Projecting the economic burden of health impacts of aircraft noise: a case study of Baltimore Washington International Thurgood Marshall Airport.

BACKGROUND: While the Next Generation Air Transportation System (NextGen) in the United States optimizes flight patterns, it has led to the unintended consequence of increasing aircraft noise exposure in some communities near airports. Despite the evidence that chronic exposure to high noise levels produces detrimental health effects, potential adverse health consequences due to increased noise in the affected communities have not been adequately considered in aviation policy discussions. OBJECTIVE: We assessed the long-term health and associated economic burden of increased aircraft noise caused by NextGen near the Baltimore-Washington Thurgood Marshall International (BWI) airport in Maryland. METHODS: A probabilistic Markov model projected the incremental health and associated economic burden over 30, 20, and 10 years, comparing post-NextGen noise exposure levels to pre-NextGen levels. Health outcomes included cardiovascular disease (CVD), anxiety disorders, noise annoyance, and low birth weight (LBW). Noise exposure was categorized into four levels (<55 dB DNL, 55-60 dB DNL, 60-65 dB DNL, >65 dB DNL). A Monte Carlo simulation with 2000 iterations was run to obtain incremental burden estimates and uncertainty intervals. One-way sensitivity analyses for noise effect parameters were conducted. RESULTS: Increased aircraft noise exposure was estimated to produce (discounted) incremental mortality costs of $362 million, morbidity costs of $336 million, and losses of 15,326 Quality-Adjusted Life Years (QALYs) over the next 30 years. Sensitivity analyses revealed the greatest uncertainty for CVD outcomes. IMPACT: NextGen is a system that can increase the operational efficiency of airports by optimizing flight patterns. While operational efficiency is beneficial in many ways, changes in flight patterns and volume can also produce noise pollution, a major public health concern that should be considered in policy decision-making. This study quantifies the long-term health and economic implications of increased aircraft noise exposure following the implementation of NextGen in communities near the Baltimore-Washington International Airport. Our findings underscore the importance of considering public health consequences of noise pollution.

Enhancing heat transfer at low temperatures by laser functionalization of the inner surface of metal pipes.

The latent heat transfer during vapour condensation in the condenser section of passive heat transport devices such as the two-phase closed thermosiphon is limited by film condensation. Dropwise condensation provides an increase of the heat transfer coefficient by up to one order of magnitude and can be achieved with a water-repellant surface. The inner surface of pipes made from stainless steel was functionalized by laser surface texturing with ultrashort laser pulses and subsequent storage in a liquid containing long-chained hydrocarbons. The pipes were separated into half-pipes by wire eroding to enable laser texturing of the inner surface, and were then joined by electron beam welding after laser texturing. As a result, superhydrophobic and water-repellent surfaces with a contact angle of 153° were obtained on the inner surface of the pipes with a length of up to 1 m. The functionalized pipes were used in the condenser section of a two-phase closed thermosiphon to demonstrate a heat transfer rate of 0.92 kW at 45 °C, which is approximately three times the heat transfer rate of 0.31 kW of a smooth reference pipe.

The influence of pre-operative Computed Tomography (CT) on surgical approach and fixation for fractures of the tibial plateau.

Background: It is well known that a computed tomography (CT) scan improves the classification of tibial plateau fractures (TPF) compared with radiographs. However, it is less clear how this translates into clinical practice. The aim of this study is to establish to what extent a pre-operative CT scan alters the approach, setup and fixation choice in TPF compared to radiographs. Methods: 50 consecutive TPF with a preoperative CT and radiographic imaging available, were assessed by 4 consultant surgeons. First, anonymised radiographs were classifying according to the column classification and the planned setup, approach, and fixation technique documented. At a 1-month interval, randomised matched CT scans were assessed and the same data collected. A tibial plateau disruption score (TPDS) was derived for all 4 quadrants (no injury = 0, split = 1, split/depression = 2 and depression = 3). Radiograph and CT TPDS were assessed using an unpaired T-test. Results: 26 female and 24 male patients, mean age 50.3, were included. Mean TPDS on radiographs and CT scans were 2.77 and 3.17 respectively. A significantly higher CT TPDS, of 0.4 (95%CI 0.10-0.71)[P = 0.0093] was observed, demonstrating that radiographs underestimate the extent of injury. The surgical approach changed in 28.5% of cases, thus influencing a change in the patient setup in theatre in 27% of cases. Identification of fractures within a column changed in 34% of cases. A high intra-observer reliability was observed when surgeons were asked to repeat their assessment in a third round at a further one month interval. Conclusion: A pre-operative CT scan has a significant effect on the approach required to fix TPF. This therefore influences the setup of the patient and can justifiably be requested as part of pre-operative planning.

Interlaboratory Study to Evaluate a Testing Protocol for the Safety of Food Packaging Coatings.

According to European regulations, migration from food packaging must be safe. However, currently, there is no consensus on how to evaluate its safety, especially for non-intentionally added substances (NIAS). The intensive and laborious approach, involving identification and then quantification of all migrating substances followed by a toxicological evaluation, is not practical or feasible. In alignment with the International Life Sciences Institute (ILSI) and the European Union (EU) guidelines on packaging materials, efforts are focused on combining data from analytics, bioassays and in silico toxicology approaches for the risk assessment of packaging materials. Advancement of non-targeted screening approaches using both analytical methods and in vitro bioassays is key. A protocol was developed for the chemical and biological screening of migrants from coated metal packaging materials. This protocol includes guidance on sample preparation, migrant simulation, chemical analysis using liquid chromatography (LC-MS) and validated bioassays covering endocrine activity, genotoxicity and metabolism-related targets. An inter-laboratory study was set-up to evaluate the consistency in biological activity and analytical results generated between three independent laboratories applying the developed protocol and guidance. Coated packaging metal panels were used in this case study. In general, the inter-laboratory chemical analysis and bioassay results displayed acceptable consistency between laboratories, but technical differences led to different data interpretations (e.g., cytotoxicity, cell passages, chemical analysis). The study observations with the greatest impact on the quality of the data and ultimately resulting in discrepancies in the results are given and suggestions for improvement of the protocol are made (e.g., sample preparation, chemical analysis approaches). Finally, there was agreement on the need for an aligned protocol to be utilized by qualified laboratories for chemical and biological analyses, following best practices and guidance for packaging safety assessment of intentionally added substances (IAS) and NIAS to avoid inconsistency in data and the final interpretation.

Variations in foam collapse and thin film stability with constant interfacial and bulk properties.

The stability of foams is commonly linked to the interfacial properties of the proteins and other surfactants used. This study aimed to use these relationships to explain differences in foam stability observed among similar beer samples from different breweries. The foam stability was different for each sample (Nibem foam stability ranged from 206 to 300 s), but ranking was similar for all three foaming methods used, thus independent of the method, gas, etc. Differences in foam stability were dominated by differences in coalescence, as illustrated by the correlation with the stability of single bubbles and thin liquid films. The differences in coalescence stability could not be explained by the measured interfacial properties (e.g. surface pressure, adsorption rate, dilatational modulus and surface shear viscosity), or the bulk properties (concentration, pH, ionic strength, viscosity), since they were similar for all samples. The drainage rates and disjoining pressure isotherms measured in thin liquid films were also similar for all samples, further limiting the options to explain the differences in foam stability using known arguments. The differences in coalescence stability of the thin films was shown to depend on the liquid in between the adsorbed layers of the thin film, using a modified capillary cell to exchange this liquid (to a buffer, or one of the other samples). This illustrates the need to review our current understanding and to develop new methods both for experimental study and theoretical description, to better understand foam stability in the future.

Empirical Evaluation of the "Caregivers Passage through Dementia" on African American Caregivers.

OBJECTIVES: The purpose of this study was to empirically examine a new psychoeducational intervention that was designed for African American caregivers. METHODS: African American caregivers (N = 49) to older adults with dementia were recruited from the community to participate in Universal Dementia Caregivers' (UCD) Bootcamp. Participants completed a pre- and post-assessment of dementia and caregiving knowledge, and a 30-day follow-up interview. RESULTS: Caregivers who went through the UCD Bootcamp demonstrated an increase in basic knowledge of dementia, caregiving burden and coping strategies. In follow-up interviews, caregivers reported developing confidence, knowledge, and adaptive changes in attitudes toward self and loved one. CONCLUSIONS: The Bootcamp is a novel psychoeducational intervention that improves caregiver knowledge and confidence. Our model, Caregiver Passage Through Dementia, is a training that can improve caregiver and family members' quality of life. Additionally, developing culturally sensitive interventions could help address the mistrust that exist in African American communities toward medical systems and research. CLINICAL IMPLICATIONS: Clinicians reframing of caregiving as a gift resonates with many African American caregivers. Empowering caregivers through spirituality is often a necessary ingredient to working with African American caregivers. Clinicians need to demonstrate cultural sensitivity when working with African American caregivers.

Adherence to an injury prevention program in male amateur football players is affected by players' age, experience and perceptions.

Objectives: Adherence to injury prevention programmes in football remains low, which is thought to drastically reduce the effects of injury prevention programmes. Reasons why (medical) staff and players implement injury prevention programmes, have been investigated, but player's characteristics and perceptions about these programmes might influence their adherence. Therefore, this study investigated the relationships between player's characteristics and adherence and between player's perceptions and adherence following an implemented injury prevention programme. Methods: Data from 98 of 221 football players from the intervention group of a cluster randomised controlled trial concerning hamstring injury prevention were analysed. Results: Adherence was better among older and more experienced football players, and players considered the programme more useful, less intense, more functional and less time-consuming. Previous hamstring injuries, educational level, the programme's difficulty and intention to continue the exercises were not significantly associated with adherence. Conclusion: These player's characteristics and perceptions should be considered when implementing injury prevention programmes.

Cumulative mean fluorescent intensities of HLA specific antibodies predict antibody mediated rejections after kidney transplantation.

It is still not fully elucidated which pretransplant donor-specific HLA antibodies (DSA) are harmful after kidney transplantation. In particular, it needs to be clarified whether cumulative mean fluorescence intensities (MFI) against multiple HLA specificities have a predictive value for allograft function. Our retrospective single centre study analyzed preformed HLA antibodies determined by Luminex™ Single Antigen Bead (SAB) assay, including C1q addition, in relation to rejection and clinical outcome in 255 cross match negative kidney allograft recipients. Only 33 recipients (13%) of the total cohort showed early AMR during the first year posttransplant, but in patients with pre-transplant DSA the rate was increased to 15 out of 40 (38%). Three year graft survival was significantly shorter in patients with histological signs of AMR compared with patients without AMR or with no biopsy (74%, 92%, and 97%, respectively, p < 0.0001). In patients with HLA-DSA, a cumulative MFI value of all HLA antibodies of more than 103.000 indicated the highest risk for AMR posttransplant (p = 0.01). In conclusion, in patients with HLA-DSA, the cumulative MFI value may help to further stratify the risk of AMR after kidney transplantation.

The cost-effectiveness of standalone HEPA filtration units for the prevention of airborne SARS CoV-2 transmission.

OBJECTIVE: Airborne infection from aerosolized SARS-CoV-2 poses an economic challenge for businesses without existing heating, ventilation, and air conditioning (HVAC) systems. The Environmental Protection Agency notes that standalone units may be used in areas without existing HVAC systems, but the cost and effectiveness of standalone units has not been evaluated. STUDY DESIGN: Cost-effectiveness analysis with Monte Carlo simulation and aerosol transmission modeling. METHODS: We built a probabilistic decision-analytic model in a Monte Carlo simulation that examines aerosol transmission of SARS-CoV-2 in an indoor space. As a base case study, we built a model that simulated a poorly ventilated indoor 1000 square foot restaurant and the range of Covid-19 prevalence of actively infectious cases (best-case: 0.1%, base-case: 2%, and worst-case: 3%) and vaccination rates (best-case: 90%, base-case: 70%, and worst-case: 0%) in New York City. We evaluated the cost-effectiveness of improving ventilation rate to 12 air changes per hour (ACH), the equivalent of hospital-grade filtration systems used in emergency departments. We also provide a customizable online tool that allows the user to change model parameters. RESULTS: All 3 scenarios resulted in a net cost-savings and infections averted. For the base-case scenario, improving ventilation to 12 ACH was associated with 54 [95% Credible Interval (CrI): 29-86] aerosol infections averted over 1 year, producing an estimated cost savings of $152,701 (95% CrI: $80,663, $249,501) and 1.35 (95% CrI: 0.72, 2.24) quality-adjusted life years (QALYs) gained. CONCLUSIONS: It is cost-effective to improve indoor ventilation in small businesses in older buildings that lack HVAC systems during the pandemic.

Impact of aeroplane noise on mental and physical health: a quasi-experimental analysis.

OBJECTIVES: Historically, departures at New York City's LaGuardia airport flew over a large sports complex within a park. During the US Open tennis games, flights were diverted to fly over a heavily populated foreign-born neighbourhood for roughly 2 weeks out of the year so that the tennis match was not disturbed (the 'TNNIS' departure). In 2012, the use of the TNNIS departure became year-round to better optimise flight patterns around the metropolitan area. METHODS: We exploited exogenously induced spatial and temporal variation in flight patterns to examine difference-in-difference effects of this new exposure to aircraft noise on the health of individual residents in the community relative to individuals residing within a demographically similar community that was not impacted. We used individual-level Medicaid records, focusing on conditions associated with noise: sleep disturbance, psychological stress, mental illness, substance use, and cardiovascular disease. RESULTS: We found that increased exposure to aeroplane noise was associated with a significant increase in insomnia across all age groups, but particularly in children ages 5-17 (OR=1.64, 95% CI=1.12 to 2.39). Cardiovascular disease increased significantly both among 18-44-year-old (OR=1.45, 95% CI=1.41 to 1.49) and 45-64-year-old Medicaid recipients (OR=1.15, 95% CI=1.07 to 1.25). Substance use and mental health-related emergency department visits also increased. For ages 5-17,rate ratio (RR) was 4.11 (95% CI=3.28 to 5.16); for ages 18-44, RR was 2.46 (95% CI=2.20 to 2.76); and for ages 45-64, RR was 1.48 (95% CI=1.31 to 1.67). CONCLUSION: We find that increased exposure to aeroplane noise was associated with an increase in diagnosis of cardiovascular disease, substance use/mental health emergencies and insomnia among local residents.

[The Individual Surgeon is an Independent Risk Factor for Morbidity after Cholecystectomy. A Multivariate Analysis of 710 Patients Operated on by Experienced Surgeons]. / Der erfahrene Chirurg als unabhängiger Risikofaktor für die Morbidität nach Cholezystektomie. Eine multivariate Analyse von 710 Patienten.

BACKGROUND: In sophisticated surgical procedures, e. g. colectomy, cardiac surgery, arterial reconstruction and liver resection, the individual surgeon is a major influence on postoperative morbidity. For the everyday procedure of cholecystectomy, clear data on the morbidity related to the individual surgeon are lacking. AIMS: To assess the individual impact on the outcome of cholecystectomy in a cohort of experienced surgeons. METHODS: The analysis covered n = 710 consecutive patients who had received cholecystecomy between January 2014 and December 2018 - performed by experienced surgeons (> n = 300 cholecystectomies before entry in the study and > 5 years after specialty registration). In a univariate analysis, the influence of patient characteristics, laboratory findings and surgical data on postoperative morbidity were investigated. Variables with statistical significance were entered into a multivariate logistic regression. RESULTS: Mortality was 5/710 (0.7%), and morbidity was 58/710 (8.2%), including 37/710 patients with surgical morbidity and 21/710 patients with non-surgical morbidity. In a multivariable analysis the independent risk factors for overall morbidity were creatinine level (OR 1.29, CI 1.01-1.648, p = 0.042), GOT (OR 1.005, CI 1-1.01, p = 0.03), open/conversion surgery (OR 4.134, CI 1.587-10.768, p = 0.004) and the individual surgeon (OR up to 40.675, p = 0.001). In the analysis of surgical complications, open/conversion surgery (OR 8.104, CI 3.03-21.68, p < 0.001) and the individual surgeon (OR up to 79.69, p = 0.005) remained of significant influence. CONCLUSIONS: The individual surgeon is of major influence on the outcome after an everyday procedure such as cholecystectomy in a group of experienced surgeons with specialty registration. The individual outcome of each surgeon should be measured as a basis of targeted improvement programs.

Aryl hydrocarbon reporter gene bioassay for screening polyhalogenated dibenzo-p-dioxins/furans and dioxin-like polychlorinated biphenyls in hydrochar and sewage sludge.

The suitability of the AhR reporter gene bioassays to screen the presence of polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (dl-PCBs) in sewage sludge (SL) and related hydrochar (HC) was here investigated. Samples of SL obtained from six WWTPs were processed by hydrothermal carbonization to obtain the resultant HCs and both tested with DR-CALUX® bioassay. Levels of PCDD/Fs and dl-PCBs were also determined analytically in the same samples by GC-MS/MS. Bioanalytical Toxicity Equivalent values (BEQ) resulted in one order of magnitude higher in HC compared to SL samples and those obtained from the dl-PCBs fraction higher than those from PCDD/Fs. BEQ and TEQWHO values, the latter obtained by GC-MS/MS analysis on the same matrices, were highly correlated showing also a similar trend in the six WWTPs (RS= 0.8252, p < 0.001; Pearson's R RP =0.8029, p < 0.01). The suitability of AhR bioassays and in particular of the DR-CALUX® to screen the presence and biological activity of legacy organohalogen compounds in both SL and HC matrices was demonstrated for the first time which support their usage for the assessment of potential risks associated with their further environmental applications.

Alteração refracional após capsulotomia posterior com laser Nd: YAG / Change on refraction after Nd: YAG laser posterior capsulotomy

RESUMO Objetivo: Identificar se há mudança refracional significativa após realização de capsulotomia posterior com laser Nd:YAG em olhos pseudofácicos. Métodos: Estudo retrospectivo com análise de prontuários de pacientes atendidos em um hospital com diagnóstico de opacificação de cápsula posterior do cristalino tratada com capsulotomia posterior com laser Nd:YAG no período de outubro de 2019 a março de 2021. A comparação entre a refração antes e após o procedimento foi realizada calculando-se o equivalente esférico. Também foi avaliada a mudança da acuidade visual, aferida por LogMAR. Resultados: Foram analisados 90 prontuários, totalizando 140 olhos, de pacientes submetidos à capsulotomia posterior com laser Nd:YAG. O equivalente esférico médio pré-procedimento foi de -0,07±0,89D, mínimo de -3,0D e máximo de +2,5D, mediana (intervalo interquartil) de 0,0D (-0,50D a +0,375D). A média pós-procedimento foi de -0,18±0,86D, mínimo de -3,5D e máximo de +2,25D, mediana (intervalo interquartil) de -0,125D (-0,50D a 0,0D). com p<0,0082. Dos 140 olhos, 66 sofreram miopização e 37 hipermetropização. A média de alteração do equivalente esférico geral foi de -0,12±0,51D, mínimo de -2,50D e máximo de +1,25D, mediana (intervalo interquartil) de 0,0D (-0,375D a +0,125D). Ao se comparar a diferença entre o equivalente esférico antes e após o procedimento do grupo de olhos que sofreu miopização (n=66) ou hipermetropização (n=37), separadamente, ambos obtiveram p<0,0001. Ao se compararem todos os olhos que sofreram alguma alteração refracional (n=103), foi encontrado p=0,008. A acuidade visual média pré-procedimento foi de 0,23±0,32, mínimo de 0,0 e máximo de 2,3. Pós-procedimento, a média foi de 0,06±0,13, mínimo de -0,12 e máximo de 0,7, com p<0,0001. Conclusão: A capsulotomia posterior com laser Nd:YAG gerou melhora significativa da acuidade visual nos pacientes do estudo, porém também gerou alteração refracional significativa após o procedimento, tanto para miopização (a mais frequente), quanto para hipermetropização.

ABSTRACT Objective: To identify if there is a significant change on refraction after Nd:YAG laser posterior capsulotomy in pseudophakic eyes. Methods: A retrospective study with analysis of medical records of patients treated at a hospital, with diagnosis of opacification of posterior lens capsule treated with Nd:YAG laser posterior capsulotomy, from October 2019 to March 2021. The comparison of refraction before and after the procedure was performed by calculating the spherical equivalent. Changes in visual acuity (VA), measured by LogMAR, were also evaluated. Results: A total of 90 medical records (140 eyes) of patients submitted to Nd:YAG laser posterior capsulotomy were analysed. The mean pre-procedure spherical equivalent was -0.07±0.89D, minimum of -3.0D and maximum of +2.5D, median (interquartile range) of 0.0D (-0.50D to +0.375D). The post-procedure mean was -0.18±0.86D, minimum of -3.5D and maximum of +2.25D, median (interquartile range) of -0.125D (-0.50D to 0.0D), with p <0.0082. Of the 140 eyes, 66 underwent myopia and 37 hyperopia, the mean change in the general spherical equivalent was -0.12±0.51D, minimum -2.50D and maximum +1.25D, median (interquartile range) of 0.0D (-0.375D to +0.125D). When comparing the difference between the spherical equivalent before and after the procedure of the group of eyes that underwent myopia (n=66) or hyperopia (n=37), separately, both obtained p<0.0001. When comparing all eyes that suffered any change on refraction (n=103), the p value was 0.008. The mean pre-procedure visual acuity was 0.23±0.32, minimum of 0.0 and maximum of 2.3. After the procedure, the mean was 0.06±0.13, minimum of -0.12 and maximum of 0.7, p<0.0001. Conclusion: Nd:YAG laser posterior capsulotomy significantly improved visual acuity of patients in this study; however, it also led to a significant change on refraction after the procedure, both for myopization, which was more frequent, and for hyperopization.

The cost-effectiveness of common strategies for the prevention of transmission of SARS-CoV-2 in universities.

BACKGROUND: Most universities that re-open in the United States (US) for in-person instruction have implemented the Centers for Disease Prevention and Control (CDC) guidelines. The value of additional interventions to prevent the transmission of SARS-CoV-2 is unclear. We calculated the cost-effectiveness and cases averted of each intervention in combination with implementing the CDC guidelines. METHODS: We built a decision-analytic model to examine the cost-effectiveness of interventions to re-open universities. The interventions included implementing the CDC guidelines alone and in combination with 1) a symptom-checking mobile application, 2) university-provided standardized, high filtration masks, 3) thermal cameras for temperature screening, 4) one-time entry ('gateway') polymerase chain reaction (PCR) testing, and 5) weekly PCR testing. We also modeled a package of interventions ('package intervention') that combines the CDC guidelines with using the symptom-checking mobile application, standardized masks, gateway PCR testing, and weekly PCR testing. The direct and indirect costs were calculated in 2020 US dollars. We also provided an online interface that allows the user to change model parameters. RESULTS: All interventions averted cases of COVID-19. When the prevalence of actively infectious cases reached 0.1%, providing standardized, high filtration masks saved money and improved health relative to implementing the CDC guidelines alone and in combination with using the symptom-checking mobile application, thermal cameras, and gateway testing. Compared with standardized masks, weekly PCR testing cost $9.27 million (95% Credible Interval [CrI]: cost-saving-$77.36 million)/QALY gained. Compared with weekly PCR testing, the 'package' intervention cost $137,877 (95% CrI: $3,108-$19.11 million)/QALY gained. At both a prevalence of 1% and 2%, the 'package' intervention saved money and improved health compared to all the other interventions. CONCLUSIONS: All interventions were effective at averting infection from COVID-19. However, when the prevalence of actively infectious cases in the community was low, only standardized, high filtration masks clearly provided value.

Best Practices in the Clinical Management of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Consensus Statement of the CurePSP Centers of Care.

Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS; the most common phenotype of corticobasal degeneration) are tauopathies with a relentless course, usually starting in the mid-60s and leading to death after an average of 7 years. There is as yet no specific or disease-modifying treatment. Clinical deficits in PSP are numerous, involve the entire neuraxis, and present as several discrete phenotypes. They center on rigidity, bradykinesia, postural instability, gait freezing, supranuclear ocular motor impairment, dysarthria, dysphagia, incontinence, sleep disorders, frontal cognitive dysfunction, and a variety of behavioral changes. CBS presents with prominent and usually asymmetric dystonia, apraxia, myoclonus, pyramidal signs, and cortical sensory loss. The symptoms and deficits of PSP and CBS are amenable to a variety of treatment strategies but most physicians, including many neurologists, are reluctant to care for patients with these conditions because of unfamiliarity with their multiplicity of interacting symptoms and deficits. CurePSP, the organization devoted to support, research, and education for PSP and CBS, created its CurePSP Centers of Care network in North America in 2017 to improve patient access to clinical expertise and develop collaborations. The directors of the 25 centers have created this consensus document outlining best practices in the management of PSP and CBS. They formed a writing committee for each of 12 sub-topics. A 4-member Steering Committee collated and edited the contributions. The result was returned to the entire cohort of authors for further comments, which were considered for incorporation by the Steering Committee. The authors hope that this publication will serve as a convenient guide for all clinicians caring for patients with PSP and CBS and that it will improve care for patients with these devastating but manageable disorders.

Placebo effects in low back pain: A systematic review and meta-analysis of the literature.

BACKGROUND AND OBJECTIVE: The current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP. DATABASES AND DATA TREATMENT: The study protocol was registered in the international prospective register of systematic reviews Prospero (CRD42019148745). A literature search (in PubMed, Embase, The Cochrane Library, CINAHL and PsycINFO) up to 2021 February 16th yielded 2,423 studies. Two independent reviewers assessed eligibility and risk of bias. RESULTS: Eighteen studies were eligible for the systematic review and 5 for the meta-analysis. Fourteen of the 18 studies were clinical treatment studies, and 4 were experimental studies specifically assessing placebo effects. The clinical treatment studies provided varying evidence for placebo effects in chronic LBP but insufficient evidence for acute and subacute LBP. Most experimental studies investigating chronic LBP revealed significant placebo effects. The meta-analysis of 5 treatment studies investigating chronic LBP depicted a significant moderate effect size of placebo for pain intensity (SMD = 0.57) and disability (SMD = 0.52). CONCLUSIONS: This review shows a significant contribution of placebo effects to chronic LBP symptom relief in clinical and experimental conditions. The meta-analysis revealed that placebo effects can influence chronic LBP intensity and disability. However, additional studies are required for more supporting evidence and evidence for placebo effects in acute or subacute LBP. SIGNIFICANCE: This systematic review and meta-analysis provides evidence of true placebo effects in low back pain (LBP). It shows a significant contribution of placebo effects to chronic LBP symptom relief. The results highlight the importance of patient- and context-related factors in fostering treatment effects in this patient group. New studies could provide insight into the potential value of actively making use of placebo effects in clinical practice.

Occurrence and spatial distribution of dioxin and dioxin-like compounds in topsoil of Taranto (Apulia, Italy) by GC-MS analysis and DR-CALUX® bioassay.

The aim of the present study was to assess the occurrence and spatial distribution of PCDD/Fs and dioxin-like compounds in topsoils of Taranto (Apulia Region), one of the most heavily industrialized and contaminated area of Southern Italy. A combined approach of chemical analysis by GC-MS/MS and AhR reporter gene bioassay was applied in a subset of topsoil samples (n = 20) collected in 2017-18 from ten sites embracing three levels of risk (from high to low) in the framework of a large survey inside Taranto municipality. TCDD-BEQs and GC-MS/MS TEQWHO and TEQTHEORETICAL revealed a decreasing trend with the distance from main industrial settings and landfill areas. A strong correlation between TCDD-BEQs and TEQWHO values (R2 = 0.85) and TEQTHEORETICAL (R2 = 0.88) was also found. In 3 out of 10 topsoil investigated, BEQs and TEQWHO/THEORETICAL resulted above Italian National Regulatory Limits for ∑PCDD/Fs in green, private and recreational used soils (10 ng TEQ/kg d.w. D.Lgs 152/2006) and for ∑PCDD/F/dl-PCBs in agricultural and farming soil (6 ng TEQ/kg d.w. D.M. 46/2019). GC-MS/MS pattern revealed the highest prevalence of dl-PCBs in 6 out of 10 sites, followed by PCDFs and PCDDs. Those sites are all located in proximity of main industrial steel and iron ore sinter plant, steel plant's landfills and illegal dumping sites. An update on occurrence and spatial distribution of PCDD/Fs and dl-PCBs contamination of Taranto urban soils was obtained and the DR-CALUX® bioassay was further recommended as a suitable screening tool for environmental and human risk assessment.

Should the Government Be Allowed to Take Control over Your Car as Part of a Disaster Management Plan?

INTRODUCTION: With the Safety Ensuring Lives Future Deployment and Research in Vehicle Evolution (SELF DRIVE) Act in the United States, there is a growing interest in autonomous vehicles (AVs). One avenue of innovation would be to use them to mobilize and coordinate response efforts during natural disasters. This study uses an earthquake response in an urban, developed setting as a hypothetical example case study. In this hypothetical scenario, private AVs would be mobilized to help rescue victims from collapsed structures. METHODS: A Markov model compared an intervention arm with AVs to a status quo arm using a hypothetical cohort of American earthquake victims. The three possible health states were trapped but alive, rescued and alive, and dead. The cycle length of the Markov model was 6 h. RESULTS: The cost of deploying AVs was $90,139 relative to $87,869 in status quo arm. Using AVs produced an incremental cost of $2269 (95% credible interval (CI) = $-12,985-$8959). Victims have 7.33 quality-adjusted life years (QALYs) in the intervention arm compared to 7.20 QALYs in the status quo arm, resulting in an incremental gain of 0.13 (95% CI = -0.73-2.19) QALYs. The incremental cost-effectiveness ratio (ICER) was $16,960/QALY gained (95% CI = cost-saving-$69,065/QALY). DISCUSSION: The mobilization of private AVs in the setting of an earthquake has the potential to save money and reduce the loss of life. AVs may advance emergency management competencies.

Differences between blacks and whites in well-being, beliefs, emotional states, behaviors and survival, 1978-2014.

OBJECTIVES: Material well-being, beliefs, and emotional states are believed to influence one's health and longevity. In this paper, we explore racial differences in self-rated health, happiness, trust in others, feeling that society is fair, believing in God, frequency of sexual intercourse, educational attainment, and percent in poverty and their association with mortality. STUDY DESIGNS: Age-period-cohort (APC) study. METHODS: Using data from the 1978-2014 General Social Survey-National Death Index (GSS-NDI), we conducted APC analyses using generalized linear models to quantify the temporal trends of racial differences in our selected measures of well-being, beliefs, and emotional states. We then conducted APC survival analysis using mixed-effects Cox proportional hazard models to quantify the temporal trends of racial differences in survival after removing the effects of racial differences in our selected measures. RESULTS: For whites, the decline in happiness was steeper than for blacks despite an increase in high school graduation rates among whites relative to blacks over the entire period, 1978-2010. Self-rated health increased in whites relative to blacks from 1978 through 1989 but underwent a relative decline thereafter. After adjusting for age, sex, period effects, and birth cohort effects, whites, overall, had higher rates of self-rated health (odds ratio [OR] = 1.88; 95% confidence interval [CI] = 1.63, 2.16), happiness (OR = 2.05; 1.77, 2.36), and high school graduation (OR = 2.88; 2.34, 3.53) compared with blacks. Self-rated health, happiness, and high school graduation also mediated racial differences in survival over time. CONCLUSIONS: We showed that some racial differences in survival could be partly mitigated by eliminating racial differences in health, happiness, and educational attainment. Future research is needed to analyze longitudinal clusters and identify causal mechanisms by which social, behavioral, and economic interventions can reduce survival differences.