Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists.

The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.

Reflections on the OECD guidelines for in vitro skin absorption studies.

At the 8th conference of Occupational and Environmental Exposure of the Skin to Chemicals (OEESC) (16-18 September 2019) in Dublin, Ireland, several researchers performing skin permeation assays convened to discuss in vitro skin permeability experiments. We, along with other colleagues, all of us hands-on skin permeation researchers, present here the results from our discussions on the available OECD guidelines. The discussions were especially focused on three OECD skin absorption documents, including a recent revision of one: i) OECD Guidance Document 28 (GD28) for the conduct of skin absorption studies (OECD, 2004), ii) Test Guideline 428 (TGD428) for measuring skin absorption of chemical in vitro (OECD, 2004), and iii) OECD Guidance Notes 156 (GN156) on dermal absorption issued in 2011 (OECD, 2011). GN156 (OECD, 2019) is currently under review but not finalized. A mutual concern was that these guidance documents do not comprehensively address methodological issues or the performance of the test, which might be partially due to the years needed to finalize and update OECD documents with new skin research evidence. Here, we summarize the numerous factors that can influence skin permeation and its measurement, and where guidance on several of these are omitted and often not discussed in published articles. We propose several improvements of these guidelines, which would contribute in harmonizing future in vitro skin permeation experiments.

Announcement: Federally Assisted Housing Standards for Blood Lead Levels Aligned with CDC-Recommended Threshold.

On January 13, 2017, the U.S. Department of Housing and Urban Development (HUD) lowered the threshold of lead in young children's blood that triggers interventions to evaluate and control exposure hazards from 20 µg/dL to 5 µg/dL, matching the reference level used by CDC (1). The rule includes a process to continue HUD alignment with any future updates to CDC's reference level (1).

Findings from the Initial Use of the Healthy Homes Rating System (HHRS) in Three American Cities.

HUD's Healthy Homes Rating System (HHRS) is a modification of the English version, using scoring values developed in England. The goal of the HUD Three-City Healthy Homes Rating System (HHRS) study was to create a baseline of the prevalence and severity of 29 home health hazards in three cities-Detroit, MI; Greensboro, NC; and Alameda County, CA-and to compare the results to the prevalence and severity found in England. We analyzed 978 housing assessments over 3 years. Hygrothermal hazards (e.g., excess cold) were the most prevalent across the sites. However, significant differences in the type and severity of hazards across communities were found and were more severe in US sample homes than in their English counterparts. The results suggest that the tool shows promise in its ability to identify home health hazards.

EPA Takes Action Against Harmful "Forever Chemicals" in the US Water Supply.

This Medical News article discusses new EPA advisories for a class of synthetic chemical compounds known as PFAS, which are ubiquitous in the environment and in humans, as well as new National Academies guidance on expanded testing for exposure.

Requirements for Notification, Evaluation and Reduction of Lead-Based Paint Hazards in Federally Owned Residential Property and Housing Receiving Federal Assistance; Response to Elevated Blood Lead Levels. Final rule.

This final rule amends HUD's lead-based paint regulations to reduce blood lead levels in children under age six (6) who reside in federally-owned or -assisted pre-1978 housing, formally adopting a revised definition of "elevated blood lead level" (EBLL) in children under the age of six (6), in accordance with Centers for Disease Control and Prevention (CDC) guidance. It also establishes more comprehensive testing and evaluation procedures for the housing where such children reside. This final rule also addresses certain additional elements of the CDC guidance pertaining to assisted housing and makes technical corrections and clarifications. This final rule, which follows HUD's September 1, 2016, proposed rule, takes into consideration public comments submitted in response to the proposed rule.

Richtwerte für Toluol und gesundheitliche Bewertung von C7-C8-Alkylbenzolen in der Innenraumluft : Mitteilung des Ausschusses für Innenraumrichtwerte.

The German Committee on Indoor Guide Values issues indoor air guide values to protect public health. For health evaluation of inhaled toluene a number of valid studies in humans is available. Toluene is a neurotoxic substance and the guide values are based on deficits in neurobehavioural tests observed at workers with chronic exposure of 337 mg toluene/m³. For the derivation of guide values the assumed continuous exposure is considered by a factor of 4.2, the interindividual variability by a factor of 10 and the elevated respiratory rate in children as compared to adults by a factor of 2. The resulting health hazard guide value (guide value II) is 4 mg toluene/m³. As the difference to the former indoor air guide value of 1996 for toluene is only caused by the slightly changed extrapolation factor for continuous exposure, the committee maintains the guide value II of 3 mg toluene/m³ and the precautionary guide value (guide value I) of 0.3 mg toluene/m³ indoor air. As all C7-C8 alkylbenzenes are neurotoxic the committee evaluates toluene, ethylbenzene and the xylenes as a group. In order to achieve a total evaluation the ratios of concentration and respective guide value of each compound were added. The total guide values I and II are regarded to be complied with if the corresponding sum falls below 1.

[Novosibirsk Research Hygiene Institute - 85 years serving sanitary epidemiologic well-being of Siberia population].

The authors present review ot themes covered by Novosibirsk Research Hygiene Institute and the study results obtained over recent years. Evidences are that industrial Siberian centers demonstrate general positive changes in environmental pollution decrease and better health state of children and adolescents, but the situation remains warning about medical and sanitary care for workers engaged into hazardous work conditions, about lower diagnostic coverage of occupational diseases in periodic medical examinations. Facts are that qualified early diagnosis of primary signs of workers' disablement and opportune rehabilitation and preventive treatment enable to stop occupational diseases formation.

[Effects in eyes, caused by laser rays emitted by laser-beam projectors].

Health assessment of laser radiation emitted by laser-beam projectors used for laser shows in concert and theatrical events was carried out. The effects of various laser radiation wavelengths and regimes on functional state of eye retina were studied.

[Psychophysiological research of changes of the functional condition of the neuro-psychic sphere of younger schoolchildren during the school day at luminescent and LED lighting in the classroom].

The purpose of the study is to test the hypothesis that the LED lighting (LL) in training class does not have a negative impact on the change in the functional state of the neuro-psychiatric sphere in pupils by the end of the school day, if compared with traditional for schools fluorescent lighting (FL). With the help of specially matched methods for psychophysiological examination there was performed the testing of changes in the functional state of the neuro-psychiatric in pupils during the school day and there was made an analysis of these changes in dependence on the type of lighting the classroom. LL, if compared to FL, was established to lead to a significant weakening of the negative changes of functional lability of the visual analyzer, the power of excitation of the nervous system and cognitive functions, as well as to an increase in positive changes in psychomotorics. The data obtained allow us to recommend the use of LED lighting equipment in modern schools.

An investigation of sound levels on intensive care units with reference to the WHO guidelines.

INTRODUCTION: Patients in intensive care units (ICUs) suffer from sleep deprivation arising from nursing interventions and ambient noise. This may exacerbate confusion and ICU-related delirium. The World Health Organization (WHO) suggests that average hospital sound levels should not exceed 35 dB with a maximum of 40 dB overnight. We monitored five ICUs to check compliance with these guidelines. METHODS: Sound levels were recorded in five adult ICUs in the UK. Two sound level monitors recorded concurrently for 24 hours at the ICU central stations and adjacent to patients. Sample values to determine levels generated by equipment and external noise were also recorded in an empty ICU side room. RESULTS: Average sound levels always exceeded 45 dBA and for 50% of the time exceeded between 52 and 59 dBA in individual ICUs. There was diurnal variation with values decreasing after evening handovers to an overnight average minimum of 51 dBA at 4 AM. Peaks above 85 dBA occurred at all sites, up to 16 times per hour overnight and more frequently during the day. WHO guidelines on sound levels could be only achieved in a side room by switching all equipment off. CONCLUSION: All ICUs had sound levels greater than WHO recommendations, but the WHO recommended levels are so low they are not achievable in an ICU. Levels adjacent to patients are higher than those recorded at central stations. Unit-wide noise reduction programmes or mechanical means of isolating patients from ambient noise, such as earplugs, should be considered.

In situ exposure to non-directional beacons for air traffic control.

In situ electromagnetic field exposure of workers and the general public due to non-directional beacons (NDB) for air traffic control is assessed and characterized. For occupational exposure, the maximal measured electric field value is 881.6 V/m and the maximal magnetic field value is 9.1 A/m. The maximum electric fields exceed the International Commission on Non-Ionizing Radiation Protection (ICNIRP) reference levels at all seven NDB sites, and the magnetic fields at two of the seven NDB sites (occupational exposure). Recommendations and compliance distances for workers and the general public are provided.

Summary of night noise guidelines for Europe.

Considering the scientific evidence on the threshold of night noise exposure indicated by L night as defined in the Environmental Noise Directive (2002/49/EC), L night value of 40 dB should be the target of the night noise guideline (NNG) to protect the public, including the most vulnerable groups such as children, the chronically ill and the elderly. L night value of 55 dB is recommended as an interim target for countries which cannot follow NNG in the short term for various reasons and where policy-makers choose to adopt a stepwise approach. These guidelines may be considered an extension to the previous World Health Organization (WHO) guidelines for community noise (1999).

Environmental magnetic field in a Neonatal Intensive Care Unit. A relevant verification. / Campo magnético ambiental en una Unidad de Terapia Intensiva Neonatal. Importancia de su verificación.

Preterm infants are born with immature organs, thus affecting the immune system. Electromagnetic fields influence melatonin production with low exposure levels. These infants require medical equipment 24/7 to recover, so they are constantly exposed to magnetic fields during their stay in the Intensive Care Unit. Our objective was to measure magnetic field levels generated around each incubator using a gauss meter and compare our results to the 2010 recommendations by the International Commission on Non-Ionizing Radiation Protection and the IEC 60601-1-2:2004 standard by the International Electrotechnical Commission (IEC). Among 11 hospitalized newborn infants, radiation was found within the recommended limits, but there was electromagnetic interference resulting from medical equipment layout problems in the unit.

Los neonatos pretérminos nacen con inmadurez en los órganos, lo que lleva al compromiso del sistema inmunológico. Los campos electromagnéticos afectan la producción de melatonina a niveles bajos de exposición. Estos niños necesitan equipamiento médico las 24 horas del día para su recuperación, por lo que están expuestos a los campos magnéticos durante todo el tiempo que se encuentren en la Unidad de Terapia Intensiva. El objetivo fue medir los niveles de campo magnético que se generan alrededor de cada una de las incubadoras utilizando un gaussímetro y comparar los resultados con las recomendaciones de la Comisión Internacional para la Protección contra las Radiaciones No Ionizantes de 2010 y la norma de la International Electrotechnical Commission (IEC) IEC 60601-1-2:2004. En 11 neonatos internados, los valores de radiación se encontraban dentro de los recomendados, pero existía interferencia electromagnética por problemas de disposición de los equipos en el área.

[A new occupational and environmental hazard - nanoplastic]. / Nowe zagrozenie zawodowe i srodowiskowe ­ nanoplastik.

Problems arising from the accumulation of plastic waste in the environment have become global. Appeals to stop the usage of disposable drinking straws or plastic cutlery did not come out without reason - 320 million tons of plastic products are produced annually, of which 40% are disposable items. More and more countries and private enterprises are giving up these types of items in favor of their biodegradable substitutes, e.g., cardboard drinking straws. Plastic waste in the environment is subject to a number of physicochemical interactions and biodegradation in which bacteria are involved. By using synthetic waste, they reduce the size of plastic garbage while increasing its dispersion in the environment. Small plastic particles, invisible to the naked eye, are called nanoplastic. Nanoplastic is not inert to living organisms. Due to its size, it is taken up with food by animals and passed on in the trophic chain. The ability to penetrate the body's barriers through nanoplastic leads to the induction of biological effects with various outcomes. Research studies on the interaction of nanoplastic with living organisms are carried out in many laboratories; however, their number is still a drop in the ocean of the data needed to draw clear-cut conclusions about the impact of nanoplastic on living organisms. There is also no data on the direct exposure to nanoplastic contamination at workplaces, schools and public utilities, standards describing the acceptable concentration of nanoplastic in food products and drinking water, and in vitro tests on nanoparticles other than polystyrene nanoparticles. Complementing the existing data will allow assessing the risks arising from the exposure of organisms to nanoplastic. Med Pr. 2020;71(6):743-56.

Variations in Athlete Heat-Loss Potential Between Hot-Dry and Warm-Humid Environments at Equivalent Wet-Bulb Globe Temperature Thresholds.

CONTEXT: Many organizations associated with sports medicine recommend using wet-bulb globe temperature (WBGT)-based activity-modification guidelines that are uniform across the country. However, no consideration has been given to whether the WBGT thresholds are appropriate for different weather conditions, such as warm-humid (WH) relative to hot-dry (HD), based on known differences in physiological responses to these environments. OBJECTIVE: To identify if personnel in regions with drier conditions and greater evaporative cooling potential should consider using WBGT-based activity-modification thresholds that differ from those in more humid weather. DESIGN: Observational study. SETTING: Weather stations across the contiguous United States. MAIN OUTCOME MEASURE(S): A 15-year hourly WBGT dataset from 217 weather stations across the contiguous United States was used to identify particular combinations of globe temperature, wet-bulb temperature, and air temperature that produce WBGTs of 27.9°C, 30.1°C, and 32.3°C. A total of 71 302 observations were clustered into HD and WH environmental conditions. From these clusters, maximum heat-loss potential and heat-flux values were modeled at equivalent WBGT thresholds with various activity levels, clothing, and equipment configurations. RESULTS: We identified strong geographic patterns, with HD conditions predominant in the western half and WH conditions predominant in the eastern half of the country. Heat loss was systematically greater in HD than in WH conditions, indicating an overall less stressful environment, even at equivalent WBGT values. At a WBGT of 32.3°C, this difference was 11 W·m-2 at an activity velocity of 0.3 m·s-1, which doubled for an activity velocity of 0.7 m·s-1. The HD and WH difference increased with the WBGT value, demonstrating that evaporative cooling differences between HD and WH conditions were even greater at a higher, rather than lower, WBGT. CONCLUSIONS: Potential heat loss was consistently greater in HD than in WH environments despite equal WBGTs. These findings support the need for further clinical studies to determine the appropriate WBGT thresholds based on environmental and physiological limits to maximize safety while avoiding unnecessary limitations.

Health effects of radiofrequency electromagnetic energy.

The issues of real or suspected health effects of radiofrequency fields, produced by cellphones, their base stations and many other devices, are complex and controversial. We believe that the most balanced and valid assessments of these issues are given by the extensive reports produced by reputable, multidisciplinary, expert groups. These use the principles of a comprehensive review to assess all available published literature and form their conclusions by consideration of the strength of the evidence from the available studies. This paper provides links to several of these reports, and shows how others can be accessed. These reports are large and complex, but freely available on websites. We summarise the most recent New Zealand report, which itself refers to and summarises many other reports. The scientific literature on these issues is enormous, particularly in animal and laboratory studies. There are some comprehensive reviews of these, demonstrating that the quality of the studies is very variable, and that, for example, results claiming to show increased genetic damage or other biological effects are much more common in studies of low quality, whereas higher-quality studies predominantly show no significant effects. Thus, while there are many reports which in isolation suggest health effects, there is no consistent evidence supporting important health effects caused by low intensities of radiofrequencies similar to those experienced by the general population. There are certainly many unanswered questions, and new studies need to be assessed carefully and replicated where possible. Thus, expert groups in several countries including New Zealand need to continue to regularly review new studies.