Staff Reporter

PROBAHO’s pure drinking water creating hopes for rural life

March 25, 2022 by Staff Reporter

World Water Day is being commemorated across the country today with the goal of raising public awareness about the importance of safe drinking water.

The presence of Arsenic contamination was first observed back in 1993. Later on, it was shown to be widespread in shallow tube wells in numerous parts of Bangladesh.

Consumption of arsenic-contaminated water resulted in significant health consequences for those exposed. Apart from arsenic contamination, the salinity of drinking water in the country’s coastal regions has long been a concern. Due to the high salinity of tube well water, over 70% of coastal residents use pond water for drinking needs.

During the last 35 years, the region’s water salinity has increased by 35% and continues to climb at an alarming rate each year. According to recent research by the World Bank, approximately 20% of women in coastal areas experience early miscarriages as a result of the dangerous effects of saline water, and 3% of children die prematurely. The terrible state of affairs further emphasizes the relevance of World Water Day in Bangladesh, more than in any other country.

Bangladesh government and numerous non-governmental organisations have launched a number of projects aimed at resolving the water crisis. Joining forces with this statewide initiative, ‘PROBAHO’ has been establishing safe water plants in an effort to alleviate the residents’ clean water scarcity.

PROBAHO has installed 111 water purification plants in 21 districts of Bangladesh during the previous 12 years; additionally, PROBAHO has met the daily water needs of 273,000 people by supplying 565,000 liters of pure water. Regrettably, the nation’s salinity-prone coastal districts, particularly Satkhira, face extreme water scarcity.

Stepping into its 13th year, Probaho, in line with the government’s initiative to secure access to safe drinking water in remote places, plans to establish multiple water purification plants for marginalized communities, which will primarily serve the coastal region’s need for pure water.

PROBAHO has been distributing purified water in arsenic-prone areas for more than a decade, including the tourist destination St. Martin’s Island, the green city of Rajshahi, and the hilly areas of Bandarban. Istafunnesa, a 90-year-old woman from Amjhupi village in Meherpur district, described her predicament as follows: “Before this pure water project came to our area in 2011, it was extremely difficult for us to find arsenic-free drinking water.” There were few sources of safe drinking water. We were forced to collect water from alternative sources such as rainwater or pond water, or from a two-kilometer-distance arsenic-free tube well. At the moment, we are protected from a variety of ailments due to our use of PROBAHO’s pure drinking water.”

The initiative’s impact has been applauded and given immense recognition through the bestowal of various awards such as the prestigious ‘Asia Responsible Entrepreneurship Award (AREA)’ in 2015 and “Bangladesh Innovation Award” 2018 by Bangladesh Brand Forum.

The initiative proudly supports Bangladesh government’s aim to achieve Sustainable Development Goals (SDGs) # 3 (Good Health & Wellbeing) and # 10 (Reduced Inequalities) to Ensure 100% population using safely managed drinking water services by 2030. Probaho’s rich legacy of 13 years provides inspiration to move forth with pride and purpose, to ensure a safer today and tomorrow for all.

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Toyochem develops low-odor, low-VOC acrylic adhesive for vehicle & building interiors; T-VOC 10% of conventional products

March 25, 2022 by Staff Reporter

Toyochem Co., Ltd., the polymers and coatings arm of Japan’s Toyo Ink Group, launched a new low-odor, low-VOC acrylic pressure-sensitive adhesive (PSA), the Oribain EXK 21-046, for use in enclosed spaces such as vehicles and building interiors. EXK 21-046 PSAs not only demonstrate good bonds to metals, plastics, textiles and other substrates, but they are also are capable of reducing total volatile organic compounds (T-VOC), or the indoor air concentration of a mixture of multiple VOCs, to levels less than one-tenth of that of conventional products.

The new low-VOC acrylic PSAs also effectively reduce odor levels, resulting in the increased health and comfort of indoor occupants.

The demand for low-impact interior materials has become a global trend as VOC emission regulations tighten worldwide due to growing public and industry awareness of the importance of indoor air quality. VOCs are suspected to be one of the major causes of sick building syndrome and sensory irritation, so building interior materials made from low VOC-emitting materials are being used where possible.

In addition, the rise in electric vehicles and automated driving technology is expected to drive the demand for low-odor, low-VOC materials used in automobile interiors.

While our conventional PSAs clear the indoor VOC concentration guidelines set by the Japanese government, the newly developed EXK 21-046 system were able to dramatically reduce trace amounts of T-VOCs that remain in standard-type products and to improve air quality.

Toyochem research teams achieved this by developing a material that is not easily retained in the adhesive system and by applying our original polymerization and compounding technologies to better control viscoelasticity of the adhesive material. This results in a substantial reduction in T-VOC concentrations and lower odor intensity without compromising adhesive performance—a feat that had once been difficult to achieve.

—Nao Nakamura, general manager of Toyochem’s adhesives divisio

The EXK 21-046 PSA achieves T-VOC emissions rates of 18 µgC/g, substantially down from 310 µgC/g registered by Toyochem’s conventional PSAs. Moreover, the new PSA system realizes a 3.5 grade (clearly noticeable, but still not objectionable) on a 6-grade odor intensity scale, a reduction of 1.5 points from the typical 5 grade (very objectionable) recorded by the company’s standard-type products.

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Originally Appeared Here

Learn What They All Mean

March 25, 2022 by Staff Reporter

The laundry symbols printed on the tags of your clothes offer important cleaning information.
Each symbol tells you all you need to know about the care and upkeep of your garment.
The system covers five basic areas: washing, bleaching, drying, ironing, and dry-cleaning.
Visit Insider’s Home & Kitchen Reference library for more stories.

An easy way to think about laundry symbols is that they are cheat codes for doing laundry. They tell you all you need to know about caring for certain garments to help you get the most out of them.

According to James Chandler, the CEO and founder of Laundry On Demand, the Federal Trade Commission requires that all clothing have at least one set of care instructions. Those care instructions come as a standard set of internationally recognized cleaning symbols.

“It’s important to follow the instructions on the label, so your clothes don’t shrink, burn up, and last as long as possible,” says Chandler.

In total, there are over 30 laundry symbols, which include specific variations on one of the five main categories:

Once you start recognizing these main symbols, you’ll be able to understand how to properly launder any thing with a quick glance.

Here’s a visual breakdown of what every laundry symbol means and how to use them.

Laundry symbols for washing clothes

Washing guidelines are always represented by a washtub.

Alex Ford/Insider

The washing symbol is one of the easiest to identify because it resembles a washtub, with lines indicating the recommended washing cycle and black dots representing the recommended water temperature.

One line on the bottom of the washing symbol indicates that you should run it on permanent press to minimize wrinkles. Two lines means you should use the gentle or delicate cycle, to prevent damage. An X means not to machine wash at all, and a washing symbol with a hand inside means — you guessed it — hand-wash only.

Water temperature plays a big role in laundry, and the black dots give you an idea of the recommended temperature for the best results. One dot means cold, two dots means warm, three means hot, and so on. No dots means any temperature is fine.

Note: The UK has different markings for recommended temperature. A number inside the washthub icon also indicates the temperature (in Celsius) you should wash the item. For example, a 30 means that the garment should be washed in cold water of 86 degrees Farenheit.

Laundry symbols for bleaching clothes

Bleach guidelines are always represented by a triangle.

Alex Ford/Insider

The triangle symbol on the care instructions tells you if a garment can handle bleach, and if so, what kind. Some fabrics, like cotton or linen, respond well to bleach, while others, including wool and silk, will disintegrate upon contact.

There are two types of bleach: chlorine or oxygen. Chlorine bleach is good for disinfecting and removing stains from white fabric, but will cause colored fabric to fade. Oxygen bleach, or chlorine-free bleach, is color-safe, and an effective stain remover and fabric brightener.

If the triangle symbol you’re looking at is made up of just an outline, you can use either kind of bleach as needed. Use only oxygen bleach if there are two diagonal lines inside of the triangle, and avoid bleach altogether if you see a solid triangle with an X.

Laundry symbols for drying clothes

Drying guidelines are always represented by a square.

Alex Ford/Insider

Drying instructions, indicated by a square symbol with lines or a circle inside, tell you the best way to, well, dry your garment. Improper drying can permanently damage a garment, so it’s important to heed this guidance.

“The most important thing is don’t dry for too long in high heat,” says Chandler.

A drying symbol with an X should never be machine dried, and is usually accompanied by other drying instructions. Drying symbols with lines give you additional information, like a square with a curved line means you should hang-dry the garment on a clothesline, drying rack, or hanger. One horizontal line means to dry flat by spreading it out on a table or a flat drying rack.

The last thing to note is the black dots inside a circle, which indicates the recommended drying temperature.

Quick tip: A crossed-out symbol tells you immediately what not to do with a garment. “Looking at the care label quickly, I first look for the Xs. That tells me what will ruin my clothes,” says Chandler.

Laundry symbols for dry-cleaning clothes

Dry-cleaning guidelines are always represented by a circle.

Alex Ford/Insider

There are certain fabrics — think wool, silk, suede, or leather — that can’t withstand wet washing. In other words, they need to be professionally dry-cleaned.

There are many variations on this symbol that give the dry cleaner information about the garment, but the only two that consumers need to know are the circle with an X or without. An X means the fabric won’t respond well to the chemicals used in dry cleaning, and you’re better off washing at home. An item with a plain circle, however, requires dry-cleaning.

Laundry symbols for ironing clothes

Ironing guidelines are always represented by an iron.

Alex Ford/Insider

The ironing symbols tell you how a garment handles heat from an iron or steamer. The ironing symbol is perhaps the most obvious to discern; look at the dots to know the appropriate temperature for ironing or steaming.

An ironing symbol with an X means not to iron, such as with nylon clothing. If you see an iron with crossed out lines coming out of the bottom, that item should not be steamed.

Insider’s takeaway

There are over 30 laundry symbols that fall into one of five categories: washing, bleaching, drying, ironing, and dry-cleaning. These symbols indicate the best way to care for your clothes to avoid damage and help them last as long as possible. Once you understand the main symbol for each category, it’s easy from there to determine what the variations mean.

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Yokogawa Successfully Completes Proof of Concept for Optimization of Operations at US Wastewater Reclamation Facility Producing Potable Water

March 25, 2022 by Staff Reporter

– Project receives Transformational Innovation award from the WateReuse Association –

TOKYO, March 25, 2022–(BUSINESS WIRE)–Yokogawa Electric Corporation (TOKYO: 6841) announces that it has successfully completed a proof of concept test of technology that reduces energy consumption and stabilizes the quality of the water discharged by the Tapia Water Reclamation Facility of the Las Virgenes Municipal Water District (LVMWD), located in Los Angeles County, California. This initiative was undertaken as part of the company’s proposal to improve the performance of existing wastewater reclamation facilities in conjunction with a program sponsored by the Japan Ministry of Economy, Trade and Industry that seeks to examine opportunities for the overseas deployment of high quality energy infrastructure.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20220324006055/en/

Tapia Water Reclamation Facility, California, USA (Photo credit: Las Virgenes Municipal Water District)

Water stress is an increasingly pressing issue worldwide due to the effects of climate change and the rising demand for water driven by population growth. In order to ensure stability in water resources, more and more countries are looking to make proactive use of reclaimed water. In the USA, the state of California is considering changes in regulations*1 that will allow the direct use of reclaimed water for drinking water by the end of 2023, and this is the subject of serious discussions and cooperation between the public and private sectors.

This proof of concept was conducted as part of the Pure Water Project and led by the LVMWD, whose aim is to produce potable water from highly treated wastewater in compliance with State water quality standards. Doing so required LVMWD to consider alternative technological approaches, as treating water to potable quality consumes enormous amounts of electricity and is more maintenance intensive. Yokogawa has been studying ways to address such challenges by making use of the company’s extensive process knowledge and experience in monitoring and control of industrial facilities.

Story continues

Given the large fluctuations in the quality of the wastewater that flows into reclamation facilities, plant operators must take proper care while monitoring the inflow rate to ensure that the mandated water quality standards are met, and rely on their knowledge and technical expertise to make the necessary adjustments. Yokogawa applied its advanced data driven modeling for optimization (DDMO) software suite to model and then predict setpoints to optimize operations and support operator decision making while maintaining the targeted water quality at water treatment facilities.

As this proof of concept was conducted during the COVID-19 pandemic, Yokogawa used its Yokogawa Cloud platform to minimize the site activities and move site data to Japan where the DDMO software utilized real-time operational data to derive control setpoints that were sent back to operators at the Tapia Water Reclamation Facility. After conducting a multifaceted evaluation and performing a concrete verification of effectiveness, it was revealed that improvements in operational efficiency had yielded an over 10% reduction in power consumption, while meeting all water quality standards. Impressed with these results, the WateReuse Association presented Yokogawa and its partners with a 2022 Transformational Innovation award*2.

Tsuyoshi Abe, a Yokogawa Electric vice president and head of the Marketing Headquarters, says, “Water is a public asset and a finite resource. Goal 6 of the SDGs is to ‘Ensure access to water and sanitation for all,’ and this is an important area where Yokogawa can contribute. Toward this end, the effective utilization of reclaimed water as a sustainable water source for communities is a groundbreaking approach. The efficient purification and provision of safe and secure drinking water requires the understanding of all stakeholders and a lot of revolutionary technology. In order to build a circular ecosystem for water resources and create new value, we will work to further strengthen our collaboration with partners to drive forward co-innovation, and utilizing our capabilities to measure and connect, we will fulfill our responsibilities for the future of our planet.”

*1 The California Water Boards: Regulating direct potable reuse in California
https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/direct_potable_reuse.html
*2 WateReuse Awards for Excellence, Transformational Innovation award, presented at the 37th Annual WateReuse Symposium. Award recipients: Yokogawa Electric Corporation, Las Virgenes Municipal Water District, Carollo Engineers, the National Water Research Institute, Metropolitan Water District, Bureau of Reclamation, IOSight
https://watereuse.org/news-events/awards/past-award-winners/watereuse-award-winners-2022/

About Yokogawa
Yokogawa provides advanced solutions in the areas of measurement, control, and information to customers across a broad range of industries, including energy, chemicals, materials, pharmaceuticals, and food. Yokogawa addresses customer issues regarding the optimization of production, assets, and the supply chain with the effective application of digital technologies, enabling the transition to autonomous operations.
Founded in Tokyo in 1915, Yokogawa continues to work toward a sustainable society through its 17,500 employees in a global network of 119 companies spanning 61 countries.
For more information, visit www.yokogawa.com

The names of corporations, organizations, products, services and logos herein are either registered trademarks or trademarks of Yokogawa Electric Corporation or their respective holders.

View source version on businesswire.com: https://www.businesswire.com/news/home/20220324006055/en/

Contacts

Media inquiries:
PR Section
Integrated Communications Center
Yokogawa Electric Corporation
E-mail: [email protected]

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Originally Appeared Here

New purpose for pool | News, Sports, Jobs

March 25, 2022 by Staff Reporter

MARSHALL — It’s been a year of changes for the former swimming pool facility at Marshall Middle School.

While not all the renovations are complete, a major part of the project — filling in the old pool — is finished.

“It’s falling into place nicely,” said Dion Caron, business services director at Marshall Public Schools.

The end goal for the old pool area will be to convert it into a home for both Marshall Public Schools and Marshall Community Services’ gymnastics programs, Caron said.

“We feel like it’s going to grow the program,” he said.

Last year, MPS started work to fill in the old pool and put a new concrete floor, new lighting and a new HVAC system in the room. New wall surfaces have been put in over the old tile on the walls. The pool facility already got a new roof a couple of years ago.

New paint and windows are planned to be installed this spring.

Caron said the large windows in the pool area are in their original frames from the 1960s, and are single-pane. They’ll be replaced with updated and better insulated windows.

Turning the former pool into a gymnastics facility will be a much better fit for holding competitions, Caron said. The district’s gymnastics equipment is currently in a smaller space at Marshall High School.

“Every time we have a meet, we need to move it” into the MHS gymnasium, Caron said. At the middle school location, that extra work won’t be necessary.

Caron said the pool renovation has an estimated cost of roughly $750,000.

“A majority of that is for the HVAC system being added to the pool area, which is being funded through a general obligation facility maintenance bond,” Caron said.

The bond covers indoor air quality projects at both MMS and Park Side Elementary.

The roofing portion of the pool renovations would be a larger portion of the total cost, Caron said. The roof portion of the project was funding through a four-year facility maintenance bond, which also funded re-roofing projects at MMS and Park Side.

“There was no tax impact to residential or commercial property and ag land owners actually saw a small decrease as it relates to this bond,” Caron said.

Other parts of the pool renovation costs, like filling in the pool, installing drywall and updating the windows, will be covered by long-term facilities maintenance funds, Caron said.

The swimming pool, which was original to the school building, hadn’t been used for around 17 years. As enrollment grew at MPS in recent years, the school district put forward ideas to renovate the space for other purposes. A proposal to turn the old pool area into a multipurpose room was part of a failed 2017 building referendum.

Caron said there’s still a need for space at MMS, but with the completion of building additions at Park Side, it’s not necessarily classroom space that’s in short supply. When the Early Childhood department moved to Park Side, it freed up a few existing rooms at the middle school.

“Where we’re running out of space is physical education and recess,” Caron said. The renovated pool area could be used during the day for PE classes or possibly indoor recess, he said.

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Bring back the masks – the Spectrum

March 25, 2022 by Staff Reporter

Getting rid of the mask mandate is not the move

This month marks the two-year anniversary of the Covid-19 pandemic shutting down NDSU’s campus. I can still recall leaving for spring break as a freshman, only to not return to campus for the rest of the academic year. I was ecstatic to come back to campus the next year and see my friends, although we were all masked.

With all the recent advancements that have come about, such as vaccines to help prevent serious illness and platforms like Zoom offering ways to connect, the future of campus life was looking bright.

However, as of March 7, 2022, NDSU dropped its mask mandate in classrooms. While faculty members have the option to continue the requirement of masks in their class, I do not think many students will be happy to honor that expectation.

In my in-person classes, three out of the five have professors that ask us to keep our masks on. These classes are in all different areas of my studies, and include communications, political science and women and gender studies. The main reason why my other two classes are not wearing masks is because they are art classes that take place downtown, with adequate room for social distancing.

Lifting the mask mandate right now is not the move. After living on campus over spring break and seeing how quiet everything was, I can only imagine how intense the large influx of students is going to affect the germ pool.

Yes, Cass County’s Covid community level is currently designated as “low”, but students that are coming back from super spreader hotspots will be putting everyone at risk. Campus could have at least waited a few more weeks, but now only time will tell how fast the virus will be passed around.

Photo Credit | Prachatai on Creative Commons

There have been studies through Yale that have shown that school districts with masking policies were less likely to have Covid outbreaks. Although, with so many other requirements, such as vaccination, it is difficult to pinpoint which measure was the most effective or if it was a mix of them all.

I do not believe that this is a political issue. Instead, I find it to be an issue of common human decency. I personally would like to live on a healthy campus in which students and employees want to do their part to keep others safe. I have family and friends that are high risk, and I want to help keep them healthy.

There is another, more trivial issue that I have with the mask mandate being lifted. None of you look like how I imagined you would. I have learned how to identify my classmates for the past two years on their eyes and voices alone, and I am absolutely startled by how you actually look. This is not necessarily a bad thing, just mildly uncomfortable. But I am sure we will all adjust with time.

I intend to keep wearing my mask. I have bought so many with different patterns in order to match my outfits. I like this fashion accessory. I believe that you should do the same. The mask is there to keep you healthy, not muzzled from your rights. If a piece of fabric really threatens you that much, then you have some personal reflecting to do.

If you refuse to take my opinion into consideration, please try to follow some of the CDC’s other risk reduction practices. These include getting vaccinated, practicing social distancing when possible, staying home when you feel sick and disinfecting frequently touched objects. If you think you have been exposed to Covid-19, or are experiencing symptoms, call the student health service at 701-231-7331. Testing is quick and free.

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Originally Appeared Here

5 diabetes truisms that are (at least partially) false

March 24, 2022 by Staff Reporter

Many people, including patients with diabetes and their health care providers, strongly adhere to ideas and accepted truths about diabetes and diabetic retinopathy (DR) that are not entirely based in scientific fact. By definition, truisms are statements so obviously true or self-evident that they deserve little attention, serve as a rhetorical device, eg, if the sun has not risen, it must be night and daylight will return.

Their truth, however, depends on specific factual assumptions, eg, the sun has not vanished forever by cosmological or supernatural means, observers are not wearing a blackout cloak and otherwise have the capacity to detect the sun’s rising, etc.

In philosophy, truisms refer to factual statements that the overwhelming majority of humans believe to be true and do not require fidelity with reality.1 Precisely for this reason, truisms may serve as instruments of both power and deception.

Here, I will attempt to convincingly dispense with at least some of this diabetes flapdoodle.

Related: RGX-314 clinical program: second pivotal trial to begin

UNTRUISM #1: Type 2 diabetes (T2DM) is a lifestyle disease attributable to poor patient choices.

We know that excess consumption of highly refined carbohydrates and processed fats contributes to abdominal obesity that drives insulin resistance underlying T2DM.2 However, there are a myriad of other nonlifestyle factors that are causally linked to T2DM, including:

genetic influences (eg, alteration of mitochondrial DNA in mothers with diabetes that modulates transmission to offspring)3;
particulate air pollution causing complement system activation, infl ammation, and insulin resistance, leading to T2DM, rates of which are significantly higher in residential proximity to traffic density4,5;
increased ambient indoor air temperatures (causally linked to T2DM)6;
communities and workplaces that are engineered to reduce the need for walking/ standing/movement7;
hypothalamic insulin resistance that drives insatiable hunger despite the stomach being full8,9;
widespread environmental contamination with obesogenic, endocrine-disrupting contaminants like pesticides, and small-particle plastics that leach into food and water supplies10;
high prevalence of material inequality and food insecurity in even the wealthiest nations (a predicament 80% more common in diabetes and 240% more common in those with DR)11 that fuels consumption of low-cost, high-sugar/ high-calorie foods with low nutrient density as well as production of stress hormones causally linked to T2DM12;
increased light exposure prior to sleep—from both indoor LED screen use and outside sources—that negatively affects sleep quality and insulin sensitivity13; and excess antibiotic use reducing intestinal microbiome diversity that modulates insulin sensitivity, thereby increasing diabetes risk.14

Nearly half of American adults have diabetes or prediabetes.15 It’s time to recognize that the world we have created promotes development of both disorders, irrespective of “personal choice” (see Figure 1).

Related: Open your eyes: diabetes of the eye

UNTRUISM #2: Diabetes is like pregnancy—you either have it or you don’t.

This is patent baloney and inconsistent with the gradual pathogenesis of many diseases. There is a long, continuous dysglycemic road on the way to developing diabetes. Insulin response in those with normal blood glucose who subsequently develop T2DM is elevated years before meeting diagnostic thresholds.16

Glucose thresholds for diagnosing diabetes are, in fact, somewhat arbitrary and rates of cardiovascular and microvascular complications (ie, retinopathy) are signifi cantly higher in people with prediabetes having glucose levels that fall below these thresholds.17

Remission of T2DM with bariatric surgery and fasting regimes also vitiates against the view that diabetes is all or nothing. A prominent prediabetes researcher presenting at the European Association for the Study of Diabetes Annual Meeting 2021 recently quipped that “prediabetes, simply, is an early stage of diabetes.”18 Patients can, in fact, have a “touch” of diabetes just like they can have preperimetric glaucoma or high-risk macular drusen with good visual acuity.

Related: Optic disk swelling in an asymptomatic patient with diabetes

UNTRUISM #3: Glycated hemoglobin (HbA1c) measures patients’ average blood glucose levels.

This one is half true. It has been shown that patients with the same HbA1c values may have significantly dissimilar mean blood glucose levels when assessed by validated continuous glucose monitoring systems. For example, a patient with an HBA1c level of 9% may have a better mean glucose than a patient with an HBA1c of 7%.19 High HbA1c is defi nitely a risk factor for development of microvascular complications and is related to mean glucose levels, but it is not the gold standard we once believed it to be.

UNTRUISM #4: A patient’s current HbA1c reflects their risk for DR incidence and progression.

HbA1c is merely a snapshot—a less-than-perfect one, given No. 3 above—of glycemic status over a 60- to 90-day period. Multiple randomized clinical trials have shown that long-term glycemic control, especially in the fi rst 10 years, has more impact on the development of DR than current control.20

This phenomenon, called metabolic memory (see “Mitigate diabetic retinopathy with early improved glucose control” in the January 2022 issue of Optometry Times) means eye doctors should review patients’ lifetime history of metabolic control, including asking, “What was your A1c test result when you were fi rst diagnosed with diabetes and what has it been since then?”

Ideally, patients will also have access to their glucose time-in-range (TIR; percentage of time glucose values range between 70 and 180 mg/dl) and time-above-range (TAR) via CGMS, values that predict diabetic retinopathy independently of HbA1c.21

Related: Central serous retinopathy is not a benign disease

UNTRUISM #5: Eye doctors should base decisions to refer and treat vision threatening DR (severe NPDR, PDR and DME) on patients’ current HbA1c because patients with excellent control are unlikely to progress or experience vision loss.

Posthoc analysis of the PANORAMA trial (NCT02718326), which randomized patients with moderately severe or severe nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME) to either observation (usual care) or injections of aflibercept for 100 weeks, showed that patients with “good” glycemic control at study entrance were slightly more likely to progress to proliferative disease or DME than were patients with worse glucose control.22

Multiple patients who progressed to NPDR/ DME in this trial had HbA1c levels < 6.5% at study entrance. The same lack of protection was also found with respect to diabetes duration and body mass index (ie, neither low/ high BMI nor shorter/longer duration of diabetes protected against development of PDR/ DME in this cohort. This may be a reflection of long-term glucose levels (metabolic memory), the inadequacies of A1c, and/or other factors that have yet to be determined. This means that any patient with more than moderate NPDR should be considered for anti-VEGF therapy. The horse is already out of the barn.

These are a few of the most important fallacies that pervade our diabetes consciousness. Others include the following:

Clinical examination by retina specialists accurately stages DR severity in all cases.
Only obese patients develop T2DM.
All patients with long-term diabetes will ultimately develop sight-threatening DR.Patients who experience diabetes-related vision loss have only themselves to blame.
Dilated retinal exams are no longer important with the use of ultrawide-fi eld retinal imaging.
ODs are in no position to critically evaluate the overall diabetes treatment plan.

All of these, like what precedes them, are partial or total nonsense, baloney, balderdash, malarkey, moonshine, and flapdoodle. Don’t be duped. Tell a friend.

More by Dr. Chous: Mitigate diabetic retinopathy with early improved glucose control

References

1. Oxford English Dictionary. Truisms. Accessed January 19, 2022. https:// www.oed.com/

2. McEvoy CT, Cardwell CR, Woodside JV, Young IS, Hunter SJ, McKinley

MC. A posteriori dietary patterns are related to risk of type 2 diabetes: findings from a systematic review and meta-analysis. J Acad Nutr Diet. 2014;114(11):1759-75.e4. doi:10.1016/j.jand.2014.05.001

3. Zheng, LD, Linarelli LE, Liu L, et al. Insulin resistance is associated with epigenetic and genetic regulation of mitochondrial DNA in obese humans. Clin Epigenetics. 2015;7(1)60. doi:10.1186/s13148-015-0093-1

4. Yang M, Cheng H, Shen C, et al. Effects of long-term exposure to air pollution on the incidence of type 2 diabetes mellitus: a meta-analysis of cohort studies. Environ Sci Pollut Res Int. 2020;27(1):798-811. doi:10.1007/ s11356-019-06824-1

5. Zhao Z, Lin F, Wang B, Cao Y, Hou X, Wang Y. Residential proximity to major roadways and risk of type 2 diabetes mellitus: a meta-analysis. Int J Environ Res Public Health. 2016;14(1):3. doi:10.3390/ijerph14010003

6. Speakman J, Heidari-Bakavoli S. Type 2 diabetes, but not obesity, prevalence is positively associated with ambient temperature. Sci Rep. 2016;6:30409. doi:10.1038/srep30409

7. Hamilton MT, Hamilton DG, Zderic TW. Sedentary behavior as a mediator of type 2 diabetes. Med Sport Sci. 2014;60:11-26. doi:10.1159/000357332

8. Kullmann S, Valenta V, Wagner R, et al. Brain insulin sensitivity is linked to adiposity and body fat distribution. Nat Commun. 2020;11(1):1841. doi: 10.1038/s41467-020-15686-y

9. Isganaitis E, Lustig RH. Fast food, central nervous system insulin resistance, and obesity. Arterioscler Thromb Vasc Biol. 2005;25(12):2451- 2462. doi:10.1161/01.ATV.0000186208.06964.91

10. Kumar M, Sarma DK, Shubham S, et al. Environmental endocrinedisrupting chemical exposure: role in non-communicable diseases. Front Public Health. 2020;8:553850. doi:10.3389/fpubh.2020.553850

11. Kirby JB, Bernard D, Liang L. The prevalence of food insecurity is highest among Americans for whom diet Is most critical to health. Diabetes Care. 2021;44(6):e131-e132. doi:10.2337/dc20-3116

12. Berm dez-Mill n A, Wagner JA, Feinn RS, et al. Inflammation and stress biomarkers mediate the association between household food insecurity and insulin resistance among Latinos with type 2 diabetes. J Nutr. 2019;149(6):982-988. doi:10.1093/jn/nxz021

13. Nagai N, Ayaki M, Yanagawa T, et al. Suppression of blue light at night ameliorates metabolic abnormalities by controlling circadian rhythms. Invest Ophthalmol Vis Sci. 2019;60(12):3786-3793. doi:10.1167/iovs.19- 27195

14. Yuan J, Hu YJ, Zheng J, et al. Long-term use of antibiotics and risk of type 2 diabetes in women: a prospective cohort study. Int J Epidemiol. 202049(5):1572-1581. doi:10.1093/ije/dyaa122

15. US Centers for Disease Control and Prevention. National Diabetes Statistics Report 2020. Reviewed August 28, 2020. Accessed January 19, 2022. www.cdc.gov/diabetes/data/statistics-report/index.html

16. Sagesaka H, Sato Y, Someya Y, et al. Type 2 diabetes: when does it start? J Endocr Soc. 2018;2(5):476-484. doi:10.1210/js.2018-00071

17. Baranowska-Jurkun A, Matuszewski W, Bandurska-Stankiewicz E. Chronic microvascular complications in prediabetic states-an overview. J Clin Med. 2020 Oct;9(10):3289. doi:10.3390/jcm9103289

18. Sehauser C. Prediabetes: Does It Really Matter? Paper presented at the EASD Prediabetes Symposium; September 30, 2021.

19. Beck RW, Connor CG, Mullen DM, Wesley DM, Bergenstal RM. The fallacy of average: how using HbA1c alone to assess glycemic control can be misleading. Diabetes Care. 2017;40(8):994-999. doi: 10.2337/dc17- 0636

20. Zhang L, Chen B, Tang L. Metabolic memory: mechanisms and implications for diabetic retinopathy. Diabetes Res Clin Pract. 2012;96(3):286-293. doi:10.1016/j.diabres.2011.12.006

21. Gabbay MAL, Rodacki M, Calliari LE, et al. Time in range: a new parameter to evaluate blood glucose control in patients with diabetes. Diabetol Metab Syndr. 2020;12:22. doi:10.1186/s13098-020-00529-z

22. Brown DM, Wykoff CC, Boyer D, et al. Evaluation of intravitreal aflibercept for the treatment of severe nonproliferative diabetic retinopathy: results from the PANORAMA randomized clinical trial. JAMA Ophthalmol. 2021;139(9):946-955. doi:10.1001/ jamaophthalmol.2021.2809

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Sterifre Medical prepares to launch its Aura desktop disinfection device

March 24, 2022 by Staff Reporter

The Sterifre Aura disinfection system [Photo courtesy of Sterifre]Sterifre Medical is demonstrating its Aura device and courting investors as it prepares to launch the automatic point-of-care disinfection system.

The Aura is a portable machine that circulates hydrogen peroxide and activated oxygen with the push of a single button to disinfect stethoscopes, sensors, pumps, tablets, phones, keys, badges and anything else you can fit in the chamber. The device emits no harmful chemicals, leaves no residue and can get into the nooks and crannies that are hard to reach with the disinfectant wipes and handheld sprays traditionally used in health care settings.

“About 85% of things that are cleaned and disinfected in the hospital go through disinfection, not sterilization,” Sterifre CEO Rick Shea said in an interview. “We thought if we could take this technology, miniaturize it and get it close to point of care, we would clearly have a unique opportunity for a long time because the sterilization companies have this big equipment sitting in the basement of hospitals and clinics.”

Get the full story at our sister site, Medical Design & Outsourcing.

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Harbor Commissions Adopt Spending Plan for Clean Truck Fund Ahead Of Launch

March 24, 2022 by Staff Reporter

A spending plan to use the Clean Truck Fund program to provide incentives for zero-emission trucks and infrastructure was approved by the Los Angeles and Long Beach harbor commissions Thursday ahead of the program’s introduction April 1.

The ports of Los Angeles and Long Beach, which are the two largest container ports in the country, charge cargo owners for using trucks that don’t meet clean air standards and use the revenue to incentivize the transition to zero-emission trucks at the San Pedro Port Complex.

“Our two ports have set a high bar for getting clean trucks on our streets, and this spending plan and its incentives will help accelerate that transition. We are the only port complex in the nation that is driving a changeover to cleaner trucks and broader zero-emission drayage truck technology commercialization to this magnitude. It’s truly a groundbreaking effort,” Los Angeles Harbor Commission President Jaime Lee said in a statement.

The ports will collect a fine of $10 per 20-foot equivalent unit hauled by a truck that does not have an exemption. Zero-emission trucks are exempt from the rate, along with trucks that meet or exceed California’s low nitrogen oxide standard through Dec. 31, 2027. Loaded containers entering or leaving marine terminals by on-dock rail will also be exempt. The rate is set to expire on Dec. 31, 2034, according to the port.

The spending plan outlines priorities for using the funds, including a program to give at least $150,000 to licensed motor carriers in the Port Drayage Truck Registry that purchase zero-emission trucks. Each truck funded through the incentive must provide drayage services to the San Pedro Bay Port Complex for three years.

The spending plan also includes an Infrastructure Funding Program, which is modeled after existing federal, state and local grant programs and will provide funds to help carriers install or obtain zero-emission charging and fueling infrastructure.

“The Clean Truck Program allows us to aggressively balance pursuing zero-emissions operations with economic vitality and competitiveness,” Port of Long Beach Executive Director Mario Cordero said in a statement. “The Clean Truck Fund spending plan is a vital part of this. It is our hope the incentives and infrastructure program will lead to other public and private investments as we work together with our many partners to transition our operations to a greener future.”

The Clean Truck Fund Rate is expected to collect about $45 million annually for each port. Each port aims to eliminate all emissions from trucks at the port by 2035.

The Port of Los Angeles and Port of Long Beach first set the rate for planning purposes in March 2020, and it was developed as part of the 2017 Clean Air Action Plan Update with outreach to the industry and community.

Port-related emissions in the San Pedro Bay have decreased since 2005 by 90% for diesel particulate matter, 63% for nitrogen oxides and 97% for sulfur oxides, according to the port, which aims to reduce greenhouse gases to 40% below 1990 levels by 2030 and 80% below 1990 levels by 2050.

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EPA Publishes Coronavirus Best Practices for Indoor Air Quality

March 24, 2022 by Staff Reporter

Related Practices & Jurisdictions

The U.S. Environmental Protection Agency (EPA) has released new guidance on best practices to improve indoor air quality (IAQ) as part of the administration’s overall pandemic response plan for combating COVID-19.

Called the “Clean Air in Buildings Challenge,” the guidance advises, “[b]uilding owners and operators should engage experts, facilities managers, and others who are skilled, trained, and/or certified in HVAC work to develop and implement plans to improve IAQ and manage air flows.”

Recommended Best Practices

The guidance outlines the steps building owners and operators should take:

Create an action plan for clean indoor air in buildings that assesses indoor air quality, plans for upgrades and improvements, and includes HVAC inspections and maintenance. This involves first determining how clean outdoor air is brought into the building and distributed to all occupied spaces and understanding and documenting how the building’s HVAC systems work. The guidance recommends working with an HVAC expert to assess and inspect systems for ventilation, filtration, and air cleaning. The assessment should determine whether carbon dioxide monitors are needed, determine how much clean air (outdoor air + filtered HVAC recirculation air) is needed, measure air delivery for each room or space, and determine whether particular spaces need a different direction of air flow. Building owners or operators should have an HVAC expert verify the system is working properly through testing and create a preventive maintenance schedule, including filter replacements and upgrades or improvements as needed.

Optimize fresh air ventilation by bringing in and circulating clean outdoor air indoors. Ensure outdoor air is acceptably clean or is adequately filtered as it is brought into the building, run HVAC systems during all hours when the building is occupied and even for an hour or two after the building when the building is unoccupied to circulate fresh air, ensure exhaust fans in bathrooms are functioning and running when the building is occupied, increase the volume of clean, outdoor air at times of higher risk (e.g., at times of elevated risk of COVID-19), adjust HVAC settings while considering thermal comfort, humidity, outdoor air quality, and energy use, and, as much as possible, enable cross ventilation by opening windows and doors at opposite sides of the room or building.

Enhance air filtration and cleaning using the central HVAC system and in-room air cleaning devices by installing MERV-13 air filters or the highest rated MERV filters the HVAC system can accommodate. Use portable air cleaners and consider using an upper room Ultraviolet Germicidal Irradiation system.

Communicate with building occupants to increase awareness about IAQ, commitment to improving IAQ, and solicit feedback and suggestions from building tenants.

According to the EPA, implementing these measures can reduce the risk of exposure to particles, aerosols, and other contaminants and improve the health of building occupants.

OSHA

Throughout the pandemic, the Occupational Safety and Health Administration (OSHA) has provided guidance for mitigating COVID-19 in the workplace, which has included assessing, improving, and regularly maintaining HVAC systems. OSHA last updated its guidance on August 13, 2021.The OSHA website now states that the guidance will be updated soon.

In what is known in the safety world as the hierarchy of controls for managing safety and health hazards, engineering controls (such as ventilation systems) are the next best mitigation strategy if elimination or substitution of the hazard cannot be achieved.

The new EPA guidance is couched as a strategy for combatting COVID-19 and focuses on an engineering control that should exist in every building. It is not yet known how OSHA will view the EPA guidance. Given the importance of engineering controls to mitigating workplace safety and health hazards, OSHA may seek to rely on the EPA guidance for “industry knowledge” to support a violation under Occupational Safety and Health Act (OSH Act) 5(a)(1) general duty clause for any employer that is not attempting to mitigate COVID-19 by at least assessing its HVAC system. Earlier this year, the U.S. Supreme Court blocked the agency’s COVID-19 Vaccine-or-Test Emergency Temporary Standard and, in doing so, stated that, for most industries, COVID-19 is not an occupational hazard. As an agency whose mission is to help ensure the safety and health of workers, it is unsurprising that OSHA views that decision narrowly and does not read it to restrict its authority to enforce alleged COVID-19 violations under the general duty clause of the OSH Act.

Employers will have to watch closely for new and updated guidance from OSHA to align with other federal agency guidance on COVID-19 (such as from the Centers for Disease Control and Prevention and EPA).

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