Assessment of Right Ventricular Function by Strain Imaging in Patients Presenting with Acute Myocardial Infarction: An Original Research.

Objective: This study sought to determine the relationship between right ventricular (RV) function and clinical variables and prognosis in individuals with acute myocardial infarction (AMI) utilizing strain imaging. Materials and Methods: A prospective observational research involving 150 patients who had been admitted with AMI was carried out. Utilizing two-dimensional speckle-tracking strain imaging, RV function was assessed. Age, sex, risk factors, and comorbidities were recorded as clinical parameters. A 12-month follow-up was conducted to assess major adverse cardiovascular events (MACE). Results: 65% of the study's participants were men, with a mean age of 58.2 years. When compared to a healthy control group, individuals with AMI had significantly lower RV longitudinal strain (RVLS) (P 0.001). RVLS and left ventricular ejection fraction had a statistically significant connection (r = 0.642, P 0.001). Patients with compromised RVLS had a greater rate of MACE over the follow-up period compared to those with maintained RV function (P = 0.014). Conclusion: In conclusion, strain imaging offers useful information for evaluating RV function in patients with AMI. Reduced left ventricular performance and a higher likelihood of unfavorable clinical outcomes are linked to impaired RVLS. Utilizing strain imaging to detect RV dysfunction early can help direct treatment plans and enhance patient outcomes.

Enhancing spatial inference of air pollution using machine learning techniques with low-cost monitors in data-limited scenarios.

Ensuring environmental justice necessitates equitable access to air quality data, particularly for vulnerable communities. However, traditional air quality data from reference monitors can be costly and challenging to interpret without in-depth knowledge of local meteorology. Low-cost monitors present an opportunity to enhance data availability in developing countries and enable the establishment of local monitoring networks. While machine learning models have shown promise in atmospheric dispersion modelling, many existing approaches rely on complementary data sources that are inaccessible in low-income areas, such as smartphone tracking and real-time traffic monitoring. This study addresses these limitations by introducing deep learning-based models for particulate matter dispersion at the neighbourhood scale. The models utilize data from low-cost monitors and widely available free datasets, delivering root mean square errors (RMSE) below 2.9 µg m-3 for PM1, PM2.5, and PM10. The sensitivity analysis shows that the most important inputs to the models were the nearby monitors' PM concentrations, boundary layer dissipation and height, and precipitation variables. The models presented different sensitivities to each road type, and an RMSE below the regional differences, evidencing the learning of the spatial dependencies. This breakthrough paves the way for applications in various vulnerable localities, significantly improving air pollution data accessibility and contributing to environmental justice. Moreover, this work sets the stage for future research endeavours in refining the models and expanding data accessibility using alternative sources.

Residual LSTM-based short duration forecasting of polarization current for effective assessment of transformers insulation.

The empirical application of polarization and depolarization current (PDC) measurement of transformers facilitates the extraction of critical insulation-sensitive parameters. This technique, rooted in time-domain dielectric response analysis, forms the bedrock for parameterization and insulation modeling. However, the inherently time-consuming nature of polarization current measurements renders them susceptible to data corruption. This article explores deep-learning-based short-duration techniques for forecasting polarization current to address this limitation. By incorporating spatial shortcuts, the residual long short-term memory (LSTM) network facilitates the seamless propagation of spatial and temporal gradients. Furthermore, the relative forecasting assessment of the proposed residual LSTM model's performance is made against traditional LSTM, attention LSTM, gated recurrent units (GRU), and convolutional neural network (CNN) models. Thus, optimal model selection strategies are evaluated based on their capability to capture extended dependencies and short-term information present in the data. In addition, the Monte Carlo dropout prediction is employed to estimate uncertainty in polarization current forecasts. The findings demonstrate that the proposed residual LSTM network model for polarization current forecasting yields the lowest error metrics and maintains prediction consistency over the testing duration. Thus, the proposed approach significantly reduces PDC measurement time, providing an effective means to develop proactive maintenance strategies for evaluating the insulation condition of transformers.

Echocardiographic and Angiographic Assessment of Right Ventricular Function and Right Coronary Artery Stenosis in Acute Inferior Wall Myocardial Infarction.

BACKGROUND: Cardiovascular diseases (CVDs) are a global concern. CVD remains a primary cause of death despite reduced coronary heart disease death rates. Acute coronary syndrome (ACS) involves myocardial infarction (MI) and unstable angina, sharing mechanisms such as plaque instability. Our study assesses the right ventricular (RV) function's predictive value in acute inferior wall MI (IWMI) to identify high-risk patients with an elevated likelihood of experiencing severe cardiac complications, hemodynamic instability, or a higher mortality risk following an acute IWMI. METHODOLOGY: The research was conducted in the Department of Cardiology at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, from July 2021 to June 2022, following the necessary ethical approval. A cohort of 140 patients with IWMI, carefully chosen according to rigorous criteria, clearly understood the study's objectives before providing informed consent. The evaluations were conducted in the following order: clinical assessments, followed by blood testing, then echocardiography, and finally, coronary angiography. Furthermore, the study examined risk factors and utilized statistical methods to elucidate the associations between qualities and results. RESULTS: The study included 140 participants, with 61% being male and 39% female. Among the participants, 14% were aged 30-45, 50% were aged 46-60, and 30% were over 60. Age shows significant proportions in different categories. Diabetes, dyslipidemia, hypertension, and smoking/tobacco addiction did not differ among stenosis groups. Proximal right coronary artery (RCA) stenosis patients had elevated jugular venous pressure (JVP). The echocardiograms were performed within 48 hours of post-percutaneous coronary intervention, and significant differences between groups were observed. Participants with proximal stenosis had lower tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC), which showed compromised RV systolic function. Proximal stenosis patients had reduced systolic motion velocity (Sm), indicating impaired myocardial contraction. Echocardiographic parameters such as early diastolic velocity (Em), atrial contraction velocity (Am), Em/Am ratio (a marker of diastolic function), isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET) between groups were different, indicating distinct cardiac functions. Proximal stenosis increased the myocardial performance index (MPI), indicating cardiac impairment. The left ventricular ejection fraction (LVEF) was comparable in the two stenosis groups, indicating similar left ventricular performance. CONCLUSION:  Echocardiography showed significant RV function differences in acute inferior wall ST-segment elevation myocardial infarction (STEMI) patients with proximal and distal RCA lesions. RV dysfunction is linked to right ventricle myocardial infarction (RVMI), and echocardiographic markers can provide valuable insights. Results emphasize that acute inferior wall STEMI is diagnosed by electrocardiogram (ECG) criteria, particularly ST-segment elevation. However, these markers emphasize the importance of RV assessment in RCA involvement assessment. These findings suggest that RV function can help diagnose acute inferior wall STEMI RCA involvement. In acute inferior STEMIs, RV function echocardiography is essential for RCA lesion location.

Evaluating the Performance of Low-Cost PM2.5 Sensors in Mobile Settings.

Low-cost sensors (LCSs) for measuring air pollution are increasingly being deployed in mobile applications, but questions concerning the quality of the measurements remain unanswered. For example, what is the best way to correct LCS data in a mobile setting? Which factors most significantly contribute to differences between mobile LCS data and those of higher-quality instruments? Can data from LCSs be used to identify hotspots and generate generalizable pollutant concentration maps? To help address these questions, we deployed low-cost PM2.5 sensors (Alphasense OPC-N3) and a research-grade instrument (TSI DustTrak) in a mobile laboratory in Boston, MA, USA. We first collocated these instruments with stationary PM2.5 reference monitors (Teledyne T640) at nearby regulatory sites. Next, using the reference measurements, we developed different models to correct the OPC-N3 and DustTrak measurements and then transferred the corrections to the mobile setting. We observed that more complex correction models appeared to perform better than simpler models in the stationary setting; however, when transferred to the mobile setting, corrected OPC-N3 measurements agreed less well with the corrected DustTrak data. In general, corrections developed by using minute-level collocation measurements transferred better to the mobile setting than corrections developed using hourly-averaged data. Mobile laboratory speed, OPC-N3 orientation relative to the direction of travel, date, hour-of-the-day, and road class together explain a small but significant amount of variation between corrected OPC-N3 and DustTrak measurements during the mobile deployment. Persistent hotspots identified by the OPC-N3s agreed with those identified by the DustTrak. Similarly, maps of PM2.5 distribution produced from the mobile corrected OPC-N3 and DustTrak measurements agreed well. These results suggest that identifying hotspots and developing generalizable maps of PM2.5 are appropriate use-cases for mobile LCS data.

Efficacy assessment of green-blue nature-based solutions against environmental heat mitigation.

Nature-based solutions (NBS) such as green (vegetation) and blue (waterbodies) infrastructure are being promoted as cost-effective and sustainable strategies for managing the heatwaves risks, but long-term monitoring evidence is needed to support their implementation. This work aims to conduct a comparative assessment of the cooling efficiency of green (woodland and grassland) and blue (waterbody) NBS in contrast to a built-up area. Over a year of continuous fixed monitoring showed that the average daily maximum temperatures at NBS locations were 2-3 °C (up-to 15%) lower than the built-up area. Woodland showed the maximum temperature reduction in almost all seasons, followed by waterbody and grassland. NBS performed the best during the summers, peak sunshine, and heatwave hours (up to âˆ¼ 6 °C cooler than built-up area). Using an e-bike for mobile monitoring, the areas where green-blue NBS were combined showed the highest spatial cooling extent, followed by waterbody, woodland, and grassland areas. The database generated can validate city-scale environmental models and assist city planners to incorporate NBS into urban dwellings based on the opportunity, need and scope, aligning with Sustainable Development Goals 11 (sustainable cities and communities) and 13 (climate action).

Nature-based solutions can help reduce the impact of natural hazards: A global analysis of NBS case studies.

The knowledge derived from successful case studies can act as a driver for the implementation and upscaling of nature-based solutions (NBS). This work reviewed 547 case studies to gain an overview of NBS practices and their role in reducing the adverse impact of natural hazards and climate change. The majority (60 %) of case studies are situated in Europe compared with the rest of the world where they are poorly represented. Of 547 case studies, 33 % were green solutions followed by hybrid (31 %), mixed (27 %), and blue (10 %) approaches. Approximately half (48 %) of these NBS interventions were implemented in urban (24 %), and river and lake (24 %) ecosystems. Regarding the scale of intervention, 92 % of the case studies were operationalised at local (50 %) and watershed (46 %) scales while very few (4 %) were implemented at the landscape scale. The results also showed that 63 % of NBS have been used to deal with natural hazards, climate change, and loss of biodiversity, while the remaining 37 % address socio-economic challenges (e.g., economic development, social justice, inequality, and cohesion). Around 88 % of NBS implementations were supported by policies at the national level and the rest 12 % at local and regional levels. Most of the analysed cases contributed to Sustainable Development Goals 15, 13, and 6, and biodiversity strategic goals B and D. Case studies also highlighted the co-benefits of NBS: 64 % of them were environmental co-benefits (e.g., improving biodiversity, air and water qualities, and carbon storage) while 36 % were social (27 %) and economic (9 %) co-benefits. This synthesis of case studies helps to bridge the knowledge gap between scientists, policymakers, and practitioners, which can allow adopting and upscaling of NBS for disaster risk reduction and climate change adaptation and enhance their preference in decision-making processes.

Integrating CFD-GIS modelling to refine urban heat and thermal comfort assessment.

Constant urban growth exacerbates the demand for residential, commercial and traffic areas, leading to progressive surface sealing and urban densification. With climate change altering precipitation and temperature patterns worldwide, cities are exposed to multiple risks, demanding holistic and anticipatory urban planning strategies and adaptive measures that are multi-beneficial. Sustainable urban planning requires comprehensive tools that account for different aspects and boundary conditions and are capable of mapping and assessing crucial processes of land-atmosphere interactions and the impacts of adaptation measures on the urban climate system. Here, we combine Computational Fluid Dynamics (CFD) and Geographic Information System (GIS) capabilities to refine an existing 2D urban micro- and bioclimatic modelling approach. In particular, we account for the vertical and horizontal variability in wind speed and air temperature patterns in the urban canopy layer. Our results highlight the importance of variability of these patterns in analysing urban heat development, intensity and thermal comfort at multiple heights from the ground surface. Neglecting vertical and horizontal variability, non-integrated CFD modelling underestimates mean land surface temperature by 7.8 °C and the Universal Thermal Climate Index by 6.9 °C compared to CFD-integrated modelling. Due to the strong implications of wind and air temperature patterns on the relationship between surface temperature and human thermal comfort, we urge caution when relying on studies solely based on surface temperatures for urban heat assessment and hot spot analysis as this could lead to misinterpretations of hot and cool spots in cities and, thus, mask the anticipated effects of adaptation measures. The integrated CFD-GIS modelling approach, which we demonstrate, improves urban climate studies and supports more comprehensive assessments of urban heat and human thermal comfort to sustainably develop resilient cities.

Health risk assessment of exposure to ambient formaldehyde in carpet manufacturing industries.

Formaldehyde is categorized as a definitive carcinogen by the International Agency for Research on Cancer. To the best of our knowledge, no study has assessed the health risks of occupational exposure of workers in carpet manufacturing plants to formaldehyde. Therefore, this study assesses the health risks of the occupational exposure to formaldehyde of 67 male workers in carpet manufacturing plants in Iran in 2022. Exposure to formaldehyde was quantitatively determined after collecting personal exposure samples from the workers' respiratory zone and spectrophotometric analysis based on method number 3500 of the National Institute of Occupational Safety and Health. In the next step, the carcinogenic and noncarcinogenic risks based on personal exposure to formaldehyde were evaluated. Sensitivity analyses were employed using the Monte Carlo simulation method. The mean inhalation exposure of workers to formaldehyde was 0.636 mg m-3. The inhalation cancer risk value based on the integrated risk information system for formaldehyde was 4.06×10-4 ± 3.17×10-5 (mean ± standard deviation), which exceeded the value reported by the US Environmental Protection Agency. An unacceptable carcinogenic risk level was found in 75.6% of workers. The highest mean inhalation cancer risk was 6.74×10-4 (i.e., 6.74 additional cases per 10,000 employees exposed) was found in sizing post employees. The hazard quotient of formaldehyde was 0.311±0.024. The formaldehyde concentration had a considerable effect on the health risk. The findings of this study provide valuable scientific information that supports the development of future policies to enhance the health status of employees in carpet manufacturing plants.

Current and next-generation formulation strategies for inactivated polio vaccines to lower costs, increase coverage, and facilitate polio eradication.

Implementation of inactivated polio vaccines (IPV) containing Sabin strains (sIPV) will further enable global polio eradication efforts by improving vaccine safety during use and containment during manufacturing. Moreover, sIPV-containing vaccines will lower costs and expand production capacity to facilitate more widespread use in low- and middle-income countries (LMICs). This review focuses on the role of vaccine formulation in these efforts including traditional Salk IPV vaccines and new sIPV-containing dosage forms. The physicochemical properties and stability profiles of poliovirus antigens are described. Formulation approaches to lower costs include developing multidose and combination vaccine formats as well as improving storage stability. Formulation strategies for dose-sparing and enhanced mucosal immunity include employing adjuvants (e.g. aluminum-salt and newer adjuvants) and/or novel delivery systems (e.g. ID administration with microneedle patches). The potential for applying these low-cost formulation development strategies to other vaccines to further improve vaccine access and coverage in LMICs is also discussed.

Enhanced Ambient Sensing Environment-A New Method for Calibrating Low-Cost Gas Sensors.

Accurate calibration of low-cost gas sensors is, at present, a time consuming and difficult process. Laboratory calibration and field calibration methods are currently used, but laboratory calibration is generally discounted due to poor transferability, and field methods requiring several weeks are standard. The Enhanced Ambient Sensing Environment (EASE) method described in this article, is a hybrid of the two, combining the advantages of a laboratory calibration with the increased accuracy of a field calibration. It involves calibrating sensors inside a duct, drawing in ambient air with similar properties to the site where the sensors will operate, but with the added feature of being able to artificially increases or decrease pollutant levels, thus condensing the calibration period required. Calibration of both metal-oxide (MOx) and electrochemical (EC) gas sensors for the measurement of NO2 and O3 (0-120 ppb) were conducted in EASE, laboratory and field environments, and validated in field environments. The EC sensors performed marginally better than MOx sensors for NO2 measurement and sensor performance was similar for O3 measurement, but the EC sensor nodes had less node inter-node variability and were more robust. For both gasses and sensor types the EASE calibration outperformed the laboratory calibration, and performed similarly to or better than the field calibration, whilst requiring a fraction of the time.

Assessment of cardiac function in children by strain imaging and its correlation with conventional echocardiographic parameter.

Background: The objectives of this study were to find out of normal reference value for age-dependent longitudinal strain values in children and find its correlation with conventional echocardiographic parameters. Methods: In total, 100 healthy normal children aged between 2 and 15 years were enrolled and divided into three age groups, namely, 2-5 years, 5-10 years, and 10-15 years. Using the GE Vivid 7 ultrasound platform with 4 or 7 MHz probes, both LV and RV global longitudinal strains and conventional echocardiographic parameters were acquired. Results: In normal healthy children, left ventricular GLS values were -20.10 to -19.68 (mean: -19.89), -21.93 to -21.02 (mean: -21.48), and -20.87 to -20.41 (mean: -20.64)) in children aged 2-5 years, 5-10 years, and 10-15 years and right ventricular GLS values were -16.80 to -16.44 (mean: -16.62), -27.85 to -27.27 (mean: -27.56), -28.44 to -27.93 (mean: -28.19) in the above three groups, respectively. No significant increase was noted in the left ventricular strain value from basal to the apical segment from age group 2 years to 15 years and no gender differences were seen. None of the conventional echocardiographic parameters commonly used to assess the left or right ventricular systolic function had a significant correlation with LVGLS and RVGLS. Conclusions: The mean LVGLS values were -19.89, -21.48, and -20.64 and RVGLS were -16.62, -27.56, and -28.19 in healthy normal children aged 2-5 years, 5-10 years, and 10-15 years, respectively, and conventional echocardiographic parameters did not have any significant correlation with these values.

Exposure assessment of PM2.5 in temple premises and crematoriums in Kanpur, India.

Regular use of incense and earthen lamps in temples leads to the release of particulate matter (PM), airborne flecks, and gaseous pollutants. Similarly, the cremation of dead bodies using timber and other accessories such as incense, organic chemicals containing carbon, and clothes generates air pollutants. It is currently unclear how much emissions and exposure these activities may lead. This work attempts to fill this gap in our understanding by assessing the associated emissions of PM2.5 and the corresponding exposure. Ten temples and two cremation grounds were considered for the sampling of PM2.5. The average PM2.5 concentration at the ten temples and the two crematoriums was found to be 658.30 ± 112.63 µg/m3 and 1043.50 ± 191.63 µg/m3, respectively. The range of real-time PM2.5 data obtained from the nearest twelve stations located in the vicinity was 113-191 µg/m3. The exposure assessment in terms of deposition dose was carried out using the ICRP model. The maximum and minimum total respiratory deposition dose rate for PM2.5 for temples was 175.75 µg/min and 101.15 µg/min, respectively. For crematoriums, the maximum and minimum value of same was 252.3 µg/min and 194.31 µg/min, respectively, for an exposure period of 10 min.

Exposure and dose assessment of school children to air pollutants in a tropical coastal-urban area.

This study estimates exposure and inhaled dose to air pollutants of children residing in a tropical coastal-urban area in Southeast Brazil. For that, twenty-one children filled their time-activities diaries and wore the passive samplers to monitor NO2. The personal exposure was also estimated using data provided by the combination of WRF-Urban/GEOS-Chem/CMAQ models, and the nearby monitoring station. Indoor/outdoor ratios were used to consider the amount of time spent indoors by children in homes and schools. The model's performance was assessed by comparing the modelled data with concentrations measured by urban monitoring stations. A sensitivity analyses was also performed to evaluate the impact of the model's height on the air pollutant concentrations. The results showed that the mean children's personal exposure to NO2 predicted by the model (22.3 µg/m3) was nearly twice to those measured by the passive samplers (12.3 µg/m3). In contrast, the nearest urban monitoring station did not represent the personal exposure to NO2 (9.3 µg/m3), suggesting a bias in the quantification of previous epidemiological studies. The building effect parameterisation (BEP) together with the lowering of the model height enhanced the air pollutant concentrations and the exposure of children to air pollutants. With the use of the CMAQ model, exposure to O3, PM10, PM2.5, and PM1 was also estimated and revealed that the daily children's personal exposure was 13.4, 38.9, 32.9, and 9.6 µg/m3, respectively. Meanwhile, the potential inhalation daily dose was 570-667 µg for PM2.5, 684-789 µg for PM10, and 163-194 µg for PM1, showing to be favourable to cause adverse health effects. The exposure of children to air pollutants estimated by the numerical model in this work was comparable to other studies found in the literature, showing one of the advantages of using the modelling approach since some air pollutants are poorly spatially represented and/or are not routinely monitored by environmental agencies in many regions.

Nature-based solutions efficiency evaluation against natural hazards: Modelling methods, advantages and limitations.

Nature-based solutions (NBS) for hydro-meteorological risks (HMRs) reduction and management are becoming increasingly popular, but challenges such as the lack of well-recognised standard methodologies to evaluate their performance and upscale their implementation remain. We systematically evaluate the current state-of-the art on the models and tools that are utilised for the optimum allocation, design and efficiency evaluation of NBS for five HMRs (flooding, droughts, heatwaves, landslides, and storm surges and coastal erosion). We found that methods to assess the complex issue of NBS efficiency and cost-benefits analysis are still in the development stage and they have only been implemented through the methodologies developed for other purposes such as fluid dynamics models in micro and catchment scale contexts. Of the reviewed numerical models and tools MIKE-SHE, SWMM (for floods), ParFlow-TREES, ACRU, SIMGRO (for droughts), WRF, ENVI-met (for heatwaves), FUNWAVE-TVD, BROOK90 (for landslides), TELEMAC and ADCIRC (for storm surges) are more flexible to evaluate the performance and effectiveness of specific NBS such as wetlands, ponds, trees, parks, grass, green roof/walls, tree roots, vegetations, coral reefs, mangroves, sea grasses, oyster reefs, sea salt marshes, sandy beaches and dunes. We conclude that the models and tools that are capable of assessing the multiple benefits, particularly the performance and cost-effectiveness of NBS for HMR reduction and management are not readily available. Thus, our synthesis of modelling methods can facilitate their selection that can maximise opportunities and refute the current political hesitation of NBS deployment compared with grey solutions for HMR management but also for the provision of a wide range of social and economic co-benefits. However, there is still a need for bespoke modelling tools that can holistically assess the various components of NBS from an HMR reduction and management perspective. Such tools can facilitate impact assessment modelling under different NBS scenarios to build a solid evidence base for upscaling and replicating the implementation of NBS.

Developing a manufacturing process to deliver a cost effective and stable liquid human rotavirus vaccine.

Despite solid evidence of the success of rotavirus vaccines in saving children from fatal gastroenteritis, more than 82 million infants worldwide still lack access to a rotavirus vaccine. The main barriers to global rotavirus vaccine coverage include cost, manufacturing capacity and suboptimal efficacy in low- and lower-middle income countries. One vaccine candidate with the potential to address the latter is based on the novel, naturally attenuated RV3 strain of rotavirus, RV3-BB vaccine administered in a birth dose strategy had a vaccine efficacy against severe rotavirus gastroenteritis of 94% at 12 months of age in infants in Indonesia. To further develop this vaccine candidate, a well-documented and low-cost manufacturing process is required. A target fully loaded cost of goods (COGs) of ≤$3.50 per course of three doses was set based on predicted market requirements. COGs modelling was leveraged to develop a process using Vero cells in cell factories reaching high titers, reducing or replacing expensive reagents and shortening process time to maximise output. Stable candidate liquid formulations were developed allowing two-year storage at 2-8 °C. In addition, the formulation potentially renders needless the pretreatment of vaccinees with antacid to ensure adequate gastric acid neutralization for routine oral vaccination. As a result, the formulation allows small volume dosing and reduction of supply chain costs. A dose ranging study is currently underway in Malawi that will inform the final clinical dose required. At a clinical dose of ≤6.3 log10 FFU, the COGs target of ≤$3.50 per three dose course was met. At a clinical dose of 6.5 log10 FFU, the final manufacturing process resulted in a COGs that is substantially lower than the current average market price, 2.44 USD per dose. The manufacturing and formulation processes were transferred to BioFarma in Indonesia to enable future RV3-BB vaccine production.

Diagnostic and economic evaluation of a point-of-care test for respiratory syncytial virus.

Respiratory syncytial virus is a common cause of bronchiolitis. Historically, point-of-care tests have involved antigen detection technology with limited sensitivity. The aim of this study was to prospectively evaluate the diagnostic accuracy and model the economic impact of the Roche cobas® Liat® point-of-care influenza A/B and respiratory syncytial virus test. The "DEC-RSV" study was a multi-centre, prospective, observational study in children under 2 years presenting with viral respiratory symptoms. A nasopharyngeal aspirate sample was tested using the point-of-care test and standard laboratory-based procedures. The primary outcome was accuracy of respiratory syncytial virus detection. The cost implications of adopting a point-of-care test were modelled using study data. A total of 186 participants were recruited, with both tests performed on 177 samples. The point-of-care test was invalid for 16 samples (diagnostic yield 91%) leaving 161 available for primary analysis. After resolving discrepancies, the cobas® Liat® respiratory syncytial virus test had 100.00% (95% CI 96.07%-100.00%) sensitivity and 98.53% (95% CI 92.08%-99.96%) specificity. Median time to result was 0.6 h (interquartile range (IQR) 0.5-1) for point-of-care testing and 28.9 h (IQR 26.3-48.1) for standard laboratory testing. Estimated non-diagnostic cost savings for 1000 patients, based on isolation decision-making on point-of-care test result, were £57 010, which would increase to £94 847 when cohort nursing is used. In young children the cobas® Liat® point-of-care respiratory syncytial virus test has high diagnostic accuracy using nasopharyngeal aspirates (currently an off-licence sample type). Time to result is clinically important and was favourable compared to laboratory-based testing. The potential exists for cost savings when adopting the point-of-care test.

Assessment of clean cooking technologies under different fuel use conditions in rural areas of Northern India.

The study was conducted to assess the performance of improved and traditional cookstoves using wood as a fuel and three combinations of other fuel mixes - (i) wood and cow dung, (ii) wood and mustard stalks, and (iii) cow dung and mustard stalks). Energy and emission parameters such as specific energy consumption (SEC), emission factors (EFs) of carbon monoxide (CO), particulate matter (PM) and black carbon (BC) were used to compare four different types of cookstoves. These included top-feed forced draft (TF-FD), top-feed natural draft (TF-ND), front-feed natural draft (FF-ND) and front-feed traditional (FF-TR) cookstoves. Controlled cooking test (CCT) was used as the test protocol. The results showed the performance of improved cookstove technologies can vary based on the fuel used for cooking. It was observed that emission factors for PM and CO increased by 67-96% and 45-90% respectively when all three improved cookstoves were tested with three fuel combinations against wood as cooking fuel. Among the tested cookstoves, a marked difference was observed between performance of forced draft and natural draft cookstoves. Forced draft cookstoves emitted higher amount of all pollutant emissions compared to natural draft cookstoves when used with mustard stalks in combination with either wood or cowdung. The results are of critical importance given that forced draft cookstoves have been promoted in geographical regions where fuel mix use is prevalent. Therefore, forced draft cookstove might not be the right choice when the goal is climate mitigation and reduction in impact on human health. It is imperative to study comprehensively the influence of various field variables on performance of cookstoves, which have severe implications on the performance of cookstoves.

A new approach to airway assessment-"Line of Sight" and more. Recommendations of the Task Force of Airway Management Foundation (AMF).

Assessment of airway is recommended by every airway guideline to ensure safe airway management. Numerous unifactorial and multifactorial tests have been used for airway assessment over the years. However, there is none that can identify all the difficult airways. The reasons for the inadequacy of these methods of airway assessment might be their dependence on difficult to remember and apply mnemonics and scores, inability to identify all the variations from the "normal", and their lack of stress on evaluating the non-patient factors. Airway Management Foundation (AMF) experts and members have been using a different approach, the AMF Approach, to overcome these problems inherent to most available models of airway assessment. This approach suggests a three-step model of airway assessment. The airway manager first makes the assessment of the patient through focused history, focused general examination, and focused airway assessment using the AMF "line of sight" method. The AMF "line of sight" method is a non-mnemonic, non-score-based method of airway assessment wherein the airway manager examines the airway along the line of sight as it moves over the airway and notes down all the variations from the normal. Assessment of non-patient factors follows next and finally there is assimilation of all the information to help identify the available, difficult, and impossible areas of the airway management. The AMF approach is not merely intubation centric but also focuses on all other methods of securing airway and maintaining oxygenation. Airway assessment in the presence of contagion like COVID-19 is also discussed.

Public health implications of particulate matter inside bus terminals in Sao Paulo, Brazil.

Good quality ambient air is recognised as an important factor of social justice. In addition, providing access to high-capacity public transportation in big cities is known to be a good practice of social equity, as well as economic and environmental sustainability. However, the health risks associated with air pollution are not distributed equally across cities; the most vulnerable people are more exposed to ambient air as they commute to work and wait for buses or trains at the stations. The overall goal of this work was to assess the determinants of human exposure to particulate matter (PM) during commuting time spent inside bus terminals in the Metropolitan Area of Sao Paulo (MASP), in Brazil. Fine and coarse particles were collected at four bus terminals in the MASP. The concentrations of PM and its harmful constituents (black carbon and metals) were used in order to estimate potential doses and the associated health risk during the time spent at bus terminals in the MASP. Our findings show that bus commuters travelling through the bus terminal in the MASP on weekdays inhaled up to 94% higher doses of PM10 than did those travelling outside the terminal; even on weekends, that difference was as high as 88%. Our risk assessment indicated that time spent inside a bus terminal can result in an intolerable health risk for commuters, mainly because of the Cr present in fine particles. Although bus commuters are exposed to fine particle concentrations up to 2 times lower than the worldwide average, we can affirm that inhalable particles in the MASP bus terminals pose a high carcinogenic risk to the daily users of those terminals, mainly those in the most susceptible groups, which include people with heart or lung disease, older adults and children.