Pediatric Optic Pathway Gliomas Resource Utilization and Prevalence in the OptumLabs Data Warehouse.

BACKGROUND: Although significant progress has been made in improving the rate of survival for pediatric optic pathway gliomas (OPGs), data describing the methods of diagnosis and treatment for OPGs are limited in the modern era. This retrospective study aims to provide an epidemiological overview in the pediatric population and an update on eye care resource utilization in OPG patients using big data analysis. METHODS: Using the OptumLabs Data Warehouse, 9-11 million children from 2016 to 2021 assessed the presence of an OPG claim. This data set was analyzed for demographic distribution data and clinical data including average ages for computed tomography (CT), MRI, strabismus, and related treatment (surgery, chemotherapy, and radiation), as well as yearly rates for optical coherence tomography (OCT) and visual field (VF) examinations. RESULTS: Five hundred fifty-one unique patients ranging in age from 0 to 17 years had an OPG claim, with an estimated prevalence of 4.6-6.1 per 100k. Among the 476 OPG patients with at least 6 months of follow-up, 88.9% had at least one MRI and 15.3% had at least one CT. Annual rates for OCT and VF testing were similar (1.26 vs 1.35 per year), although OCT was ordered for younger patients (mean age = 9.2 vs 11.7 years, respectively). During the study period, 14.1% of OPG patients had chemotherapy, 6.1% had either surgery or radiation, and 81.7% had no treatment. CONCLUSIONS: This study updates OPG demographics for the modern era and characterizes the burden of the treatment course for pediatric OPG patients using big data analysis of a commercial claims database. OPGs had a prevalence of about 0.005% occurring equally in boys and girls. Most did not receive treatment, and the average child had at least one claim for OCT or VF per year for clinical monitoring. This study is limited to only commercially insured children, who represent approximately half of the general child population.

Solutions to a Radical Problem: Overview of Current and Future Treatment Strategies in Leber's Hereditary Opic Neuropathy.

Leber's Hereditary Optic Neuropathy (LHON) is the most common primary mitochondrial DNA disorder. It is characterized by bilateral severe central subacute vision loss due to specific loss of Retinal Ganglion Cells and their axons. Historically, treatment options have been quite limited, but ongoing clinical trials show promise, with significant advances being made in the testing of free radical scavengers and gene therapy. In this review, we summarize management strategies and rational of treatment based on current insights from molecular research. This includes preventative recommendations for unaffected genetic carriers, current medical and supportive treatments for those affected, and emerging evidence for future potential therapeutics.

Neuro-Ophthalmic Emergencies.

Neuro-ophthalmic emergencies include optic nerve, central visual pathway, and ocular motility disorders that, if not identified and treated promptly, may lead to permanent vision loss, other significant morbidity, or mortality. This article provides a framework for approaching patients with neuro-ophthalmic symptoms and reviews the presentation, evaluation, and treatment of select emergent conditions that can cause them. Emergent causes of blurry vision, transient vision loss, papilledema, and diplopia, including giant cell arteritis, cardioembolic disease, and aggressive infection, are discussed.

Climate injustice, criminalisation of land protection and anti-colonial solidarity: Courtroom ethnography in an age of fossil fuel violence.

As plans for expanding fossil fuel infrastructure continue to ramp up despite threats to the planet, how are geographers to address the criminalisation and prosecution of peaceful acts of defending earth, water and land? Reflecting on a courtroom ethnography and debates spanning legal geography, political ecology and social movements studies, this article explores embodied struggles around oil, 'justice' and geographies of caring - discussing how Indigenous youth, grandmothers in their eighties and others were convicted of 'criminal contempt' for being on a road near an oil pipeline expansion project. The project ("Trans Mountain Pipeline Expansion") was created to transport unprecedented levels of heavy oil (bitumen) across hundreds of kilometres of Indigenous peoples' territory that was never ceded to settler-colonial authorities in Canada. Focusing on a controversial injunction designed to protect oil industry expansion, the discussion explores the performativity of a judge's exercise of power, including in denying the necessity to act defence, side-lining Indigenous jurisdiction, and escalating prison sentences. Courtroom ethnography offers a unique vantage point for witnessing power at work and vast resources used by state actors to suppress issues fundamental to the United Nations Declaration on Rights of Indigenous Peoples and the Paris Climate Accord. It also provides a lens into the intersectional solidarity and ethics of care among those who dare to challenge colonialism and hyper-extractivism, inviting engagement with multiple meanings of 'irreparable harm' at various scales. The article calls for more attention to power relations, values and affects shaping courtroom dynamics in an age in which fossil fuel interests, climate crisis and settler-colonial control over courts are entwined in evermore-complex violent entanglements.

Visual Storytelling, Intergenerational Environmental Justice and Indigenous Sovereignty: Exploring Images and Stories amid a Contested Oil Pipeline Project.

Visual practices of representing fossil fuel projects are entangled in diverse values and relations that often go underexplored. In Canada, visual media campaigns to aggressively push forward the fossil fuel industry not only relegate to obscurity indigenous values but mask evidence on health impacts as well as the aspirations of those most affected, including indigenous communities whose food sovereignty and stewardship relationship to the land continues to be affronted by oil pipeline expansion. The Tsleil-Waututh Nation, based at the terminal of the Trans Mountain Pipeline in Canada, has been at the forefront of struggles against the pipeline expansion. Contributing to geographical, environmental studies, and public health research grappling with the performativity of images, this article explores stories conveying health, environmental, and intergenerational justice concerns on indigenous territory. Adapting photovoice techniques, elders and youth illustrated how the environment has changed over time; impacts on sovereignty-both food sovereignty and more broadly; concepts of health, well-being and deep cultural connection with water; and visions for future relationships. We explore the importance of an intergenerational lens of connectedness to nature and sustainability, discussing visual storytelling not just as visual counter-narrative (to neocolonial extractivism) but also as an invitation into fundamentally different ways of seeing and interacting.

Occupational Health Programs for Artisanal and Small-Scale Gold Mining: A Systematic Review for the WHO Global Plan of Action for Workers' Health.

Background: Workers in the informal economy often incur exposure to well-documented occupational health hazards. Insufficient attention has been afforded to rigorously evaluating intervention programs to reduce the risks, especially in artisanal and small-scale gold mining (ASGM). Objectives: This systematic review, conducted as part of the World Health Organization's Global Plan of Action for Workers' Health, sought to assess the state of knowledge on occupational health programs and interventions for the informal artisanal and small-scale gold mining (ASGM) sector, an occupation which directly employs at least 50 million people. Methods: We used a comprehensive search strategy for four well-known databases relevant to health outcomes: PubMed, Engineering Village, OVID Medline, and Web of Science, and employed the PRISMA framework for our analysis. Findings: Ten studies met the inclusion criteria of a primary study focused on assessing the impact of interventions addressing occupational health concerns in ASGM. There were no studies evaluating or even identifying comprehensive occupational health and safety programs for this sector although target interventions addressing specific hazards exist. Major areas of intervention-education and introduction of mercury-reducing/eliminating technology were identified, and the challenges and limitations of each intervention taken into assessment. Even for these, however, there was a lack of standardization for measuring outcome or impact let alone long-term health outcomes for miners and mining communities. Conclusion: There is an urgent need for research on comprehensive occupational health programs addressing the array of hazards faced by artisanal and small-scale miners.

Oil pipelines and food sovereignty: threat to health equity for Indigenous communities.

Energy projects may profoundly impact Indigenous peoples. We consider effects of Canada's proposed Trans Mountain oil pipeline expansion on the health and food sovereignty of the Tsleil-Waututh Nation (TWN) through contamination and impeded access to uncontaminated traditional foods. Federal monitoring and TWN documentation show elevated shellfish biotoxin levels in TWN's traditional territory near the terminus where crude oil is piped. Although TWN restoration work has re-opened some shellfish-harvesting sites, pipeline expansion stands to increase health risk directly through rising bioaccumulating chemical toxins as well as through increased hazardous biotoxins. Climate change from increased fossil fuel use, expected via pipeline expansion, also threatens to increase algae blooms through higher temperature and nutrient loading. As the environmental impact assessment process failed to effectively consider these local health concerns in addition to larger impacts of climate change, new assessment is needed attending to linked issues of equity, sustainability and Indigenous food sovereignty.

Tackling injustices of occupational lung disease acquired in South African mines: recent developments and ongoing challenges.

BACKGROUND: South Africa's mineral resources have produced, and continue to produce, enormous economic wealth; yet decades of colonialism, apartheid, capital flight, and challenges in the neoliberal post-apartheid era have resulted in high rates of occupational lung disease and low rates of compensation for ex-miners and their families. Given growing advocacy and activism of current and former mine workers, initiatives were launched by the South African government in 2012 to begin to address the legacy of injustice. This study aimed to assess developments over the last 5 years in providing compensation, quantify shortfalls and explore underlying challenges. METHODS: Using the database with compensable disease claims from over 200,000 miners, the medical assessment database of 400,000 health records and the employment database with 1.6 million miners, we calculated rates of claims, unpaid claims and shortfall in claim filing for each of the southern African countries with at least 25,000 miners who worked in South African mines, by disease type and gender. We also conducted interviews in Johannesburg, Eastern Cape, Lesotho and a local service unit near a mine site, supplemented by document review and auto-reflection, adopting the lens of a critical rights-based approach. RESULTS: By the end of 2017, 111,166 miners had received compensation (of which 55,864 were for permanent lung impairment, and another 52,473 for tuberculosis), however 107,714 compensable claims remained unpaid. Many (28.4%) compensable claims are from Mozambique, Lesotho, Swaziland, Botswana and elsewhere in southern Africa, a large proportion of which have been longstanding. A myriad of diverse systemic barriers persist, especially for workers and their families outside South Africa. Calculating predicted burden of occupational lung disease compared to compensable claims paid suggests a major shortfall in filing claims in addition to the large burden of still unpaid claims. CONCLUSION: Despite progress made, our analysis reveals ongoing complex barriers and illustrates that the considerable underfunding of the systems required for sustained prevention and social protection (including compensation) needs urgent attention. With class action suits in the process of settlement, the globalized mining sector is now beginning to be held accountable. A critical rights-based approach underlines the importance of ongoing concerted action by all.

Occupational health, mercury exposure, and environmental justice: learning from experiences in Tanzania.

Mercury is a potent neurotoxin that is used by poverty-driven miners to extract gold in more than 50 countries. This article examines efforts of the United Nations to address occupational health and environmental justice amid these challenges, focusing on a 3-year campaign in one of the fastest-growing mining communities in Tanzania. By providing an integrative analysis of environmental health risks, labor practices, public health policies, and drivers of social inequity and marginalization, this study highlights the need for interdisciplinary public health approaches that support community development by strengthening local capacities. It illustrates why, to ensure that the needs of vulnerable populations are met, environmental justice and public health paradigms have to expand beyond the conventionally narrow attention paid to toxic exposure and emissions issues.

Socioeconomic consequences of mercury use and pollution.

In the past, human activities often resulted in mercury releases to the biosphere with little consideration of undesirable consequences for the health of humans and wildlife. This paper outlines the pathways through which humans and wildlife are exposed to mercury. Fish consumption is the major route of exposure to methylmercury. Humans can also receive toxic doses of mercury through inhalation of elevated concentrations of gaseous elemental mercury. We propose that any effective strategy for reducing mercury exposures requires an examination of the complete life cycle of mercury. This paper examines the life cycle of mercury from a global perspective and then identifies several approaches to measuring the benefits of reducing mercury exposure, policy options for reducing Hg emissions, possible exposure reduction mechanisms, and issues associated with mercury risk assessment and communication for different populations.

Mercury reduction in Munhena, Mozambique: homemade solutions and the social context for change.

The health and environmental impacts of artisanal gold mining are of growing concern in Munhena, Mozambique, where more than 12,000 people are involved in such activities. Gold is extracted using mercury amalgamation, posing a considerable threat to human and environmental health. A pilot project ascertained the feasibility of reducing mercury use and emissions by promoting control measures utilizing local resources. Retorts were fabricated with local materials. Training workshops introduced the homemade retorts, and a portable mercury monitor revealed effective mercury reduction. Barriers to widespread technology adoption include poverty, lack of knowledge and trust, and the free supply of mercury from private gold buyers. Homemade retorts are inexpensive and effective, and miners could benefit by building community amalgamation centers. The government could play a greater role in gold purchasing to reduce mercury pollution.