Vision-related quality of life in children: Cross-cultural adaptation and test-retest reliability of the Danish version of the paediatric refractive error profile 2.

PURPOSE: To translate and cross-culturally adapt PREP2 into Danish and to investigate the face validity and reliability of Danish PREP2 through cognitive interviewing, Rasch and reliability analyses. METHODS: The Danish PREP2 was translated using a standardized procedure and then pretested following the Three-Steps-Interviews (TSTI) process. A total of 15 myopic children aged 7-14 wearing either orthokeratology lenses (ortho-k) or single-vision spectacles (SVS) were included in pretesting comprising cognitive interviews and Rasch analysis. Data from cognitive interviewing was analysed thematically according to Collins. Rasch analysis was used to pretest the psychometric properties in terms of person- and item-fit statistics. Reliability was assessed via test-retest using Intra-class correlation coefficient (ICC) in the CONTROL study population, which consisted of 60 Danish children aged 7-14 years wearing either ortho-k or SVS. RESULTS: Fifteen children participated in pilot studies comprising of cognitive interviewing and Rasch analysis and 44 out of 60 CONTROL children participated in test-retest reliability analysis. The translation process resulted in a Danish version of PREP2 corroborating the original. Pretesting highlighted issues in the contextualization of items and in marking responses. Thus, we introduced a digital format with help texts. Cognitive interviewing identified issues in the following Collins' themes: comprehension (understanding of concepts), judgement (ambiguity of items) and response (selecting answers). Rasch analysis indicated that help texts were useful for clarifying context. The ICC was 0.77 (95% CI: 0.66-0.85). CONCLUSIONS: The cross-cultural adaptation of PREP2 was satisfactory and issues were identified and corrected through pretesting. The test-retest reliability showed substantial consistency. The instrument could be validated in a more generalizable setting in future studies. TRIAL REGISTRATION: NCT03246464 (CONTROL study).

Two-Year Results of 0.01% Atropine Eye Drops and 0.1% Loading Dose for Myopia Progression Reduction in Danish Children: A Placebo-Controlled, Randomized Clinical Trial.

We investigated the two-year safety and efficacy of 0.1% loading dose and 0.01% low-dose atropine eye drops in Danish children for reduction in myopia progression in an investigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months and then 0.01% for eighteen months (loading dose group, N = 33), 0.01% for two years (0.01% group, N = 32) or placebo for two years (placebo, N = 32). Axial length (AL) and spherical equivalent refraction (SER) were primary outcomes. Secondary outcomes included adverse events and reactions, choroidal thickness, and other ocular biometrical measures. Outcomes were measured from baseline and at six-month intervals. Individual eyes nested by participant ID were analyzed with linear-mixed model analysis. Data were analyzed with intention-to-treat. Mean AL was 0.08 mm less (95% confidence interval (CI): -0.01; 0.17, p-value = 0.08) in the 0.1% loading dose and 0.10 mm less (95% CI: 0.01; 0.19, p-value = 0.02) in the 0.01% group after two years of treatment compared to placebo. Mean SER progression was 0.12 D (95% CI: -0.10; 0.33) less in the loading dose and 0.26 D (95% CI: 0.04; 0.48) less in the 0.01% groups after two years of treatment compared to placebo (p-value = 0.30 and 0.02, respectively). In total, 17 adverse events were reported in the second-year follow-up, and all were rated as mild. Adjusting for iris color did not affect treatment effect estimates. Intra-ocular pressure increased over two years comparably between all groups but remained within normal limits. Two-year treatment with 0.01% low-dose atropine eye drops is a safe and moderately efficacious intervention in Danish children for reducing myopia progression.

Myopia in children and adolescents.

The prevalence of myopia is estimated to be 2.6 billion people worldwide and the percentage of individuals with sight-threatening high myopia (≤ -6 diopters) is increasing. Myopia is primarily caused by excessive axial elongation of the eyeball, and treatment modalities attempt to reduce this progression. While increased outdoor time is known to delay myopia onset, new pharmacological and optical interventions aim to reduce myopia progression. This review finds that these promising interventions are expected to significantly decrease the future prevalence of sight-threatening high myopia.

Safety and efficacy of 0.01% and 0.1% low-dose atropine eye drop regimens for reduction of myopia progression in Danish children: a randomized clinical trial examining one-year effect and safety.

BACKGROUND: To investigate the efficacy and safety of 0.1% and 0.01% low-dose atropine eye drops in reducing myopia progression in Danish children. METHODS: Investigator-initiated, placebo-controlled, double-masked, randomized clinical trial. Ninety-seven six- to twelve-year old myopic participants were randomized to 0.1% loading dose for six months followed by 0.01% for six months (loading dose group, Number (N) = 33), 0.01% for twelve months (0.01% group, N = 32) or vehicle for twelve months (placebo, N = 32). Primary outcomes were axial length and spherical equivalent refraction. Secondary outcomes included adverse events and reactions, choroidal thickness and ocular biometry. Outcomes were measured at baseline and three-month intervals. Data was analyzed with linear-mixed model analysis according to intention-to-treat. RESULTS: Mean axial elongation was 0.10 mm less (95% confidence interval (CI): 0.17; 0.02, adjusted-p = 0.06) in the 0.1% loading dose and 0.07 mm less (95% CI: 0.15; 0.00, adjusted-p = 0.16) in the 0.01% group at twelve months compared to placebo. Mean spherical equivalent refraction progression was 0.24 D (95% CI: 0.05; 0.42) less in the loading dose and 0.19 D (95% CI: 0.00; 0.38) less in the 0.01% groups at twelve months, compared to placebo (adjusted-p = 0.06 and 0.14, respectively). A total of 108 adverse events were reported during the initial six-month loading dose period, primarily in the loading dose group, and 14 were reported in the six months following dose switching, all deemed mild except two serious adverse events, unrelated to the intervention. CONCLUSIONS: Low-dose atropine eye drops are safe over twelve months in otherwise healthy children. There may be a modest but clinically relevant reduction in myopia progression in Danish children after twelve months treatment, but the effect was statistically non-significant after multiple comparisons adjustment. After dose-switching at six months the loading dose group approached the 0.01% group, potentially indicating an early "rebound-effect". TRIAL REGISTRATION: this study was registered in the European Clinical Trials Database (EudraCT, number: 2018-001286-16) 05/11/2018 and first posted at www. CLINICALTRIALS: gov (NCT03911271) 11/04/2019, prior to initiation.

Low-Dose Atropine Induces Changes in Ocular Biometrics in Myopic Children: Exploring Temporal Changes by Linear Mixed Models and Contribution to Treatment Effect by Mediation Analyses.

This study aimed to investigate changes in non-cycloplegic ocular biometrics during the initial six months of treatment with a 0.1% atropine loading dose and 0.01% atropine compared with a placebo and analyze their contribution to the treatment effect on cycloplegic spherical equivalent (SE) progression. The study was based on a randomized, double-masked, placebo-controlled, multicenter trial evaluating a 0.1% atropine six-month loading dose and 0.01% atropine in reducing myopic progression in Danish children. The treatment phase was 24 months, and the washout phase was 12 months. Parameters measured included changes in axial length (AL), anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD), and choroidal thickness (ChT), while cycloplegic SE and lens power were calculated. Longitudinal changes and contributions to treatment effects were analyzed using constrained linear mixed models and mediation analyses, respectively. After six months, AL was 0.13 mm shorter (95% confidence interval [CI], -0.18 to -0.07 [adjusted p < 0.001]) and 0.06 mm shorter (95% CI, -0.11 to -0.01 [adjusted p = 0.060]) with a 0.1% atropine loading dose and 0.01% atropine, respectively, compared to the placebo group. Similar concentration-dependent changes were found with ACD, LT, VCD, ChT, and cycloplegic SE. Although the treatment effects trended toward concentration-dependent responses, only the treatment effect mediated by AL at three months differed significantly between 0.01% atropine and a 0.1% atropine loading dose (adjusted p = 0.023). Several ocular biometrics, including AL, ACD, and LT, changed dose-dependently during low-dose atropine treatment. Moreover, the treatment effect of atropine on SE progression was mediated by a subset of ocular biometrics, mainly AL, with trends toward concentration dependency and distributional shifts over time.

Reproducibility of Mesopic and Photopic Pupil Sizes in Myopic Children Using a Dedicated Pupillometer with Human-Assisted or Automated Reading.

This study aimed to investigate the reproducibility of pupil size measurements over time and between reading methods when comparing human-assisted reading to automated reading. Pupillary data were analyzed on a subset of myopic children enrolled in a multicenter randomized clinical trial on myopia control with low-dose atropine. Pupil size measurements were obtained prior to randomization at two time points (screening and baseline visits) using a dedicated pupillometer under mesopic and photopic conditions. A customized algorithm was built to perform automated readings, allowing comparisons between human-assisted and automated readings. Reproducibility analyses followed the principles of Bland and Altman and included the calculation of the mean difference between measurements and limits of agreement (LOA). We included 43 children. Mean (standard deviation) age was 9.8 (1.7) years and 25 (58%) children were girls. Using human-assisted readings, reproducibility over time showed mesopic mean difference of 0.02 mm with LOA from -0.87 mm to 0.91 mm, whereas photopic mean difference was -0.01 mm with LOA from -0.25 mm to 0.23 mm. Reproducibility between human-assisted and automated readings was also higher under photopic conditions, with mean difference of 0.03 mm and LOA from -0.03 mm to 0.10 mm at screening and mean difference of 0.03 mm and LOA from -0.06 mm to 0.12 mm at baseline. Using a dedicated pupillometer, we found that examinations performed under photopic conditions demonstrated higher reproducibility over time and between reading methods. We speculate whether mesopic measurements are sufficiently reproducible to be monitored over time. Furthermore, photopic measurements may be of greater relevance when evaluating the side effects of atropine treatment, such as photophobia.

Myopia Control with Low-Dose Atropine in European Children: Six-Month Results from a Randomized, Double-Masked, Placebo-Controlled, Multicenter Study.

The effect and safety of low-dose atropine in myopia control have not been studied in randomized, placebo-controlled trials outside Asia. We investigated the efficacy and safety of 0.1% atropine loading dose and 0.01% atropine compared with a placebo in a European population. Investigator-initiated, randomized, double-masked, placebo-controlled, equal-allocation, multicenter study comparing 0.1% atropine loading dose (six months) followed by 0.01% atropine (18 months), 0.01% atropine (24 months), and placebo (24 months). Participants were monitored for a 12-months washout period. Outcome measures were axial length (AL), cycloplegic spherical equivalent (SE), photopic and mesopic pupil size, accommodation amplitude, visual acuity, intraocular pressure (IOP), and adverse reactions and events. We randomized 97 participants (mean [standard deviation] age, 9.4 [1.7] years; 55 girls (57%) and 42 boys (43%)). After six months, AL was 0.13 mm shorter (95% confidence interval [CI], -0.18 to -0.07 [adjusted p < 0.001]) with 0.1% atropine loading dose and 0.06 mm shorter (95% CI, -0.11 to -0.01 [adjusted p = 0.06]) with 0.01% atropine than in the placebo group. We observed similar dose-dependent changes in SE, pupil size, accommodation amplitude, and adverse reactions. No significant differences in visual acuity or IOP were found between groups, and no serious adverse reactions were reported. We found a dose-dependent effect of low-dose atropine in European children without adverse reactions requiring photochromatic or progressive spectacles. Our results are comparable to those observed in East Asia, indicating that results on myopia control with low-dose atropine are generalizable across populations with different racial backgrounds.

Peripheral refraction, relative peripheral refraction, and axial growth: 18-month data from the randomised study-Clinical study Of Near-sightedness; TReatment with Orthokeratology Lenses (CONTROL study).

PURPOSE: To investigate changes in peripheral and relative peripheral refraction (RPR) during orthokeratology lens (OKL) use in children, and predictors for myopia progression in a randomized controlled trial. METHODS: Refraction and axial length (AL) were measured at baseline, 6, 12, and 18 months for children aged 6-12 years, with myopia of 0.5 to 4.75 dioptres (D) spherical component randomized to either OKL or single-vision spectacles (SVS) at baseline. Cycloplegic spherical equivalent refractive error (SEQ) was measured on-axis and eccentric at 10°, 20°, and 30° during nasal and temporal gaze in the horizontal plane with Shin-Nippon Nvision-K 5001. RPR was computed as SEQ(eccentricity) minus SEQ(on axis) . AL was measured with Lenstar LS900. RESULTS: Twenty-one and 28 subjects from the OKL and SVS groups, respectively were available for analysis. OKL wear induced significant myopic RPR at all eccentricities (p ≤ 0.004) whereas peripheral refraction only changed in two out of six eccentric measuring points. Baseline peripheral refraction SEQ at all eccentricities, baseline on-axis SEQ, and baseline RPR at 30° nasal eccentricity were positively correlated to treatment efficacy defined as change in AL. CONCLUSION: We found no correlations between change in RPR and treatment efficacy defined as change in AL. Interestingly, our results suggest that the central emmetropisation that occurs during OKL-use accounts for most of the optical changes and to a lesser extent the mid-peripheral plus-zone of the lens.

Periocular basal cell carcinoma results and surgical outcome during a 5-year period in a larger Danish population.

BACKGROUND: To report tumour pathology, surgical procedure, complication rates and overall outcome of periocular basal cell carcinoma (BCC) in the Department of Ophthalmology at Sygehus Lillebaelt, Southern Denmark Region over a 5-year period. METHODS: Medical records for all patients who underwent surgery for periocular BCC between January 2016 and December 2020 were reviewed. All tumours were excised with a 3 mm margin beyond the clinically apparent delimitation of the tumour and analysed by frozen section histological examination. Paraffin sections were subsequently examined for a final histopathological diagnosis. Patient age, gender, date of resection, former cancer history, referring unit and follow-up time were recorded. Furthermore, histological subtypes identified from biopsy and resection, lesion location, lesion diameter, free margin after the first operation, lacrimal punctum involvement, reconstructive techniques and complications were also recorded. RESULTS: A total of 242 surgical excisions from 237 patients were recorded. The mean age was 69.7 ± 12.6 with women significantly predominant compared to men (1.8:1, p < 0.0001, binomial test). The mean tumour diameter was 4.29 mm (range 0.5-20 mm). The most common location and histological subtype was the lower eyelid and nodular BCC respectively (64.9% and 74.0% of cases). In 17.4% of the patients, the initial resection margin on the frozen section histology was not free of tumour cells and the risk was significantly greater for BCC subtypes considered aggressive in terms of growth pattern (morphea form, infiltrative and micronodular features) as compared to non-aggressive BCC subtypes (nodular and superficial) (p = 0.002, X2). In 239 (98.8%) of the patients, the BCC was found to be radically removed after final histopathological examination. The sensitivity of identification of aggressive subtypes of periocular BCC in biopsies was 47.7%. No recurrences were found during the 5-year period. CONCLUSION: This study demonstrated a tendency towards more women than men being diagnosed with periocular BCC. The initial biopsy performed for all patients underestimated the aggressiveness of BCC in almost half of the cases while aggressive BCC subtypes were more likely to need further resection after frozen section compared to non-aggressive subtypes.

Achieving Optimal Correction for Young Myopic Children: A Concept Study.

The purpose of this article is to explore alternative ways of achieving optimal correction for myopic children who cannot cooperate to subjective manifest refraction (SR). The study included myopic children aged 9-12 years who underwent non-cycloplegic SR and autorefraction with and without cycloplegia using the Shin-Nippon Nvision-K 5001 autorefractor (AR) as well as non-cycloplegic autorefraction using the Topcon KR-800S AR. There were 21 children (mean age, 10.62 years) included. The spherical equivalent refractive error of SR was not significantly different from that of non-cycloplegic AR measurements, but it was significantly different from that of cycloplegic Shin-Nippon Nvision-K 5001 measurements (p < 0.001). Compared with SR, cycloplegic Shin-Nippon Nvision-K 5001 measured a less myopic refractive error (median: -2.44 D vs. -2.88 D, p < 0.001). For both ARs, the axis measurements and astigmatic dioptre values between SR and autorefraction were not significantly different. Compared with non-cycloplegic SR, cycloplegic measurements showed a lesser degree of myopic refractive error. There was no significant difference between SR and non-cycloplegic autorefraction. Therefore, the Topcon KR-800S and the Shin-Nippon Nvision-K 5001 ARs may be useful for prescribing glasses in myopic children who cannot cooperate during SR. However, caution should be taken with cylinders <0.75 D because the agreement in axis between SR and AR measurement is poor. Therefore, in such cases, we suggest to add half the cylinder to the spherical component.

Control of myopia using orthokeratology lenses in Scandinavian children aged 6 to 12 years. Eighteen-month data from the Danish Randomized Study: Clinical study Of Near-sightedness; TReatment with Orthokeratology Lenses (CONTROL study).

PURPOSE: To investigate the efficacy of myopia control defined by axial elongation and safety of orthokeratology lenses (OKL) in a Scandinavian (Danish) population. METHODS: Sixty Danish children aged 6-12 years with myopia ranging from 0.5 to 4.75 dioptres (D) spherical component and refractive astigmatism ≤2.5 D in both eyes were randomly assigned to either OKL or single-vision spectacles (SVS). Study duration was 18 months. Outcome measures were axial length (AL) measured with Lenstar LS900 (Haag-Streit, Koeniz, Switzerland) and adverse events graded with Efron Grading Scale for Contact Lens Complications. RESULTS: Nineteen participants completed the 18-month follow-up in the OKL group and 28 in the SVS group. The average AL elongation in the OKL group was 0.24 mm smaller as compared to the SVS group (95% confidence interval 0.12-0.36, mixed model adjusted for baseline sex, age and AL). There were no fast progressors (>0.75 D/year) in the OKL group during the follow-up period in contrast to 22% in the SVS group. No treatment-requiring or vision-threatening adverse events were observed. CONCLUSION: Orthokeratology lenses reduced AL elongation in myopic Scandinavian children by 59%, with no treatment-requiring or vision-threatening adverse events. The results align with outcomes of previous clinical trials.

Repeatability and inter-observer variation of choroidal thickness measurements using swept-source optical coherence tomography in myopic danish children aged 6-14 years.

PURPOSE: To estimate repeatability and inter-observer variation of choroidal thickness measurements in myopic Danish children aged 7-14 years using swept-source optical coherence tomography (SS-OCT). METHODS: Thirty-nine children were enrolled. Optical correction was single-vision spectacles (SVS) or orthokeratology lenses (OKL). Three repeated 7 × 7 mm 3-dimensional SS-OCT macula scans and three repeated 9 mm SS-OCT line scans were collected for each child using a DRI OCT Triton. Choroidal thickness was measured using three different methods: line scan method 1 (LM1), line scan method 2 (LM2) and 3D macula scan method (3DM). Segmentation was adjusted if needed. Coefficients of repeatability (CR) and limits of agreement (LoA) were calculated. RESULTS: The CRs ranged from 13.4 to 23.9 µm, 14.5 to 26.2 µm and 5.2 to 10.7 µm for LM1, LM2 and 3DM, respectively. The LoA ranged from -22.9 to +31.5 µm, -23.3 to +32.2 µm and -10.2 to +12.4 µm for LM1, LM2 and 3DM, respectively. Segmentation was adjusted in most scans (63%-92%). Mean choroidal thickness ranged from 142.2 ± 47.2 to 253.8 ± 60.9 µm and 190.1 ± 64.0 to 299.0 ± 55.8 µm for the SVS and OKL groups, respectively, measured by 3DM. CONCLUSION: The 3DM was the most repeatable method in this paediatric population. It yielded a CR of 10.7 µm, confidence interval 2.4 µm, which makes the minimal detectable difference between two measurements 13.1 µm. Most inter-observer variation could be explained by the intramethod variation. Segmentation adjustment on 3D macula scans did not increase CR on a group level.

Variations in keratometric values (K-value) after administration of three different eye drops - effects on the intraocular lens calculations in relation to cataract surgery.

PURPOSE: To investigate the variance in keratometric (K) values after administration of different eye drops (three tested), and the effects on intraocular lens (IOL) power calculations in relation to standard cataract surgery. METHODS: A prospective intervention study (pilot study) on 38 participants (22 women, 16 men, 58-88 years) undergoing 57 cataract surgeries. Three keratometries on each eye were performed: a baseline ('standard') keratometry about 9 weeks preoperatively, and two on the operation day; a 'dry'-measurement before interventions and a 'wet'-measurement after applying one of three eye drops (saline, Systane Ultra® , or Systane Complete® ). All standard cataract operations were uneventful. Variabilities in K-values, spherical equivalents (SEQs) for IOL power calculations (Barrett TK Universal II) and subjective manifest refractions (SRs) 6 weeks postoperatively were compared between groups. RESULTS: The 'wet' K-values had a similar variability to those of the 'standard' and 'dry' K-values (p > 0.05, anova on ranks). The mean paired differences in K-measurements between groups ranged within a small interval from -0.0107 to 0.0096 mm. After comparing the SEQ predictions with SR-measurements, the most precise IOL calculation was achieved after administration of a saline eye drop, but the precision was not statistically improved compared to the other drop modalities. CONCLUSION: The variability in K-values was not significantly changed by administration of any of the different eye drops tested, suggesting that artificial eye drops do not impact the keratometry or IOL power prediction.

Dairy products viscosity estimated by laser speckle correlation.

Dairy products exhibit several physical properties that are crucial to define whether we like the food or not: firmness, creaminess, thickness, or lightness. Viscosity changes the flow properties of food and influences the appearance and the consistency of a product; this control variable is important in most production stages-manufacture, processing, and storage. Viscosity of heterogeneous products at a given temperature depends on its composition and physical state of its substances. Although rheology provides a method to access the product viscosity, it lacks non-contact full-field monitoring. We apply a simple correlation analysis of laser speckle images to evaluate viscosity properties of dairy products. Our approach ensures robust measurements with high degree of detectability.

Investigation of pausing fermentation of salamis with multispectral imaging for optimal sensory evaluations.

The fermentation process of salamis involves several parameters influencing taste, texture, and color of the salami. One significant parameter is the fermentation time. It is difficult to conduct sensory evaluations to assess the effect of time without introducing variation between observation days. It may be possible to overcome this by stalling or pausing the fermentation by deep-chilling the salamis. This study investigates the difference of non- and deep-chilled salamis with the use of a multispectral imaging system. The statistical investigation, based on image features relating to size, visual texture, and color of the sausages over time, showed that it may be possible to stall the fermentation process. It was shown that a statistical difference in the two kinds of samples is present. For the size feature the difference could be quantified into a number of days. However, for the important color feature only a statistical difference was observed, whereas the visual difference expressed in terms of ΔEab⁎ was barely present.

Life-Cycle Costing of Food Waste Management in Denmark: Importance of Indirect Effects.

Prevention has been suggested as the preferred food waste management solution compared to alternatives such as conversion to animal fodder or to energy. In this study we used societal life-cycle costing, as a welfare economic assessment, and environmental life-cycle costing, as a financial assessment combined with life-cycle assessment, to evaluate food waste management. Both life-cycle costing assessments included direct and indirect effects. The latter are related to income effects, accounting for the marginal consumption induced when alternative scenarios lead to different household expenses, and the land-use-changes effect, associated with food production. The results highlighted that prevention, while providing the highest welfare gains as more services/goods could be consumed with the same income, could also incur the highest environmental impacts if the monetary savings from unpurchased food commodities were spent on goods/services with a more environmentally damaging production than that of the (prevented) food. This was not the case when savings were used, e.g., for health care, education, and insurances. This study demonstrates that income effects, although uncertain, should be included whenever alternative scenarios incur different financial costs. Furthermore, it highlights that food prevention measures should not only demote the purchase of unconsumed food but also promote a low-impact use of the savings generated.

Evaluation of Yogurt Microstructure Using Confocal Laser Scanning Microscopy and Image Analysis.

The microstructure of protein networks in yogurts defines important physical properties of the yogurt and hereby partly its quality. Imaging this protein network using confocal scanning laser microscopy (CSLM) has shown good results, and CSLM has become a standard measuring technique for fermented dairy products. When studying such networks, hundreds of images can be obtained, and here image analysis methods are essential for using the images in statistical analysis. Previously, methods including gray level co-occurrence matrix analysis and fractal analysis have been used with success. However, a range of other image texture characterization methods exists. These methods describe an image by a frequency distribution of predefined image features (denoted textons). Our contribution is an investigation of the choice of image analysis methods by performing a comparative study of 7 major approaches to image texture description. Here, CSLM images from a yogurt fermentation study are investigated, where production factors including fat content, protein content, heat treatment, and incubation temperature are varied. The descriptors are evaluated through nearest neighbor classification, variance analysis, and cluster analysis. Our investigation suggests that the texton-based descriptors provide a fuller description of the images compared to gray-level co-occurrence matrix descriptors and fractal analysis, while still being as applicable and in some cases as easy to tune.

External costs of atmospheric lead emissions from a waste-to-energy plant: a follow-up assessment of indirect exposure via topsoil ingestion.

In this study the Impact Pathway Approach (IPA) was used to calculate the external costs associated with indirect exposure, via topsoil ingestion, to atmospheric emissions of lead (Pb) from a waste-to-energy plant in Denmark. Three metal-specific models were combined to quantify the atmospheric dispersion of lead, its deposition and accumulation in topsoil, and the increase in blood lead concentration for children resulting from lead intake via topsoil ingestion. The neurotoxic impact of lead on children was estimated using a lead-specific concentration-response function that measures impaired cognitive development in terms of IQ points lost per each incremental µg/dl of lead in blood. Since IQ loss during childhood can be associated with a percent decrease in expected lifetime earnings, the monetary value of such an impact can be quantified and the external costs per kg of lead emitted from the plant were then calculated. The costs of indirect exposure calculated over a time horizon of 100 years, for the sub-population of children of 0-3 years, and discounted at 3%, were in the range of 15-30 €/kg. Despite the continued accumulation of lead in topsoil resulting in increasing future indirect exposure, the results indicate that costs associated with this exposure pathway are of the same order of magnitude as costs associated with direct exposure via inhalation, calculated at 45-91 €/kg. Moreover, when the monetary value of future impacts is discounted to the present, the differences between the two exposure pathways are diminished. Finally, setting a short time horizon reduces the uncertainties but excludes part of the costs of indirect exposure from the assessment.