Mortalità e incidenza di tumore in una coorte di lavoratori esposti ad asbesto nel settore della navalmeccanica. Confronti esterni, interni e caso-controllo nested

Obiettivi. Lo scopo di questo studio è di confrontare la mortalità e l’incidenza per tutte le cause, tutti i tumori, tumori specifici e per le cause non neoplastiche, in una coorte dei lavoratori impiegati nel cantiere navale di Monfalcone (GO) tra il 1974 e il 1994, con quella della popolazione generale della regione FVG e d’Italia. L’obiettivo è eseguire tali confronti considerando il livello di esposizione ad amianto, la durata di esposizione (in anni) precedente al 1985, il periodo di prima assunzione, quali principali indicatori di esposizione occupazionale ad asbesto. Obiettivo secondario è quello di contribuire alla conoscenza circa la correlazione tra esposizione ad asbesto e l’incidenza di tumori nelle principali sedi digestive. Metodi. Tramite metodo indiretto sono stati calcolati SIR (periodo 1995-2009) e SMR (periodo 1995-2012) per tumore maligno della pleura, tumore di trachea bronchi e polmone, per tutti i tumori e per malattie non neoplastiche. È stato condotto uno studio caso- controllo nested per la stima degli gli ORs rispettivamente per tumore maligno della pleura e del polmone. Sono stati applicati modelli di Poisson per la stima degli IRRs riguardanti le principali sedi digestive, utilizzando quali variabili esplicative: a) il rischio di esposizione ad asbesto legato alla mansione e b) il numero di anni di esposizione precedenti al 1985. Risultati. Nell’intera coorte (5582 uomini) gli SMR indicavano un eccesso di mortalità per tumore maligno della pleura incrementato rispettivamente di circa 7 volte (SMR= 7,03; IC95% 5,61-8,79) e di poco più di 14 volte (SMR= 14,20; IC95% 11,33-17,75) rispettivamente quando il confronto è stato fatto con la popolazione standard del FVG e dell’Italia. L’aumento della mortalità per tumore maligno della pleura risulta fortemente aumentato in tutte le stratificazioni. Gli SMR per il tumore di trachea, bronchi e polmone sono risultati essere prossimi all'unità quando le analisi sono state eseguite nell’intera coorte, mentre risultano aumentati in modo significativo rispetto alla popolazione generale quando calcolati nei soggetti a rischio medio e assunti presso i cantieri navali di Monfalcone prima del 1974 (SMR= 1,38 95%CI 1,00-1,85) e nei soggetti classificati a rischio medio e assunti nel periodo 1985-1994 (SMR= 4,88 95%CI 1,00-14,25). Analogamente, nell’intera coorte, i SIR per tumore maligno della pleura calcolati nell’intera coorte erano aumentati di oltre 7 volte (SIR= 7,65; IC95% 6,19-9,49), mentre l’incidenza del tumore di trachea bronchi e polmone non vede incrementi rispetto alla popolazione di riferimento. Coloro che hanno avuto una durata di esposizione maggiore di 30 anni prima del 1985 dimostrano un aumento dell’incidenza di tumore di trachea, bronchi e polmone (SIR=1,34 IC95% 1,00-1,77), statisticamente significativo, così come per coloro che son stati classificati a rischio medio di esposizione e assunti precedentemente al 1974 (SIR=1,46 IC95% 1,06-1,95) e per coloro che sono stati classificati ad alto rischio e assunti nel periodo 1985-1994 (SIR=5,68 IC95% 1,17-16,60). Nell’intera coorte si registra un significativo aumento di incidenza di tumore dello stomaco in coloro classificati a alto rischio (SIR= 1,47 IC95% 1,05-2,00), mentre l’incidenza di tumore del pancreas vede un incremento dell’incidenza in coloro classificati a medio rischio di esposizione ad asbesto (SIR= 2,21 IC95% 1,21-3,72). Il sottogruppo le cui informazioni risultavano mancanti mostrano un incremento del SIR, borderline ma non significativo, per tumore del colon-retto (SIR= 1,29 IC95% 0,94-1,73). Emerge un significativo aumento dell’incidenza del tumore dello stomaco in coloro con un periodo di esposizione precedente al 1985 compreso tra 10 e 20 anni (SIR= 1,71 IC95% 1,12-2,49). Anche i SIR per il tumore del pancreas vedono un incremento statisticamente significativo in coloro che hanno una durata di esposizione precedente al 1985 inferiore a 10 anni e maggiore di 30: rispettivamente i SIR sono stati di 2,23 (IC95% 1,07-4,10) e 2,57 (IC95% 1,53-4,07). I risultati relativi ai confronti interni non mostrano significatività statistica. Conclusioni. I risultati indicano che nella coorte degli uomini ex- lavoratori dei cantieri navali di Monfalcone vi era un incremento forte e statisticamente significativo della mortalità e dell’incidenza di tumore maligno della pleura rispetto sia alla popolazione generale del FVG sia a quella dell’Italia. Eccessi di mortalità ed incidenza sono stati rilevati talvolta anche per il tumore di trachea, bronchi e polmone, quando le analisi sono state condotte stratificando la coorte in gruppi omogenei di rischio. Il più elevato eccesso rispetto all’atteso sia della mortalità per tumore maligno della pleura e del tumore del polmone, che dell’incidenza, si osservava nei lavoratori con mansioni a rischio medio, seguito dal gruppo con mansioni a rischio elevato. I Risultati riguardanti l’incidenza dei tumori delle principali sedi digestive ha visto nell’intera coorte un aumento significativo dei SIR per tumore dello stomaco e del pancreas, anche quando condotti per sottogruppi. Tuttavia le stime relative agli outcome diversi dal tumore maligno della pleura e del tumore del polmone devono essere interpretate con cautela. Le associazioni positive riscontrate tramite confronti interni non presentano significatività statistica.

(Table 1) Neodymium and Strontium measurements from sediment core MD01-2451

In the nineties, cold-water coral mounds were discovered in the Porcupine Seabight (NE Atlantic, west of Ireland). A decade later, this discovery led to the drilling of the entire Challenger cold-water coral mound (Eastern slope, Porcupine Seabight) during IODP Expedition 307. As more than 50% of the sediment within Challenger Mound consists of terrigenous material, the terrigenous component is equally important for the build-up of the mound as the framework-building corals. Moreover, the terrigenous fraction contains important information on the dynamics and the conditions of the depositional environment during mound development. In this study, the first in-depth investigation of the terrigenous sediment fraction of a cold-water coral mound is performed, combining clay mineralogy, sedimentology, petrography and Sr-Nd-isotopic analysis on a gravity core (MD01-2451G) collected at the top of Challenger Mound. Sr- and Nd-isotopic fingerprinting identifies Ireland as the main contributor of terrigenous material in Challenger Mound. Besides this, a variable input of volcanic material from the northern volcanic provinces (Iceland and/or the NW British Isles) is recognized in most of the samples. This volcanic material was most likely transported to Challenger Mound during cold climatic stages. In three samples, the isotopic ratios indicate a minor contribution of sediment deriving from the old cratons on Greenland, Scandinavia or Canada. The grain-size distributions of glacial sediments demonstrate that ice-rafted debris was deposited with little or no sorting, indicating a slow bottom-current regime. In contrast, interglacial intervals contain strongly current-sorted sediments, including reworked glacio-marine grains. The micro textures of the quartz-sand grains confirm the presence of grains transported by icebergs in interglacial intervals. These observations highlight the role of ice-rafting as an important transport mechanism of terrigenous material towards the mound during the Late Quaternary. Furthermore, elevated smectite content in the siliciclastic, glaciomarine sediment intervals is linked to the deglaciation history of the British-Irish Ice Sheet (BIIS). The increase of smectite is attributed to the initial stage of chemical weathering processes, which became activated following glacial retreat and the onset of warmer climatic conditions. During these deglaciations a significant change in the signature of the detrital fraction and a lack of coral growth is observed. Therefore, we postulate that the deglaciation of the BIIS has an important effect on mound growth. It can seriously alter the hydrography, nutrient supply and sedimentation processes, thereby affecting both sediment input and coral growth and hence, coral mound development.

Lysine requirements of pre-lay broiler breeder pullets: Determination by indicator amino acid oxidation

The indicator amino acid oxidation (IAAO) method allows the determination of amino acid requirements under conditions of low growth rate as found in pre-laying broiler breeder pullets. Cobb 500 breeder pullets (20 wk old; 2290 +/- 280 g, n = 4) were adapted (6 d) to a pelleted, purified control diet containing all nutrients at greater than or equal to 110% of NRC recommendations. After recovery from surgery for implantation of a jugular catheter, each bird was fed, in random order, test diets containing one of nine levels of lysine (0.48, 0.96, 1.92, 2.88, 3.84, 4.80, 7.68, 9.60 and 14.40 g/kg of diet). Indicator oxidation was determined during 4-h primed (74 kBq/kg body), constant infusions (44 kBq (.) h(-1) (.) kg body(-1)) of L-[1-C-14]phenylalanine. Using the breakpoint of a one-slope broken-line model, the lysine requirement was determined to be 4.88 +/- 0.96 g/kg of diet or 366 +/- 72 mg (.) hen(-1) (.) d(-1) with an upper 95% Cl of 6.40 g/kg of diet or 480 mg (.) hen(-1) (.) d(-1). IAAO allows determination of individual bird amino acid requirements for specific ages and types of birds over short periods of time and enables more accurate broiler breeder pullet diet formulation.

Clinical evaluation of the Grand Seiko Auto Ref/Keratometer WAM-5500

Purpose: A clinical evaluation of the Grand Seiko Auto Ref/Keratometer WAM-5500 (Japan) was performed to evaluate validity and repeatability compared with non-cycloplegic subjective refraction and Javal–Schiotz keratometry. An investigation into the dynamic recording capabilities of the instrument was also conducted. Methods: Refractive error measurements were obtained from 150 eyes of 75 subjects (aged 25.12 ± 9.03 years), subjectively by a masked optometrist, and objectively with the WAM-5500 at a second session. Keratometry measurements from the WAM-5500 were compared to Javal–Schiotz readings. Intratest variability was examined on all subjects, whilst intertest variability was assessed on a subgroup of 44 eyes 7–14 days after the initial objective measures. The accuracy of the dynamic recording mode of the instrument and its tolerance to longitudinal movement was evaluated using a model eye. An additional evaluation of the dynamic mode was performed using a human eye in relaxed and accommodated states. Results: Refractive error determined by the WAM-5500 was found to be very similar (p = 0.77) to subjective refraction (difference, -0.01 ± 0.38 D). The instrument was accurate and reliable over a wide range of refractive errors (-6.38 to +4.88 D). WAM-5500 keratometry values were steeper by approximately 0.05 mm in both the vertical and horizontal meridians. High intertest repeatability was demonstrated for all parameters measured: for sphere, cylinder power and MSE, over 90% of retest values fell within ±0.50 D of initial testing. In dynamic (high-speed) mode, the root-mean-square of the fluctuations was 0.005 ± 0.0005 D and a high level of recording accuracy was maintained when the measurement ring was significantly blurred by longitudinal movement of the instrument head. Conclusion: The WAM-5500 Auto Ref/Keratometer represents a reliable and valid objective refraction tool for general optometric practice, with important additional features allowing pupil size determination and easy conversion into high-speed mode, increasing its usefulness post-surgically following accommodating intra-ocular lens implantation, and as a research tool in the study of accommodation.

Use of medications with anticholinergic activity and self-reported injurious falls in older community-dwelling adults

Objectives: To assess the association between the use of medications with anticholinergic activity and the subsequent risk of injurious falls in older adults. Design: Prospective, population-based study using data from The Irish Longitudinal Study on Ageing. Setting: Irish population. Participants: Community-dwelling men and women without dementia aged 65 and older (N = 2,696). Measurements: Self-reported injurious falls reported once approximately 2 years after baseline interview. Self-reported regular medication use at baseline interview. Pharmacy dispensing records from the Irish Health Service Executive Primary Care Reimbursement Service in a subset (n = 1,553). Results: Nine percent of men and 17% of women reported injurious falls. In men, the use of medications with definite anticholinergic activity was associated with greater risk of subsequent injurious falls (adjusted relative risk (aRR) = 2.55, 95% confidence interval (CI) = 1.33-4.88), but the risk of having any fall and the number of falls reported were not significantly greater. Greater anticholinergic burden was associated with greater injurious falls risk. No associations were observed for women. Findings were similar using pharmacy dispensing records. The aRR for medications with definite anticholinergic activity dispensed in the month before baseline and subsequent injurious falls in men was 2.53 (95% CI = 1.15-5.54). Conclusion: The regular use of medications with anticholinergic activity is associated with subsequent injurious falls in older men, although falls were self-reported after a 2-year recall and so may have been underreported. Further research is required to validate this finding in men and to consider the effect of duration and dose of anticholinergic medications.

Higher-order soliton generation in hybrid mode-locked thulium-doped fiber ring laser

A thulium-doped all-fiber laser passively mode-locked by the co-action of nonlinear polarization evolution and single-walled carbon nanotubes operating at 1860-1980 nm wavelength band is demonstrated. Pumped with the single-mode laser diode at 1.55 μm laser generates near 500-fs soliton pulses at repetition rate ranging from 6.3 to 72.5 MHz in single-pulse operation regime. Having 3-m long cavity average output power reached 300 mW, giving the peak power of 4.88 kW and the pulse energy of 2.93 nJ with slope efficiency higher than 30%. At a 21.6-m long ring cavity average output power of 117 mW is obtained, corresponding to the pulse energy up to 10.87 nJ and a pulse peak power of 21.7 kW, leading to the higher-order soliton generation.

Fatores determinantes da near miss materna em uma unidade de terapia intensiva obstétrica: avaliação das competências profissionais da área médica

Objective: Evaluate the determinants of morbidity and mortality in an obstetric intensive care unit and professional medical skills of students/residents at a university hospital. Methods: observational cross - sectional with 492 pregnant/pue rperal women and 261 students/residents. Patients were admitted to the obstetric intensive care unit during a year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and G raphPad6. Chi - square tests were used to evaluate risk factors and student t test evaluates resident/students' skills concerning the cognitive test and the Mini - Cex. Results: the main risk factors to near miss were: non - white race (OR = 2.527; RR = 2.342) ; marital status(married women) (OR = 7.968; RR = 7.113) , schooling (primary) (OR = 3.177 ; RR = 2.829) , from country town (OR = 4.643 ; RR = 4.087), low income (OR = 7014 ; RR = 5.554) , gestational hypertensive disorders (OR = 16.35 ; RR = 13.27) , re alization of pre - natal (OR = 5.023 ; RR = 4.254) and C - section before labor(OR = 39.21 ; RR = 31.25). In cognitive/Mini - cex analysis were noted significant difference in the performance of students on the subject (3.75 ± 0.93, 4.03 ± 0.94 and 4.88 ± 0.35). We still observed the best performance of residents, when compared to graduation students (p < 0.01). Conclusions: the prevalence of near miss was associated with socioeconomic/clinics factors and care issues, revealing the importance of interventions to improve these indicators. In addition, we suggest a better curriculum insertion of this subject in the medical Course disciplines due the importance to avoid the near miss through of adequacy of medical education.

Reconstructions of eolian dust accumulation in northwest African margin sediments

Reconstructions of eolian dust accumulation in northwest African margin sediments provide important continuous records of past changes in atmospheric circulation and aridity in the region. Existing records indicate dramatic changes in North African dust emissions over the last 20 ka, but the limited spatial extent of these records and the lack of high-resolution flux data do not allow us to determine whether changes in dust deposition occurred with similar timing, magnitude and abruptness throughout northwest Africa. Here we present new records from a meridional transect of cores stretching from 31°N to 19°N along the northwest African margin. By combining grain size endmember modeling with 230Th-normalized fluxes for the first time, we are able to document spatial and temporal changes in dust deposition under the North African dust plume throughout the last 20 ka. Our results provide quantitative estimates of the magnitude of dust flux changes associated with Heinrich Stadial 1, the Younger Dryas, and the African Humid Period (AHP; ~11.7-5 ka), offering robust targets for model-based estimates of the climatic and biogeochemical impacts of past changes in North African dust emissions. Our data suggest that dust fluxes between 8 and 6 ka were a factor of ~5 lower than average fluxes during the last 2 ka. Using a simple model to estimate the effects of bioturbation on dust input signals, we find that our data are consistent with abrupt, synchronous changes in dust fluxes in all cores at the beginning and end of the AHP. The mean ages of these transitions are 11.8±0.2 ka (1Sigma) and 4.9±0.2 ka, respectively.

Enviromagnetic, major element, and grain-size analyses of surface sediment samples along the continental margin between East Brazil and Patagonia

Continental margin sediments of SE South America originate from various terrestrial sources, each conveying specific magnetic and element signatures. Here, we aim to identify the sources and transport characteristics of shelf and slope sediments deposited between East Brazil and Patagonia (20°-48°S) using enviromagnetic, major element, and grain-size data. A set of five source-indicative parameters (i.e., chi-fd%, ARM/IRM, S0.3T, SIRM/Fe and Fe/K) of 25 surface samples (16-1805 m water depth) was analyzed by fuzzy c-means clustering and non-linear mapping to depict and unmix sediment-province characteristics. This multivariate approach yields three regionally coherent sediment provinces with petrologically and climatically distinct source regions. The southernmost province is entirely restricted to the slope off the Argentinean Pampas and has been identified as relict Andean-sourced sands with coarse unaltered magnetite. The direct transport to the slope was enabled by Rio Colorado and Rio Negro meltwaters during glacial and deglacial phases of low sea level. The adjacent shelf province consists of coastal loessoidal sands (highest hematite and goethite proportions) delivered from the Argentinean Pampas by wave erosion and westerly winds. The northernmost province includes the Plata mudbelt and Rio Grande Cone. It contains tropically weathered clayey silts from the La Plata Drainage Basin with pronounced proportions of fine magnetite, which were distributed up to ~24° S by the Brazilian Coastal Current and admixed to coarser relict sediments of Pampean loessoidal origin. Grain-size analyses of all samples showed that sediment fractionation during transport and deposition had little impact on magnetic and element source characteristics. This study corroborates the high potential of the chosen approach to access sediment origin in regions with contrasting sediment sources, complex transport dynamics, and large grain-size variability.