Summary Background Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30–30·30 million) new cases of TBI and 0·93 million (0·78–1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331–412) per 100 000 population for TBI and 13 (11–16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40–57·62 million) and of SCI was 27·04 million (24·98–30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (−0·2% [−2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (−3·6% [−7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0–10·4 million) YLDs and SCI caused 9·5 million (6·7–12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82–141) per 100 000 for TBI and 130 (90–170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of indi...

Support was observed for hypothesized excess neurodegenerative disease associated with a variety of occupations, 60 Hz magnetic fields and welding.

Global positioning system (GPS) technology is used widely for business and leisure activities and offers promise for human time-location studies to evaluate potential exposure to environmental contaminants. In this article we describe the development of a novel GPS instrument suitable for tracking the movements of young children. Eleven children in the Seattle area (2-8 years old) wore custom-designed data-logging GPS units integrated into clothing. Location data were transferred into geographic information systems software for map overlay, visualization, and tabular analysis. Data were grouped into five location categories (in vehicle, inside house, inside school, inside business, and outside) to determine time spent and percentage reception in each location. Additional experiments focused on spatial resolution, reception efficiency in typical environments, and sources of signal interference. Significant signal interference occurred only inside concrete/steel-frame buildings and inside a power substation. The GPS instruments provided adequate spatial resolution (typically about 2-3 m outdoors and 4-5 m indoors) to locate subjects within distinct microenvironments and distinguish a variety of human activities. Reception experiments showed that location could be tracked outside, proximal to buildings, and inside some buildings. Specific location information could identify movement in a single room inside a home, on a playground, or along a fence line. The instrument, worn in a vest or in bib overalls, was accepted by children and parents. Durability of the wiring was improved early in the study to correct breakage problems. The use of GPS technology offers a new level of accuracy for direct quantification of time-location activity patterns in exposure assessment studies.

ObjectiveFinely resolved PM2.5 exposure measurements at the level of individual participants or over a targeted geographic area can be challenging due to the cost, size and weight of the monitoring equipment. We propose re-purposing the low-cost, portable and lightweight Shinyei PPD42NS particle counter as a particle counting device. Previous field deployment of this sensor suggests that it captures trends in ambient PM2.5 concentrations, but important characteristics of the sensor response have yet to be determined. Laboratory testing was undertaken in order to characterize performance.MethodsThe Shinyei sensors, in-line with a TSI Aerosol Particle Sizer (APS) model 3321, tracked particle decay within an aerosol exposure chamber. Test atmospheres were composed of monodisperse polystyrene spheres with diameters of 0.75, 1, 2 3 and 6 um as well as a polydisperse atmosphere of ASHRAE test dust #1.ResultsTwo-minute block averages of the sensor response provide a measurement with low random error, within sensor, for particles in the 0.75–6μm range with a limit of detection of 1 μg/m3. The response slope of the sensors is idiomatic, and each sensor requires a unique response curve. A linear model captures the sensor response for concentrations below 50 μg/m3 and for concentrations above 50 μg/m3 a non-linear function captures the response and saturates at 800 μg/m3. The Limit of Detection (LOD) is 1 μg/m3. The response time is on the order of minutes, making it appropriate for tracking short-term changes in concentration.ConclusionsWhen paired with prior evaluation, these sensors are appropriate for use as ambient particle counters for low and medium concentrations of respirable particles (< 100 ug/m3). Multiple sensors deployed over a spatial grid would provide valuable spatio-temporal variability in PM2.5 and could be used to validate exposure models. When paired with GPS tracking, these devices have the potential to provide time and space resolved exposure measurements for a large number of participants, thus increasing the power of a study.

We conducted a nested case-control study (177 cases, 550 controls) to assess the relation between retrospective magnetic field measures and clinical miscarriage among members of the northern California Kaiser Permanente medical care system. We also conducted a prospective substudy of 219 participants of the same parent cohort to determine whether 12-week and 30-week exposure assessments were similar. We evaluated wire codes, area measures, and three personal meter metrics: (1) the average difference between consecutive levels (a rate-of-change metric), (2) the maximum level, and (3) the time-weighted average. For wire codes and area measures we found little association. For the personal metrics (30 weeks after last menstrual period), we found positive associations. Each exposure was divided into quartiles, with the lowest quartile as referent. Starting with the highest quartile, adjusted odds ratios and 95% confidence intervals were 3.1 (95% CI = 1.6-6.0), 2.3 (95% CI = 1.2-4.4), and 1.5 (95% CI = 0.8-3.1) for the rate-of-change metric; 2.3 (95% CI = 1.2-4.4), 1.9 (95% CI = 1.0-3.5), and 1.4 (95% CI = 0.7-2.8) for the maximum value; and 1.7 (95% CI = 0.9-3.3), 1.7 (95% CI = 0.9-3.3), and 1.7 (95% CI = 0.9-3.3) for the time-weighted average. The odds ratio conveyed by being above a 24-hour time-weighted average of 2 milligauss was 1.0 (95% CI = 0.5-2.1). Exposure assessment measurements at 12 weeks were poorly correlated with those taken at 30 weeks. Nonetheless, the prospective substudy results regarding miscarriage risk were consistent with the nested study results.