Desenvolvimento de competências para evacuação aeromédica em emergências e desastres: protocolo de revisão de escopo / Skill development for aeromedical evacuation in emergencies and disasters: a scoping review protocol

OBJETIVO: mapear a produção técnico-científica sobre as competências necessárias para o desenvolvimento de evacuações aeromédicas em situações de emergências e desastres envolvendo agentes químicos, biológicos, radiológicos e nucleares. MÉTODO: protocolo de revisão de escopo. A elaboração deste protocolo foi baseada nas recomendações do Instituto Joanna Briggs, atendendo às recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Este protocolo orientará o processo de identificação de fontes de informação, extração de dados e análise de resultados, a partir da necessidade de dar suporte à análise das ações de capacitação de equipes de saúde frente às demandas clínicas e gerenciais a serem criteriosamente observadas em tais situações.

OBJECTIVE: to map the technical-scientific production on the skills necessary for aeromedical evacuation in emergency and disaster situations involving chemical, biological, radiological, and nuclear agents. METHOD: scoping review protocol. The elaboration of this protocol was based on the Joanna Briggs Institute's recommendations, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This protocol will guide the identification of the sources of information, data extraction, and the analysis of the results based on the need to support the analysis of training actions for health teams facing clinical and managerial demands that must be carefully considered in such situations.

Chemical, biological, radiological, and nuclear mass casualty medicine: a review of lessons from the Salisbury and Amesbury Novichok nerve agent incidents.

On March 4, 2018, two casualties collapsed on a park bench in Salisbury, Wiltshire, UK. They were later discovered to have been the victims of an attempted murder using the Soviet-era Novichok class of nerve agent. The casualties, along with three further critically ill patients, were cared for in Salisbury District Hospital's Intensive Care Unit. Before the COVID-19 pandemic, the Salisbury and Amesbury incidents were the longest-running major incidents in the history of the UK National Health Service. This narrative review seeks to reflect on the lessons learned from these chemical incidents, with a particular focus on hospital and local organisational responses.

Quemadura con cloroformiato de etilo en ocasión de la respuesta a una emergencia química. A propósito de un caso / Burning by Ethyl chloroformate in response to a chemical emergency. A case report

Resumen Se describe un caso de quemadura causada por cloroformiato de etilo en ocasión de la respuesta a un incidente que requirió el trasvase del producto desde contenedores defectuosos a otros seguros. La investigación del evento puso en evidenciala necesidad de mantener un protocolo de registro de materiales que ingresan a la zona caliente, que debe ser tenido en cuentaal momento del retiro de los mismos, procediendo a su correcta descontaminación bajo la fiscalización del oficial de seguridad.

Abstract A burn by Ethyl chloroformate in occasion of response to a chemical emergency which required to transfer products from defective containers to safe containers is described. The investigation of the event highlighted the need to maintain aprotocol for the registration of materials to be entered in the hot zone, which must be considered al the moment of remove andproceeding to the proper decontamination under the supervision of the security officer.

Health risk assessment for multimedia exposure of formaldehyde emitted by chemical accident.

This study was conducted to provide basic data for chemical accident response by assessing the health risks of residents living near a chemical accident site due to long-term exposure. The study considered the temporal concentration changes of the leaked chemical (i.e., its behavior in the environment and dilution) until its extinction. A virtual chemical accident was assumed, in which 40 t of formaldehyde was accidentally discharged for 1 h in Ulsan Metropolitan City, Korea. Formaldehyde concentrations over time in each environmental medium after the accident were calculated using a multimedia environmental dynamics model. Exposure subjects divided into four age groups were considered. Carcinogenic risks due to respiration and non-carcinogenic risks due to soil intake were assessed. For all the age groups, the excess cancer risk did not exceed 1.0 × 10-6, indicating that no harmful health impact was caused by inhalation exposure to formaldehyde. The hazard index exceeded 1 for all the age groups, confirming that harmful health impacts were caused by exposure to soil containing the formaldehyde. This study is the first to assess chronic health risks by reflecting long-term residual and temporal concentration changes of a pollutant released in a chemical accident in each environmental medium until its extinction. This work is also significant in that it reflects the exposure characteristics of the toxic chemical.

Clinical Presentations and Outcomes of Industrial Chlorine Gas Exposure Incidence in Oman.

OBJECTIVE: The main objective was to study different clinical presentations and outcomes of patients after acute industrial chlorine gas exposure in Oman with evaluation of overall incident management to help develop a chemical exposure incident protocol. METHODS: This was a retrospective observational study of 15 patients exposed to chlorine gas after an accidental chlorine gas leak in a metal melting factory in Oman. RESULTS: Six (40%) patients were admitted and nine (60%) patients were discharged from the emergency department (ED) after initial management. The important post-chlorine gas exposure clinical symptoms were eye irritation (66.6%), cough (73.3%), shortness of breath (40.0%), chest discomfort (66.6%), rhinorrhea (66.6%), dizziness (40.0%), vomiting (46.6%), sore throat (13.3%), and stridor (53.3%). Important signs included tachycardia (40.0%), tachypnea (40.0%), wheeze (20.0%), and use of accessory muscles for breathing (20.0%). Signs and symptoms of eye irritation, rhinorrhea, tachycardia, tachypnea, wheeze, and use of accessory muscles for breathing have shown significant correlation with outcome (admission) having P value of <.05. CONCLUSION: In the presented acute chlorine gas exposure incidence, 15 exposed persons were brought to the ED, out of which six were admitted and nine were discharged after symptomatic treatment. Signs and symptoms of eye irritation, rhinorrhea, tachycardia, tachypnea, wheeze, and use of accessory muscles of breathing show significant relation with the outcome of admission.

Mortality in Yusho patients exposed to polychlorinated biphenyls and polychlorinated dibenzofurans: a 50-year retrospective cohort study.

BACKGROUND: In 1968, the Yusho incident resulted in accidental exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related compounds in Japan. This study updated the risk of mortality in Yusho patients. METHODS: We obtained updated cohort data for all Yusho patients for the period 1968-2017. We calculated standardized mortality ratios (SMRs) for all-cause and cause-specific mortality over a 50-year follow-up period compared with the general population in Japan. RESULTS: A total of 1664 Yusho patients with 63,566 person-years of follow up were included in the analysis. Among males, excess mortality was observed for all cancers (SMR: 1.22, 95% confidence interval [CI]: 1.02 to 1.45) and lung cancer (SMR: 1.59, 95% CI: 1.12 to 2.19). Among females, increased mortality was observed for liver cancer (SMR: 2.05, 95% CI: 1.02 to 3.67). No significant increase was seen in non-cancer-related mortality compared with the general population. CONCLUSIONS: Carcinogenic risk in humans after exposure to PCBs and PCDFs remains higher among Yusho patients. Our findings suggest the importance of care engagement and optimum management to deal with the burden of Yusho disease.

Development on Health Risk Assessment Method for Multi-Media Exposure of Hazardous Chemical by Chemical Accident.

In this study, a long-term health risk assessment was conducted for complex, multimedia exposure where the exposure duration was set for the leak of a hazardous chemical spilled after an accident. The study designed a virtual chemical accident scenario where 40 tons of benzyl chloride leaked in a factory inside the Ulsan Petrochemical Industrial Complex for one hour on 1 January 2017. Using a multimedia environmental dynamics model, benzyl chloride concentrations in air and soil were estimated. The time when the atmospheric concentration was less than or equal to the background concentration was recorded as the end point. An assessment of the cancer risk via soil ingestion was carried out after dividing the subjects into four age groups (0-9 years; 10-18 years; 19-65 years; >65 years). All age groups showed an increased cancer risk where the values exceeded 1.0 × 10-6. The 0-9 years age group showed the largest distribution (4.27% of the total area) with the highest maximum and mean values. The distribution maps for all age groups exhibited a trend towards the southeast of the accident site.

A case study on oil pollution in Istanbul Strait: Revisiting 1994 Nassia tanker accident by utilising Potential Incident Simulation Control and Evaluation System (PISCES-II) simulation. What would be different in terms of response if Nassia accident happened today?

Turkey, with her two important straits, is geographically in the middle of one of the major transportation routes and will continue to face risks the oil tankers pose in those sensitive areas. This paper revisits the site of an oil tanker accident that occurred at the northern entrance of the Istanbul Strait in 1994. The aim of the study was to simulate the same accident in PISCES-II Simulator to compare the response actions of the time with the present capabilities. Effort is also made to understand how the negative impacts of an oil spill accident can be lessened. Therefore, the study is planned to set to cover two separate response scenarios for the identical oil spill incident, actually simulating the 1994 M/T Nassica accident. The results showed that oil pollution response in places with strong currents like Istanbul Strait needs special care to sea conditions as well as related assets.

Health effect research on Hebei Spirit Oil Spill (HEROS) in Korea: a cohort profile.

PURPOSE: The Hebei Spirit Oil Spill occurred on 7 December 2007 and resulted in the spillage of 12 547 kl of crude oil on the coastline near Taean. Historically, this was the largest oil spill in Korean water. The health effect research on Hebei Spirit Oil Spill (HEROS) is a prospective cohort study that aimed to evaluate the long-term health effects of oil spill exposure on residents in the affected community. PARTICIPANTS: The Taean Environmental Health Center initially enrolled adults, adolescents and children living in Taean in 2009 and 2010. Follow-up surveys of participating adults and children were conducted every other year. By 2017, a total of 9585 adults and 2216 children and adolescents were enrolled. Of these, 294 adults and 102 children and adolescents were included in all subsequent surveys. FINDINGS TO DATE: Children who lived closer to the oil spill site exhibited a lower level of pulmonary function and higher prevalence of allergic rhinitis, than those who lived further away from the oil spill site. Adults who lived in a highly exposed area or participated in clean-up work had higher urine levels of the oxidative stress biomarkers malondialdehyde and 8-hydroxydeoxyguanosine. Changes in haematological parameters during a 3-year period were observed in residents of both sexes in highly exposed areas, in addition to increases in respiratory diseases and mental health problems in female and male participants, respectively. FUTURE PLANS: The findings of this study will better enable policy makers to develop environmental health policies intended to prevent adverse health effects in residents of communities affected by oil spills, as well as policies regarding the management of future oil accidents. The HEROS study will continue to follow participants in future and will be updated to enable an investigation of long-term health effects.

Chemical pneumonitis in a 9-year-old following chlorine gas exposure.

A previously fit and well 9-year-old boy developed shortness of breath and chest pain after playing with friends on a building site where bonfire materials were being collected. Firstline investigations failed to explain his symptoms, which worsened over the next 24 hours, necessitating endotracheal intubation and mechanical ventilation. When public health and the police retraced his steps, they found barrels of sodium hypochlorite and red diesel at the bonfire site, which when mixed had the potential to form chlorine gas leading to the diagnosis of a chemical pneumonitis secondary to chlorine gas inhalation. Supportive care was continued, and he was successfully extubated after 48 hours. At 6-week follow-up, he had no ongoing pulmonary symptoms.

Chronic impact of an accidental wastewater spill from a smelter, China: A study of health risk of heavy metal(loid)s via vegetable intake.

Chronic impact will last from a sudden pollution accident, however, potential adverse effects of heavy metal(loid)s are overlooked when pollution decreased during years of equilibration. Here, we assessed the potential health risks of heavy metal(loid)s via intake of vegetables from fields affected by the smelting wastewater spill eight years later, basing on site-specific target hazard quotient (STHQ) and cancer risk (SCR) models. Results showed kohlrabi, lettuce and garlic had significant high concentrations of Sb (10.4 mg kg-1), Pb (21.0 mg kg-1), Cd (6.49 mg kg-1), and Zn (441 mg kg-1), and sweet potato and garlic enriched high levels of As (19.6 mg kg-1) and Cu (14.1 mg kg-1), respectively. Transfer factors of metal(loid)s from soil to plants were enhanced by high soluble metal(loid) concentrations, and Sb, As, Pb and Cd in most edible tissues exceeded the contamination limitations for food in China and FAO/WHO. Chinese cabbage had significant high STHQ of As (adult 9.31 and child 19.8) and Sb (adult 0.76 and child 1.61) (p < 0.05), and the highest STHQ of Cd (adult 1.41 and child 3.02) was in lettuce, whereas the highest STHQ of other elements from vegetables were below 1. However, the non-carcinogenic risks based on total STHQ values of these vegetables were several times higher than the acceptable level of 1. In addition, the total SCR values at 5% were hundreds times of safety level of 5.0 × 10-5 set by International Commission on Radiological Protection. Considering food frequency and metal(loid) levels, long-term consumption of local vegetables, especially lettuce and Chinese cabbage, are likely to increase non-carcinogenic and carcinogenic (e.g. As and Cd) health risks. Child's health risk of toxic elements was far greater than adult. This study might serve as a case study of long-term adverse impact for other pollutant incidents. People should pay attention to human health through food chain, and the government should solve the outstanding environmental problems that harm the health of the masses.

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE).

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.

Temporal changes in biological traits of diatom communities in response to an oil spill in a subtropical river.

Diatom growth strategies, which are used as a proxy to analyze disturbances and environmental impacts, can also provide reliable information about environmental gradients. In this study, we used diatom communities and biological traits to assess the structure of epilithic diatoms after an oil spill in a large tributary of the Iguaçu River (Paraná, Brazil). Epilithon and water samples were taken on July 12th, 2004, and after an unexpected oil spill, on the following days: 09/19, 10/03, and 10/13/2004. We observed that the spill caused a distinct shift in both diatom composition and guild group. Diversity decreased and pollution-tolerant diatoms of the motile group became dominant in response to the elevated nutrient levels and reduced light. Tube-forming diatoms, which are strong competitors for light, dominated the epilithon 24 days after the oil spill. Both diatom guilds and growth forms were successfully used to predict the environmental conditions. While diatom guilds responded to disturbances along a temporal gradient, changes inside the guilds were the main factor for understanding the environmental gradient.

[Follow-up of the cohort of workers exposed to arsenic in the Manfredonia petrochemical plant (Apulia Region, Southern Italy)]. / Follow-up della coorte dei lavoratori esposti ad arsenico nel petrolchimico di Manfredonia.

INTRODUCTION: in 1976, a major chemical accident occurred in Manfredonia (Apulia Region, Southern Italy) due to an explosion in the fertilizer area. More than 10 tons of arsenic were released into the atmosphere, contaminating the plant and the surrounding areas. At the end of the 90s, criminal proceedings were initiated and a cohort study was conducted within the trial. OBJECTIVES: to update the vital status of workers enrolled within the trial; some relevant results are also given. METHODS: two different approaches were used to update the vital status depending on the residence of the individuals in the cohort. We computed cause-specific standardised mortality ratios (SMRs), stratified according to the type of employment (urea sector, caprolactam sector, and contract workers), with 95% confidence intervals (95%CI). For internal comparison purpose, Cox regression models were used and hazard ratios (HRs) were calculated, considering workers from the caprolactam area as a reference category. RESULTS: the cohort consisted of 1,467 workers; 114 were dead at the end of the previous follow-up. Among 728 workers residing in Manfredonia, we identified 619 people still alive and 93 deceased. Among 625 not-residents, 508 were alive and 93 deceased. For 285 cases out of 306, cause of death was ascertained. Contract workers show a statistically significant SMR for lung cancer (SMR: 1.26; 95%CI 1.05-1.54) and an increased risk for overall mortality (HR: 2.3; 95%CI 1.1-4.9). Workers residing in Manfredonia show a higher risk of lung cancer mortality in comparison to not-residents (HR: 2.3; 95%CI 1.1-4.9). CONCLUSIONS: workers who were most exposed to arsenic during the site cleaning show an increased risk of overall mortality compared to the least exposed and an increased risk of lung cancer compared to the general population.

Occupational exposure and poisoning by chemical products in the Federal District.

OBJECTIVE: to describe case of occupational exposure to chemical products. METHOD: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. RESULTS: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. CONCLUSION: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.

Occupational exposure and poisoning by chemical products in the Federal District / Exposición e intoxicación ocupacional a productos químicos en el Distrito Federal / Exposição e intoxicação ocupacional a produtos químicos no Distrito Federal

ABSTRACT Objective: to describe case of occupational exposure to chemical products. Method: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. Results: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. Conclusion: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.

RESUMEN Objetivo: describir casos de exposición ocupacional a productos químicos. Método: estudio retrospectivo descriptivo utilizando datos del prontuario de 382 trabajadores atendidos en el Ambulatorio de Toxicología Ocupacional del Centro de Referencia en Salud del Trabajador del Distrito Federal entre 2009 y 2013. Resultados: El 66,7% eran hombres, el 55,2% tenía hasta 9 años de actividad y el 81% no usaba el equipo de protección individual (EPI). Casi el 60% eran agricultores y agentes de vigilancia ambiental, expuestos a agrotóxicos (63%), de los cuales 40% insecticidas organofosforados. La mayoría (68%) presentó actividad de butirilcolinesterasa disminuida, principalmente agricultores (85,9%); el 57,3% de los trabajadores fueron considerados intoxicados, 61,6% por agrotóxicos y 37,9% por productos químicos industriales, y alejados del trabajo por lo menos 10 días. Conclusión: El perfil de los trabajadores atendidos fue de hombres, predominantemente de 30 a 39 años, que no utilizaban el EPI, indicando la necesidad de acciones de prevención junto a esa población para evitar la ocurrencia de intoxicaciones.

RESUMO Objetivo: descrever casos de exposição ocupacional a produtos químicos. Método: estudo retrospectivo descritivo utilizando dados do prontuário de 382 trabalhadores atendidos no Ambulatório de Toxicologia Ocupacional do Centro de Referência em Saúde do Trabalhador do Distrito Federal, entre 2009 e 2013. Resultados: 66,7% eram homens, 55,2% tinham até 9 anos de atividade e 81% não usavam equipamento de proteção individual (EPI). Quase 60% eram agricultores e agentes de vigilância ambiental, expostos a agrotóxicos (63%), dos quais 40% inseticidas organofosforados. A maioria (68%) apresentou atividade de butirilcolinesterase diminuída, principalmente agricultores (85,9%); 57,3% dos trabalhadores foram considerados intoxicados, 61,6% por agrotóxicos e 37,9% por produtos químicos industriais, e afastados do trabalho por pelo menos 10 dias. Conclusão: O perfil dos trabalhadores atendidos foi de homens, predominantemente de 30 a 39 anos, que não utilizavam EPI, indicando a necessidade de ações de prevenção junto a essa população para evitar a ocorrência de intoxicações.

Association of fried food consumption with all cause, cardiovascular, and cancer mortality: prospective cohort study.

OBJECTIVE: To examine the prospective association of total and individual fried food consumption with all cause and cause specific mortality in women in the United States. DESIGN: Prospective cohort study. SETTING: Women's Health Initiative conducted in 40 clinical centers in the US. PARTICIPANTS: 106 966 postmenopausal women aged 50-79 at study entry who were enrolled between September 1993 and 1998 in the Women's Health Initiative and followed until February 2017. MAIN OUTCOME MEASURES: All cause mortality, cardiovascular mortality, and cancer mortality. RESULTS: 31 558 deaths occurred during 1 914 691 person years of follow-up. For total fried food consumption, when comparing at least one serving per day with no consumption, the multivariable adjusted hazard ratio was 1.08 (95% confidence interval 1.01 to 1.16) for all cause mortality and 1.08 (0.96 to 1.22) for cardiovascular mortality. When comparing at least one serving per week of fried chicken with no consumption, the hazard ratio was 1.13 (1.07 to 1.19) for all cause mortality and 1.12 (1.02 to 1.23) for cardiovascular mortality. For fried fish/shellfish, the corresponding hazard ratios were 1.07 (1.03 to 1.12) for all cause mortality and 1.13 (1.04 to 1.22) for cardiovascular mortality. Total or individual fried food consumption was not generally associated with cancer mortality. CONCLUSIONS: Frequent consumption of fried foods, especially fried chicken and fried fish/shellfish, was associated with a higher risk of all cause and cardiovascular mortality in women in the US.

Remote sensing assessment of oil spills near a damaged platform in the Gulf of Mexico.

An oil platform in the Mississippi Canyon 20 (MC-20) site was damaged by Hurricane Ivan in September 2004. In this study, we use medium- to high-resolution (10-30 m) optical remote sensing imagery to systematically assess oil spills near this site for the period between 2004 and 2016. Image analysis detects no surface oil in 2004, but ~40% of the cloud-free images in 2005 show oil slicks, and this number increases to ~70% in 2006-2011, and >80% since 2012. For all cloud-free images from 2005 through 2016 (including those without oil slicks), delineated oil slicks show an average oil coverage of 14.9 km2/image, with an estimated oil discharge rate of 48 to ~1700 barrels/day, and a cumulative oil-contaminated area of 1900 km2 around the MC-20 site. Additional analysis suggests that the detected oil slick distribution can be largely explained by surface currents, winds, and density fronts.

Comparison of Machine Learning Models for Hazardous Gas Dispersion Prediction in Field Cases.

Dispersion prediction plays a significant role in the management and emergency response to hazardous gas emissions and accidental leaks. Compared with conventional atmospheric dispersion models, machine leaning (ML) models have both high accuracy and efficiency in terms of prediction, especially in field cases. However, selection of model type and the inputs of the ML model are still essential problems. To address this issue, two ML models (i.e., the back propagation (BP) network and support vector regression (SVR) with different input selections (i.e., original monitoring parameters and integrated Gaussian parameters) are proposed in this paper. To compare the performances of presented ML models in field cases, these models are evaluated using the Prairie Grass and Indianapolis field data sets. The influence of the training set scale on the performances of ML models is analyzed as well. Results demonstrate that the integrated Gaussian parameters indeed improve the prediction accuracy in the Prairie Grass case. However, they do not make much difference in the Indianapolis case due to their inadaptability to the complex terrain conditions. In addition, it can be summarized that the SVR shows better generalization ability with relatively small training sets, but tends to under-fit the training data. In contrast, the BP network has a stronger fitting ability, but sometimes suffers from an over-fitting problem. As a result, the model and input selection presented in this paper will be of great help to environmental and public health protection in real applications.