Recent improvements in U.S. air quality are saving thousands of lives per year, according to the latest Health of the Air report from the American Thoracic Society (ATS) and New York University (NYU).
The report, published in Annals of the American Thoracic Society, looked at the health effects of particulate matter and ozone pollution above ATS-recommended levels. The annual number of premature deaths associated with these substances fell from about 12,600 in 2010 to 7,140 in 2017, the report says. Together, the pollutants were also responsible for some 15,500 serious illnesses, down from nearly 27,000 in 2010.
Those changes were driven almost entirely by improvements in particulate matter pollution, rather than reductions in ozone pollution, the report says.
U.S. air quality has improved dramatically since the Clean Air Act passed in 1970. Subsequent addendums to the law and newer policies, like regulations on vehicle emissions and the Obama-era Clean Power Plan, have also reduced air pollution. Since 2010 alone, the report says, mortality associated with particulate matter—exposure to which is associated with health problems including respiratory issues, cancer, and heart disease—fell by 60%.
But progress began to stall at the tail end of that time period, according to the report—around the time the Trump Administration began to roll back some environmental protection policies. Other research supports that idea. The American Lung Association’s most recent State of the Air report found that more cities had days of high particulate and ozone pollution from 2015-2017 than they did in 2014-2016.
In the ATS’ new report, only 15% of the 530 counties analyzed for particulate matter concentrations exceeded the group’s recommendations. Western U.S. cities, especially those in California, tended to have the highest pollution levels.
Meanwhile, levels of ozone pollution, which is associated with a range of respiratory problems, have remained stubbornly stable since 2010, the report says. More than 80% of the 726 counties analyzed by the ATS for ozone levels did not meet the group’s standards. (See how your area performed here.)
Kevin Cromar, co-author of the study and director of the Air Quality Program at NYU, says that’s in part because ozone is more difficult than particulate matter to manage. Particulate matter comes either from direct particle emissions, such as those from smokestacks or fires, or from gases that convert into particulate matter in the atmosphere, such as sulfur dioxide and nitrogen oxides produced by power plants and industry. Controlling emissions at the source, Cromar says, reliably cuts down on particulate pollution in the atmosphere. But the chemical reaction that creates ozone pollution is more complicated, so it usually takes a coordinated effort at the state, regional and national levels to reduce its impact, Cromar says.
The ATS’ paper comes just days after the New York Times reported that the U.S. Environmental Protection Agency (EPA), which is planning to replace the Clean Power Plan with a new rule that would relax some regulations for the energy industry, intends to use a new calculation system that would reduce the number of premature deaths predicted to be associated with its rule. Initial estimates said the proposed plan, called the Affordable Clean Energy rule, would be associated with an additional 1,400 deaths per year. But according to the Times, the EPA’s new projections would “assume there is little or no health benefit to making the air any cleaner than what the law requires,” slashing that number.
Past research, however, strongly suggests that there are benefits associated with reducing pollution below national benchmarks. One 2017 study suggests that virtually any amount of air pollution increases premature death risks.
The EPA disputed sections of the Times’ original report, including an assertion that the new methodology was not scientifically sound or peer-reviewed, spokesperson James Hewitt told TIME. “EPA sets national ambient air quality standards at a level that protects public health with a margin of safety. A longstanding and important question is how much benefit is derived by further reducing ambient levels below the national standards,” Hewitt said. “We are considering changes to how such benefits are calculated. No change to this scientific method will be made unless and until the new approach has been peer reviewed.”
Still, Cromar says any modeling method that assumes there are no health benefits beyond what’s decreed by the law “defies rational thinking” and is “bad policy,” since—assuming there’s any pollution in the air—there’s no scientifically accepted threshold at which benefits stop accumulating and health risks vanish. [...]
Have you wondered what happens when a medical equipment fails in hospitals? If a ventilator stops suddenly or a surgical stapler malfunctions?
Worst case scenario: the patient dies.
A year-long joint investigation of the global medical devices industry, carried out in 2018 by NBC, the International Consortium of Investigative Journalists and more than 50 media partners, found that across all types of medical devices, more than 1.7 million injuries and nearly 83,000 deaths were reported to the United States Food and Drug Administration (FDA) over the last decade.
“In the US, preventable medical errors cause about 100,000 to 300,0000 deaths a year and is the third leading cause of death after cardiopulmonary disease and cancer.
“Of the preventable medical errors, among the top five are malfunction of medical equipment, infection and medication error.
“Not all of them lead to death, but some do,” reveals Dr Marcus Schabacker, president and CEO of ECRI Institute, a non-profit, independent organisation committed to the safety, efficacy and cost-effectiveness of healthcare.
In the last 50 years, the billion-dollar medical device industry has revolutionised treatment for some of the deadliest scourges of modern medicine, introducing devices to treat or diagnose heart disease, cancer and diabetes.
But who keeps tabs on these devices?
The tragic death of a young child in a Philadelphia emergency room, caused by a malfunctioning defibrillator led physician Joel J. Nobel to focus his energy on improving resuscitation technology, which eventually resulted in the setting up of ECRI Institute.
Since its establishment in 1968, the organisation has helped saved countless lives through scientific research and dedicated search for meaningful improvements in medical devices and patient care.
Today, ECRI Institute has more than 5,000 members worldwide, ranging from hospitals to government agencies and manufacturers.
“In the past two years, our engineering team conducted 170 evaluations on devices in 50 medical categories, including anaesthesia and respiratory care, imaging, infection reduction, infusion therapies and patient monitoring.
“As a result, manufacturers voluntarily made significant improvements to 55 medical devices – improvements directly attributed to ECRI’s research and influence in the healthcare community.
“We believe our approach is the quickest, most effective way to make medical devices safer.
“And we’re the only independent organisation in the world doing this,” says Dr Schabacker, who is an anaesthesiologist and intensive care specialist by training.
There are a myriad of medical devices being used to screen, diagnose and treat patients every day. — 123rf.com
He was speaking at the recent opening of The ECRI Institute International Research Centre, the organisation’s first medical device evaluation laboratory outside the US.
Located in Bandar Sunway, Selangor, it will evaluate medical devices used across all care settings in Europe and Asia to help medical professionals make informed decisions that improve patient safety.
ECRI Institute, which has its headquarters in Pennsylvania, US, established its Asia-Pacific office in Kuala Lumpur 20 years ago to support healthcare technology decision-making and patient safety throughout the region.
“There was an incident here about 20-odd years ago when a piece of equipment failed and the patient died.
“Someone from the Health Ministry sought our experts from the US to perform investigations and that led to the setting up of ECRI here.
“We are also a third party forensic investigator for medical devices; we look at what went wrong and share our findings,” says Eric Woo, ECRI Institute Asia Pacific’s regional director.
Testing for safety
Dr Schabacker says, “Basic healthcare problems are similar all over the world. The Asia Pacific region is one of the fastest growing healthcare markets.
“We are getting better at treating diseases and people are living longer.
“Also, the demand for qualified personnel is higher than supply, so the less educated and less trained people, i.e. friends or family members, need to take over the care and treatment of the patient.
“Care is moving out of the traditional location of the hospital into ambulatory surgical centres, cancer centres, etc.
“Standards that have been developed over decades in the hospitals are not being applied in these care settings and are not being adhered to by less trained people.
“ECRI wants to ensure that the equipment that is going to be used is safe and effective. The Health Ministry has been helpful in allowing us to bring in products not registered n Malaysia for testing. So, we’re going to be able to test additional products that we couldn’t test before, especially from Asia Pacific members.”
Medical devices, an integral part of disease diagnosis and treatment, are prone to malfunction if overused or not maintained properly. — TNS
Devices sold internationally will be evaluated in Malaysia under the same protocols ECRI Institute uses in the US.
The devices to be tested are dependent on key trends in healthcare, and if a member identifies a problem with a product.
“For example, this month, we may want to test ventilators. We look at what’s available in the market and see who are the key manufacturers, reach out to them and tell them we’re testing the product.
“Most of them comply and send us their product, or we will buy or lease the device for testing,” explains Dr Schabacker.
Once the tests are completed, a summary and rating is sent to each of the participating manufacturers.
“As you can imagine, there is a variety of reactions, particularly if it is not a good rating. We give them a chance to comment and fix the problem.
“Once fixed, we retest the device and modify our report, which is published. All our findings are based on facts.
“We try to [...]
Antimicrobials are medicines that inhibit the growth of microorganisms such as bacteria, fungi, viruses and parasites, and cause their death.
Over the years, due to overuse/misuse of antimicrobials, these microorganisms have mutated into “superbugs” that have the ability to resist antimicrobial treatment.
As a result, infections continue to persist, resulting in prolonged illness and the increased risk of death, as well as increasing the risk of spreading the bugs to other people.
Small organisms, big problems
Antimicrobials have revolutionised and transformed medicine, saving millions of lives.
But over the last two decades, antibiotics usage has increased for both medical and non-medical applications, leading to the development of antibiotic resistance.
The World Health Organization’s (WHO) Global Antimicrobial Surveillance System (GLASS) reveals that nearly 700,000 people around the world die each year because of drug resistance.
It also predicts that the figure could rise to one million deaths annually with an exponential increase in medical costs of over RM400 trillion.
Although this is global data, Malaysia is no different from the rest of the world.
Causes of the crisis
• Overuse/misuse of antimicrobials
Way back in 1945, Sir Alexander Fleming, in his Nobel Prize acceptance speech, had remarked that when the public demands these drugs, there will begin an era of abuse.
As predicted, due to the lack of regulations in many countries, these medicines are sold over the counter without prescription.
Antibiotics are also frequently prescribed improperly in terms of indication, choice, dose and duration of treatment.
Even when correctly prescribed, patients often do not finish the full course of their medicine, which contributes to antibiotic resistance.
On the flip side of the coin, unnecessary usage can also lead to harmful side effects.
• Widespread agricultural use
The majority of antibiotics are actually used as growth supplements in healthy animals, or as a preventative measure for animals living in crowded or unsanitary conditions.
When humans ingest such animals, resistant microorganisms can get transmitted to them and cause severe infections.
• New antibiotics
Due to financial and regulatory constraints, the development of new antibiotic drugs has almost come to a standstill.
Pharmaceutical companies do not find these investments to be profitable as these drugs are meant to be taken only for a short time, and are generally curative.
The problem is that the pace of new drug discovery simply cannot match the pace of growing resistance.
If existing antibiotics are not used judiciously, even the commonest infections may become difficult to treat.
Antibiotics are often given to animals living in crowded conditions to prevent them from getting sick. However, this contributes to the rise of antibiotic-resistant microorganisms, which will affect humans.
Diffusing the time bomb
Antibiotic resistance is rising to precariously high levels, and without urgent action, the world is heading towards a post-antibiotic era.
Most of the causes responsible for this crisis can be tackled wisely.
One of the key strategies to prevent antibiotic resistance is by preventing infections of these antibiotic-resistant microorganisms.
This can be achieved by making drastic changes to the prescribing practices of antibiotics by doctors and their usage by patients.
How can you as a patient contribute?
• Never demand antibiotics. Only use antibiotics when prescribed by a health professional and always follow their advice.
Be sure to ask questions if anything is unclear.
• Always finish the full course of your prescribed antibiotics; never stop taking them halfway through the course, even when you feel better.
• Never share or use leftover antibiotics.
• Take good care of your personal health and hygiene.
Wash hands regularly, practice hygienic food preparation, avoid close contact with sick people and ensure your vaccinations are up to date.
• Go for meats and fishes that have been produced without the use of antibiotics.
Fighting the resistance
Antibiotic awareness week has been held every November since 2015.
This global initiative focuses on spreading awareness about antibiotic resistance, recommending guidelines for optimising antibiotic usage, and strengthening surveillance and research in countering antimicrobial resistance.
During the 68th World Health Assembly in May 2015, all member states were guided to set up national antimicrobial resistance surveillance systems that can yield reliable data.
In accordance to this, the Health Ministry and the Agriculture and Agro-Based Industry Ministry initiated the Malaysian Action Plan to combat antimicrobial resistance (MyAP-AMR).
This plan includes comprehensive educational and awareness programmes to educate both the public and professionals.
However, surveillance is still in its infancy, hence commitment and complementary efforts from all related sectors including veterinarians, farmers, fishery officers, health professionals and all related stakeholders, are required to tackle one of the biggest threats to global public health.
As responsible individuals, it is our duty to safeguard the world with our coordinated efforts against antibiotic resistance.
Otherwise, we will find our so-called “high-tech world” reverting back to the pre-antibiotic era in the not-too-distant future.
Dr Deepthi Shridhar P. is a lecturer in pharmacology at the Perdana University Graduate School of Medicine. This article is courtesy of Perdana University. For more information, email email@example.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any [...]
HONG KONG: Divorced, in his 40s and fearing a solitary future, Zhou Xinsen went online like thousands of other Chinese men to find an affordable and fast solution to bachelordom — a Vietnamese bride.He was among millions of his gender struggling on the sidelines of China’s ultra competitive marriage market, where a decades-long one-child policy and sex-selective abortions of daughters has resulted in a massive gender gap.“It’s very hard for people my age to find a Chinese wife,“ 41-year-old Zhou says.Single men, many in remote rural villages, are known as “bare branches”, a pejorative term in a country where pressure to marry and extend the family tree is sharp.Running out of time, Zhou forked out nearly US$20,000 to find his second wife — a 26-year-old from Vietnam who he relocated to Jiangsu province.“For people my age, time is bought with money.”Having fixed his romantic quandary, Zhou then opened his own match-making business, taking a small slice from China’s multi-million-dollar annual trade in overseas brides.He charges around 120,000 yuan (RM72,817) to connect Chinese men with Vietnamese brides via his website, which shows photos of women aged 20-35 “waiting to be married”.It’s “profitable”, he says, remaining coy on the amount of money he has made.A portion of the money from matches is meant to be funnelled back to families in poor Mekong area countries.While many unions flourish, others quickly lurch into crisis with women disappointed at swapping village poverty in Cambodia, Laos, Vietnam and Myanmar for life in rural China.China’s single men are often older, divorced, disabled or too poor to pay the traditional “bride price” — a dowry in gifts or cash — for a Chinese wife.Those costs rose to between US$22,000-US29,000 in parts of the country last year, according to state media.Problems start when the brides feel duped about what they are getting into, says Zhou, who sends a monthly remittance to his wife’s family of $175 as a show of goodwill.“This is nothing to us, but for them it’s lifesaving,“ he adds.Family business Chinese men face a barrage of economic, psychological and cultural pressures to find a wife, says Jiang Quanbao, a Professor at Xi’an Jiaotong University’s Institute for Population and Development Studies.“Marriage is not only a personal matter, it concerns an entire family... especially the parents,“ Jiang told AFP.As women — especially in the cities — push back marriage while they work, study and enjoy single life, China’s villages are fast losing their female population. Sons left unmarried become an issue of family “face” in tight village communities, says Jiang.That crushing social expectation has driven a grim trade in brides.Increasing numbers of woman — and teenage girls — from neighbouring countries are kidnapped, tricked or forced into marriage, according to several rescue groups across the Mekong who spoke to AFP.“Buying a woman who has been kidnapped becomes a kind of hopeless choice,“ Jiang adds.Last year Chinese police rescued women sold into forced marriages in Henan, Anhui, Shandong and Jiangsu provinces, as the buy-a-bride trade billows out to the eastern provinces. Crime and deceptionUnder Chinese law, the abduction and trafficking of women or children is punishable by five to ten years jail. But critics say the law needs updating as the trade surges.“It’s extremely profitable and there’s no incentive at all for traffickers to stop,“ Mimi Vu of the Vietnam-based Pacific Links Foundation, which works to prevent human trafficking.“The demand is there and the money, the profit is there to be made.”Beijing switched from a one-child to a two-child policy in 2016, but experts say it may take decades to see a rise in the number of women of marriage age.That means the bride trade is unlikely to dissipate anytime soon.Zhou describes his work as “a public service” in a country where there are 33 million fewer women than men.But the outcomes for Chinese men are often far from perfect, with money warping motives throughout the system. Cautionary tales — of dodgy brokers, trafficked women and brides pocketing money then fleeing — abound on Chinese social media as the market widens.“It is an industry, and many of them (marriages) are fraudulent,“ one Weibo user wrote recently. “It’s time the government takes care of this business.” Another man in Hubei told state media he paid a broker US$8,700 to meet a young Vietnamese woman who left him after three months, later aborting their baby as she went on the lookout for another husband.“Now I have neither a wife nor the money,“ he told the Chutian Metropolis Daily. “I’m a laughing stock in the village.” — AFP [...]
Pak Daud took over the silversmith business from his uncle back in 1964. — Pictures by Ham Abu Bakar
KUALA LUMPUR, Dec 4 — Pak Daud, 70, is one of the very few artisans left keeping the tradition of silversmithing alive in Kelantan.His exquisite works include silverware for royalty and even a keris which was presented to former US President Barack Obama!Craftsmen of his calibre are fast dying out but with the Kelantan silver jewellery shoe project supported by Yayasan Hasanah, a foundation of Khazanah Nasional, his work will soon receive world recognition.
Yayasan Hasanah senior vice president arts heritage & culture, Zainariah Johari, explains how they are using Italian handmade shoes to promote the dwindling Kelantan silver industry.
Silver embellishments, made by Pak Daud and four other silversmiths, will be adorning handmade Italian shoes.The project was first mooted back in 2016 by Yayasan Hasanah, following a study by Kraftangan Malaysia and Tradisi Busana PR Sdn Bhd that showed the number of silversmith artisans are now less than 40.It's a drastic decline from around 200 silversmiths back in 1995. The study highlighted that this was due to a lack of demand for silverware since most people aren't aware of the fine craft.
Designs for the silver pieces were inspired by the surroundings in Kelantan like this floral matt silver piece.
Pak Daud, whose full name is Mohd Daud bin Yusoff, said another difficulty artisans faced was the fluctuating price of silver. He lamented that at one time, it went up to RM5,000 per kilogramme! Sometimes it can drop down to, say, RM1,000 per kilogramme.This causes uncertainty for their pricing. In terms of crafting the silverware, it needs a pair of hands versus machines. For instance, Muhammaad Khairi bin Suhaimi, 20, explained that the craftsmen need to ketuk (knock) by hand, as the silver is too soft to do otherwise.
The elegant black Italian handmade shoe is enhanced with the handcrafted silver piece made by the Kelantan silversmith artisans.
Yayasan Hasnah, senior vice President, arts heritage & culture, Zainariah Johari, explained that initially they were approached by Dodi Mohammad from Tradisi Busana PR to do preservation work.As Dodi was a protege for 20 years of celebrity shoe designer Jimmy Choo, they decided to combine the silverware industry revival with shoes.She added, “Our silver craftsmen are always producing household items or decorative items like brooches. We feel the industry needs a lot of boost and with a big name behind it, this will take it a couple of steps beyond.”
Carry a piece of Malaysian 'wau' crafted from silver on this patent men's shoe.
The eight-month project identified five silversmiths scattered around Kelantan that included Pak Daud from Pengkalan Chepa. The rest are KB Permai, Zaini Arif, Suhaimi Mat Jusoh and Razak Ismail.All of these artisans specialise in various items that range from jewellery and trophies to royal ceremonial items. Usually, these items are commissioned by various parties.Pak Daud explained that for his designs, he'll see what raw materials are easily available around him. Hence, he uses bull horns, since it's found in his village.
Kelantan silverware needs a lot of patience as you need to carve and 'ketuk' by hand to achieve its beautiful texture.
As part of expanding the pool of silversmiths, these artisans selected six proteges from their own village. Some of the artisans also have the new generation helping out like Suhaimi Mat Jusoh's two sons and Pak Daud's son and daughter.To further facilitate the project, a fashion consultant was also brought in to advise. The project also included teaching the artisans how to be sustainable, which was done via an academician from a higher learning institute.“You cannot just create something beautiful but it sits on the shelf. You need to be sustainable. But that remains a challenge, as an artisan is an artisan,” said Zainariah.With the crafting of Italian shoes, they worked closely with the Italian Trade Commissioner Dr Samuele Porsia. It's via the know-how shared by the Italian shoe makers that the Kelantanese artisans learnt how to create special hooks for the silver pieces to attach onto the shoes.
Suhaimi Mat Jusoh is famous for his carving techniques on metal substances like this elegant silver handbag.
The collection features a total of seven shoe designs: Five for women and two for men. The designs of the silver adornments are all inspired by the Kelantan environment and feature wayang kulit characters, wau and flowers.Tradisi Busana PR has also secured a retail space at Amato Couture Gallery in Dubai to market these shoes.Yayasan Hasanah is hopeful that this project will be the stepping stone to bigger things to come for the whole industry. As Zainariah explained, “The shoe is not the hero. The hero is the craftsman. We want to save the craft and the product is the silver. The shoe is just a tool. It could be bags.”
Syahrul Syazwan explains to customers about their silver jewellery pieces.
Seeing the exquisite silver craftwork, two companies have also signed a memorandum of understanding with the artisans to promote their craft.The first is Nusantara Collection, a local company with an established customer base in the US for their website designs. Another is LORD's Tailor who is well known for their handmade suits. They have plans to introduce silver lapel pins, buttons and cufflinks, which highlight the Malaysian tradition and the Kelantan silver craftsman.With the awareness created, there's hope for the artisans to make more ties with other companies to promote their work. Yayasan Hasanah has also invited other charity foundations to consider funding further initiatives.
Various brooches made by Razak Ismail who started learn [...]
KUALA LUMPUR (Nov 17): Aside from the 1Malaysia Development Bhd scandal, the problems at the Federal Land Development Authority (FELDA) were part of the reason... [...]
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