Keratinocyte skin cancer risks for working school teachers: Scenarios and implications of the timing of scheduled duty periods in Queensland, Australia.

Relative keratinocyte skin cancer risks attributable to lifetime occupational and casual sunlight exposures of working school teachers are assessed across the state of Queensland for 1578 schools. Relative risk modeling utilizing annual ultraviolet exposure assessments of teachers working in different geographic locations and exposed during periods of measured daily playground duty times for each school were made for local administrative education districts by considering traditional school opening and closing hours, and playground lunchtime schedules. State-wide, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) relative risk estimates varied by 24% for BCC and 45% for SCC. The highest relative risk was calculated for the state's north (sunshine) coast education district which showed that risk could increase by as much as 32% for BCC and 64% for SCC due to differences in teacher duty schedules. These results highlight the importance of playground duty scheduling as a significant risk factor contributing to the overall burden of preventable keratinocyte skin cancers in Queensland.

A site-specific standard for comparing dynamic solar ultraviolet protection characteristics of established tree canopies.

A standardised procedure for making fair and comparable assessments of the ultraviolet protection of an established tree canopy that takes into account canopy movement and the changing position of the sun is presented for use by government, planning, and environmental health authorities. The technique utilises video image capture and replaces the need for measurement by ultraviolet radiometers for surveying shade quality characteristics of trees growing in public parks, playgrounds and urban settings. The technique improves upon tree shade assessments that may be based upon single measurements of the ultraviolet irradiance observed from a fixed point of view. The presented technique demonstrates how intelligent shade audits can be conducted without the need for specialist equipment, enabling the calculation of the Shade Protection Index (SPI) and Ultraviolet Protection Factor (UPF) for any discreet time interval and over a full calendar year. •Tree shade UPF measurements are presented using video capture analysis of moving canopies•A standard method for making accurate assessments of tree shade has been developed•Tree shade comparisons are made without the need for specialist equipment.

A comprehensive approach to evaluating and classifying sun-protective clothing.

BACKGROUND: National standards for clothing designed to protect the wearer from the harmful effects of solar ultraviolet radiation (UVR) have been implemented in Australia/New Zealand, Europe and the U.S.A. Industry standards reflect the need to protect the skin by covering a considerable proportion of the potentially exposed body surface area (BSA) and by reducing UVR-transmission through fabric (the Ultraviolet Protection Factor; UPF). OBJECTIVES: This research aimed to develop a new index for rating sun-protective clothing that incorporates the BSA coverage of the garment in addition to the UPF of the fabric. METHODS: A mannequin model was fixed to an optical bench and marked with horizontal lines at 1-cm intervals. An algorithm (the Garment Protector Factor; GPF) was developed based on the number of lines visible on the clothed vs. unclothed mannequin and the UPF of the garment textile. This data was collected in 2015/16 and analysed in 2016. RESULTS: The GPF weights fabric UPF by BSA coverage above the minimum required by international sun-protective clothing standards for upper-body, lower-body and full-body garments. The GPF increases with BSA coverage of the garment and fabric UPF. Three nominal categories are proposed for the GPF: 0 ≤ GPF < 3 for garments that 'meet' minimum standards; 3 ≤ GPF < 6 for garments providing 'good' sun protection; and GPF ≥ 6 indicating 'excellent' protection. CONCLUSIONS: Adoption of the proposed rating scheme should encourage manufacturers to design sun-protective garments that exceed the minimum standard for BSA coverage, with positive implications for skin cancer prevention, consumer education and sun-protection awareness.

Concurrent evaluation of personal damaging and beneficial UV exposures over an extended period.

Personal exposure to solar ultraviolet radiation (UVR) is acknowledged as having both positive and negative effects on human health. This study aimed to measure concurrently the personal erythemal UV, UVA and vitamin D effective exposures of participants in each season of a year. Participants were all indoor office workers located at two different sites less than 6.5 km apart at the sub-tropical location of Toowoomba (27°33'S 151°55'E). The subjects wore a combined dosimeter badge horizontally on the shoulder for a minimum of one week in each season; this badge used 8-methoxypsoralen film to record the UVA waveband and polyphenylene oxide film for the erythemal and the vitamin D effective UV wavebands. The results show that median erythemal exposure was highest during the spring and lowest during winter, as was the vitamin D effective exposure. Median UVA exposures were at a similar level in winter and summer, autumn was higher (double) and spring at a lower level. The duration and time of day participants spent outdoors changed in each season; in winter, participants spent an average of 101 minutes outdoors between 10:00-14:00 h over the week, whereas in summer this fell to 79 minutes even though they were outdoors more often. The daily UVA/UVB ratio is lowest between 10:00-14:00 h and also changes with the season resulting in the differences between the distributions of exposure for each of the wavebands. Each category of exposures must be assessed individually as each season and each waveband has different distributions. The results also demonstrate that the dual film dosimeter developed and characterized with a calibration to three different biological responses, is an effective device for the concurrent measurement of erythemal UV, UVA and vitamin D effective UV exposures for periods of up to seven days.

Measurements of occupational ultraviolet exposure and the implications of timetabled yard duty for school teachers in Queensland, Australia: preliminary results.

Simultaneous personal measurements of the occupational ultraviolet exposure weighted to the International Commission on Non-Ionising Radiation Protection hazard sensitivity spectrum (UVICNIRP) were made over a five week period (44 person-days) in the second half of the summer school term of 2012 in Queensland, Australia for individual high school teachers located at latitudes of 27.5°S and 23.5°S. These teachers were employed for the duration of the study in a predominately indoor classroom teaching role, excluding mandatory periods of lunch time yard duty and school sport supervisions. Data is presented from personal measurements made to the shirt collar using polyphenylene oxide (PPO) film UV dosimeters. UVICNIRP exposure data is presented for each week of the study period for the shirt collar measurement site and are further expressed relative to the measured ambient horizontal plane exposure. Personal exposures were correlated with time outdoors, showing a higher exposure trend on days when teachers were required to supervise outdoor areas for more than 2h per week (mean daily exposure: 168Jm(-2)UVICNIRP±5Jm(-2) (1σ)) compared to the study average (mean daily exposure: 115Jm(-2)UVICNIRP±91Jm(-2) (1σ)). Time spent in an open playground environment was found to be the most critical factor influencing the occupational UVICNIRP exposure. A linear model was developed showing a correlation (R(2)=0.77) between the time teachers spent on yard duty and UVICNIRP exposure, expressed relative to ambient. The research findings indicate a greater reduction in personal exposure can be achieved by timetabling for yard duty periods in playground areas which offer more shade from trees and surrounding buildings. All mean daily personal exposures measured at the shirt collar site were higher than the ICNIRP occupational daily exposure limit of 30Jm(-2) for outdoor workers.

Comparison of human facial UV exposure at high and low latitudes and the potential impact on dermal vitamin D production.

The results presented in this paper allow for the estimation of the monthly UV exposure of the human facial region at various locations across the earth. The technique allows a graphical representation of the UV exposures over the face. The erythemal UV exposures as well as the vitamin D exposures to the human facial region have been investigated. The results gained in this paper, for a clear sky and constant ozone indicate that the sun's capability to promote the development of vitamin D in the human body does not follow the erythemal UV irradiances, in particular at high latitudes. For Amsterdam (52 degrees N) in late winter, approximately 20% more UV is required to produce 215 J m(-2) of vitamin D weighted UV than erythemal UV.

Understanding the UVA environment at a sub-tropical site and its consequent impact on human UVA exposure.

Daily UVA and erythemal irradiance data on a horizontal plane at a sub-tropical site were measured during a period from March 2000 to February 2001. On a relative basis, UVA radiation was shown to be a greater concern to human exposure during the winter months than summer months. In summer (December to February), the peak daily UVA exposure was 205 J cm(-2) and in winter (June to August), the minimum daily value was 19 J cm(-2). The peak daily UVery exposure was 37 MED in summer and the winter minimum was 4 MED. The occupational work day UVA exposure to the vertex of the head was estimated using the collected UV data. The outdoor workers received 89% of the available UVA radiation whilst the home workers received 18% of the available ambient UVA radiation. This result parallels the exposure patterns of these two population groups, with the outdoor workers spending most of the working week outdoors, whilst the home workers spend small, intermittent time periods outdoors in the sun.

Mild nephrotoxicity associated with vancomycin use.

Nephrotoxicity related to vancomycin hydrochloride therapy has been reported at overall rates of 7% to 16% and as high as 35% when combined with an aminoglycoside antibiotic. We conducted a prospective study in older men. A group that received vancomycin was compared with a control group to determine the incidence of nephrotoxicity secondary to vancomycin therapy alone and in combination with aminoglycosides, to identify possible risk factors associated with nephrotoxicity, and to determine the incidence of other adverse effects associated with vancomycin use. Nephrotoxicity occurred in 11 (17%) of 66 patients receiving vancomycin and in 3 (5%) of 57 controls overall. Stepwise logistic-regression analysis failed to identify underlying illnesses or concurrent risks that may have contributed to the development of nephrotoxicity associated with vancomycin. Adverse effects, including phlebitis (14%), neutropenia (1%), rash (0%), and red neck syndrome (0%), occurred at rates similar to previous reports.

Intra-articular amphotericin B treatment of Sporothrix schenckii arthritis.

Arthritis caused by Sporothrix schenckii may not respond satisfactorily to a full course of intravenous amphotericin B therapy. Left untreated, the fungus continues to be recovered from cultures of joint fluid, and the patient typically has serious joint disability. We have shown in one patient with sporotrichosis of the knee that direct low-dose injections of amphotericin B can be performed safely, resulting in eradication of the fungus. The patient has had continued useful range of motion and weight bearing on the involved knee.

Mixed bacterial meningitis.

Two recent cases of mixed bacterial meningitis at the Kansas City Veterans Administration Medical Center were studied. A review of the literature suggests that 1% of all cases of meningitis are caused by more than one bacterial species. Before 1950 such cases occurred predominantly in children and were caused by combinations of bacteria commonly associated with meningitis. Since 1950 a largely adult population has been affected by mixed bacterial meningitis, with a higher incidence of gram-negative bacillary organisms cultured from the cerebrospinal fluid. Common predisposing factors in this older group of patients include infection at contiguous foci, tumors in close proximity to the central nervous system, or fistulous communications with the central nervous system. Mortality was 26% for cases occurring before 1950 and 63% for those occurring after 1950. Failure to recognize one of the organisms present in the cerebrospinal fluid may result in the initiation of inadequate therapy in as many as 67% of cases. Empiric broad-spectrum antimicrobial therapy is indicated in symptomatic patients predisposed to mixed bacterial meningitis until culture results become available.

Bordetella bronchiseptica bronchitis.

The clinical course of a patient with bronchitis caused by Bordetella bronchiseptica is described. The organism was recovered on one occasion from a protected catheter brush specimen obtained at bronchoscopy and on two occasions from expectorated sputum specimens. The infection was eradicated with antimicrobial therapy.