2 SED, PpIX dose 18.2 J cm-2), whilst PpIX dose achieves threshold during winter months (Camborne, November, 0.8 SED, PpIX dose 7.1 J cm-2). Cyprus and Gibraltar (with high UV exposure during dPDT) experience a maximum of 14.3 SED and 12.9 SED, with respective PpIX doses of 36.1 J cm-2 and 35.1 J cm-2, in June. UVA exposure is also presented for comparison. CONCLUSION: Therapeutically effective dPDT doses can be achieved at times of the day and year when UV exposure is minimal.

Optical performance characterization of light-logging actigraphy dosimeters.

There are several wearable products specially developed or marketed for studying sleep, circadian rhythms, and light levels. However, new recommendations relating to human physiological responses to light have changed what measurements researchers may demand. The performances of 11 light-logging dosimeters from eight manufacturers were compared. The directional and spectral sensitivities, linearity, dynamic range, and resolution were tested for seven models, and compared along with other published data. The sample mainly comprised light-logging actigraphy dosimeters wearable as badges, in accordance with measurement protocols for larger-scale field studies. A proposed standard for optical performance assessments is set out.

Sunglass Filter Transmission and Its Operational Effect in Solar Protection for Civilian Pilots.

INTRODUCTION: The ocular effects of excess solar radiation exposure are well documented. Recent evidence suggests that ocular ultraviolet radiation (UVR) exposure to professional pilots may fall outside international guideline limits unless eye protection is used. Nonprescription sunglasses should be manufactured to meet either international or national standards. The mean increase in UVR and blue light hazards at altitude has been quantified and the aim of this research was to assess the effectiveness of typical pilot sunglasses in reducing UVR and blue light hazard exposure in flight. METHOD: A series of sunglass filter transmittance measurements were taken from personal sunglasses (N = 20) used by pilots together with a series of new sunglasses (N = 18). RESULTS: All nonprescription sunglasses measured conformed to international standards for UVR transmittance and offered sufficient UVR protection for pilots. There was no difference between right and left lenses or between new and used sunglasses. All sunglasses offered sufficient attenuation to counter the mean increase in blue light exposure that pilots experience at altitude, although used sunglasses with scratched lenses were marginally less effective. One pair of prescription sunglasses offered insufficient UVR attenuation for some flights, but would have met requirements of international and national standards for UV-A transmittance. This was likely due to insufficient UVR blocking properties of the lens material. CONCLUSIONS: Lenses manufactured to minimally comply with standards for UVR transmittance could result in excess UVR exposure to a pilot based on in-flight irradiance data; an additional requirement of less than 10% transmittance at 380 nm is recommended.

Occupational Ocular UV Exposure in Civilian Aircrew.

INTRODUCTION: Ultraviolet radiation (UVR) increases with altitude; however, there are a number of other factors which may influence ocular exposure during flight. The aim of this study was to assess ocular UVR exposure of pilots in airline and off-shore helicopter operations on different aircraft types and to compare with exposure in a typical office environment. METHOD: In-flight data were captured on equipment including a CCD array spectroradiometer on five return sector European airline flights and one transatlantic flight from London Gatwick in addition to four helicopter flights from Aberdeen Dyce airport. Further data were collected in an office environment from three workstations during summer and winter months. RESULTS: A wide variation in ocular UVA dose was found during flights. The main factor influencing exposure was the UVR transmission of the windshield, which fell into two distinct profile types. In an aircraft with good UVA blocking properties, ocular exposure was found to be equivalent to office exposure and did not exceed international guideline limits regardless of external conditions or flight time. Most aircraft assessed had poor UVA blocking windshields which resulted in an ocular exposure to the unprotected eye in excess of international guideline limits (up to between 4.5 to 6.5 times greater during one flight). No significant UVB dose was found. DISCUSSION: Pilots should be warned of the potential high UVA exposure during flight and advised on the use of sunglasses. A windshield labeling system would allow the pilot to tailor their eye protection practices to that particular aircraft.

DYNAMIC RESPONSE OF CCD ARRAY SPECTRORADIOMETERS.

A number of factors affect the measurements by charge coupled (CCD) array spectroradiometers, including stray light, dynamic response and ambient temperature. The departure from linearity was assessed for four CCD array spectroradiometers and linearity correction calculated with standard uncertainties error estimates. A fixed irradiance source supplemented with neutral density filters was used to allow tests to cover a full range of operational conditions. The dependence of the dynamic response on well depth and integration time was investigated. One spectroradiometer exhibited an accumulated departure from linearity of ∼20 % near the top of the well; for others the departure from linearity was less pronounced.

International Intercomparison of Solar UVR Spectral Measurement Systems in Melbourne in 2013.

Monitoring ambient solar UVR levels provides information on how much there is in both real time and historically. Quality assurance of ambient measurements of solar UVR is critical to ensuring accuracy and stability and this can be achieved by regular intercomparisons of spectral measurement systems with those of other organizations. In October and November of 2013 a solar UVR spectroradiometer from Public Health England (PHE) was brought to Melbourne for a campaign of intercomparisons with a new Bentham spectrometer of Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) and one at the Australian Bureau of Meteorology (BOM), supported by New Zealand's National Institute for Water and Atmosphere (NIWA). Given all three spectroradiometers have calibrations that are traceable to various national standards, the intercomparison provides a chance to determine measurement uncertainties and traceability that support UV measurement networks in Australia, New Zealand and the UK. UV Index measurements from all three systems were compared and ratios determined for clear sky conditions when the scans from each instrument were within 2 min of each other. While wavelengths below 305 nm showed substantial differences between the PHE unit and the two other systems, overall the intercomparison results were encouraging, with mean differences in measured UV Index between the BOM/NIWA and those of PHE and ARPANSA of <0.1% and 7.5%, respectively.

Survey of UV Emissions from Sunbeds in the UK.

Increased use of indoor tanning for cosmetic purposes has led to concerns for its impact on the risk of cutaneous cancers. The effects on UVR on skin depend on radiant dose, i.e. combination of irradiance and exposure duration. While a number of studies surveyed accessible emission from sunbeds, majority did not include the information on doses received during tanning sessions. Spectral irradiance of 195 sunbeds in five areas of the United Kingdom was measured in order to assess the radiant doses for comparison with the SED. Erythema weighted irradiance of more than 85% of all tested solaria exceeded 0.3 W m(-2) , consistent with the findings of other studies. However, evaluation of radiant doses showed no evidence of increasing exposure per session in the United Kingdom in the last decade despite the increasing sunbed emission levels. Use of sunbeds for cosmetic purposes should be discouraged, with effective enforcement of the ban on under-18 use, strict control on tanning duration and promotion of information on health risks of sunbed use. Such an integrated approach on safe equipment, safe use, and information should reduce the risk of detrimental impact of sunbed use on public health.