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- Stewart, C., et al.
(författare)
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Volcanic air pollution and human health: recent advances and future directions
- 2022
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Ingår i: Bulletin of Volcanology. - : Springer Science and Business Media LLC. - 0258-8900 .- 1432-0819. ; 84:1
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Tidskriftsartikel (refereegranskat)abstract
- Volcanic air pollution from both explosive and effusive activity can affect large populations as far as thousands of kilometers away from the source, for days to decades or even centuries. Here, we summarize key advances and prospects in the assessment of health hazards, effects, risk, and management. Recent advances include standardized ash assessment methods to characterize the multiple physicochemical characteristics that might influence toxicity; the rise of community-based air quality monitoring networks using low-cost gas and particulate sensors; the development of forecasting methods for ground-level concentrations and associated public advisories; the development of risk and impact assessment methods to explore health consequences of future eruptions; and the development of evidence-based, locally specific measures for health protection. However, it remains problematic that the health effects of many major and sometimes long-duration eruptions near large populations have gone completely unmonitored. Similarly, effects of prolonged degassing on exposed populations have received very little attention relative to explosive eruptions. Furthermore, very few studies have longitudinally followed populations chronically exposed to volcanic emissions; thus, knowledge gaps remain about whether chronic exposures can trigger development of potentially fatal diseases. Instigating such studies will be facilitated by continued co-development of standardized protocols, supporting local study teams and procuring equipment, funding, and ethical permissions. Relationship building between visiting researchers and host country academic, observatory, and agency partners is vital and can, in turn, support the effective communication of health impacts of volcanic air pollution to populations, health practitioners, and emergency managers.
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| 2. |
- Ayres-de-Campos, D., et al.
(författare)
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A randomised clinical trial of intrapartum fetal monitoring with computer analysis and alerts versus previously available monitoring
- 2010
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central Ltd.. - 1471-2393 .- 1471-2393. ; 10:71
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intrapartum fetal hypoxia remains an important cause of death and permanent handicap and in a significant proportion of cases there is evidence of suboptimal care related to fetal surveillance. Cardiotocographic (CTG) monitoring remains the basis of intrapartum surveillance, but its interpretation by healthcare professionals lacks reproducibility and the technology has not been shown to improve clinically important outcomes. The addition of fetal electrocardiogram analysis has increased the potential to avoid adverse outcomes, but CTG interpretation remains its main weakness. A program for computerised analysis of intrapartum fetal signals, incorporating real-time alerts for healthcare professionals, has recently been developed. There is a need to determine whether this technology can result in better perinatal outcomes. Methods/design: This is a multicentre randomised clinical trial. Inclusion criteria are: women aged ≥ 16 years, able to provide written informed consent, singleton pregnancies ≥ 36 weeks, cephalic presentation, no known major fetal malformations, in labour but excluding active second stage, planned for continuous CTG monitoring, and no known contra-indication for vaginal delivery. Eligible women will be randomised using a computer-generated randomisation sequence to one of the two arms: continuous computer analysis of fetal monitoring signals with real-time alerts (intervention arm) or continuous CTG monitoring as previously performed (control arm). Electrocardiographic monitoring and fetal scalp blood sampling will be available in both arms. The primary outcome measure is the incidence of fetal metabolic acidosis (umbilical artery pH < 7.05, BDecf > 12 mmol/L). Secondary outcome measures are: caesarean section and instrumental vaginal delivery rates, use of fetal blood sampling, 5-minute Apgar score < 7, neonatal intensive care unit admission, moderate and severe neonatal encephalopathy with a marker of hypoxia, perinatal death, rate of internal monitoring, tracing quality, and signal loss. Analysis will follow an intention to treat principle. Incidences of primary and secondary outcomes will be compared between groups. Assuming a reduction in metabolic acidosis from 2.8% to 1.8%, using a two-sided test with alpha = 0.05, power = 0.80, and 10% loss to follow-up, 8133 women need to be randomised. Discussion: This study will provide evidence of the impact of intrapartum monitoring with computer analysis and real-time alerts on the incidence of adverse perinatal outcomes, intrapartum interventions and signal quality. (Current controlled trials ISRCTN42314164)
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