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A critical review of the current state of knowledge of chemical emissions from indoor sources, partitioning among indoor compartments, and the ensuing indoor exposure leads to a proposal for a modular mechanistic framework for predicting human exposure to semivolatile organic compounds (SVOCs). Mechanistically consistent source emission categories include solid, soft, frequent contact, applied, sprayed, and high temperature sources. Environmental compartments are the gas phase, airborne particles, settled dust, indoor surfaces, and clothing. Identified research needs are the development of dynamic emission models for several of the source emission categories and of estimation strategies for critical model parameters. The modular structure of the framework facilitates subsequent inclusion of new knowledge, other chemical classes of indoor pollutants, and additional mechanistic processes relevant to human exposure indoors. The framework may serve as the foundation for developing an open-source community model to better support collaborative research and improve access for application by stakeholders. Combining exposure estimates derived using this framework with toxicity data for different end points and toxicokinetic mechanisms will accelerate chemical risk prioritization, advance effective chemical management decisions, and protect public health.

Objectives: Pill dysphagia is common and costly with a significant risk of pill retention, caustic injury, and poor medication compliance. The purpose of this investigation was to determine the validity and reliability of the PILL-5, a self-administered patient reported outcome measure (PROM) to quantify the degree of pill (tablet and capsule) dysphagia. The PILL-5 is a 5-item questionnaire with a maximum symptom score of 20. Methods: The PILL-5 was administered to 190 patients with dysphagia referred for videofluoroscopic esophagography (VFE). Construct validity was assessed by comparing PILL-5 composite scores to delayed barium tablet transit on VFE. Normative data was obtained by administering the instrument to a cohort of healthy community based volunteers. Internal consistency was assessed with the Cronbach alpha. Test/retest reliability was determined by administering the instrument to the same cohort of patients at two time points. Results: The mean PILL-5 was 5.6 (±4.9) for persons with dysphagia and 1.6 (±2.7) for healthy volunteers (p < 0.001). The internal consistency of the instrument was high (Cronbach alpha = 0.85). The mean PILL-5 was 4.3 (±4.1) for patients with normal transit and 7.6 (±5.3) for patients with delayed barium tablet transit on esophagography, indicating excellent criterion based validity (p < 0.001). Reproducibility was high with an intraclass correlation coefficient of 0.83 (p < 0.001). Conclusions: Healthy individuals report some degree of swallowing difficulty with pills. Normative data suggest that a PILL-5 > 6 is abnormal (mean + 2 SD). The instrument demonstrated excellent criterion based validity and reliability. The PILL-5 is the first validated patient reported outcome measure for pill dysphagia.

Post-radiotherapy atrial fibrillation (AF) in breast cancer patients is a relatively new and understudied topic. These arrhythmias, associated with high-impact health pathologies (stroke, heart failure, dementia), compromise patients' quality of life and survival. Early detection of AF is therefore essential for optimal management. Smartwatches with ECG capability could represent a promising tool in cardio-oncology. Based on this technology, the objective of the study is to evaluate the risk of post-radiotherapy AF for breast cancer patients and to identify risk factors and cardiac radiation exposure associated with these complications. WATCH is a cohort study that will include patients over 65 years old, treated with radiotherapy (RT) for breast cancer 5 years ago (2018–2020), without a history of AF. Cross-sectional screening for AF at the time of the scheduled 5-year post-RT visit will be conducted by recording data from a Withings ScanWatch smartwatch for one month, confirmed by an ECG, and validated by a physician, following recommendations for opportunistic AF screening in individuals over 65. In addition to AF screening at the 5-year post-RT visit, a transthoracic echocardiogram (TTE) will be performed on all study patients, providing comprehensive assessment of cardiac structures and functions, allowing particularly in patients with AF to investigate underlying etiology and assess the risk of complications, especially thromboembolic events. Patient's medical record will provide information on the timing and risk factors for the occurrence of AF and other arrhythmias and conduction disorders. For dosimetric analysis, the project will include the development of deep learning algorithms for auto-segmentation analysis of potentially critical sub-structures for the occurrence of AF (cardiac chambers, sinoatrial node, atrioventricular node, coronary arteries, pulmonary veins), which will produce dosimetry for all contoured structures. Inclusions began in October 2023 and aim to cover 200 patients until December 2025. This "proof of concept" will contribute to generating new knowledge on post-RT AF in women with breast cancer and help considering AF screening into routine clinical practice in these patients over 65. Identifying the dose-risk relationship could improve RT delivery protocols to limit the occurrence of these arrhythmias and, if necessary, initiate appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. Methods: Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Results: Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Conclusions: Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.

Describes the method and principles, including the clinical presentation model, used by the Medical Council of Canada in developing goals for the education of medical students. Outlines basic steps in developing the curriculum and examination objectives from identifying attributes through deducing learning objectives from practice-related behaviors. (SLD)

This article considers whether the freedom for any person to navigate at sea for leisure purposes still constitutes, with regard to measures protecting the environment, a cornerstone of the freedom of navigation or if the „environmental value” constitutes a new principle, which, like the safety of navigation, becomes an element of the freedom of navigation. The study of marine natural parks suggests that environmental protection has become a component of the freedom of navigation. [ABSTRACT FROM AUTHOR]

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Iron sulfur (Fe-S) clusters rank among the most ancient and conserved prosthetic groups. Fe-S clusters containing proteins are present in most, if not all, organisms. Fe-S clusters containing proteins are involved in a wide range of cellular processes, from gene regulation to central metabolism, via gene expression, RNA modification or bioenergetics. Fe-S clusters are built by biogenesis machineries conserved throughout both prokaryotes and eukaryotes. We focus mostly on bacterial ISC machinery, but not exclusively, as we refer to eukaryotic ISC system when it brings significant complementary information. Besides covering the structural and regulatory aspects of Fe-S biogenesis, this review aims to highlight Fe-S biogenesis facets remaining matters of discussion, such as the role of frataxin, or the link between fatty acid metabolism and Fe-S homeostasis. Last, we discuss recent advances on strategies used by different species to make and use Fe-S clusters in changing redox environmental conditions. [ABSTRACT FROM AUTHOR]

Abstract Semivolatile organic compounds (SVOCs) in indoor environments can partition into the gas phase, airborne particles, and settled dust and onto available surfaces. A long-term dynamic model was developed to predict the hourly concentrations of SVOCs over a year in the gas phase, airborne particles, and settled dust and on each sink surface. The model takes into account mass transfer mechanisms, the reactivity of SVOCs with oxidants indoors, and the influence of four indoor environmental factors (the air temperature, relative humidity, concentration of indoor airborne particles, and air exchange rate) on the mass transfer parameters. The model was validated for DEHP (di-2-ethylhexyl phthalate) and BBzP (butyl benzyl phthalate) by comparing the predicted concentrations in all the phases with the measured concentrations obtained in an environmental chamber and a test house. The model was then used to predict the hourly averaged concentration of BBzP in all the phases under real environmental conditions over a year. More than 52% of the variance in the BBzP concentrations was found to be associated with the covariance of the environmental factors. The air exchange rate explained at least 16% of the variance in the BBzP concentrations. In addition, the indoor air temperature explained 9% of the variance in the BBzP gas-phase concentration and the relative humidity explained 7% of the variance in the BBzP settled dust concentration. The variance in the concentration of the total suspended particles explained 10% of the variance in the BBzP concentration on the walls and windows. Highlights • A dynamic model was developed to predict indoor SVOC concentrations. • The model provides hourly SVOC concentrations over a year as output. • SVOC emission, partition and reactivity in difference phases are characterized. • The influence of four environmental factors on SVOC mass transfer is quantified. [ABSTRACT FROM AUTHOR]

Indoor air quality (IAQ) measurements were carried out in two field campaigns (summer and winter) in European office buildings (approximately 140 office rooms) in eight countries, as part of the EU-funded OFFICAIR project. A source identification study was performed with principal component analysis (varimax rotation) on a database containing volatile organic compound (VOC) and aldehyde concentration data during summer and winter monitoring campaigns. The common indoor and outdoor sources of VOCs and aldehydes were identified through a critical evaluation based on checklist data and knowledge of material and product emissions from the literature. The dominant source of variance, accounting for 29% and 26% of the explained variance in the summer and winter campaigns, respectively, was attributed to the ingress of outdoor air into indoor environments. The other most relevant sources for variance were directly or indirectly associated with building materials, such as flooring materials (in particular carpets), wood-based products and various types of paint. Ozone-initiated indoor air chemistry played a key role only during summer, in which a specific source linked to ozone-initiated reactions was clearly identified. Other indoor sources explained less than 10% of the variance, such as printer emissions in both campaigns and cleaning products in winter. [ABSTRACT FROM AUTHOR]

Studies about microplastics in various environments highlighted the ubiquity of anthropogenic fibers. As a follow-up of a recent study that emphasized the presence of man-made fibers in atmospheric fallout, this study is the first one to investigate fibers in indoor and outdoor air. Three different indoor sites were considered: two private apartments and one office. In parallel, the outdoor air was sampled in one site. The deposition rate of the fibers and their concentration in settled dust collected from vacuum cleaner bags were also estimated. Overall, indoor concentrations ranged between 1.0 and 60.0 fibers/m 3 . Outdoor concentrations are significantly lower as they range between 0.3 and 1.5 fibers/m 3 . The deposition rate of the fibers in indoor environments is between 1586 and 11,130 fibers/day/m 2 leading to an accumulation of fibers in settled dust (190–670 fibers/mg). Regarding fiber type, 67% of the analyzed fibers in indoor environments are made of natural material, primarily cellulosic, while the remaining 33% fibers contain petrochemicals with polypropylene being predominant. Such fibers are observed in marine and continental studies dealing with microplastics. The observed fibers are supposedly too large to be inhaled but the exposure may occur through dust ingestion, particularly for young children. [ABSTRACT FROM AUTHOR]

The evaluation of indoor air quality (IAQ) in buildings is complex because IAQ involves a broad spectrum of substances and agents that vary over time and space. To address this complexity, IAQ indexes are used to describe, classify and improve IAQ by providing easy-to-understand and comprehensive rankings of IAQ levels in buildings. Although many IAQ indexes have been proposed all over the world, their relevancy regarding the evaluation of IAQ levels has not been fully studied in a large number of dwellings. In this study, six measurement-based IAQ indexes proposed for use in the USA, France, Taiwan, and Hong Kong were evaluated. The calculation of IAQ levels was based on nine indoor parameters measured in 567 French dwellings, i.e., indoor air temperature, relative humidity, and concentrations of formaldehyde, total volatile organic compounds, radon, carbon monoxide, carbon dioxide, PM 2.5 , and PM 10 . A factorial analysis using the multiple correspondence analysis and the hierarchical cluster analysis methods was performed to determine whether the calculated IAQ levels of different indexes in the studied dwellings were repeatable across all indexes. The results showed that three of the indexes tended to provide only positive IAQ ratings, while the other three indexes were more discriminating. Three classes of IAQ levels in dwellings, along with indoor parameters associated with each class, were identified. All of the indoor parameters were associated with the classification of IAQ levels, while the formaldehyde concentration and relative humidity were the key parameters to identify the dwellings with the best IAQ. [ABSTRACT FROM AUTHOR]

Objectives Ocular discomfort is a prevalent health complaint in offices. It is hypothesized that, in addition to individual and occupational factors, the buildings' indoor environment may affect eye complaints. However, insight in potential building-related causal factors, needed to allow development of effective prevention strategies in building design, operation and maintenance is limited. This study aimed to investigate the relations between modern office building characteristics and dry eye complaints. Methods Comprehensive characteristics of 167 office buildings in eight European countries, were linked to questionnaire data from 7441 office workers. Multilevel modeling was applied to explore relations between building characteristics and self-reported dry eye complaints, in a cross-sectional study. Results Among office workers investigated, 34% declared dry eye complaints during the past four weeks. Majority of workers (91.2%) experiencing these symptoms, reported improvement on days away from the office. After full adjustment, the regression model revealed a significant increased risk for: proximity (<100 m) to potential sources of outdoor air pollution (OR: 1.41, 95% CI: 1.06–1.88), absence of operable windows (OR: 1.70, 95% CI: 1.34–2.16), portable humidifiers in the offices (OR: 1.58, 95% CI: 1.18–2.11), exposed concrete and/or plaster (OR: 1.29, 95% CI 1.02–1.62) and dispersion and/or emulsion paint as wall covering in offices (OR: 1.20, 95% CI: 1.01–1.41). A negative association was found for cleaning surfaces at least once per week (OR: 0.75, 95% CI: 0.61–0.91). Conclusions Building characteristics were associated with dry eye complaints of office workers. Focused studies are recommended to investigate underlying causes to prevent these symptoms. [ABSTRACT FROM AUTHOR]

Juniperus phoenicea is a tree that can grow on vertical cliff faces in dry and warm Mediterranean climate conditions. These trees are adapted to extreme growing conditions where the main constraints are verticality, compact hard limestone, and low water supply. They respond to these constraints via various specific features and high longevity. The objective of this study is to confirm whether or not their tree-rings are annual in order to specify growth strategies and accurately date these trees. Trunk morphology, anatomical wood anomalies and radial growth were analyzed on 53 trees in the Ardèche canyon. Crossdating of the ring widths using traditional dendrochronological techniques was unsuccessful, so radiocarbon dating of tree pith was used to assess tree age, and wiggle-match dating was used to test for differences between number of rings counted and radiocarbon dates. Radiocarbon dates span the period 2520–685 BP. Minimal difference between radiocarbon dates and ring counts was apparently small—missing rings occur, but not in large numbers. Tree-ring formation is annual and radial growth is low, which creates stunted old trees. Such old living trees are uncommon in the Mediterranean basin, especially at low elevation. They can provide long tree-ring chronologies back to 792–524 cal BC. Results from the radiocarbon dating indicate that accurate annual dating of these rings may be possible by crossdating. J. phoenicea growing on cliffs offer a valuable model to better understand cliff population ecology and the functional responses of trees that can live in harsh environmental conditions. [ABSTRACT FROM AUTHOR]

This study aims to test if CO 2 concentration could be used as a proxy for indoor air quality. It focuses on the observed correlations between concentrations of carbon dioxide (CO 2 ) and indoor air pollutants within two measurement campaigns in France (567 dwellings and 310 nurseries, kindergartens and elementary schools). In dwellings, the weekly averaged concentration of CO 2 was positively and significantly correlated with formaldehyde, acetaldehyde, acrolein, benzene and particulate matter (PM 2.5 and PM 10 fractions). In schools, similar significant correlations were observed between CO 2 and both formaldehyde and benzene. With high concentration of CO 2 in dwellings and schools, the probability to exceed the pollutant health guideline values for long term exposure increased. CO 2 concentration was used as a diagnosis test to predict the probability to exceed a guideline value. The real gain in exceedance detection probability was at best +33% for acetaldehyde (guideline value of 9 μg/m 3 ) in dwellings and +23% for formaldehyde (guideline value of 10 μg/m 3 ) in schools. The optimum CO 2 concentration threshold that maximizes exceedance detection probability ranges from 660 ppm to 890 ppm depending on the pollutant. However, limiting CO 2 concentration is not enough to prevent exceedances to occur. CO 2 as a tracer of some pollution sources cannot be considered as a unique indoor air quality indicator. CO 2 is also often considered as a surrogate of ventilation rate. Hence, this study confirms that even with good ventilation conditions (i.e. low CO 2 level), the reduction of pollutant sources remains necessary to achieve a satisfactory indoor air quality. [ABSTRACT FROM AUTHOR]

Green building certifications aim to achieve sustainable buildings that are healthy, energy-saving, and environmentally friendly. To construct healthy built environments for occupants, a high indoor environment quality (IEQ) has to be maintained. The goal of this paper is to analyze how and to what extent indoor air quality (IAQ), as a subset of IEQ, is taken into account in green building certifications worldwide. Thus, IAQ requirements were reviewed in 31 green building certifications from 30 countries worldwide. These certification programs include 13 countries in Asia, 9 in Europe, 5 in Americas, 2 in Oceania, and 1 in Africa. Fifty-five green building schemes were selected from among the 31 certifications. Rating systems are commonly used in green building schemes to evaluate the capability and level of a building to achieve life-cycle sustainability. The average contribution of IAQ to green building schemes worldwide is 7.5%. Volatile organic compounds (VOCs), formaldehyde, and carbon dioxide (CO 2 ) are the indoor air pollutants most frequently considered. Ozone (O 3 ) and semi-volatile organic compounds (SVOCs) are mentioned in less than 6.7% of the certifications worldwide. Emission source control, ventilation, and indoor air measurement are the three main pathways used in green building schemes for IAQ management. All of the certifications include ventilation as a way to manage IAQ. Emission source control is included in 77% of the certifications and is mainly targeted at building material emissions. Indoor air measurement is included in 65% of the certifications but may be optional. [ABSTRACT FROM AUTHOR]