Potential risks and benefits of nanotechnology: perceptions of risk in sunscreens

ArticleGeneral

Authors: Paul FA Wright
The Medical Journal of Australia, June 2016

The applications for engineered nanomaterials and nanotechnology are developing exponentially, along with the awareness in government, industry and public groups of nanosafety issues. There is also growing public concern caused by negative perceptions among some high profile groups that nano-enabled products are proliferating uncontrollably and being released without adequate testing of their safety.

What are the potential risks?

In reality, a one-size-fits-all approach to evaluating the potential risks and benefits of nanotechnology for human health is not possible because it is both impractical and would be misguided. There are many types of engineered nanomaterials, and not all are alike or potential hazards. Many factors should be considered when evaluating the potential risks associated with an engineered nanomaterial: the likelihood of being exposed to nanoparticles (ranging in size from 1 to 100 nanometres, about one-thousandth of the width of a human hair) that may be shed by the nanomaterial; whether there are any hotspots of potential exposure to shed nanoparticles over the whole of the nanomaterial’s life cycle; identifying who or what may be exposed; the eventual fate of the shed nanoparticles; and whether there is a likelihood of adverse biological effects arising from these exposure scenarios.

The intrinsic toxic properties of compounds contained in the nanoparticle are also important, as well as particle size, shape, surface charge and physico-chemical characteristics, as these greatly influence their uptake by cells and the potential for subsequent biological effects. In summary, nanoparticles are more likely to have higher toxicity than bulk material if they are insoluble, penetrate biological membranes, persist in the body, or (where exposure is by inhalation) are long and fibre-like.1 Ideally, nanomaterial development should incorporate a safety-by-design approach, as there is a marketing edge for nano-enabled products with a reduced potential impact on health and the environment.

What are the potential benefits?

Numerous prospective benefits for health and the environment are offered by nanotechnology, with engineered nanomaterials being developed for renewable energy capture and battery storage, water purification, food packaging, environmental sensors and remediation, as well as greener engineering and manufacturing processes. Some examples of the latter include highly efficient, low energy lighting sources, and smart clothing including a layer of piezo-electric crystals in nanomaterials for powering the wearer’s electronic devices.

The field of nanomedicine has also rapidly progressed from specialised drug delivery applications deploying liposomes (while many are not strictly nanoparticle-sized by international standard definitions, they can be engineered at the nano-scale) to nanoshells and transdermal patches, as well as the development of biocompatible nanomaterial prosthetic implants, and the metal-containing functionalised nanoparticles used for both the imaging and treatment of various cancers. Nanotechnology is also being used to develop point-of-care internet-linked diagnostic devices (eg, “doctor-on-a-chip” diagnostic tools). Nanobionics has made advances in solving the problems of interfacing between medical devices or bionic prosthetics and the nervous system; for example, invasive cranial sensing electrodes made of traditional cytotoxic metals are being replaced by more biocompatible surface transistors that can also be coupled with a dosing device.

Some common nano-enabled products currently available contain silver nanoparticles for their antimicrobial effects, including clothing items that require less frequent washing. This was mainly because of the ease of incorporating nanosilver into the surface of such products, but the quality of these products has unfortunately been variable, with some rapidly leaching silver ions. Nanosilver should preferably be reserved for more important applications, such as medical dressings for treating resistant infections that impair wound healing.

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DOI: 10.5694/mja15.01128

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Patient Preference in Dermatologist Attire in the Medical, Surgical, and Wound Care Settings

ArticleGeneral

Authors: Joshua D. Fox; Giselle Prado; Katherine L. Baquerizo Nole; Flor Macquahe; Ingrid Herskovitz; Ashley Rosa; Shifa Akhtar; Adam Aldahan; Vidhi Shah; Stephanie Mlacker; Gabriel Cardenas; Robert S. Kirsner
JAMA Dermatology, June 2016

Abstract

To determine patient preferences for different types of dermatologist attire in dermatology medical, surgical, and wound care clinics. We hypothesized that patients in the dermatology medical setting would prefer professional attire, while patients in the dermatology surgical and wound care setting would prefer surgical scrubs.

Results

Surveys were administered to 261 persons, and 255 participated and completed enough of the questions to be included in the outcome analyses (118 men, 121 women, 22 unknown [did not answer sex question]), mean (SD) age, 56.3 (18.6) years; about 49% of those who reported their sex were men; 56% were Hispanic; and 85% were white. Approximately 72% of respondents held a college degree or higher. About 63%, 24%, and 13% of respondents were medical, surgical, and wound care dermatology patients, respectively. Roughly 73%, 19%, 6%, and 2% of cumulative responses were for professional, surgical, business, and casual attire, respectively.

Respondents who received a picture of a black male or black female physician were more likely to exclusively prefer professional attire: unadjusted odds ratios (ORs) 3.21 (95% CI, 1.39-7.42) and 2.78 (95% CI, 1.18-6.51), respectively, compared with respondents who received a picture of a white male physician.

Non-white and unemployed respondents were less likely to prefer professional attire exclusively: ORs, 0.28 (95% CI, 0.1-0.83) and 0.28 (95% CI 0.08-0.99), respectively.

Respondents preferred professional attire in all clinic settings, though respondents in the dermatology surgery clinic were less likely to prefer professional attire compared with respondents in the medical dermatology clinic: race-adjusted OR, 0.74 (95% CI, 0.56-0.98).

Wound care and medical dermatology respondents preferred professional attire comparably.

Conclusions and Relevance

In this study, most patients preferred professional attire for their dermatologists in most settings. It is possible that patients’ perceptions of their physicians’ knowledge and skill is influenced by the physicians’ appearance, and these perceptions may affect outcomes.

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DOI: 10.1001/jamadermatol.2016.1186

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Can you spot our clinic in an upcoming Cleverman episode?

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Cleverman is set in the very near future, where creatures from ancient mythology must live among humans and battle for survival in a world that wants to silence, exploit and destroy them. Created by the Indigenous Australian Ryan Griffen, with an 80% Indigenous cast, the show draws on traditional Aboriginal culture and lore, re-purposing it into a superhero show.

You’ll be surprised to learn that a 50-strong TV crew setup shop at Green Square Dermatology last year to shoot two scenes for the first season of Cleverman. Our clinic was re-branded with most of the filming took place in our reception area and one of our treatment rooms. Without giving anything away, no Cleverman characters were here for a dermatology consult …

Cleverman set at Green Square Dermatology

See if you can recognise our clinic in an upcoming episode of Cleverman, Thursday nights on the ABC.

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Community perceptions about the use of black salve

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Authors: Joshua J. Clark; Alexandra Woodcock; Sarah D. Cipriano; Mark A. Hyde; Sandra L. Edwards; Caren J. Frost; Mark J. Eliason
American Academy of Dermatology, October 2015

Abstract

Black salve describes a group of products that contain the escharotic agents zinc chloride and sanguinarine. Despite numerous side effects and a lack of predictable response, individuals continue to choose self-treatment of benign and cancerous skin lesions with black salve in the place of conventional medical therapy. To understand the factors that patients consider when choosing black salve, we surveyed 340 adult patients in primary care and dermatology clinics. Follow-up interviews were performed with 18 of 23 subjects who reported using black salve.

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DOI: 10.1016/j.jaad.2015.10.016

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Escherichia coli Harboring mcr-1 and blaCTX-M on a Novel IncF Plasmid: First report of mcr-1 in the USA

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Authors: Patrick McGann, Erik Snesrud, Rosslyn Maybank, Brendan Corey, Ana C. Ong, Robert Clifford, Mary Hinkle, Timothy Whitman, Emil Lesho and Kurt E. Schaecher
American Society for Microbiology, 2016

Abstract

The recent discovery of a plasmid-borne colistin resistance gene, mcr-1, heralds the emergence of truly pan-drug resistant bacteria. The gene has been found primarily in Escherichia coli, but has also been identified in other members of the Enterobacteriaceae from human, animal, food and environmental samples on every continent.

Antibiotic sensitvity and resistance

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DOI: 10.1128/AAC.01103-16

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