ABSTRACT
COVID-19 forced students to rely on online learning using multimedia tools, and multimedia learning continues to impact education beyond the pandemic. In this study, we combined behavioral, eye-tracking, and neuroimaging paradigms to identify multimedia learning processes and outcomes. College students viewed four video lectures including slides with either an onscreen human instructor, an animated instructor, or no onscreen instructor. Brain activity was recorded via fMRI, visual attention was recorded via eye-tracking, and learning outcome was assessed via post-tests. Onscreen presence of instructor, compared with no instructor presence, resulted in superior post-test performance, less visual attention on the slide, more synchronized eye movements during learning, and higher neural synchronization in cortical networks associated with socio-emotional processing and working memory. Individual variation in cognitive and socio-emotional abilities and intersubject neural synchronization revealed different levels of cognitive and socio-emotional processing in different learning conditions. The instructor-present condition evoked increased synchronization, likely reflecting extra processing demands in attentional control, working memory engagement, and socio-emotional processing. Although human instructors and animated instructors led to comparable learning outcomes, the effects were due to the dynamic interplay of information processing vs. attentional distraction. These findings reflect a benefit-cost trade-off where multimedia learning outcome is enhanced only when the cognitive benefits motivated by the social presence of onscreen instructor outweigh the cognitive costs brought about by concurrent attentional distraction unrelated to learning.
Subject(s)
Learning , Multimedia , Humans , Cognition/physiology , Memory, Short-Term/physiology , StudentsABSTRACT
China is one of the major global consumers of veterinary antibiotics. Insufficient recognition of emissions and environmental contamination hamper global efforts to prevent antibiotic resistance development. This pioneering study combined empirical data and modeling approaches to predict total 2010-2020 emissions of 80 veterinary antibiotics ranging from 23,110 to 40,850 tonnes/year, after 36-50% antibiotic removal by manure treatment. Following an initial increase of 10% from 2010 to 2015, emissions declined thereafter by 43%. While 85% of emissions discharged into soils, approximately 56%, 23%, and 18% of environmental residue were ultimately distributed in soils, freshwaters, and seawaters under steady-state conditions. In 2020, 657 (319-1470) tonnes entered the ocean from inland freshwaters. Median ∑antibiotics concentrations were estimated at 4.7 × 103 ng/L in freshwaters and 2.9 ng/g in soils, with tetracyclines and sulfonamides as the predominant components. We identified 44 veterinary antibiotics potentially posing high risks of resistance development in freshwaters, with seven exhibiting high risks in >10% of Chinese freshwater areas. Tetracyclines were the category with the most antibiotics exhibiting elevated risks; however, sulfamethylthiazole demonstrated the highest individual compound risk. The Haihe River Basin displayed the highest susceptibility overall. The findings offer valuable support for control of veterinary antibiotic contamination in China.
Subject(s)
Anti-Bacterial Agents , Water Pollutants, Chemical , Environmental Monitoring , Tetracyclines/analysis , Soil/chemistry , Rivers/chemistry , China , Water Pollutants, Chemical/analysis , Risk AssessmentABSTRACT
China is a significant producer and consumer of various brominated flame retardants (BFRs), raising environmental concerns due to their widespread presence and potential threats to ecosystems and organisms. This study adopts a life cycle perspective, combining material flow analysis, multimedia environmental modeling, and ecological risk assessment to systematically analyze the substance metabolism and ecological risks of six BFR types in China from 1970 to 2021. The findings reveal that China's cumulative BFR consumption reached 3.3 Mt, with the electronics sector being the predominant contributor at 52.1%. Consequently, 1.5 kt of BFRs were released into the environment, with 24.9%, 31.5%, and 43.6% being discharged into the air, water, and soil, respectively. Notably, the proportion of novel BFRs in emissions has steadily increased over the years, exemplified by the increase in decabromodiphenyl ethane (DBDPE) from 21.3% in 2010 to 30.1% in 2021. Geographically, BFR concentrations are higher in the eastern and southwestern regions compared to those in the northwest. Presently, certain BFRs like tetrabromobisphenol A (TBBPA) and DBDPE exhibit moderate to high ecological risks, primarily concentrated in the Shandong and Sichuan provinces. A combination of efficient recycling, emission control, and substitution with novel flame-retardant can minimize the exposure of BFRs to the environment and organisms.
Subject(s)
Flame Retardants , Flame Retardants/analysis , China , Risk Assessment , Environmental MonitoringABSTRACT
Fluoride pollution in water has become a global challenge. This challenge especially affects China as a country experiencing serious fluoride pollution. While the have been past studies on the spatial distribution of fluoride, there has been less attention on different forms of fluoride. This study collected 176 samples (60, 40, and 76 ice, water, and sediment samples, respectively) from Lake Ulansuhai during the freezing period. The occurrence and spatial distribution characteristics of fluoride in lake ice-water-sediment were explored using Kriging interpolation, Piper three-line diagram, and Gibbs diagram analysis methods. The migration and transformation of fluoride during the freezing period were revealed and the factors influencing fluoride concentration in the water body were discussed considering the hydrochemical characteristics of lake surface water. The results showed that the average fluoride concentrations in the upper ice, middle ice and lower ice were 0.18, 0.09, and 0.12 mg/L, respectively, decreasing from north to south in the lake. The average concentrations of fluoride in surface water and bottom water were 0.63 and 0.83 mg/L, respectively. The concentrations of fluoride in ice and water were within the World Health Organisation drinking water threshold of 1.50 mg/L and the Class III Chinese surface water standard (GB3838-2002). The average sediment total fluorine was 1344.38 ± 200 mg/kg, significantly exceeding the global average (321 mg/kg) and decreasing with depth. The contents of water soluble, exchangeable, Fe/Mn bound, organic bound, and residual fluorides were 40.22-47.18, 13.24-43.23, 49.52-160.48, and 71.59-173.03 mg/kg, respectively. There was a significant positive correlation between fluoride concentration in ice and that in water. The change in fluoride concentration in water was mainly due to specific climatic and geographical conditions, pH, hydrochemical characteristics and ice sealing. This study is of great significance for the management of high-fluorine lakes in arid and semi-arid areas.
Subject(s)
Fluorides , Water Pollutants, Chemical , Ice/analysis , Lakes/chemistry , Freezing , Fluorine/analysis , Environmental Monitoring/methods , Water/chemistry , China , Water Pollutants, Chemical/analysisABSTRACT
In the sparse studies for multiple pathway exposure, attention has predominantly been directed towards developed regions, thereby overlooking the exposure level and health outcome for the inhabitants of the semi-arid regions in northwest China. However, cities within these regions grapple with myriad challenges, encompassing insufficient sanitation infrastructure and outdated heating. In this study, we analyzed the characteristics and sources of polycyclic aromatic hydrocarbons (PAHs) pollution in PM2.5, water, diet, and dust during different periods in Lanzhou, and estimated corresponding carcinogenic health risk through inhalation, ingestion, and dermal absorption. Our observations revealed the concentrations of PAHs in PM2.5, food, soil, and water are 200.11 ng m-3, 8.67 mg kg-1, 3.91 mg kg-1, and 14.5 ng L-1, respectively, indicating that the Lanzhou area was seriously polluted. Lifetime incremental cancer risk (ILCR) showed a heightened cancer risk to men compared to women, to the younger than the elderly, and during heating period as opposed to non-heating period. Notably, the inhalation was the primary route of PAHs exposure and the risk of exposure by inhalation cannot be ignored. The total environmental exposure assessment of PAHs can achieve accurate prevention and control of PAHs environmental exposure according to local conditions and targets.
Subject(s)
Environmental Exposure , Polycyclic Aromatic Hydrocarbons , China/epidemiology , Polycyclic Aromatic Hydrocarbons/analysis , Polycyclic Aromatic Hydrocarbons/toxicity , Humans , Risk Assessment , Female , Male , Air Pollutants/analysis , Middle Aged , Adult , Particulate Matter/analysis , Environmental Monitoring , Cities , Dust/analysis , Aged , Young AdultABSTRACT
Understanding normal probability distributions is a crucial objective in mathematics and statistics education. Drawing upon cognitive psychology research, this study explores the use of drawings and visualizations as effective scaffolds to enhance students' comprehension. Although much research has documented the helpfulness of drawing as a research tool to reveal students' knowledge states, its direct utility in advancing higher-order cognitive processes remains understudied. In Study 1, qualitative methods were utilized to identify common misunderstandings among students regarding canonical depictions of the normal probability distribution. Building on these insights, Study 2 experimentally compared three instructional videos (static slides, dynamic drawing, and dynamic drawings done by a visible hand). The hand drawing video led to better learning than the other versions. Study 3 examined whether the benefits from observing a hand drawing could be reproduced by a dynamic cursor moving around otherwise static slides (without the presence of a hand). Results showed no significant learning difference between observing a hand drawing and a moving cursor, both outperforming a control. This research links the cognitive process of drawing with its educational role and provides insights into its potential to enhance memory, cognition, and inform instructional methods.
ABSTRACT
Outdated information (i.e., information that is not or no longer accurate) continues to be automatically activated during reading and can hinder learning processes. Thus, it is important to understand which factors influence the activation of outdated information and, therefore, knowledge revision processes. In three online experiments, we investigated how illustrating updated or outdated information via pictures influences the activation of outdated information. In Experiments 1 (N = 421) and 2 (N = 422), we varied whether participants read texts containing outdated information that was later updated (outdated text) or texts containing only updated information (consistent text). In addition, the updated information was or was not illustrated by a picture. In Experiment 3 (N = 441), participants read outdated texts, and we varied whether the outdated, the updated, or no information was illustrated. In all experiments, we measured reading times for a target sentence referring to the updated information and the sentence following the target sentence. Results showed that target sentences' reading times were faster for illustrated than for non-illustrated texts (Experiments 1 and 2). Moreover, reading times were longer when the outdated information was illustrated than when the updated information was illustrated (Experiment 3). These results suggest that pictures overall facilitate cognitive processes during reading, but their content matters: Pictures showing the updated information had a greater impact on reading times than pictures showing the outdated information. The results extend existing theories on knowledge revision but also reading comprehension, by demonstrating how pictures might influence cognitive processes during reading.
ABSTRACT
BACKGROUND: Medical education increasingly relies on digital learning materials. Despite recognition by the Association of American Medical Colleges Institute for Improving Medical Education, medical education design often fails to consider quality multimedia design principles. Further, the AAMC-IIME issued a call to study the role of design principles in medical education. Thus, the current study investigated the cognitive and affective effects of redesigning PowerPoint slides used to support pharmacology content during the preclinical years of medical school training. METHODS: Researchers implemented a quasi-experimental design, using traditionally-designed (original) slides with a Traditional group (n = 100) and slides redesigned to follow principles from the Cognitive Theory of Multimedia Learning with an Experimental group (n = 40). Participants in the Experimental group completed a post-survey incorporating the Situational Interest Survey for Multimedia to indicate motivational engagement with the media. Students in the Experimental group also responded to additional preference questions. Researchers analyzed survey responses and students' scores in pharmacology-related coursework across the preclinical Foundations Phase of training to determine the impact on achievement and motivation. RESULTS: Findings related to learner achievement showed a modest but significant increase in the Experimental group compared to the Traditional group in the Cardiac, Pulmonary, and Renal (CPR) educational block (105%, normalized to Traditional group, p = 0.013) and cumulative pharmacology grades (101%, normalized to Traditional group, p = 0.043). Additionally, participants in the Experimental group indicated a significantly higher average triggered situational interest in redesigned slides (M = 4.85, SD = 0.25) than the original slides (M = 3.23, SD = 1.40, t=-6.33, p < 0.001). Similarly, the interest rating of the redesigned slides (M = 4.87, SD = 0.24) was significantly greater than that of the original slides (M = 3.89, SD = 0.86, t=-6.824, p < 0.001). Moreover, results further indicated significant differences in the maintained-feeling and maintained-value constructs, and all participants in the Experimental group indicated a preference for the redesigned slides. CONCLUSIONS: The findings provide strong evidence in support of using the Cognitive Theory of Multimedia Learning design principles to intentionally design media in medical education. In addition to increased achievement scores, students in the Experimental group demonstrated significantly higher levels of situational interest in the redesigned slides, especially triggered interest and maintained-feeling interest. Medical education learning designers should seriously consider redesigning media to achieve similar results.
Subject(s)
Learning , Multimedia , Humans , Students , Motivation , Educational MeasurementABSTRACT
Advancements in assisted driving technologies are expected to enable future passengers to use a wide range of multimedia applications in electric vehicles (EVs). To address the bandwidth demands for high-resolution and immersive videos during peak traffic, this study introduces a bandwidth-management algorithm to support differentiated streaming services in heterogeneous vehicle-to-everything (V2X) networks. By leveraging cellular 6G base stations, along with Cell-Free (CF) Massive Multi-Input Multi-Output (mMIMO) Wi-Fi 7 access points, the algorithm aims to provide a high-coverage, high-speed, and low-interference V2X network environment. Additionally, Li-Fi technology is employed to supply extra bandwidth to vehicles with limited connectivity via V2V communication. Importantly, the study addresses the urgency and prioritization of different applications to ensure the smooth execution of emergency applications and introduces a pre-downloading mechanism specifically for non-real-time applications. Through simulations, the algorithm's effectiveness in meeting EV users' bandwidth needs for various multimedia streaming applications is demonstrated. During peak-bandwidth-demand periods, users experienced an average increase in bandwidth of 47%. Furthermore, bandwidth utilization across the V2X landscape is significantly improved.
ABSTRACT
Learning 2D sectional anatomy facilitates the comprehension of 3D anatomical structures, anatomical relationships, and radiological anatomy. However, the efficacy of technology-enhanced collaborative instructional activities in sectional anatomy remains unclear, especially if theoretical frameworks, namely the Cognitive Theory of Multimedia Learning (CTML), are applied in instructional design. Thus, this study compared the educational impact of distinct 45-min-long technology-enhanced collaborative learning tasks in sectional anatomy. A sample of 115 first-year medical students was randomly divided into three experimental groups that used different supporting technologies to learn the sectional anatomy of the chest: IMAIOS e-learning platform and Microsoft Surface Hub (n = 37); anatomage table (n = 38); anatomage table with CTML-based presets (n = 40). Prelearning and postlearning tests revealed that significant knowledge gains in sectional anatomy were obtained by all groups even though no inter-group differences were found. Moreover, a five-point Likert scale questionnaire showed that the learning session was highly valued by all participants and that users of the anatomage with CTML-based presets reported higher enjoyment than users of the IMAIOS system (mean difference = 0.400; p = 0.037). In addition, students using the IMAIOS system and the anatomage with CTML-based presets provided System Usability Scale (SUS) scores of 67.64 and 67.69, respectively, reaching the benchmark of usability. By contrast, students using the anatomage table without presets awarded a SUS score of 64.14. These results suggest that the integration of multimedia technologies in anatomy teaching and learning should be grounded on CTML principles of instructional design. Otherwise, students' perceptions of ed-tech usability are potentially hindered.
ABSTRACT
This systematic review and meta-analysis aimed to explore the effectiveness of preoperative multimedia educational sessions on the levels of anxiety and satisfaction among women undergoing cesarean section (CS). The Scopus, PubMed, and Cochrane databases were searched without language limitations for eligible randomized controlled trials (RCTs) published from their inception up to October 15, 2023. A random-effect meta-analysis was conducted, and the quality of this meta-analysis was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Seven RCTs (n = 1006 women) met the inclusion criteria. Preoperative multimedia sessions were found to significantly reduce anxiety levels (n = 6 RCTs, weighted mean difference: -3.10; 95 percent confidence intervals (CI): -4.48, -1.73; I2 = 44.24 percent, moderate certainty of evidence) compared to the control group. However, there was no significant difference between the two groups regarding women's satisfaction after surgery (n = 5 RCTs, risk ratio: 1.37; 95 percent CI: 0.76, 2.50; I2 = 98.26 percent, moderate certainty of evidence). Leave-one-out sensitivity analysis showed robustness of the outcomes. The findings of this meta-analysis suggest that providing multimedia educational programs before surgery could potentially have a beneficial effect on the levels of anxiety experienced by women undergoing CS. However, it is imperative to validate these results through larger samples and multi-centered RCTs.
Subject(s)
Anxiety , Cesarean Section , Multimedia , Patient Satisfaction , Preoperative Care , Female , Humans , Pregnancy , Anxiety/prevention & control , Cesarean Section/psychology , Patient Education as Topic/methods , Preoperative Care/methodsABSTRACT
The COVID-19 pandemic was a challenging period for young people in Mexico, particularly those already contending with social and structural inequality. In March 2021, the Colectivo Frontera, a research collective based in Mexico City, Mexico, which works on advancing equity and psychosocial wellbeing among marginalized communities, carried out an 8-week, online project to provide psychosocial support and promote resilience for marginalized young people from different locations in Mexico. The project entailed weekly journaling with the Pandemic Journaling Project (PJP), as well as weekly phone sessions with a mental health specialist who provided emotional support (acompañamiento emocional) through practices of active listening. The project culminated in the Escucha (Listen) Podcast for which each youth participant created an episode about their experiences during the pandemic. Many also submitted a photo to accompany their recording; one produced a song. Participant episodes were compiled into a series of five chapters. Each chapter of the podcast centers on a common theme, including reflections on loved ones lost to COVID-19, social fragmentation, gender-based constraints on expressing emotions, and the experiences and perspectives of children. The project provides a compelling example of a low-cost approach to providing support for the mental health and wellbeing of marginalized young people. It also demonstrates the importance of creating projects that help young people make meaningful connections and that leverage their creativity to foster resilience, improve social cohesion, and elevate their perspectives and voices.
Subject(s)
COVID-19 , Social Marginalization , Humans , Mexico , Adolescent , Young Adult , Social Marginalization/psychology , Resilience, Psychological , Social Support , Male , Female , Mental Health , PandemicsABSTRACT
BACKGROUND: Patient informed consent is a crucial subject in preoperative care of patients before elective hand surgery, ensuring that patients have the necessary information and a comprehensive understanding to make autonomous decisions. The use of video-based informed consent systems is an innovative concept to enhance the consent process with multimedia tools. In addition to the conventional process, mostly relying on verbal communication and written documents, the video-based approach aims to present information in a standardized and visually appealing format. METHODS: In this study, 33 patients were asked to watch a video on a tablet about the planned elective hand surgery after a conventional pre-treatment consultation including informed consent throughout verbal explanations and paper forms by an attending physician or resident. All patients were asked to complete a questionnaire after watching the video. RESULTS: An overwhelming majority of participants, specifically 97.0%, stated that the video improved their understanding of the upcoming surgery. 90.9% of the participant would refer the video to other patients undergoing elective hand surgery, while 72.7% of participants indicated that they would have appreciated the opportunity to view an informational video before undergoing different types of surgeries in the past. CONCLUSION: The use of a video-based patient information system in elective hand surgery had a positive impact on patient education and satisfaction with the informed consent process. Therefore, it is a powerful tool in preoperative management to guarantee a standardized and educative informed consent.
Subject(s)
Elective Surgical Procedures , Hand , Informed Consent , Video Recording , Humans , Informed Consent/standards , Hand/surgery , Female , Middle Aged , Male , Adult , Aged , Patient Education as Topic/methods , Surveys and Questionnaires , Patient Satisfaction , Young AdultABSTRACT
As academic libraries shift services to meet the changing needs of patrons after the COVID-19 pandemic, educational technologies and services to support them require updating. Patrons using technology that was once associated with hands-on learning and in-person interactions are preferring flexible and hybrid iterations. In this case study, the authors describe and analyze the pivot of three technology services at the Spencer S. Eccles Health Sciences Library in the post-COVID-19 environment. Technologies discussed include a multimedia studio, virtual reality (VR), and a three-dimensional (3D) printing service. This case study utilizes available usage stats and survey data to demonstrate and provide rationale for the changing strategy in services for each technology "hub." The multimedia studio has been dismantled in favor of the equipment being available for checkout, VR is now available in a staff-supported classroom, and a 3D printing service has been fully automated through an online submission platform. These examples, and the rationale behind changing them, can help offer ideas for other libraries to help find solutions that meet the demands of a changing learning environment.
Subject(s)
COVID-19 , Libraries, Medical , Humans , Pandemics , Printing, Three-Dimensional , LearningABSTRACT
Digital technology creates new opportunities to design multisensory learning experiences. Evidence suggests that digital innovation can greatly benefit health education, including nutrition programs. The COVID-19 pandemic disrupted the education sector, forcing schools to modify standard practices from exclusively in-person delivery to online or blended learning. Digitalized curriculums became particularly useful as an Emergency Remote Teaching tool. This article focuses on developing and implementing a multimedia, multisensory, and scalable Hip-Hop Healthy Eating and Living in Schools (H.E.A.L.S.) Nutrition-Math Curriculum (NMC). NMC comprises 20 lessons-music-based multimedia resources used in the classroom or at home. Fourteen lessons represent self-directed online modules (asynchronous learning) hosted on a Learning Management System (LMS) called "Gooru." The remaining six lessons are teacher-facilitated (in person or using Zoom) review sessions (synchronous learning). The article discusses (1) the development of NMC through the lens of the Multisensory Multilevel Health Education Model (MMHEM), (2) the high acceptability of NMC evaluated using a mixed-methods design among minoritized fifth-grade students attending an after-school program, and (3) the students' completion and mastery rates of the NMC modules based on LMS data. Multimedia nutrition education programs integrated with common core curriculum content, such as NMC, may be a promising avenue for disseminating health education to minoritized children living in New York City and similar high fast-food density cities.
ABSTRACT
Key word signing (KWS) is an unaided form of augmentative and alternative communication (AAC) and is frequently used by children with cognitive impairments and their families. Successful implementation of KWS requires a family environment that provides aided language input by modeling the signs. However, families face challenges implementing the signs in their everyday lives. KWS requires effort and sustained parental commitment. Users may also struggle with finding good learning resources and stimulating and enjoyable shared contexts for communication. Signed videos of popular children's books may help to implement KWS and create a signing environment which exposes children and their families to KWS in meaningful ways. The aim of this study was to create videos of this type and investigate whether and how they might serve as an attractive medium of support for families' KWS experience. Three families tested the videos. A triangulated qualitative study incorporating interviews and participant observation explored the families' experience of using these videos as a context for shared communication. The findings suggest that picture book videos supplemented by KWS may be appropriate resources for the use of KWS in everyday family life. They serve as a child-centered activity involving KWS exposure, in which children and their families can participate joyfully and naturally.
ABSTRACT
Augmented reality has promised a new paradigm in medical education. Multimedia videos are the most preferred assent for augmentation. So, this study aimed to assess the effect of using an augmented reality infographic poster for delivering micro-videos on the knowledge and satisfaction of medical students in cardiology rotation. Sixty students participated in this quasi-experimental study and were allocated to three study groups; namely routine method, routine method plus offline micro-video delivery, and routine method plus micro-video delivery in an augmented reality infographic poster. The students' knowledge and satisfaction were evaluated through a multiple-choice question pre and post-test and a satisfaction questionnaire respectively. Within-group comparison of pre and post-test scores showed a significant increase in each study group (all p-values = 0.000). The highest post-test score was for the offline micro-video delivery group and pairwise comparisons of post-test scores showed a significant difference between this group and the control one (p-value = 0.013). Additionally, the augmented reality infographic poster group had the highest satisfaction score (p-value = 0.000). This experience showed the positive effect of micro-videos in clinical education. Although students were satisfied with accessing these videos through an augmented reality infographic poster, their knowledge acquisition was better when they received them offline.
Subject(s)
Cardiology , Video Recording , Humans , Cardiology/education , Augmented Reality , Female , Male , Students, Medical , Surveys and Questionnaires , Multimedia , Educational Measurement , Young AdultABSTRACT
BACKGROUND: Randomised controlled trials are often beset by problems with poor recruitment and retention. Information to support decisions on trial participation is usually provided as printed participant information sheets (PIS), which are often long, technical, and unappealing. Multimedia information (MMI), including animations and videos, may be a valuable alternative or complement to a PIS. The Trials Engagement in Children and Adolescents (TRECA) study compared MMI to PIS to investigate the effects on participant recruitment, retention, and quality of decision-making. METHODS: We undertook six SWATs (Study Within A Trial) within a series of host trials recruiting children and young people. Potential participants in the host trials were randomly allocated to receive MMI-only, PIS-only, or combined MMI + PIS. We recorded the rates of recruitment and retention (varying between 6 and 26 weeks post-randomisation) in each host trial. Potential participants approached about each host trial were asked to complete a nine-item Decision-Making Questionnaire (DMQ) to indicate their evaluation of the information and their reasons for participation/non-participation. Odds ratios were calculated and combined in a meta-analysis. RESULTS: Data from 3/6 SWATs for which it was possible were combined in a meta-analysis (n = 1758). Potential participants allocated to MMI-only were more likely to be recruited to the host trial than those allocated to PIS-only (OR 1.54; 95% CI 1.05, 2.28; p = 0.03). Those allocated to combined MMI + PIS compared to PIS-only were no more likely to be recruited to the host trial (OR = 0.89; 95% CI 0.53, 1.50; p = 0.67). Providing MMI rather than PIS did not impact on DMQ scores. Once children and young people had been recruited to host trials, their trial retention rates did not differ according to intervention allocation. CONCLUSIONS: Providing MMI-only increased the trial recruitment rate compared to PIS-only but did not affect DMQ scores. Combined MMI + PIS instead of PIS had no effect on recruitment or retention. MMIs are a useful tool for trial recruitment in children and young people, and they could reduce trial recruitment periods.
Subject(s)
Multimedia , Adolescent , Humans , Child , Patient Selection , Surveys and Questionnaires , Randomized Controlled Trials as TopicABSTRACT
Since the phase-out of polybrominated diphenyl ethers (PBDEs), large amounts of alternative halogenated flame retardants (AHFRs) have been introduced to the market. Due to their persistence and toxicity, halogenated flame retardants (HFRs) have become a concern for the ecosystem and human health. However, there remains limited assessment of the atmospheric loadings, sources, and environmental fate of HFRs in Lake Ontario, which receives urban-related inputs and cumulative chemical inputs from the upstream Great Lakes from Canada and the United States. We combined long-term measurements with a modified multimedia model based on site-specific environmental parameters from Lake Ontario to understand the trends and fate of HFRs. All HFRs were detected in the air, precipitation, lake trout, and herring gull egg samples throughout the sampling periods. General decreasing trends were found for PBDEs, while the temporal trends for AHFRs were not clear. Physical-chemical properties and emissions significantly influence the levels, profiles, and trends. Using the probabilistic modeling, HFR concentrations in lake water and sediment were predicted to be close to the measurement, suggesting a good performance for the modified model. The loadings from tributaries and wastewater effluent were the primary input pathways. Transformations in the water and sedimentation were estimated to be the dominant output pathway for the three HFRs.
Subject(s)
Flame Retardants , Humans , Ontario , Ecosystem , Halogenated Diphenyl Ethers , Lakes , WaterABSTRACT
Organophosphite antioxidants (OPAs) have been seriously neglected as potential sources of organophosphate esters (OPEs) in environments. This study utilizes a modeling approach to quantify for the first time national emissions and multimedia distributions of triphenyl phosphate (TPHP)âa well-known flame retardantâand three novel OPEs: tris(2,4-ditert-butylphenyl) phosphate (AO168âO), bis(2,4-ditert-butylphenyl) pentaerythritol diphosphate (AO626âO2), and trisnonylphenol phosphate (TNPP). Emphasis is on the quantitative assessment of OPA source in China. TPHP has 1.1-9.7 times higher emission (300 Mg/year in 2019 with half from OPA sources) than AO168âO (278 Mg/year), AO626âO2 (53 Mg/year), and TNPP (32 Mg/year), but AO168âO is predominant in environments (63-79%) except freshwaters. About 72-99% of the studied OPEs are emitted via air, with 88-99% ultimately distributed into soils as the major sink. OPA-source emissions contribute 9.5-57% and 4.7-56% of TPHP masses and concentrations (except in sediments) in different media, respectively. Both AO168âO and AO626âO2 exhibit high overall persistence ranging between 2 and 11 years. Source emissions and environmental concentrations are elevated in economically developed areas, while persistence is higher in northern areas, where precipitation and temperature are lower. This study shows the significance of the sources of OPA to OPE contamination, which supports chemical management of these substances.