Real-time x-ray abnormality alerts for emergency departments using a radiographer comment model - a multisite pilot study

INTRODUCTION

The timely communication of clinically significant image appearances to Emergency Department (ED) referrers is necessary for optimum patient care. Australian reliance on verbal communication only is time-limited, open to misinterpretation and lacks transparency. A combined radiographer alert and comment model was designed to reliably communicate image abnormalities to ED referrers in real-time.

METHODS

A multidisciplinary steering group designed the model for all ED general imaging. Protocols were developed to document radiographer comments (critical, urgent and clinically significant) in patients' medical records. Critical findings were communicated directly to ED. Five NSW hospitals varying in size, complexity and population demographics piloted the model between three to twelve months during 2021-2022. Site auditors compared comments with the radiology report and designated each as True Positive (TP), False Positive (FP), indeterminate and clinically significant. Indeterminate cases were analysed by an external radiologist. Inter-observer consensus was obtained for all classifications via two independent auditors. The Positive Predictive Value (PPV), or precision of the comment, was calculated for each site.

RESULTS

Radiographers (n = 69) provided comments for 1102 cases. The pooled average PPV for TP was 0.96; (0.947-0.971; 95% CI). The weighted mean error (FP comments) was 3.9%; (2.9% - 5.3%.; 95% CI).

CONCLUSION

The Radiographer Comment model provided consistent levels of commenting precision and reproducibility across a range of sites with a pooled average PPV (0.96). The False Positive rate or weighted mean error (FP) of 3.9% (2.9% - 5.3%.; 95% CI) was low.

IMPLICATIONS FOR FUTURE PRACTICE

A strategic, interprofessional approach in the implementation of an image alert combined with a Radiographer Comment can be adapted across a variety of hospital settings for ED and other departments.

P–070 Evaluation of SARS-CoV–2 in human semen and effect on total sperm number: A prospective observational study

Study question

Is the SARS-CoV–2 virus present in human semen and what is the impact on semen parameters following an infection?

Summary answer

SARS-CoV–2 infection, though not detected in semen of recovered men, can affect TSN in ejaculate in the acute setting.

What is known already

Early epidemiological data has suggested that the primary mode of transmission is through respiratory droplets, but the presence of SARS-CoV–2 has been identified in other bodily fluids such as feces, urine, and semen.

Study design, size, duration

We prospectively recruited thirty men diagnosed with acute SARS-CoV–2 infection using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) of pharyngeal swab specimens. Thirty semen samples from recovered men were obtained 11–64 days after testing positive for SAR-CoV–2 infection. The median duration between positive SAR-CoV–2 test and semen collection was 37 days (IQR=23).

Participants/materials, setting, methods

Semen samples were collected from each individual using mailed kits. Follow-up semen samples were done with mailed kits or in-person in office setting. Semen analysis and PCR was performed after samples were received.

Main results and the role of chance

The median total sperm number (TSN) in ejaculate was 12.5 million (IQR=53.1). When compared with age-matched SARS-CoV–2(-) men, TSN was lower among SARS-CoV–2(+) men (p = 0.0024). Five men completed a follow-up sperm analysis (median 3 months) and had a median TSN of 18 million (IQR=21.6). No RNA was detected by means of RT-PCR in the semen in 16 samples tested.

Limitations, reasons for caution

First, most of the semen samples came from non-severe men of whom were in the recovery stage and lacked symptoms. Additionally, our sample size was relatively small and overnight mail-in semen analysis kits were used during the acute phase of infection to minimize contact with positive subjects.

Wider implications of the findings: Our findings suggest extremely low risk of viral transmission during sexual contact and assisted reproductive techniques, although further data need to be obtained. The impact on TSC in recovered men from SARS-CoV–2 infection is concerning, nevertheless long-term follow-up of these men is critical to determine the nadir of TSC.

Trial registration number

20200401

Negative effects of the sea lice therapeutant emamectin benzoate at low concentrations on benthic communities around Scottish fish farms

Emamectin benzoate is used as an in-feed treatment for the control of sea lice parasites in all of the main farmed Atlantic salmon (Salmo salar) facilities worldwide (Norway, Chile, Scotland and Canada). Investigations into its effect on non-target benthic fauna resulting from its excretion from farmed fish and uneaten feed have been limited. This paper presents the findings from a study that intended to assess the impact of emamectin benzoate on benthic fauna using a new low detection method for emamectin benzoate. Eight fish farms in the Shetland Isles, Scotland were surveyed, with sediment sampled along transects radiating from the farms analysed for benthic ecology, sediment chemistry and sediment veterinary medicine residues (analysed for emamectin benzoate and teflubenzuron). Canonical Correspondence Analysis (CCA) and Generalised Linear Mixed Modelling (GLMM) were used to assess which environmental parameters observed during the survey had the biggest effect on benthic community composition and abundance, and more specifically crustacean abundance and richness. Emamectin benzoate was found in 97% of samples, demonstrating widespread dispersion in the sediments sampled. The CCA showed that species composition was predominantly ordinated along a gradient of particle size, with a secondary axis dominated by a change in emamectin benzoate and organic carbon enrichment. Peaks in abundance of crustacean species were predicted to be organised along a gradient of emamectin benzoate concentration. The GLMM corroborated this by showing that emamectin benzoate had the strongest negative effect on total crustacean abundance and species richness, though there was some degree of collinearity with organic carbon, that had a smaller effect. Overall, this study shows that, following its use as an in-feed treatment for sea lice, emamectin benzoate residues are more widely distributed in the benthic environment than previously thought, and have a statistically significant effect on benthic ecology at the concentrations observed in this study.

Trends in management of obstructive sleep apnea in pediatric patients with Down syndrome

INTRODUCTION

Residual obstructive sleep apnea (OSA) after adenotonsillectomy (T&A) is a common problem in children with Down Syndrome (DS). Our objective was to describe trends in surgical and medical management of OSA in pediatric patients with DS, and to present an algorithmic approach to managing these children.

METHODS

Retrospective case series of children with DS seen at a tertiary care medical center between 1/2008-6/2016 who underwent polysomnography (PSG) after having a T&A performed for sleep disordered breathing (SDB).

RESULTS

Sixty-five patients met inclusion criteria. The mean age at T&A was 4.8 years and 52.0% were male. The mean apnea-hypopnea index (AHI) was 23.2 events/hour for patients who had pre-T&A PSGs. The mean AHI was 10.7 events/hour after T&A. Twenty-three patients (35.4%) underwent at least one additional surgical procedure after T&A; 5 (7.7%) patients had ≥ two additional procedures. The most common additional surgical procedures were revision adenoidectomies (n = 8) and lingual tonsillectomies (n = 13). Fifteen (23.1%) patients underwent at least one drug-induced sleep endoscopy (DISE) to help direct selection of surgical site/s.

CONCLUSIONS

Residual OSA is common after T&A in children with Down syndrome and can be managed by additional surgical interventions in many instances with successful reduction of the AHI. DISE has become part of a standard algorithm for managing persistent OSA in children with Down syndrome after T&A.

Developmental profiling of microRNAs in the human embryonic inner ear

Due to the extreme inaccessibility of fetal human inner ear tissue, defining of the microRNAs (miRNAs) that regulate development of the inner ear has relied on animal tissue. In the present study, we performed the first miRNA sequencing of otic precursors in human specimens. Using HTG miRNA Whole Transcriptome assays, we examined miRNA expression in the cochleovestibular ganglion (CVG), neural crest (NC), and otic vesicle (OV) from paraffin embedded (FFPE) human specimens in the Carnegie developmental stages 13-15. We found that in human embryonic tissues, there are different patterns of miRNA expression in the CVG, NC and OV. In particular, members of the miR-183 family (miR-96, miR-182, and miR-183) are differentially expressed in the CVG compared to NC and OV at Carnegie developmental stage 13. We further identified transcription factors that are differentially targeted in the CVG compared to the other tissues from stages 13-15, and we performed gene set enrichment analyses to determine differentially regulated pathways that are relevant to CVG development in humans. These findings not only provide insight into the mechanisms governing the development of the human inner ear, but also identify potential signaling pathways for promoting regeneration of the spiral ganglion and other components of the inner ear.

The GALAD scoring algorithm based on AFP, AFP-L3, and DCP significantly improves detection of BCLC early stage hepatocellular carcinoma

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of death in cirrhotic patients worldwide. The detection rate for early stage HCC remains low despite screening programs. Thus, the majority of HCC cases are detected at advanced tumor stages with limited treatment options. To facilitate earlier diagnosis, this study aims to validate the added benefit of the combination of AFP, the novel biomarkers AFP-L3, DCP, and an associated novel diagnostic algorithm called GALAD. Material and methods: Between 2007 and 2008 and from 2010 to 2012, 285 patients newly diagnosed with HCC and 402 control patients suffering from chronic liver disease were enrolled. AFP, AFP-L3, and DCP were measured using the µTASWako i30 automated immunoanalyzer. The diagnostic performance of biomarkers was measured as single parameters and in a logistic regression model. Furthermore, a diagnostic algorithm (GALAD) based on gender, age, and the biomarkers mentioned above was validated. Results: AFP, AFP-L3, and DCP showed comparable sensitivities and specifities for HCC detection. The combination of all biomarkers had the highest sensitivity with decreased specificity. In contrast, utilization of the biomarker-based GALAD score resulted in a superior specificity of 93.3 % and sensitivity of 85.6 %. In the scenario of BCLC 0/A stage HCC, the GALAD algorithm provided the highest overall AUROC with 0.9242, which was superior to any other marker combination. Conclusions: We could demonstrate in our cohort the superior detection of early stage HCC with the combined use of the respective biomarkers and in particular GALAD even in AFP-negative tumors.

Feasibility and construct validity of a Frailty index for patients with chronic kidney disease

AIM

To determine whether the frailty status of patients with chronic kidney disease (CKD) can be measured using a Frailty index (FI).

METHODS

One hundred and eleven attending a nephrology clinic were approached to complete a one-page questionnaire evaluating cognitive, psychological and functional status. Data were coded as deficits, summed and divided by the total number of deficits considered, to derive an FI-CKD.

RESULTS

One hundred and ten (mean age 65.2 years) agreed to participate and assessments took approximately 10 minutes to complete. Mean FI-CKD was 0.25 (SD 0.12). The FI-CKD increased with age at 3% per year, correlated with a modified Fried phenotype (P < 0.001) and increased significantly across CKD stages (P = 0.04).

CONCLUSIONS

The FI-CKD is feasible in the outpatient setting and has good construct validity. The greater granularity of a continuous measure has the potential to inform decision-making regarding appropriate interventions for patients at the 'frail' end of the health spectrum.

A 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients

PURPOSE

To improve jugular central venous access device (CVAD) securement, prevent CVAD failure (composite: dislodgement, occlusion, breakage, local or bloodstream infection), and assess subsequent trial feasibility.

MATERIALS AND METHODS

Study design was a 4-arm, parallel, randomized, controlled, nonblinded, pilot trial. Patients received CVAD securement with (i) suture+bordered polyurethane (suture + BPU; control), (ii) suture+absorbent dressing (suture + AD), (iii) sutureless securement device+simple polyurethane (SSD+SPU), or (iv) tissue adhesive+simple polyurethane (TA+SPU). Midtrial, due to safety, the TA+SPU intervention was replaced with a suture + TA+SPU group.

RESULTS

A total of 221 patients were randomized with 2 postrandomization exclusions. Central venous access device failure was as follows: suture + BPU controls, 2 (4%) of 55 (0.52/1000 hours); suture + AD, 1 (2%) of 56 (0.26/1000 hours, P=.560); SSD+SPU, 4 (7%) of 55 (1.04/1000 hours, P=.417); TA+SPU, 4 (17%) of 23 (2.53/1000 hours, P=.049); and suture + TA+SPU, 0 (0%) of 30 (P=.263; intention-to-treat, log-rank tests). Central venous access device failure was predicted (P<.05) by baseline poor/fair skin integrity (hazard ratio, 9.8; 95% confidence interval, 1.2-79.9) or impaired mental state at CVAD removal (hazard ratio, 14.2; 95% confidence interval, 3.0-68.4).

CONCLUSIONS

Jugular CVAD securement is challenging in postcardiac surgical patients who are coagulopathic and mobilized early. TA+SPU was ineffective for CVAD securement and is not recommended. Suture + TA+SPU appeared promising, with zero CVAD failure observed. Future trials should resolve uncertainty about the comparative effect of suture + TA+SPU, suture + AD, and SSD+SPU vs suture + BPU.

Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study

AIM

To use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare.

METHODS

We conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J-index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c , mean glucose, area under the glucose-time curve) were assessed. Multi-level regression analysis was used to identify the predictors of change.

RESULTS

Complete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean (sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation (r = -0.30) and mean amplitude of glycaemic excursion (r = -0.26), but not with J-index; HbA1c correlated with J-index (r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean (sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J-index [from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/l; P < 0.001]. Baseline HbA1c correlated with a greater J-index reduction (r = -0.45; P < 0.001). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia.

CONCLUSION

Insulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short-acting insulin therapy.

Endoscopic endonasal resection of a giant middle fossa epidermoid cyst

Intracranial epidermoid cysts are rare. We report a case of a 55-year-old man who presented with trigeminal neuralgia and was found, on imaging, to have an epidermoid cyst located in the right middle fossa. He was managed via an entirely endoscopic endonasal approach. Postoperative magnetic resonance imaging confirmed complete removal of the mass, and the patient continued to have complete resolution of symptoms at a 1-year follow-up.

[Drug-induced liver injury as predominant cause of acute liver failure in a monocenter study]

BACKGROUND AND AIM

Clinical course and mortality of acute liver failure (ALF) are determined by its causes. Traditionally, fulminant hepatitis B infection (HBV) was thought to be the predominant etiology of ALF in Germany. However, recent studies, conducted in American and European cohorts pointed to drug-induced liver injury (DILI) as the major cause. Aim of this study was to identify currently predominant etiologies of ALF in a monocenter study at a leading transplant center in Germany.

PATIENTS AND METHODS

The data of 161 patients admitted with ALF from 1/2002 to 12/2012 were analyzed retrospectively. All patients fulfilled the criteria of the "Acute Liver Failure Study Group Germany" (international normalized ratio (INR) ≥ 1.5, hepatic encephalopathy ≥ stage 1).

RESULTS

DILI was the leading cause of ALF in this cohort. About 20 % of ALF patients with DILI died or received liver transplantats. Mortality rate was highest in ALF patients with unknown etiology and those without specific therapy available.

CONCLUSIONS

In Europe ALF etiologies exhibit a North-South divide. In Germany the most common cause for ALF is idiosyncratic pharmacological intoxication followed by acute hepatitis B.

Evaluations of combined zebrafish (Danio rerio) embryo and marine phytoplankton (Diacronema lutheri) toxicity of dissolved organic contaminants in the Ythan catchment, Scotland, UK

A wide variety of organic contaminants including pesticides, polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) have previously been detected in surface waters in the river Ythan catchment, North East Scotland UK. While the concentrations detected were below Water Framework Directive Environmental Quality Standards (WFD-EQSs) environmental exposures to the diverse mixtures of contaminants, known and unknown, may pose chronic and/or sublethal effects to non target organisms. The present study assessed the embryo and algal toxicity potential of freely dissolved organic contaminants from the Ythan catchment using silicone rubber passive sampling devices (SR-PSDs) and miniaturised bioassay techniques. Zebrafish (Danio rerio) embryos and marine phytoplankton species (Diacronema lutheri) were exposed to extracts from SR-PSDs deployed at different locations along the river Ythan and an undeployed procedural blank. Statistically significant developmental and algal toxicities were measured in all tests of extracts from deployed samples compared with the procedural blanks. This indicates environmental exposure to, and the combined toxicity potential of, freely dissolved organic contaminants in the catchment. The present and previous studies in the Ythan catchment, coupling SR-PSDs and bioassay techniques, have both helped to understand the interactions and combined effects of dissolved organic contaminants in the catchment. They have further revealed the need for improvement in the techniques currently used to assess environmental impact.

Effects of HbA1c and weight reduction on blood pressure in patients with type 2 diabetes mellitus treated with exenatide*

AIM

Treatment of patients with type 2 diabetes with glucagon-like peptide-1 (GLP-1) receptor agonist exenatide has showed improvements in glycaemic control coupled with weight loss and lowered blood pressure (BP). We examined the synergy between improved glycaemia and weight loss on BP reduction in patients treated with either exenatide twice daily (BID) or once weekly (QW).

METHODS

Combining data from three controlled trials, 686 (53% male) patients [baseline mean ± SD: age 55 ± 10 years, weight 95 ± 20 kg, systolic blood pressure (SBP)/diastolic blood pressure (DBP) 130/79 ± 15/9 mmHg, HbA(1c) 8.3 ± 1.1%] treated with exenatide QW (n = 541) or BID (n = 145) were observed over 26 weeks. Using weighted means (WMs) of the longitudinal measures of HbA(1c) and weight, patients were subdivided into four groups at each visit by glycaemic and weight responses; patients who failed to reduce both HbA(1c) and weight below WMs became the reference group (R). The other three groups corresponded to patients with HbA(1c) reduction (A), weight reduction (W) and both HbA(1c) and weight reduction (AW).

RESULTS

Compared with R, patients in AW, A and W groups had a significantly higher likelihood of improving SBP <130 mmHg by 88, 30 and 61%, respectively. Compared with R, patients in AW, A and W had 63, 13 and 45% higher likelihood of improving DBP <80 mmHg.

CONCLUSION

Although the mechanism of BP-lowering effect of exenatide is not established, it appears that the short-term dynamics of BP is related to concomitant effects on glycaemia and body weight. These data offer a preliminary insight into the possible cardiometabolic effects of GLP-1 receptor agonism.

Bursts and the efficacy of selective serotonin reuptake inhibitors

We present a new hypothesis for the efficacy of selective serotonin reuptake inhibitors (SSRIs). We propose that SSRIs bring the response to the phasic firing of raphe nucleus cells back to normal, even though the average extracellular 5HT concentration remains low. We discuss burst firing in the raphe nuclei and use mathematical models to argue that tonic firing and phasic firing may be decoupled and may come from different mechanisms. We use a mathematical model for serotonin synthesis, release, and reuptake in terminals to illustrate the responses in terminal regions to bursts in a normal individual and in an individual with low vesicular serotonin. We then show that acute doses of SSRIs do not bring the response to bursts back to normal, but that chronic doses do return the response to normal. These model results need to be confirmed by new electrophysiological and pharmacological experiments.

Concentrations of polycyclic aromatic hydrocarbons (PAHs) in the eggs of predatory birds in Britain

The eggs of gannets from two Scottish colonies (Ailsa Craig, Bass Rock) of golden eagles from the Hebrides and Highlands and of merlin eggs from the Scottish borders were analyzed for 52 PAHs, including 2-7 ring parent and alkylated PAHs. Phenanthrene was the most abundant PAH in gannet eggs from Ailsa Craig, and methylnaphthalenes predominated in the eggs from other locations and species. Most PAHs were detected in eggs but none were at likely embryotoxic concentrations. The sum concentrations for all the PAHs analyzed (3.1-5.7 ng g(-1) wet wt.) and for the U.S. EPA 16 priority PAHs (2.0-4.3 ng g(-1) wet wt.) did not differ significantly between species or locations. This uniform, low-level accumulation suggests background exposure to diffuse sources. PCA indicated that 3 ring parent and alkylated PAHs predominated in the eggs of merlins and gannets from Ailsa Craig and Hebridean golden eagles; other eggs had a more mixed profile. Source signature diagnostics largely suggested a petrogenic origin for the PAHs in the merlin eggs that we analyzed but otherwise gave equivocal results and further work is needed to determine which diagnostics can be successfully applied to PAHs in eggs.

Retinal vein occlusion: an approach to diagnosis, systemic risk factors and management

Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and is a common cause of visual morbidity and blindness in the elderly. A large proportion of patients with RVO have a history of cardiovascular disease, hypertension, diabetes mellitus or open-angle glaucoma. Although RVO is sometimes associated with thrombophilias and coagulation abnormalities, the role of coagulation factors in the development of RVO remains unclear. This review did not find strong evidence to support an extensive work-up for thrombophilic and coagulation diseases for the vast majority of patients. However, when tests for common cardiovascular risk factors for RVO are negative, evaluation for potential coagulation disorders may be indicated, particularly in young patients and in patients with bilateral RVO, a history of previous thromboses or a family history of thrombosis.

Long-term trends in mercury and PCB congener concentrations in gannet (Morus bassanus) eggs in Britain

Gannet (Morus bassanus) eggs from Bass Rock (North Sea) and Ailsa Craig (eastern Atlantic) were monitored for PCB congeners (1990-2004) and total mercury (1974-2004). Congener profiles for both colonies were dominated by PCBs 153, 138, 180, 118 and 170. All declined in concentration at Ailsa Craig but some (153, 170, 180) remained stable or increased slightly at Bass Rock. Egg congener concentrations at Bass Rock were typically 10-fold higher than at Ailsa Craig by 2002, and Principal Component Analysis indicated that colony differences were driven by the dominant congeners. Egg mercury concentrations were significantly lower at Bass Rock than at Ailsa Craig and temporal trends differed, there being a significant decline at Ailsa Craig but a marginal increase at Bass Rock. Our results suggest there may be differences in contamination between the eastern Atlantic and North Sea and/or there are colony differences in prey selection and associated contaminant loads.

The Predatory Bird Monitoring Scheme: identifying chemical risks to top predators in Britain

The Predatory Bird Monitoring Scheme (PBMS) is a long term (>40 y), UK-wide, exposure monitoring scheme that determines the concentration of selected pesticides and pollutants in the livers and eggs of predatory birds. This paper describes how the PBMS works, and in particular highlights some of the key scientific and policy drivers for monitoring contaminants in predatory birds and describes the specific aims, scope, and methods of the PBMS. We also present previously unpublished data that illustrates how the PBMS has been used to demonstrate the success of mitigation measures in reversing chemical-mediated impacts; identify and evaluate chemical threats to species of high conservation value; and finally to inform and refine monitoring methodologies. In addition, we discuss how such schemes can also address wider conservation needs.

Second generation anticoagulant rodenticides in tawny owls (Strix aluco) from Great Britain

Secondary exposure of vertebrate predators to second generation anticoagulant rodenticides (SGARs) is widespread in Britain. Tawny owl (Strix aluco) populations in the UK are thought to have declined since the 1970s, when SGARs were first introduced, and these compounds may have contributed to any decline in owl numbers. Our aims were to conduct the first systematic survey of SGAR exposure in tawny owls and ascertain whether there had been a change in the proportion of exposed birds that was concurrent with the decline in the population. Liver difenacoum, bromadiolone, flocoumafen and brodifacoum concentrations in British tawny owls from two periods (1990-1993 and 2003-2005) were quantified. In total, some 20% of birds contained detectable residues of one or more SGAR. The extent of exposure (% of birds exposed, magnitude of residues) to different SGARs did not change consistently between time periods. Of the raptors analysed to date in Britain, tawny owls had the lowest proportion of individuals that contained detectable liver residues and so appear to be the least vulnerable to exposure and/or assimilation of SGARs. We found no clear evidence to implicate SGARs as a major factor affecting tawny owl numbers in Britain between 1990 and 2005.

Housing conditions and respiratory health in a Boston public housing community

OBJECTIVES

To determine frequency of and possible associations between environmental housing factors and self-reported respiratory symptoms in public housing.

METHODS

We used a community-participatory method in which trained residents conducted in-person interviews with a random sample of 53 households in one housing development in Boston, Massachusetts.

RESULTS

Environmental factors suspected of affecting respiratory health that were reported by more than 30 percent of respondents included: Moisture (43 percent), mold (43 percent), cracks in walls, floors and ceilings (49 percent), sewage leaks (33 percent), unexplained odor (35 percent), use of air fresheners (91 percent), use of gas ovens for heating (38 percent), no vent for the oven (74 percent), stuffy air (66 percent), overheating at least part of the winter (73 percent), cockroaches (70 percent), rodents (40 percent), pets (39 percent), frequent renovations (40 percent), repeated requests for repairs (52 percent), dust from construction (45 percent), use of more than three hazardous household products (32 percent), vehicle traffic nearby (81 percent), and smoking in the household (57 percent). Forty percent of respondents reported having asthma. Respondents also reported that 56 percent of their children had asthma. Forty percent of respondents reported wheeze and 48 percent reported coughing or sneezing episodes in the preceding month. We found the following positive statistically significant associations, adjusted for age, sex, Black or Hispanic origin, and years lived in public housing: wheeze with moisture problems (OR = 4.8; CI = 1.2, 19.3), sewage leaks (OR = 6.3; CI = 1.3, 30.3), odor (OR = 7.5; CI = 1 .4, 39.0), cracks in walls,floors and ceilings (OR = 8.6; CI 1.9, 38.0), and frequency of renovations (OR = 9.8; CI = 1.8, 54.4); cough with moisture problems (OR = 5.3; CI = 1.3, 20.8), stuffy air (OR = 4.4; CI = 1.2, 16.7), cockroaches (OR = 5.4; CI = 1.2, 24.2), smoking (OR = 5.0; CI = 1.2, 20.5), odor (OR = 10.9; CI = 2.3, 53.0), cracks in walls, floors and ceilings (OR = 6.2; CI = 1.8, 22.3) and frequency of renovations (OR = 4.4; CI = 1.1, 17.5); and sneeze with cockroaches (OR = 5.2; CI = 1.1, 24.2), stuffy air (OR = 6.3; CI = 1.5, 26.5), cracks in walls, floors and ceilings (OR = 6.3; CI = 1.7, 23.1), repeated requests for repairs (OR = 5.6; CI = 1.4, 21.5), and construction dust (OR = 15.6; CI = 2.2, 112.3).

CONCLUSIONS

Housing conditions that affect respiratory health were common in this public housing development. Self-reported rates of respiratory symptoms and asthma were extremely high. Statistical associations between housing conditions and respiratory symptoms in the preceding month were frequently positive and sometimes statistically significant. Engaging community residents strengthened the research process.