Vinyl bag cover method to avoid droplet-containing aerosol escape from endoscopic forceps channel caps during COVID-19 pandemic (with Video 1 and Video 2)

Endoscopists are at high risk of allowing transmission of coronavirus disease 2019 (COVID-19) during gastrointestinal endoscopy (GIE) procedures under pandemic conditions. The main avenues of droplet-containing aerosol generated during GIE are the mouth, anus, and endoscopic forceps channel. Although the usefulness of personal protective equipment for preventing COVID-19 dissemination has been well reported, measures to address infected aerosol escaping during endoscopic forceps use have been neglected. Pathogen-contaminated aerosol from the endoscopic forceps channel, leading into the gastrointestinal lumen, has been confirmed and is a highly problematic source of infection. We developed a technique that entails covering the forceps entry/exit hole with a vinyl bag, thereby preventing contamination of the endoscopy room by the infected aerosol that escapes from this hole. The technique can be used in daily clinical endoscopic practice. Furthermore, this shielding technique is useful for all patients who undergo GIE, regardless of the purpose of the procedure such as for making a diagnosis, administering therapy, or in an urgent situation. In this letter, we introduce our novel, easily performed, inexpensive method of infection prevention by disallowing infected aerosol to escape from a COVID-19-infected patient into the air during a procedure that requires the use of endoscopic forceps.     

Assessment and management of residential radon health risks: a report from the health Canada radon workshop

Epidemiologic studies of uranium miners and other underground miners have consistently shown miners exposed to high levels of radon to be at increased risk of lung cancer. More recently, concern has arisen about lung cancer risks among people exposed to lower levels of radon in homes. The current Canadian guideline for residential radon exposure was set in 1988 at 800 Bq/m(3). Because of the accumulation of a considerable body of new scientific evidence on radon lung cancer risks since that time, Health Canada sponsored a workshop to review the current state-of-the-science on radon health risks. The specific objectives of the workshop were (1) to collect and assess scientific information relevant to setting national radon policy in Canada, and (2) to gather information on social, political, and operational considerations in setting national policy. The workshop, held on 3-4 March 2004, was attended by 38 invited scientists, regulators, and other stakeholders from Canada and the United States. The presentations on the first day dealt primarily with scientific issues. The combined analysis of North American residential radon and lung cancer studies was reviewed. The analysis confirmed a small but detectable increase in lung cancer risk at residential exposure levels. Current estimates suggest that radon in homes is responsible for approximately 10% of all lung cancer deaths in Canada, making radon the second leading cause of lung cancer after tobacco smoking. This was followed by a perspective from an UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) working group on radon. There were two presentations on occupational exposures to radon and two presentations considered the possibility of radon as a causative factor for cardiovascular disease and for cancer in other organs besides the lung. The possible contribution of environmental tobacco smoke to lung cancers in nonsmokers was also considered. Areas for future research were identified. The second day was devoted to policy and operational issues. The presentations began with a perspective from the U.S. Environmental Protection Agency, followed by a history of radon policy development in Canada. Subsequent presentations dealt with the cost-effectiveness of radon mitigation, Canadian building codes and radon, and a summary of radon standards from around the world. Provincial representatives and a private consultant were given opportunities to present their viewpoints. A number of strategies for reducing residential radon exposure in Canada were recognized, including testing and mitigation of existing homes (on either a widespread or targeted basis) and changing the building code to require that radon mitigation devices be installed at the time a new home is constructed. The various elements of a comprehensive national radon policy were set forth.     

The use of a compensator library to reduce dose inhomogeneity in tangential radiotherapy of the breast.

BACKGROUND AND PURPOSE: The dose variation throughout the volume of the breast from tangential fields can exceed 20% for large breasts. This is postulated to result in poor cosmesis [Radiother Oncol 16 (1989) 253], particularly at the inframammary fold, where the dose is highest. Compensators may be used to reduce this variation, but at the cost of the time to manufacture each unique compensator for the individual patients. This paper outlines the implementation and routine use of a library of reusable compensators. MATERIALS AND METHODS: For the period of December 1999 to May 2001, 94 patients attending for breast radiotherapy received treatment using breast compensators calculated from multiple outlines measured using the Osiris system. The compensators manufactured for the early patients were added to a library for possible reuse by later patients. Of the 94 patients, 28 patients' compensators formed the library and 66 subsequent patients have been treated using compensators derived from the library. Selection of the most appropriate library compensator was determined from the analysis of the distribution of the calculated dose-volume histogram for the whole breast, excluding lung, penumbra and build-up regions. Once the library was complete, approximately 50% of all subsequent breast patients were treated with compensators (46% from the library and 4% with individual compensators). This represented a usage rate of 92% for the library compensators for those patients requiring compensation. RESULTS: In all cases the compensators reduced the variation in the dose distribution. For example, the group treated with a library compensator demonstrated a mean reduction from 29 to 9% for the volume of breast tissue receiving more than 5% greater than the reference dose. If the same patients had been treated using their own individual compensators, the corresponding value would have been 7%. There is a small systematic, but negligible, difference in the two populations of dose variation for individual versus library compensators, but this difference (P=0.20) did not reach the level of statistical significance of P=0.05). CONCLUSION: The method of creation and selection of library compensators has proved to be simple and reliable in practice. Every patient receiving radiotherapy for breast cancer is currently investigated under full software control to ascertain whether the use of a library compensator would be advantageous.     

Persistence of individual dendritic spines in living brain slices.

A number of theories on the cellular basis of learning and memory propose that long-term changes in synaptic strength are encoded by changes in the properties of dendritic spines. Such theories imply that individual spines retain their identity over time. Using a new technique for fluorescent labelling of synaptic structures together with confocal microscopy, we have found that the appearance of individual spines on viable cells remains unchanged over observations periods of up to 5 hours. Even in slices exposed to kainic acid at concentrations that abolished synaptic transmission, groups of spines remained identifiable on cells clearly damaged by the toxin. The robust persistence of individual spines demonstrated here establishes an essential prerequisite for their potential role as mnemonic elements.