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The rail industry in Australia screens workers for probable obstructive sleep apnea (OSA) due to known safety risks. However, existing criteria to trigger screening only identify a small proportion of workers with OSA. The current study sought to examine the relationship between OSA risk and rail incidents in real-world data from Australian train drivers, and conducted a proof of concept analysis to determine whether more conservative screening criteria are justified. Health assessment (2016–2018) and subsequent rail incident data (2016–2020) were collected from two passenger rail service providers. Predictors included OSA status (confirmed no OSA with a sleep study, controlled OSA, unknown OSA [no recorded sleep assessment data] and confirmed OSA with no indication of treatment); OSA risk according to the current Standard, and OSA risk according to more conservative clinical markers (BMI threshold and cardiometabolic burden). Coded rail safety incidents involving the train driver were included. Data were analysed using zero-inflated negative binomial models to account for over-dispersion with high 0 counts, and rail safety incidents are reported using Incidence Risk Ratios (IRRs). A total of 751 train drivers, typically middle-aged, overweight to obese and mostly men, were included in analyses. There were 43 (5.7%) drivers with confirmed OSA, 62 (8.2%) with controlled OSA, 13 (1.7%) with confirmed no OSA and 633 (84.4%) drivers with unknown OSA. Of the 633 train drivers with unknown OSA status, 21 (3.3%) met 'at risk' criteria for OSA according to the Standard, and incidents were 61% greater (IRR: 1.61, 95% Confidence Interval (CI) 1.02–2.56) in the years following their health assessment compared to drivers who did not meet 'at risk' criteria. A more conservative OSA risk status using lower BMI threshold and cardiometabolic burden identified an additional 30 'at risk' train drivers who had 46% greater incidents compared to drivers who did not meet risk criteria (IRR (95% CI) 1.46 (1.00–2.13)). Our more conservative OSA risk criteria identified more workers, with greater prospective incidents. These findings suggest that existing validated tools could be considered in future iterations of the Standard in order to more sensitively screen for OSA. [ABSTRACT FROM AUTHOR]

Every country had to make several difficult decisions in the initial phase of the Coronavirus (COVID-19) pandemic to allocate resources for COVID testing. Decisions on who should be tested for COVID-19 testing are extremely vital for pandemic preparedness. In this article, we highlight the need for prioritization of testing resources including direct-to-consumer testing methods, ethical dilemmas involved in obligatory testing, and testing of refugees and immigrants. [ABSTRACT FROM AUTHOR]

Over the course of the COVID-19 pandemic, technology has been widely deployed to deter the spread of the virus. One such technology is wearable devices that can collect health data and inform health authorities about potential infections. Despite the laudable purposes of this technology, we might be on the verge of another digital Big Brother. This is not a case in which our moves are being watched, but our bodies are, in an extreme form of public health surveillance. This paper analyses the use of wearable devices to track potential COVID-19 infections within the framework of public health and related individual and state duties. The paper focuses on the threats that these devices may pose to individual rights and liberties, particularly self-determination (the freedom to not be tested for infectious diseases) and privacy (the protection of private data). [ABSTRACT FROM AUTHOR]

Although bovine viral diarrhoea virus (BVDV) is prevalent in Indian cattle causing economic losses in cattle farming, its detection in bull semen has not yet been reported. Following passage of raw bull semen (n = 4) on MDBK cells, testing for BVDV was done by antigen ELISA and real-time RT-PCR. BVDV type-2 (BVDV-2) was identified in three samples from southern India by real-time RT-PCR. Genetic typing of the 5'-UTR sequences classified all the three BVDV strains as BVDV-2a subtype. These were found genetically closely related to the strains from USA, but divergent from the BVDV-2a strains from northern India. Phylogenetic analysis of Npro sequences confirmed the findings. The results provide evidence of circulation of BVDV-2a strains in southern India. The detection of BVDV in bull semen from India highlights the importance of mandatory testing of breeding bulls and bull semen for BVDV to minimize the risk of BVDV transmission. [ABSTRACT FROM AUTHOR]

Abstract: Context: Bladder cancer (BCa) is the fourth most common cancer in men. Survival from the disease has not improved in the last 25 yr. Population-based screening theoretically provides the best opportunity to improve the outcomes of aggressive BCa. Objective: To review the current literature regarding the usefulness and feasibility of screening for bladder cancer. Evidence acquisition: We conducted a nonsystematic review restricted to English using the keywords urinary bladder neoplasms, mass screening, mandatory testing, and early detection of cancer. We retrieved 184 articles and selected 22. Evidence synthesis: There was no level 1 evidence (obtained from a randomised controlled trial [RCT]) addressing the impact of screening on BCa survival or tumour downstaging. No study assessed the diagnostic performance of urinary markers in the context of screening. Two case-control series suggested a benefit of screening on survival, and a third found a nonsignificant beneficial trend in favour of screening. Two studies suggested downstaging of BCa at diagnosis. Other reports concluded that most cancers detected with screening were of low grade and that current urinary testing cannot detect all tumours. Screening is likely to be of benefit in high-risk populations using cost-efficient high-performing urinary biomarkers. There was insufficient evidence to define an efficient screening protocol. Conclusions: Although BCa screening is theoretically feasible in a high-risk population, there is currently insufficient evidence to recommend it. This is due to insufficient data to define an efficient screening protocol with selection of an appropriate population and the lack of accurate and cost-effective urinary markers able to discriminate low-risk from high-risk cancers. Major improvements are needed in the evaluation of urinary biomarkers before evaluation in a RCT can be achieved. [Copyright &y& Elsevier]

Purpose: To establish the improved national safety testing standards and methods for mammography. Materials and Methods: We investigated and compared the current status of mammographic equipment installation with the national and international safety and quality control programs and methods. We established and verified the draft for safety testing standards and methods. Results: We propose that the investigations of the conductor system, hardware leakage radiation profile, illumination intensity test, comparison between X-ray and light photon exposure, X-ray dose exposure on the chest wall, compression equipment size, timing equipment, and the average effective radiation dose, should all be maintained as they are in the present state without any changes. However, the exposure radiation dose reproducibility, kVp and mAs, and the half value layer tests should be reconsidered and revised. Moreover, compression pressure and autonomic exposure control system (AEC) tests should be included as new criteria. Other parameter controls included in the phantom image analysis which overlap with total quality assurance should be excluded. Conclusion: We recommend that AEC and compression pressure tests should be included as new criteria and the methods for the exposure radiation dose reproducibility, kVp, and mAs, and half value layer tests should be reconsidered and revised. [ABSTRACT FROM AUTHOR]

Despite recent advances in ways to prevent transmission of HIV from a mother to her child during pregnancy, infants continue to be born and become infected with HIV, particularly in southern Africa where HIV prevalence is the highest in the world. In this region, emphasis has shifted from voluntary HIV counselling and testing to routine testing of women during pregnancy. There have also been proposals for mandatory testing. Could mandatory testing ever be an option, even in high-prevalence settings? Many previous examinations of mandatory testing have dealt with it in the context of low HIV prevalence and a well-resourced health care system. In this discussion, different assumptions are made. Within this context, where mandatory testing may be a strategy of last resort, the objections to it are reviewed. Special attention is paid in the discussion to the entrenched vulnerability of women in much of southern Africa and how this contributes to both HIV prevalence and ongoing challenges for preventing HIV transmission during pregnancy. While mandatory testing is ethically plausible, particularly when coupled with guaranteed access to treatment and care, the discussion argues that the moment to employ this strategy has not yet come. Many barriers remain for pregnant women in terms of access to testing, treatment and care, most acutely in the southern African setting, despite the presence of national and international human rights instruments aimed at empowering women and removing such barriers. While this situation persists, mandatory HIV testing during pregnancy cannot be justified. [ABSTRACT FROM AUTHOR]

Mother-to-child transmission (MTCT) of HIV represents a particularly dramatic aspect of the HIV epidemic with an estimated 600,000 newborns infected yearly, 90% of them living in sub-Saharan Africa. Since the beginning of the HIV epidemic, an estimated 5.1 million children worldwide have been infected with HIV. MTCT is responsible for 90% of these infections. Two-thirds of the MTCT are believed to occur during pregnancy and delivery, and about one-third through breastfeeding. As the number of women of child bearing age infected with HIV rises, so does the number of infected children. It is apparent that voluntary testing in Botswana has made some valuable inroads in decreasing perinatal HIV transmission, but the statistics showing the increased rate of HIV infection among women 15–24 years of age are not very promising. After reviewing all the pertinent scientific data it is clear that mandatory HIV testing of all pregnant women in conjunction with the implementation of a full package of interventions would save thousands of lives – mothers, newborns and others who could be infected as a result of these women not being aware of their HIV status. If the protection and preservation of human life is a priority in Botswana, then it is time to allow for mandatory HIV testing of all pregnant women, before it is too late for those who are the most vulnerable. To do less would be medically inappropriate and ethically irresponsible. [ABSTRACT FROM AUTHOR]

• The use of drugs by drivers is frequent in Spain, involving 1 in every 13 drivers. • THC was the most frequently detected substance, followed by cocaine. • Almost 80 % of drug-impaired drivers were found positive for one substance only. • Positive drug tests occurred more frequently in young males during daytime hours. • Positive drug drivers profile differs from positive alcohol drivers. The study assesses the prevalence rates of alcohol- and drug-involved driving in Catalonia (Spain). Drivers were randomly selected for roadside testing using a stratified random sampling procedure representative of all vehicles circulating on non-urban roads. Mandatory alcohol and drug tests were performed during autumn 2017. A sample of 6860 drivers were tested for alcohol use, of these 671 were also tested for drugs. Standard procedures were employed by traffic officers to detect alcohol and drug use. Alcohol breath tests were performed with breathalyser devices and on-site drug screening systems were used to test for drugs. The prevalence of alcohol use above the legal limit and drug use were 1.2 % (95 % CI: 0.9–1.5 %) and 8.3 % (95 % CI: 5.8–11.2 %), respectively. The most frequent drugs detected were THC (5.6 %, 95 % CI: 3.7–8.0 %), cocaine (3.5 %, 95 % CI: 2.0–5.5 %) and amphetamines (1.6 %, 95 % CI: 0.6–3.4 %). Alcohol use was detected more frequently on conventional roads, at weekends and during night-time hours. Drug use was detected more frequently in young males during daytime hours. Driver risk profiles associated with alcohol use and drug use differ. Positive alcohol use is not a predictor of drug use when controlling for all other factors. [ABSTRACT FROM AUTHOR]