After the 12-story Champlain Towers South building suddenly crumbled in Surfside, Sylvester Comprehensive Cancer Center’s Firefighter Cancer Initiative stepped up to protect rescue workers from health hazards.

About 30 hours after the shocking collapse of the Champlain Towers South condominium in Surfside, Dr. Alberto Caban-Martinez, Ph.D., D.O., M.P.H, drove his packed SUV to the disaster site. Escorted through the chaos by an ambulance, the deputy director of Sylvester Comprehensive Cancer Center’s Firefighter Cancer Initiative (FCI) was on a mission to deliver thousands of baby wipes and a dozen decontamination kits embossed with the lifesaving motto now found in hundreds of fire stations across Florida. 

Dr. Alberto Caban-Martinez

“Clean is the new badge of honor,” the large, green buckets said. Each contained the dish soap, scrub brushes, wipes, spray bottles, and hoses that Dr. Caban-Martinez hoped the search-and-rescue personnel would use to eliminate microscopic toxins he knew would cling to their skin and gear after their 12-hour shifts sifting through the debris pile that entombed nearly 100 people.

“Prevention is key,” explained Dr. Caban-Martinez, who is also an associate professor of public health sciences at the University of Miami Miller School of Medicine. “You do not want to be marinating in these compounds that are circulating in the air.”

Soon after, FCI founding director Dr. Erin Kobetz, Ph.D., M.P.H, who began collaborating with South Florida firefighters in 2014 to investigate why cancer seemed to be stalking their ranks, ordered hundreds of air-filtering P-100 respiratory masks to replenish the supply at the collapse site.

Learning From Tragedy

Turning an unthinkable tragedy into a valuable learning opportunity, she and Dr. Caban-Martinez also expanded FCI’s role in Surfside to help launch an environmental and exposure monitoring program that not only kept first responders safer on the ground but will inform future guidelines for protecting them from another occupational hazard likely to add to their risk profile. 

“We were uniquely positioned to take the evidence gleaned from our ongoing effort to address why firefighters are at increased risk of cancer incidence and mortality and rapidly translate it to a disaster that could augment this risk substantially,” said Dr. Kobetz, Sylvester’s associate director for population sciences and cancer disparity and the University of Miami’s vice provost for research and scholarship. “Our hope is that we and our firefighter colleagues learn together how to mitigate the risks that emerge in a different disaster scenario.”

Dr. Caban-Martinez is scheduled to discuss the first exposure study from the June 24 collapse at the recent annual meeting of the American College of Epidemiology. Conducted in partnership with Miami-Dade Fire Rescue and the Department of Science and Research at the International Association of Fire Fighters, the study found that rescue workers who conducted the tireless search of the collapsed 12-story structure were exposed to high concentrations of polyaromatic hydrocarbons, a massive class of known, probable, and possible carcinogens which firefighters are all too often exposed to in their line of work.

SAFE Collecting Data

Dr. Caban-Martinez also just launched SAFE — for the Surfside Assessment of First-Responder Exposures study — which aims to collect two years’ worth of toenail clippings from hundreds of firefighters who worked on the debris pile. Like slow-growing rings of a tree, Dr. Caban-Martinez said, toenail clippings can provide snapshots of a person’s exposure to heavy metals.

But the hope is that those who adhered to the health and safety rules that the MDFR and IAFF developed with guidance from Dr. Caban-Martinez and Dr. David Prezant, the co-director of the World Trade Center Health Program, mitigated the risks posed by PAHs or other toxins released by the building’s collapse and ensuing fires. If so, that outcome would be owed in part to the University’s real-time environmental and exposure monitoring efforts that were used to keep rescue workers informed of the hazards and motivated to follow decontamination and personal protective equipment protocols.

“There are usually two aspects to encouraging PPE use,” said Derek Urwin, the IAFF’s director of science and research, who collaborated with the MDFR; Federal Emergency Management Agency safety officers; and researchers and students from the Miller School, the Rosenstiel School of Marine and Atmospheric Science, and the College of Engineering to get environmental and exposure monitoring up and running at Surfside.

“One is enforcement — when your boss tells you to do it,” Urwin continued. “The other, which is more effective, is motivation — when you understand that you can protect yourself from real hazards. We were able to use real-time environmental data to convey to the firefighters that, ‘You can’t see them. You can’t smell them, but there are respiratory hazards here. So, keep your respirators on.’ It made a big difference and hopefully the outcome will be that we won’t see a lot of long-term health impacts like we did after 9/11.”

It was, ironically, the growing awareness of those health impacts that inspired the FCI, which the Florida Legislature has continuously funded since its 2015 inception. During the 20 years since terrorists crashed planes into the Word Trade Center’s Twin Towers, at least 200 New York City firefighters have died from illnesses tied to the toxic mist that enveloped Manhattan in the ensuing months. Hundreds more have been diagnosed with a variety of cancers, including multiple myeloma—the same blood cancer that killed the Palm Beach County Fire Rescue captain who first asked Dr. Kobetz to connect the dots between firefighting and cancer.

Butch Smith, who died eight years after his 2008 diagnosis at age 54, and his comrades knew too many other front-line firefighters in Florida who had been diagnosed with a variety of cancers at a young age. But since none of them had taken part in New York’s post 9/11 recovery, they reached out to Sylvester, the state’s only academic cancer center, to provide the evidence-based data that would legitimize — and hopefully one day prevent — what they knew to be true: Their jobs put them at a high risk for cancer.

Learning from 9/11

Urwin, a former Miami-Dade firefighter who has been with the Los Angeles County Fire Department for 15 years, also knew who to enlist when he realized it would fall to MDFR and the IAFF to initiate exposure monitoring in Surfside.

Erin Kobetz, Ph.D., M.P.H.

“Given the aftermath of 9/11, we all assumed that when this type of major incident takes place, some sort of government environmental monitoring program would automatically go into play,” he said. “But, after a couple of days, it became clear that was not the case, so knowing this was Miami, Alberto and Erin were my first two phone calls.”

In short order, Urwin flew from L.A. to Miami, where researchers from across the University eagerly stepped up to help. They offered their expertise, equipment, and a handful of “remarkable” students, who Urwin said provided essential assistance at the site or in the lab.

Nuresh Kumar, professor of environmental health in the Department of Public Health Sciences who specializes in the health effects of air pollution, facilitated the air-monitoring effort and employed multiple instruments and real-time pollutant sensors to monitor particles and gases circulating on and adjacent to the debris pile—and as far as six blocks away.

“Within a block of the site, I removed my respirator and had a burning sensation in my throat and eyes,” recalled Kumar, who was assisted by graduate students Johnathan Penso and Samantha Abelson. “Using readings from our real-time sensor and my own symptoms, I told Derek: ‘Tell all these folks not to remove their respirators unless they are in the tent or a protected area.’”

Lending Support

Cassandra Gaston, an assistant professor in the Department of Atmospheric Sciences—who studies the composition and size of aerosols—lent handheld, battery-operated air samplers, and her detail-oriented research assistant, Michael Sheridan.

He provided Urwin and Kumar vital in-the-field support. And Helena Solo-Gabriele, professor in the Department of Chemical, Environmental and Materials Engineering, supplied an X-ray Fluorescence Analyzer that, resembling a big gun, almost instantly detects high levels of metals in any material. Her graduate student, Afeefa Abdool-Ghany, is now analyzing dust samples and metal readings collected at the site.

The only researcher with early access to the disaster site, Urwin was also instrumental in organizing the PAH study that Dr. Caban-Martinez is discussing today. For that study, graduate student Umer Bakali processed and analyzed the data collected from 29 silicon wristbands that Urwin placed around the collapse site before the controlled demolition of the remaining tower structure and another 48 wristbands worn by rescue workers who worked on the debris pile afterward.

It was the same kind of simple wristbands that originally helped Dr. Kobetz, Dr. Caban-Martinez, and other FCI investigators begin linking firefighting to cancer. Firefighters who wore the wristbands in earlier studies eventually learned that the soot-covered fire gear they stowed in their cabs, their sleeping quarters, or their homes weren’t badges of honor. They were perfect conduits for spreading the cancer-causing contaminants that could have been wiped away with dish soap and water.

“I’m always thinking about firefighters — like what they were doing after Hurricane Ida hit the Gulf coast; what we could do to protect them from things like water contamination and infection,” Dr. Caban-Martinez said. “Because we know they will do whatever it takes to do their job, which is saving lives without considering the repercussions. But it’s our job to make sure they know how to protect themselves from hazards and reduce their risks.”

Written by Maya Bell

https://physician-news.umiamihealth.org/sylvester-researchers-explore-cancer-risks-at-surfside-condo-collapse/



The following statement is attributable to:
Gerald E. Harmon, M.D. President, American Medical Association    

“With the rapid spread of the SARS-CoV-2 Delta variant, alarming increases in COVID-19 related deaths and hospitalizations, and our health system and physicians stretched thin, the AMA is pleased by the Administration’s significant efforts to help get this pandemic under control. Aggressive measures will be needed to prevent further widespread transmission of COVID-19. Increased testing – more available and affordable – is a major step forward; a new push to vaccinate young people targets an important under-vaccinated group; increasing the supply of monoclonal antibody treatment provides much needed care; supporting schools that provide additional protections for their students and ensuring hospitals, dialysis, home health, and ambulatory surgical centers also require vaccinations – will help us reach vaccination thresholds necessary to defeat COVID-19. We look forward to reviewing and providing input on the Administration’s full plan.”



September 9 2921 – AdvaMed, the world’s leading trade association for medical technology companies—which includes the diagnostics companies that make Covid-19 tests—released the following statement from president and CEO Scott Whitaker:

“We applaud the President and his Administration for recognizing the critical roles regular testing and widespread vaccination serve in bringing the pandemic under control. We look forward to continuing to work closely with the Administration to further extend the reach of quality testing, strengthening our public-private collaboration and coordination. Our diagnostic companies, as they have been from the beginning of this crisis, are fully committed to supporting our nation’s Covid response. Our industry has been leading the way, to ensure our employees and contractors are either vaccinated or regularly tested. It’s critically important to keep facilities open and ensure they remain as safe as possible so that the important work of manufacturing the medical technologies patients rely on can continue.”

Last week, AdvaMedDx – the division within AdvaMed that serves diagnostics manufacturers – sent <<a letter>> with the American Clinical Laboratory Association (ACLA) to the White House offering a number of policy recommendations to help the diagnostic testing industry continue to meet the challenges presented by the pandemic. The recommendations included:

  • Robust expansion of specimen collection/testing sites. The shift of testing sites to mass vaccination centers drove access to critically needed vaccinations. However, reopening sample collection/testing sites is necessary to leverage the laboratory capacity available to increase testing, particularly in the two dozen states with over ten percent positivity during this surge.
  • Formalized and permanent forum for frequent, real time and meaningful communication and collaboration between the Administration and the diagnostics manufacturers and laboratories driving access to testing.
  • Development and communication of forward looking policy and insurance of testing availability for whatever may come, based on pandemic modeling, to strategize how commercial labs and manufacturers can best support the nation’s testing needs.
  • Maintain and bolster testing capacity by fully leveraging mechanisms such as the Strategic National Stockpile and agreements with diagnostics manufacturers like vendor managed inventory and warm-base contracting. Ensure CDC directly contracts with high complexity laboratories to retain and reserve personnel, equipment, test supplies and facilities necessary to quickly bring new tests and substantial capacity online when called upon to respond to an emerging pathogen threat. Strengthening public-private preparedness collaboration with the CDC and private sector laboratories and diagnostics manufacturers is critical to ensure up to date diagnostics are available and rapidly deployed, and laboratory capacity is maintained.
  • Comprehensive, consistent information to states about testing, emphasizing fully leveraging all high- quality molecular, antigen, serology, and T-cell tests across laboratory, point-of-care and over-the- counter modalities is necessary to extend the reach of testing. Strategies such as pooling should be utilized, as appropriate, and tools such as wastewater surveillance testing should be employed.
  • Significantly augment and make public CDC’s epidemiological studies using serology/antibody testing to understand the pervasiveness of the impact of COVID for all communities, while improving our collective understanding of correlative immunity as we prepare for broader administration of vaccine boosters.
  • Allow states flexibility to modify testing plans, fully supported by American Rescue Plan funding as the need arises.
  • Continued extension of public health emergency (PHE), allowing maintenance of reimbursement levels that have allowed labs to procure instrumentation and supplies, and maintain capacity.

# # #

AdvaMed member companies produce the medical devices, diagnostic products and health information systems that are transforming health care through earlier disease detection, less invasive procedures and more effective treatments. AdvaMed members range from the largest to the smallest medical technology innovators and companies. For more information, visit www.advamed.org.



Robotic cane with 3D camera can accurately guide user to chosen location, avoiding obstacles.

September 8 2021 – Equipped with a color 3D camera, an inertial measurement sensor, and its own on-board computer, a newly improved robotic cane could offer blind and visually impaired users a new way to navigate indoors. When paired with a building’s architectural drawing, the device can accurately guide a user to a desired location with sensory and auditory cues, while simultaneously helping the user avoid obstacles like boxes, furniture, and overhangs. Development of the device was co-funded by the National Institutes of Health’s National Eye Institute (NEI) and the National Institute of Biomedical Imaging and Bioengineering (NIBIB). Details of the updated design were published in the journal IEEE/CAA Journal of Automatica Sinica.

“Many people in the visually impaired community consider the white cane to be their best and most functional navigational tool, despite it being century-old technology,” said Cang Ye, Ph.D., lead author of the study and professor of computer science at the College of Engineering at the Virginia Commonwealth University, Richmond. “For sighted people, technologies like GPS-based applications have revolutionized navigation. We’re interested in creating a device that closes many of the gaps in functionality for white cane users.”

While there are cell phone-based applications that can provide navigation assistance – helping blind users stay within crosswalks, for example – large spaces inside buildings are a major challenge, especially when those spaces are unfamiliar. Earlier versions of Ye’s robotic cane began tackling this problem by incorporating building floorplans; the user could tell the cane whether he or she wished to go, and the cane – by a combination of auditory cues and a robotic rolling tip – could guide the user to their destination. But when used over long distances, the inaccuracies in the user’s location could build up, eventually leaving the user at an incorrect location.

To help correct this issue, Ye and colleagues have added a color depth camera to the system. Using infrared light, much like a mobile phone’s front-facing camera, the system can determine the distance between the cane and other physical objects, including the floor, features like doorways and walls, as well as furniture and other obstacles. Using this information, along with data from an inertial sensor, the cane’s onboard computer can map the user’s precise location to the existing architectural drawing or floorplan, while also alerting the user to obstacles in their path.

“While some cell phone apps can give people auditory navigation instructions, when going around a corner for example, how do you know you’ve turned just the right amount?” said Ye. “The rolling tip on our robotic cane can guide you to turn at just the right point and exactly the right number of degrees, whether it’s 15 degrees or 90. This version can also alert you to overhanging obstacles, which a standard white cane cannot.”

There are still a few kinks to be worked out before the system will be market-ready – it’s still too heavy for regular use, for example, and Ye’s team is looking for a way to slim down the device. Nevertheless, with the ability to easily switch between its automated mode and a simpler, non-robotic “white cane mode,” Ye believes this device could provide a key independence tool for the blind and visually impaired, without losing the characteristics of the white cane that have stood the test of time.

The study was funded by NEI and NIBIB through grant EB018117.

 NEI leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs to develop sight-saving treatments and address special needs of people with vision loss. For more information, visit https://www.nei.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®

References

Zhang H, Jin LQ, Ye C. “An RGB-D camera based visual positioning system for assistive navigation by a robotic navigation aid,” IEEE/CAA J. Autom. Sinica. 2021. 8(8):1389-1400. doi:10.1109/JAS.2021.1004084



September 8 2021 – Each September, the American Medical Association (AMA) recognizes influential female physician leaders as part of Women in Medicine Month. To showcase the accomplishments of these leaders, the AMA Women Physicians Section (WPS) and the AMA Foundation today announced the winners of the 2021 Joan F. Giambalvo Fund for the Advancement of Women research grants program.

The Joan F. Giambalvo Fund for the Advancement of Women Award is administered by the AMA Foundation on behalf of the AMA Women Physicians Section. The AMA-WPS and AMA Foundation awards scholarships of up to $10,000 to health care researchers to identity and address issues that affect women physicians and medical students. The AMA-WPS and AMA Foundation have granted 31 research awards since 2006 on topics such as flexible work options, gender differences in the practice patterns of obstetricians/gynecologists, and the promotion and retention of diversity in medical education. Additional information about the award and Joan F. Giambalvo can be found on the AMA Foundation website.

“As we celebrate Women in Medicine Month, the AMA is honored to recognize this year’s awardees for their exceptional work aimed at improving the well-being and retention of female physicians in the workforce amid the COVID-19 pandemic and ensuring gender equity in medical education,” said AMA President Gerald E. Harmon, M.D. “This annual grant program reaffirms AMA’s commitment to increasing the influence of women physicians and advocating for women’s health issues. We will continue to support efforts to shine a light on and help address the important issues facing women in medicine today.”

One of the winning 2021 projects focuses on evaluating the effects of the COVID-19 pandemic on female physicians with children, with the end goal of developing a framework for how institutions can best support and retain these physicians, particularly those physicians who are in the early stages of their careers. It will be led by two women from Beth Israel Deaconess Medical Center at Harvard Medical School, Huma Farid, M.D., Associate Program Director of the Obstetrics and Gynecology Residency program, and K. Meredith Atkins, M.D., Associate Dean of Undergraduate Medical Education.

“The pandemic has had an indelible impact on the nation, and most particularly for our frontline health care workers. As women in medicine, we have witnessed and experienced first-hand the challenges female physicians face: changing work schedules, remote learning, isolation from our families, and a lack of consistent, reliable childcare. The impossible task of balancing it all was made even more challenging during the pandemic, but there are ways to help support female physicians that we aim to explore and promote through our project. By receiving the Giambalvo Award, we feel heard and acknowledged. It has bolstered us to pursue this interest in the hope that we can use the lessons gained from the pandemic to promote physician well-being and retain female physicians in the workforce,” said Dr. Farid.

The second winning project is a multi-site longitudinal study aimed at understanding the combined impact of race, ethnicity and gender on women’s experiences in graduate medical education, also known as residency. The project will be led by Robin Klein, M.D., MEHP, Associate Professor, Department of Medicine, Emory University School of Medicine. The team of co-investigators includes 14 physicians from hospitals and medical schools across the country, including Massachusetts General Hospital; Brigham and Women’s Hospital; University of Louisville; University of Alabama Birmingham; University of Chicago; University of California, San Francisco; University of California, Los Angeles; University of California, San Diego and Veterans Administration San Diego; and University of Virginia.

“Inequities and bias in learner assessment are a critically important yet understudied problem in medicine. Disparities in assessments likely contribute to maintaining inequities and gaps in representation across the profession. While evidence suggests gender and race/ethnicity independently influence assessment, what remains unknown is how gender and race intersect in assessment in medical education. We are thankful for AMA’s support of our team’s work to examine bias in medical education assessment at the intersection of race, ethnicity and gender. We believe this work is important to achieving true gender equity in the physician workforce,” said Dr. Klein.

The AMA has adopted numerous policies aimed at encouraging medical associations and other relevant organizations to study gender difference in income and advancement trends, by specialty, experience, work hours and other practice characteristics, and develop programs to address disparities where they exist. The AMA will continue to strongly support equity and diversity across medicine and promote professional growth and development for physicians at every stage of their careers.

The AMA Women Physicians Section (WPS) consists of more than 100,000 members of the AMA and aims to increase the number and influence of women physicians in leadership roles and to advocate for and advance the understanding of women’s health issues.