Rethinking indoor air chemistry

People generate their own oxidation field and change the indoor air chemistry around them

Peer-Reviewed Publication

MAX PLANCK INSTITUTE FOR CHEMISTRY

 

IMAGE: COMPUTER MODELLING OF THE OH REACTIVITY (LEFT) AND OH CONCENTRATION (RIGHT) AROUND HUMAN BODIES IN A TYPICAL INDOOR SITUATION WHILE PEOPLE SITTING AROUND A TABLE view more 

CREDIT: UC IRVINE

People typically spend 90 percent of their lives inside, at home, at work, or in transport. Within these enclosed spaces, occupants are exposed to a multitude of chemicals from various sources, including outdoor pollutants penetrating indoors, gaseous emissions from building materials and furnishings, and products of our own activities such as cooking and cleaning. In addition, we are ourselves potent mobile emission sources of chemicals that enter the indoor air from our breath and skin.

But how do the chemicals disappear again? In the atmosphere outdoors, this happens to a certain extent naturally by itself, when it rains and through chemical oxidation. Hydroxyl (OH) radicals are largely responsible for this chemical cleaning. These very reactive molecules are also called the detergents of the atmosphere and they are primarily formed when UV light from the sun interacts with ozone and water vapor.

Indoors, on the other hand, the air is of course far less affected by direct sunlight and rain. Since UV rays are largely filtered out by glass windows it has been generally assumed that the concentration of OH radicals is substantially lower indoors than outdoors and that ozone, leaking in from outdoors, is the major oxidant of indoor airborne chemical pollutants.

OH radicals are formed from ozone and skin oils

However, now it has been discovered that high levels of OH radicals can be generated indoors, simply due to the presence of people and ozone. This has been shown by a team led by the Max Planck Institute for Chemistry in cooperation with researchers from the USA and Denmark.

"The discovery that we humans are not only a source of reactive chemicals, but we are also able to transform these chemicals ourselves was very surprising to us," says Nora Zannoni, first author of the study published in the research magazine Science, and now at the Institute of Atmospheric Sciences and Climate in Bologna, Italy. "The strength and shape of the oxidation field are determined by how much ozone is present, where it infiltrates, and how the ventilation of the indoor space is configured," adds the scientist from Jonathan Williams' team. The levels the scientists found were even comparable to outside daytime OH concentrations levels.

The oxidation field is generated by the reaction of ozone with oils and fats on our skin, especially the unsaturated triterpene squalene, which constitutes about 10 percent of the skin lipids that protect our skin and keep it supple. The reaction releases a host of gas phase chemicals containing double bonds that react further in the air with ozone to generate substantial levels of OH radicals. These squalene degradation products were characterized and quantified individually using Proton Transfer reaction Mass Spectrometry and fast gas chromatograph-mass spectrometry systems. In addition, the total OH reactivity was determined in parallel enabling the OH levels to be quantified empirically.

The experiments were conducted at the Technical University of Denmark (DTU) in Copenhagen. Four test subjects stayed in a special climate-controlled chamber under standardized conditions. Ozone was added to the chamber air inflow in a quantity that was not harmful to humans but representative of higher indoor levels. The team determined the OH values before and during the volunteers' stay both with and without ozone present.

In order to understand how the human-generated OH field looked like in space and time during the experiments, results from a detailed multiphase chemical kinetic model from the University of California, Irvine were combined with a computational fluid dynamics model from Pennsylvania State University, both based in the USA. After validating the models against the experimental results, the modeling team examined how the human-generated OH field varied under different conditions of ventilation and ozone, beyond those tested in the laboratory. From the results, it was clear that the OH radicals were present, abundant, and forming strong spatial gradients.

“Our modeling team is the first and currently the only group that can integrate chemical processes between the skin and indoor air, from molecular scales to room scales,” said Manabu Shiraiwa, a professor at UC Irvine who led the modeling part of the new work. “The model makes sense of the measurements — why OH is generated from the reaction with the skin.”

Shiraiwa added that there remain unanswered questions, like the way humidity levels impact the reactions the team traced. “I think this study opens up a new avenue for indoor air research,” he said.

Adapt test methods for furniture and building materials

"We need to rethink indoor chemistry in occupied spaces because the oxidation field we create will transform many of the chemicals in our immediate vicinity. OH can oxidize many more species than ozone, creating a multitude of products directly in our breathing zone with as yet unknown health impacts”. This oxidation field will also impact the chemical signals we emit and receive," says project leader Jonathan Williams, “and possibly help explain the recent finding that our sense of smell is generally more sensitive to molecules that react faster with OH.”

The new finding also has implications for our health: Currently, chemical emissions of many materials and furnishings are being tested in isolation before they are approved for sale. However, it would be advisable to also conduct tests in the presence of people and ozone, says atmospheric chemist Williams. This is because oxidation processes can lead to the generation of respiratory irritants such as 4-oxopentanal (4-OPA) and other OH radical-generated oxygenated species, and small particles in the immediate vicinity of the respiratory tract. These can have adverse effects, especially in children and the infirm.

These findings are part of the project ICHEAR (Indoor Chemical Human Emissions and Reactivity Project) which brought together a group of collaborating international scientists from Denmark (DTU), the USA (Rutgers University), and Germany (MPI). The modeling was part of the MOCCIE project based at the University of California Irvine and the Pennsylvania State University. Both projects were funded by grants from the A. P. Sloan foundation.

CAPTION

Not visible, but measurable: an oxidation field is generated around each person in the stainless steel climate chamber at the Technical University of Denmark.

CREDIT

 

Original publication

The Human Oxidation Field
Nora Zannoni, Pascale S. J. Lakey, Youngbo Won, Manabu Shiraiwa, Donghyun Rim, Charles J. Weschler, Nijing Wang, Lisa Ernle, Mengze Li, Gabriel Bekö, Pawel Wargocki, Jonathan Williams
Science, 1 September 2022
Doi: 10.1126/science.abn0340

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JOURNAL

Science

DOI

10.1126/science.abn0340 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The Human Oxidation Field

ARTICLE PUBLICATION DATE

2-Sep-2022

The human body produces hydroxyl radicals when exposed to ozone in indoor environments

Peer-Reviewed Publication

AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE (AAAS)

The human body’s exposure to ozone in indoor spaces generates highly reactive hydroxyl (OH), radicals which are largely responsible for the oxidation of most pollutant gases, researchers report. The findings have implications for our understanding of the role of humans in indoor air chemistry and quality. “[The authors] observed that the human body interacts with the indoor environment in an analogous manner to how Earth interacts with the atmosphere,” write Coralie Schoemaecker and Nicola Carslaw in a related Perspective. “Both the human body and Earth are chemical reactors, consuming or producing oxidants and oxidized species in their surrounding atmospheres.” The vast majority of humans spend most of their time indoors – whether at their home or workplace or while traveling between the two – and are exposed to a number of chemicals from various sources, including outdoor pollutants that find their way inside, gaseous emissions from building materials and furnishings, and products of activities such as cooking and cleaning. Moreover, the human body is also a potent mobile source of emissions. Chemical removal of gas-phase pollutants in outside air during daytime is mostly driven by the production of OH radicals, which are formed primarily by the photolysis of ozone by ultraviolet sunlight. However, indoor air quality is much less impacted by this process, as glass windows largely filter out ultraviolet light. While research has shown that some OH radicals can be generated by other means in indoor environments, few studies have evaluated the chemical influence human bodies in these environments. Through a series of experiments, Nora Zannoni and colleagues found that high concentrations of OH radicals are generated when people were exposed to different concentrations of ozone within a climate-controlled, stainless-steel chamber. According to Zannoni et al., squalene in skin oil reacted with to produce 6-methyl-5-hepten-2-one (6-MHO), which was key to establishing this human-induced oxidation field. What’s more, they found that isoprene from human breath and products of its interaction with OH also react with ozone to produce more OH radicals, suggesting that humans are a net source of reactive oxidants indoors.

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JOURNAL

Science

DOI

10.1126/science.abn0340 

ARTICLE TITLE

The human oxidation field

ARTICLE PUBLICATION DATE

2-Sep-2022

Toxins in old toys an obstacle for circular economy

Peer-Reviewed Publication

UNIVERSITY OF GOTHENBURG

 

IMAGE: MANY OF THE OLDER TOYS CONTAINED TOXINS. view more 

CREDIT: NONE

Letting children play with hand-me-down plastic toys could constitute a health risk. When researchers at the University of Gothenburg tested a large number of old toys and dress-up items made of plastic, 84 per cent of the items were found to contain toxins that can disrupt growth and development and reproductive capacities in children. These toxins are an obstacle for the circular economy in the future involving reuse and recycling, the researchers explain.

The current use-and-discard behaviour is wasteful with resources and a drain on the Earth’s finite resources. In 2021, the European Parliament adopted a Circular Economy Action Plan. It encourages the re-use, repair and recycling of products and materials. But the question is whether all products are good to reuse again?

Researchers from the University of Gothenburg have recently published an article in the Journal of Hazardous Materials Advances which shows that old toys and dress-up items may contain toxic chemicals that can cause cancer, damage DNA or disrupt the future reproductive capacities of children.

Toxic chemicals in most old toys

The hazardous chemicals that were discovered included phthalates and short chain chlorinated paraffins used as plasticizers and flame retardants in toys.  

Professor Bethanie Carney Almroth at the University of Gothenburg conducts research on the environmental impact of plastics and plastic-related chemicals, and has led the research study conducted at the interdisciplinary Centre for Future Chemical Risk Assessment and Management Strategies (FRAM). For the study, researchers selected 157 different toys, new and old, and measured their chemical content.

The study showed that most of the older toys and items (84 per cent) contained quantities of chemicals that exceed current legal limits. A total of 30 per cent of the newer toys and items also exceeded the legal limits. By far however, the older toys were significantly worse.

“The concentrations of toxic substances were significantly higher in the older items. For example, many of the old balls were found to have concentrations of phthalates totalling more than 40 per cent of the toy’s weight, which is 400 times over the legal limit,” says Bethanie Carney Almroth.

Toxins an obstacle to a circular economy

EU legislation on the chemical content of toys, known as the Toy Safety Directive, regulates the permissible quantities of a number of chemical substances found in toys in an attempt to protect the health and safety of children. At present, the permissible limit values for new toys under the Toy Safety Directive are 0.1 per cent by weight for phthalates and 0.15 per cent by weight for short chain chlorinated paraffins.

“The study indicates that reuse and recycling is not always automatically a good thing. The transition to a more circular economy requires bans and other policy measures that get rid of hazardous chemicals from plastic and other materials. Although the Toy Safety Directive has been crucial in reducing the incidence of hazardous chemicals in toys, it has only been applicable to new toys, not old ones,” explains Daniel Slunge, Environmental Economist at the University of Gothenburg. 

Facts: FRAM

FRAM is the Swedish acronym for the University of Gothenburg’s interdisciplinary Centre for Future Chemical Risk Assessment and Management Strategies. FRAM brings together expertise from the fields of science, economics, law and political science to garner support for a precautionary principle when assessing and managing risks linked to how chemical compounds impact human health and the environment.

Read the scientific journal article: Circular economy could expose children to hazardous phthalates and chlorinated paraffins via old toys and childcare articles

Links for further reading:

What counts as a toy? Read more about the Toy Safety Directive (in Swedish only)

Read more about toxic chemicals that the Swedish Chemicals Agency wants to phase out

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DOI

10.1016/j.hazadv.2022.100107 

METHOD OF RESEARCH

Content analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Circular economy could expose children to hazardous phthalates and chlorinated paraffins via old toys and childcare articles

Global analysis identifies at-risk forests

Peer-Reviewed Publication

UNIVERSITY OF UTAH

 

IMAGE: WILDFIRE AT LICK CREEK, UMATILLA NATIONAL FOREST, OREGON, UNITED STATES. view more 

CREDIT: BRENDAN O'REILLY/U.S. FOREST SERVICE

Forests are engaged in a delicate, deadly dance with climate change, sucking carbon dioxide out of the air with billions of leafy straws and hosting abundant biodiversity, as long as climate change, with its droughts, wildfires and ecosystem shifts, doesn’t kill them first.

In a study published in Science William Anderegg, inaugural director of the University of Utah’s Wilkes Center for Climate Science and Policy, and colleagues quantify the risk to forests from climate change along three dimensions: carbon storage, biodiversity and forest loss from disturbance, such as fire or drought. The results show forests in some regions experiencing clear and consistent risks. In other regions, the risk profile is less clear, because different approaches that account for disparate aspects of climate risk yield diverging answers.

“Large uncertainty in most regions highlights that there's a lot more scientific study that's urgently needed,” Anderegg says.

An international team

Anderegg assembled a team including researchers from the United Kingdom, Germany, Portugal and Sweden.

“I had met some of these folks before,” he says, “and had read many of their papers. In undertaking a large, synthetic analysis like this, I contacted them to ask if they wanted to be involved in a global analysis and provide their expertise and data.”

Their task was formidable –assess climate risks to the world’s forests, which span continents and climes and host tremendous biodiversity while storing an immense amount of carbon. Researchers had previously attempted to quantify risks to forests using vegetation models, relationships between climate and forest attributes and climate effects on forest loss.

“These approaches have different inherent strengths and weaknesses,” the team writes, “but a synthesis of approaches at a global scale is lacking.” Each of the previous approaches investigated one dimension of climate risk: carbon storage, biodiversity, and risk of forest loss. For their new analysis, the team went after all three.

Three dimensions of risk

“These dimensions of risk are all important and, in many cases, complementary. They capture different aspects of forests resilience or vulnerability,” Anderegg says.  

Carbon storage: Forests absorb about a quarter of the carbon dioxide that’s emitted into the atmosphere, so they play a critically important role in buffering the planet from the effects of rising atmospheric carbon dioxide. The team leveraged output from dozens of different climate models and vegetation models simulating how different plant and tree types respond to different climates. They then compared the recent past climate (1995-2014) with the end of the 21st century (2081-2100) in scenarios of both high and low carbon emissions.

On average, the models showed global gains in carbon storage by the end of the century, although with large disagreements and uncertainty across the different climate-vegetation models. But zooming in to regional forests and taking into account models that forecast carbon loss and changes in vegetation, the researchers found higher risk of carbon loss in southern boreal (just south of the Arctic) forests and the drier regions of the Amazon and African tropics.

Biodiversity: Unsurprisingly, the researchers found that the highest risk of ecosystems shifting from one “life zone” to another due to climate change could be found at the current boundaries of biomes – at the current transition between temperate and boreal forests, for example. The models the researchers worked from described changes in ecosystems as a whole and not species individually, but the results suggested that forests of the boreal regions and western North America faced the greatest risk of biodiversity loss.

Disturbance: Finally, the authors looked at the risk of “stand-replacing disturbances,” or events like drought, fire or insect damage that could wipe out swaths of forest. Using satellite data and observations of stand-replacing disturbances between 2002 and 2014, the researchers then forecast into the future using projected future temperatures and precipitation to see how much more frequent these events might become. The boreal forests, again, face high risk under these conditions, as well as the tropics.  

“Forests store an immense amount of carbon and slow the pace of climate change,” Anderegg says. “They harbor the vast majority of Earth's biodiversity. And they can be quite vulnerable to disturbances like severe fire or drought. Thus, it's important to consider each of these aspects and dimensions when thinking about the future of Earth's forests in a rapidly changing climate.”

Future needs

Anderegg was surprised that the spatial patterns of high risk didn’t overlap more across the different dimensions.
“They capture different aspects of forests' responses,” he says, “so they wouldn't likely be identical, but I did expect some similar patterns and correlations.”

Models can only be as good as the basis of scientific understanding and data on which they’re built and this study, the researchers write, exposes significant understanding and data gaps that may contribute to the inconsistent results. Global models of biodiversity, for example, don’t incorporate dynamics of growth and mortality, or include the effects of rising CO2 directly on species. And models of forest disturbance don’t include regrowth or species turnover.

“If forests are tapped to play an important role in climate mitigation,” the authors write, “an enormous scientific effort is needed to better shed light on when and where forests will be resilient to climate change in the 21st century.”

Key next steps, Anderegg says, are improving models of forest disturbance, studying the resilience of forests after disturbance, and improving large-scale ecosystem models.

The recently-launched Wilkes Center for Climate Science and Policy at the University of Utah aims to provide cutting-edge science and tools for decision-makers in the US and across the globe. For this study, the authors built a visualization tool of the results for stakeholders and decision-makers.  

Despite uncertainty in the results, western North America seems to have a consistently high risk to forests. Preserving these forests, he says, requires action.

“First we have to realize that the quicker we tackle climate change, the lower the risks in the West will be,” Anderegg says. “Second, we can start to plan for increasing risk and manage forests to reduce risk, like fires.”

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JOURNAL

Science

DOI

10.1126/science.abp9723 

METHOD OF RESEARCH

Computational simulation/modeling

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

A climate risk analysis of Earth’s forests in the 21st century

ARTICLE PUBLICATION DATE

2-Sep-2022

Physically active adolescents up to 23% more likely to vape than less active peers

New study is the first in the U.S. to link e-cigarette use to physical activity levels in high schoolers

Peer-Reviewed Publication

UNIVERSITY OF GEORGIA

Physically active adolescents may be more likely to use electronic cigarettes, also known as e-cigarettes or vapes, than their less active peers, according to new research from the University of Georgia.

The study found high school students who said they were physically active were at higher risk of using vape products than their classmates who were only active one day a week or less. Teenagers who reported four to five days of at least 60 minutes of physical activity were 23% more likely to smoke an electronic vapor product than their less active peers. Teens who said they were active two to three days a week were 11% more likely to use such products.

The study is the first to show a link between physical activity levels and risk of e-cigarette use among American adolescents.

“Our youth who tend to be on the healthy spectrum for physical health have heightened risk of using electronic vapor products. This may be because vape is perceived to be a healthier option to traditional smoking,” said Janani Rajbhandari-Thapa, lead author of the study and an associate professor in UGA’s College of Public Health. “Marketing campaigns have marketed vapes as a healthier option to traditional cigarettes, but data shows that additives in vape products were linked to e-cigarette, or vaping, product use-associated lung injury.

“If adolescents are thinking vapes are a better option to traditional cigarettes that is a big problem.”

Vape juice is full of potentially cancer-causing chemicals

It seems counterintuitive for the “healthy” adolescents who are reaching the recommended amount of physical activity recommended for their age group to be at higher risk of becoming vape users.

Previous studies have shown that sport participation is associated with alcohol abuse, Thapa said. Teens participating in group sports or athletic teams may face peer pressure to indulge in alcoholic beverages to celebrate wins as a means of team bonding. They also may have larger social networks than non-participating teens, putting them at risk of more social pressure to participate in risky behaviors.

Factor in that some younger vape users are under the misguided belief that they’re just inhaling water vapor with nicotine and some minor additives, and it’s a recipe for teenage addiction.

But that “water vapor” can contain not just nicotine but also benzene, which is found in car exhaust; flavorings that have been linked to lung disease; and other unidentified, possibly carcinogenic chemicals, according to the U.S. Department of Health and Human Services.

The amount of nicotine in vape products varies widely, but e-cigarettes can have higher concentrations of the drug than traditional cigarettes, according to the Centers for Disease Control and Prevention. Vapes are frequently cheaper per use, don’t smell of tobacco and can often be “smoked” in areas where tobacco products are banned, which makes them a popular option for young people.

“We have to make parents more aware that vaping is not OK,” Thapa said. “If I take my public health expertise off the table, as a parent, I may be thinking, ‘Well, my child isn’t smoking. It’s OK that he’s vaping.’ But that’s not the case. We have evidence of how harmful vaping is.”

Previous research has shown e-cigarettes can cause a variety of dangerous medical conditions, including vape-associated illness, a potentially deadly disease that causes severe respiratory symptoms including shortness of breath, cough and fever, according to the Georgia Department of Public Health.

11% of Georgia high school students reported having smoked an electronic vapor product

The researchers relied on data from the 2018 Georgia Student Health Survey 2.0, an annual, anonymous survey implemented by the Georgia Department of Education. The study included survey responses from more than 362,000 Georgia high school students from 439 schools across the state.

More than 10% of the students reported that they had smoked an electronic vapor product, such as e-cigarettes, e-pipes, vaping pens or hookah pens at least once in the past month.

Overall, the researchers found that 7% of high school students in the state had used electronic vapor products for at least one day in the past 30 days. An additional 4% reported that they had smoked both traditional cigarettes and vape products.  The rate of traditional tobacco products use was low—only 1% reported exclusive traditional smoke use.

Male students were more likely to smoke cigarettes or vapes than female students, and students in higher grades reported using both traditional smoke and vape products at higher rates than high school students in lower grades.

More active students were less likely to smoke traditional cigarettes or to use them in combination with vaping products. But they were more likely to report using e-cigarettes exclusively.

“Physically active students who are meeting the guidelines for physical activity being at higher risk of vape use brings up a concern of health belief and engagement in risky behaviors,” Thapa said. “I would like this finding to inform our state legislators specifically to address risky substance use behaviors by adolescents in our state.”

“Limiting vape use by limiting marketing, not allowing vape use around schools and implementing school-level policies to discourage vape use—we want our research to inform those policies because vaping is a threat among high school students.”

Published in Tobacco Use Insights, the study was co-authored by Kiran Thapa and Kathryn Chiang, doctoral students in the College of Public Health; Justin Ingels, a clinical assistant professor in the college; Donglan Zhang, a former assistant professor in the college; Ye Shen, an associate professor in the college; and Yan Li, of the Icahn School of Medicine at Mount Sinai.

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JOURNAL

Tobacco Use Insights

DOI

10.1177/1179173X221101786 

ARTICLE TITLE

Electronic Vapor Product Use and Levels of Physical Activity Among High School Students in Georgia

ARTICLE PUBLICATION DATE

With 'batwing' mastopexy, more women can undergo nipple-sparing mastectomy

Peer-Reviewed Publication

WOLTERS KLUWER HEALTH

August 31, 2022 – Nipple-sparing techniques can provide better outcomes for women undergoing breast reconstruction after mastectomy – but due to complication risks, these approaches are often not offered to women with sagging or larger breasts. For this group of patients, a 'batwing' incision may provide a safer option to nipple-sparing mastectomy (NSM), reports a study in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). Plastic and Reconstructive Surgery® is published in the Lippincott portfolio by Wolters Kluwer

"Our findings show that a simultaneous batwing mastopexy can be safely performed at the time of immediate breast reconstruction, while providing comparable complication rates and improving the aesthetic outcome," comments ASPS Member Surgeon Hahns Y. Kim, MD, of Loma Linda University Medical Center.

Batwing mastopexy offers safe approach to NSM in women with ptosis or larger breasts

Nipple-sparing procedures are an increasingly popular alternative for women undergoing mastectomy. In these techniques, the surgeon preserves the nipple and surrounding tissues (nipple-areola complex, or NAC) for use in immediate breast reconstruction using implants. Preserving the NAC allows for a more natural-looking reconstruction, leading to higher patient satisfaction.

However, NSM is generally not offered to women with sagging (ptosis) of the breasts or larger breasts, reflecting concerns about suboptimal aesthetic outcomes and increased risk of complications. The batwing incision – so called because it consists of two semicircular incisions above the nipple, connected by angled "wings" on either side of the NAC – enables the surgeon to perform breast lift (mastopexy) at the same time as mastectomy.

Dr. Kim and colleagues report their experience with batwing mastopexy for NSM in 80 women. About half of patients were undergoing preventive mastectomy due to high genetic risk of breast cancer. Outcomes were compared to those of 244 patients undergoing standard implant-based reconstruction, without preserving the NAC. Women selected for batwing mastopexy had larger breasts and a greater degree of ptosis.

Study participants

An average of 16 months after mastectomy and immediate reconstruction, the two groups of women had similar outcomes. At least one complication occurred in 23.8% of operated breasts in the batwing mastopexy group and 27.5% of the standard reconstruction group. Some minor complications, including hematoma (blood collections) and seroma (fluid collections), were less frequent in the batwing mastopexy group.

Necrosis (tissue death) of the skin or nipple – a more serious complication – was also less frequent in the batwing mastopexy group: 6.3% versus 11.5%. The rate of revision surgery (including fat grafting to improve the aesthetic results) was lower after batwing mastopexy (23.7% versus 30.3%). Other factors such as obesity and smoking were risk factors for skin/nipple necrosis or major infections, but batwing mastopexy was not.

New evidence can improve patient outcomes

The study shows that "complication rates in patients undergoing a simultaneous batwing mastopexy were comparable to those undergoing standard immediate implant-based reconstruction," the researchers write. Although the batwing technique is not new, the study provides new evidence that it may provide good aesthetic outcomes with no increase in complications in women with larger breasts or ptosis.

 

That's especially important, as it may allow surgeons to increase the number of patients who are offered NSM for breast cancer treatment or prevention. "A simultaneous batwing mastopexy may serve as an aesthetic enhancement for breast cancer patients undergoing immediate reconstruction," Dr. Kim and coauthors conclude. They emphasize the need for further studies to obtain higher-level evidence to help select patients who may benefit from this procedure.

Click here to read “The Batwing Mastopexy in Immediate Implant-Based Breast Reconstruction: An Aesthetic Enhancement for Patients with Cancer“

DOI: 10.1097/PRS.0000000000009380

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About Plastic and Reconstructive Surgery

For over 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2021 annual revenues of €4.8 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,800 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.

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JOURNAL

Plastic & Reconstructive Surgery

Disclaimer: AAAS and EurekAlert! are n

Canada Ranks 8th for Safest Countries for Women to Travel in Solo: Study

Sharon Miki Chan - Monday


a woman wearing an orange hat looks at lake and mountains© Pexels


We already know that Canada is a beautiful place to live, but it looks like it’s also one of the safer places for women to travel solo in — according to a new travel study.

Luggage storage company Bounce conducted a Women’s Solo Travel Safety study, which analyzed more than 30 countries globally based on factors including:
The percentage of women who have experienced violence.
The rate of female homicide victims per 100,000 victims
Safety index scores
The percentage of women who feel safe walking alone at night
Attitudes toward violence against women
Laws on domestic violence
The global gender gap index score
Overall safety score out of 10

On this list, Canada ranked eighth. Interestingly, one factor that contributed to this land’s rank, according to the study’s report, was that “the number of women who have suffered violence from a partner is a good indicator of the attitudes toward violence against women in a country, and the nation with the lowest rate is Canada.”

You may also like: The world’s coolest street in 2022 is located in Canada.
What is the safest country for women to travel solo in?

The Republic of Ireland topped the list as the safest country for women to travel solo, with the report noting that Ireland ranked “amongst the top-scoring nations for almost all of the eight factors analyzed” and that “the Emerald Isle scores particularly highly for the laws it has in place to protect women from violence, as well as when it comes to local attitudes toward violence against women.”

By way of comparison, Canada scored 6.67 out of 10 for its overall safety for women travelling solo, compared to 7.88 out of 10 for top-ranking Ireland or 2.25 out of 10 for last-ranking Columbia.

Austria, Norway, Slovenia and Switzerland rounded out the remaining countries in the top five.

See also: Dreaming of travelling to Europe solo? These 5 tips may help.

N.S. mass shooting probe told cultural shift needed to address gender-based violence

Wednesday

HALIFAX — A broad cultural shift is needed to seriously address gender-based and domestic violence in Canada, a panel of experts on Wednesday told the inquiry into the 2020 mass shootings in Nova Scotia.


During a wide-ranging roundtable discussion, the inquiry — called the Mass Casualty Commission — heard that the situation won’t change unless more funding, education, support and political will is applied to the societal problem. The inquiry is investigating how a gunman with previous domestic assault accusations drove a replica police car and murdered 22 people in Nova Scotia in April 2020.

Katreena Scott, a professor and clinical psychologist at Western University, said men who perpetrate violence need more support and services. “Very often we don’t know and we don’t see and we don’t recognize risk factors and warning signs of abuse perpetration,” Scott said.

She said that in Ontario, research has shown that a majority of perpetrators of femicides exhibited risk factors that were missed by authorities, including obsessive behaviour and violent histories with former partners. Scott said that people who witness gender-based violence or who suspect someone they know may be a victim often don't know how to help or where to get help.

“We often then lean away and guard the impact of abusive behaviours or at worst we blame the victim for their own victimization,” she said. “What we do is we empower perpetrators to continue to behave abusively.”

Scott noted that around 20 per cent of abusers are most likely to repeat their violent behaviour once they are in the justice system, which then fails to address the problem. Intervention with high-risk men needs to be more intense, and they need to be monitored closely once they enter the system, she said.

Scott said funding is needed to grow a “suite of service options” that is flexible to meet the needs of men and maintain the core goal of keeping women and children safe. “Men do access services; they will reach out when offered the opportunity. Change is possible — we should expect change and we need to act on it,” she said.

The Nova Scotia shooting rampage that began on April 18, 2020, was preceded by a domestic assault by gunman Gabriel Wortman against his spouse, Lisa Banfield. The inquiry has gathered evidence indicating he used coercive tactics against her throughout their 19-year relationship, as well as against other women.

“I think we have very few tools in the criminal justice system or outside … to deal with men like the perpetrator in this mass casualty,” said Sue Bookchin, of the feminist Be the Peace Institute. “He was not somebody who would have reached out for help.”

To prevent tragedies like the Nova Scotia shootings, children should be taught in schools about gender-based violence and about how to better handle their emotions and build healthy relationships.

“If we did it this way in schools, we could shift the perceptions of an entire generation,” said Bookchin.

Kristina Fifield, of the Halifax-based Avalon Sexual Assault Centre, said more education and accountability needs to occur in workplaces, while she said those in power need to put a higher priority on addressing gender-based violence.

Fifield said government funding needs to stop being “reactionary” and instead be tailored to specific needs. “The one-size-fits-all approach does not work for perpetrators of violence and it does not work for victims and survivors."

This report by The Canadian Press was first published Aug. 31, 2022.

Keith Doucette, The Canadian Press

Nova Scotia to require the collection of race-based data from police stops

Yesterday 

HALIFAX — Nova Scotia’s Justice Department is committing to the collection of race-based data by police, in an effort to determine if Black, Indigenous and other racialized communities are disproportionately targeted by law enforcement.



The department said Thursday it is accepting all the recommendations by a committee established to review ways of gathering race-based information from police. In a news release, Justice Minister Brad Johns said there is "no place for racism in our justice system."

"It must be addressed at every level," Johns said. "These recommendations will guide the development of a data-collection model for police stops that will help ensure police practices and interactions are free from discrimination."

The provincial government said the data is being collected to determine whether some racial groups are being stopped and questioned more often than others. Gathering race-based data, the province said, can help police improve their interactions with African Nova Scotians and Indigenous Peoples, in particular.

The committee was struck as a result of a provincially commissioned study of random police stops — known as street checks — by criminologist Scott Wortley in March 2019. Wortley’s review found that African Nova Scotians were about six times more likely to be the subjects of random police stops than their representation in the population would predict.

He condemned the practice by the Halifax regional police and by the local RCMP, saying it targeted young Black men and created a "disproportionate and negative'' impact on African Nova Scotian communities.

Since 2019, police in Nova Scotia have not been allowed to conduct street checks.

The committee that recommended the new data-collection policy included representatives from the African Nova Scotian Decade for People of African Descent Coalition, Halifax Regional Police, the Nova Scotia Chiefs of Police Association, Cape Breton Regional Police, the Nova Scotia Human Rights Commission and the provincial Department of Justice, among others.

Vanessa Fells, director of operations at the African Nova Scotian Decade for People of African Descent Coalition, said in a telephone interview the commitment is "the beginning of something."

However, she said she hoped the data will be released to the communities most affected by street checks and that the new policy will lead to changes in how police behave.

"How they will be transparent and release the data to this community is a very important step," Fells said.

"If there are issues like racial profiling, then this could help us identify those, and we can identify where it is happening."

"It should show up in the data. Why are you (a police officer) stopping this person? Are you (police officers) doing this for legal reasons, or are you just doing it just because you saw this person walking in a neighbourhood you didn't think they should be in?" she said.

The committee defined a "police stop" as a situation during which an officer stops a person — whether the person is on foot or in a vehicle — when the officer believes there is a reasonable suspicion the person has recently engaged in, or will engage in, a crime, or has information relevant to an investigation or that may help prevent crime.

Race-based data collected in these instances is described by the committee as "a mechanism to monitor the equitable delivery of policing services."

The committee says police stops are not considered situations during which police interact with the public at community meetings or when citizens request police assistance. Traffic checkpoints or situations when police are canvassing an area during an investigation are also not considered police stops.

The government said its next steps in the process include reviewing current data-collection systems used by police agencies and working with communities and police to come up with a way to gather race-based data.

This report by The Canadian Press was first published Sept. 1, 2022.

Michael Tutton, The Canadian Press