A SARS-CoV-2 outbreak investigation at a storage and distribution centre in England: an assessment of worker- and workplace-related risk factors.

An outbreak of SARS-CoV-2 (1 March to 10 May 2021) with an attack rate of 26.5% among approximately 1150 workers at a storage and distribution centre in England prompted a multidisciplinary outbreak investigation (5 May to 6 August 2021), with the aim of better understanding worker- and workplace-related risk factors for viral transmission in the warehousing sector. Overall, environmental factors (e.g., ventilation, humidity and temperature) were assessed to be appropriate at the facility. Nevertheless, 39 (51.3%) surface samples from across the site tested positive for low/ very low levels of SARS-CoV-2 RNA (Ct value ≥ 32.0 for all). Among the study participants, of whom 35.6% were confirmed or suspected cases, 95.5% reported having received COVID-19 prevention training, 100.0% reported handwashing, and 80.0% reported use of face coverings at work. Notably, 43.9% and 19.0% reported working with a symptomatic and a positive contact respectively. Furthermore, 80.5% and 46.3% had concerns regarding reduction in their income and future unemployment, respectively, due to self-isolation. The findings of this study suggest that, in addition to targeted workplace infection control measures and tailored work area specific risk assessments, an enhanced and equitable sick leave policy may help limit presenteeism and viral transmission in large workplaces.

Artificial intelligence-assisted system for the assessment of Forrest classification of peptic ulcer bleeding: a multicenter diagnostic study.

BACKGROUND: Inaccurate Forrest classification may significantly affect clinical outcomes, especially in high risk patients. Therefore, this study aimed to develop a real-time deep convolutional neural network (DCNN) system to assess the Forrest classification of peptic ulcer bleeding (PUB). METHODS: A training dataset (3868 endoscopic images) and an internal validation dataset (834 images) were retrospectively collected from the 900th Hospital, Fuzhou, China. In addition, 521 images collected from four other hospitals were used for external validation. Finally, 46 endoscopic videos were prospectively collected to assess the real-time diagnostic performance of the DCNN system, whose diagnostic performance was also prospectively compared with that of three senior and three junior endoscopists. RESULTS: The DCNN system had a satisfactory diagnostic performance in the assessment of Forrest classification, with an accuracy of 91.2% (95%CI 89.5%-92.6%) and a macro-average area under the receiver operating characteristic curve of 0.80 in the validation dataset. Moreover, the DCNN system could judge suspicious regions automatically using Forrest classification in real-time videos, with an accuracy of 92.0% (95%CI 80.8%-97.8%). The DCNN system showed more accurate and stable diagnostic performance than endoscopists in the prospective clinical comparison test. This system helped to slightly improve the diagnostic performance of senior endoscopists and considerably enhance that of junior endoscopists. CONCLUSION: The DCNN system for the assessment of the Forrest classification of PUB showed satisfactory diagnostic performance, which was slightly superior to that of senior endoscopists. It could therefore effectively assist junior endoscopists in making such diagnoses during gastroscopy.

Characteristics, sources and health risk assessment of trace metals and polycyclic aromatic hydrocarbons in PM2.5 from Hefei, China.

Trace metals (TRs) and polycyclic aromatic hydrocarbons (PAHs) are major toxic components of fine particulate matter (PM2.5) and related to various health adverse outcomes. The study aims to get a better understanding of the contents, sources and risks of PM2.5-bounded TRs and PAHs in Hefei, China, during the period of 2019-2021. We collected 504 samples and measured twelve TRs and sixteen priority PAHs by inductively coupled plasma mass spectrometry and high-performance liquid chromatography. The annual mass concentrations of PM2.5 was fluctuated in the year of 2019-2021 at 50.95, 47.48 and 59.38 µg/m3, with seasonal variations in rank order of winter > spring > autumn > summer. The median concentrations of PM2.5-bounded Æ©TRs and Æ©PAHs were also fluctuated, 132.85, 80.93 and 120.27 ng/m3 for Æ©TRs, 2.57, 5.85 and 2.97 ng/m3 for Æ©PAHs, in the year of 2019, 2020 and 2021, respectively. Seasonal variations of Æ©TRs and Æ©PAHs show the highest concentration in winter. Positive matrix factorization was used for identified pollution emission sources, and TRs mainly originated from coal combustion, traffic emission and fugitive dust, while PAHs stemmed from biomass, diesel, gasoline and coal combustion. Health risk assessment indicated that adults were more vulnerable than children, the carcinogenic risk assessment of As and Cr manifested a certain degree of cancer risk (1.0 × 10-6 < CR < 1.0 × 10-4) in adults group, and health risks of TRs were higher than PAHs in Hefei. These findings suggest that PM2.5-bounded TRs and PAHs should be considered when making emission control strategies for air pollution, and winter, combustion sources and adults should achieve more policy attention to decrease exposure risks in Hefei.

The role of place-based policies on carbon emission: A quasi-natural experiment from China's old revolutionary development program.

The effectiveness of place-based policies on carbon emission is controversial, and particularly the mechanism behind its effectiveness is unknown. We treat China's Old Revolutionary Development Program (ORDP)- a large-scale and novel type of place-based policy targeted at undeveloped regions, as a natural experiment to estimate ORDP's impact on carbon emission. Employing the panel data of 110 prefecture-level cities in China from 2010 to 2019, we perform a time-varying difference-in-differences (DID) study and discover that ORDP leads to an average of 26.7% increase in carbon emission and this effect takes a period to emerge and is not sustainable in the long term. Three mechanisms that may result in such impact are that ORDP improves economic development, changes industrial structure, and decreases technological progress. Further heterogeneity analysis indicates that ORDP results in a greater increased impact on carbon emission in old revolutionary cities that are located in western China compared to those located in central and eastern China.

Occurrence, distribution and health risk assessment of organophosphate esters in outdoor dust in Nanjing, China: Urban vs. rural areas.

With increasing use of organophosphate esters (OPEs) largely due to the phasing out of various brominated flame retardants, much more attention has been paid to their occurrence, distribution and potential health risks. In this study, we investigated the occurrence and distribution characteristics associated to their potential health risks of selected 13 OPEs in outdoor dust with a comparison between urban and rural areas in Nanjing, China as well as seasonal variations. Ten out of 13 OPEs showed higher concentrations in urban dust than those in rural dust (p < 0.05). Six OPEs congeners exhibited significantly different concentrations with seasonal variations (p < 0.01) in rural dust. Halogenated OPEs were the dominant group in both urban (median: 56.8%) and rural (median: 45.9%) dust, and tris(2-chloroisopropyl) phosphate (TCPP) was found to be the most abundant OPE in both urban (median: 48.7%) and rural (median:26.4%) dust. Principal component analysis with multiple linear regression (PCA-MLR) and spearman correlations showed the different sources of OPEs in urban and rural dust. The non-carcinogenic (Hazard Index, HI < 1.62 × 10-5) and carcinogenic risks (CR < 2.28 × 10-9) of ΣOPEs were much lower than the theoretical threshold of risk, revealing a negligible risk to local residents from the exposure of OPEs in outdoor dust.

Changes in Visual Function in the Elderly Population in the United States: 1995-2010.

PURPOSE: To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes). METHODS: Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent). RESULTS: Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma. CONCLUSION: Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.

Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death.

AIMS: Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality. METHODS: Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8). RESULTS: Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95% CI: 0.68-0.94); renal failure (OR=0. 82; 95% CI: 0.71-0.95); and death (OR=0.86; 95% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95% CI: 0.45-0.90), renal failure (OR=0.71; 95% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95% CI: 0.11-0.85), and death (OR=0.56, 95% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95% CI: 0.13-0.93). CONCLUSIONS: Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures.

Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases.

OBJECTIVE: To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM). DESIGN: Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS). PARTICIPANTS: The sample consisted of 2151 Medicare beneficiaries who responded to the HRS. METHODS: Medicare beneficiaries with ≥ 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination. MAIN OUTCOME MEASURES: The primary outcome measure was the number of 15-month periods with an eye examination. RESULTS: One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 follow-up periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations. CONCLUSIONS: Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use.

Reliability assessment of a coding scheme for the physical risk factors of work-related musculoskeletal disorders.

OBJECTIVES: This study assessed the reliability of a novel coding scheme for physical risk factors for musculoskeletal disorders reported to an occupational surveillance scheme. METHODS: Since 1997 new cases of musculoskeletal disease have been reported as part of a surveillance scheme by over 300 consultant rheumatologists in the United Kingdom; the rheumatologists also gave a short description of the tasks and activities they considered to be causal. With the use of a summary of the activities described, a coding scheme was developed comprising 16 categories of task codes and another 16 categories of movement codes. Four reviewers coded the work activities independently for 576 cases. The fourth rater coded the cases twice. With the use of a single summary kappa statistic and the matrix of kappa coefficients, both interrater reliability and intrarater reliability were assessed. RESULTS: The overall interrater agreement on the task codes was good (kappa = 0.73), with the best agreement for keyboard work (kappa = 0.96) and the worst for assembly work (kappa = 0.40, kappa = 0.37). The interrater agreement on movement codes was also good (kappa = 0.79), with the best agreement for kneeling (kappa = 0.94) and the worst for materials handling (kappa = 0.10). The intrarater agreement was somewhat better than the interrater agreement with both codes. CONCLUSIONS: The results suggest that the coding scheme was, on the whole, reliable for classifying the physical risk factors reported as causal.