Particulate matter exposure predicts residence in high-risk areas for community acquired pneumonia among hospitalized children

Particulate matter exposure is a risk factor for lower respiratory tract infection in children. Here, we investigated the geospatial patterns of community-acquired pneumonia and the impact of PM2.5 (particulate matter with an aerodynamic diameter ≤2.5 µm) on geospatial variability of pneumonia in children. We performed a retrospective analysis of prospectively collected population-based surveillance study data of community-acquired pneumonia hospitalizations among children <18 years residing in the Memphis metropolitan area, who were enrolled in the Centers for Disease Control and Prevention sponsored Etiology of Pneumonia in the Community (EPIC) study from January 2010 to June 2012. The outcome measure, residence in high- and low-risk areas for community-acquired pneumonia, was determined by calculating pneumonia incidence rates and performing cluster analysis to identify areas with higher/lower than expected rates of community-acquired pneumonia for the population at risk. High PM2.5 was defined as exposure to PM2.5 concentrations greater than the mean value (>10.75 μg/m3), and low PM2.5 is defined as exposure to PM2.5 concentrations less than or equal to the mean value (≤10.75 μg/m3). We also assessed the effects of age, sex, race/ethnicity, history of wheezing, insurance type, tobacco smoke exposure, bacterial etiology, and viral etiology of infection. Of 810 (96.1%) subjects with radiographic community-acquired pneumonia, who resided in the Memphis metropolitan area and had addresses which were successfully geocoded (Supplementary Figure F2), 220 (27.2%) patients were identified to be from high- ( n = 126) or low-risk ( n = 94) community-acquired pneumonia areas. Community-acquired pneumonia in Memphis metropolitan area had a non-homogenous geospatial pattern. PM2.5 was associated with residence in high-risk areas for community-acquired pneumonia. In addition, children with private insurance and bacterial, as opposed to viral, etiology of infection had a decreased risk of residence in a high-risk area for community-acquired pneumonia. The results from this paper suggest that environmental exposures as well as social risk factors are associated with childhood pneumonia.

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Usefulness of measuring radiographic density of axis vertebra in patients at risk of osteoporosis: A cone-beam computed tomography study

European Journal of Dentistry ◽

10.4103/ejd.ejd_375_17 ◽

2018 ◽

Vol 12 (04) ◽

pp. 496-501

Author(s):

Mustafa Alkhader ◽

Mohammad S. Alrashdan ◽

Yousef Khader

Keyword(s):

Computed Tomography ◽

At Risk ◽

High Risk ◽

Cone Beam Computed Tomography ◽

Predictive Power ◽

Mean Value ◽

Low Risk ◽

Cone Beam ◽

Patients At Risk ◽

The Mean

ABSTRACT Objective: Using cone-beam computed tomography (CBCT) images, the aim of the study was to evaluate the usefulness of measuring radiographic density of the axis vertebra (RDAV) in patients at risk of osteoporosis. Materials and Methods: Two hundred and forty-seven old patients (109 males and 138 females) aged between 50 and 80 years (mean age: 59.68 ± 7.27) were examined by CBCT. Using InVivoDental, v. 5.0 (Anatomage Inc., San Jose, CA), RDAV and mental index (MI) were measured twice and correlated using Pearson's correlation coefficients. Patients were divided into two categories: high risk and low risk of osteoporosis using 3.1 mm of MI as a cutoff value, and the mean value of RDAV was compared and correlated using independent samples' t-test and regression analysis. Receiver-operating characteristic (ROC) curve analysis was also used to examine the predictive power of RDAV. Results: The mean value of RDAV was moderately correlated with MI (r = 0.32), and in patients at low risk of osteoporosis, the mean value of RDAV was significantly higher than in patients at high risk of osteoporosis. In multivariate binary logistic regression, the odds of being at risk of osteoporosis decreased by 1% with one unit increase in RDAV (odds ratio = 0.988, 95% confidence interval: 0.983–0.993; P < 0.005). ROC analysis showed that the mean value of RDAV had a high predictive power for predicting patients at risk of osteoporosis (area under the curve = 0.761 for females and 0.649 for males). Conclusions: Measuring RDAV is considered useful in predicting patients at risk of osteoporosis.

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Collagen Fibers Structure Detected By Second-Harmonic Generation Microscopy: A Potential Prognostic Marker for High-Risk Nodular Sclerosis

Blood ◽

10.1182/blood.v126.23.5000.5000 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5000-5000

Author(s):

Guilherme Rossi Assis de Mendonça ◽

Rodrigo de Andrade Natal ◽

Bruna de Albuquerque Murbach ◽

Marcia Torresan Delamain ◽

Carmino Antônio De Souza ◽

...

Keyword(s):

High Risk ◽

Cox Regression ◽

Second Harmonic ◽

Survival Curve ◽

Mean Value ◽

Collagen Fibers ◽

Low Risk ◽

Second Harmonic Generation Microscopy ◽

Risk Patients ◽

The Mean

Abstract Introduction: Second-Harmonic Generation microscopy (SHG) has provided progresses in extracellular matrix research, mainly regarding automated analysis of collagen fibers. Nodular sclerosis-classical Hodgkin lymphoma (NS) often has a rich collagen deposition, which remains poorly explored in its biological significance and potential prognostic role. The aim of this study was to characterize the collagen component of NS using SHG, and to investigate its clinical value. Methods: Hematoxylin and eosin stained slides from 53 consecutive samples of paraffin embedded NS tissue were analyzed by SHG imaging in an Inverted Zeiss LSM 780-NLO. HIV-positive individuals were excluded. For comparative purposes, 11 reactive lymph nodes (RL) were also randomly selected. In each slide, 3 capsular areas and 3 sclerotic regions (perinodular septa - PS - in NS and fibrotic foci around germinal centers in RL) were chosen. Collagen near blood vessels was not considered. We evaluated quantity, uniformity and organization of the fibers with ImageJ and OrientationJ plug-in in 4 hotspots from each image. Shapiro-Wilk test was used to assess data normality, while t-tests and Pearson correlations were performed to analyze collagen parameters between two groups. Overall survival (OS) was defined as time from diagnosis until death from the disease or last follow-up. Event-free survival (EFS) was set as time from diagnosis until progressive disease, death from the disease or last follow-up. Collagen data were used in survival analyses as continuous variables (in Cox-hazards model) or categorical ones (by choosing the mean value as a threshold for Kaplan-Meier curves and log-rank test). Significance was set at p<0.05. Results: NS patients were mostly female (58.5%). The mean and median values of age at diagnosis were, respectively, 33 and 29 years (range: 14-82 years). Forty-two patients (79.2%) had B-symptoms, while bulky disease was seen in 23 cases (43.3%). Bone marrow was infiltrated in 4 patients (7.5%). Based on the International Prognostic Score (IPS), patients were stratified as follows: 39 (73.5%) as low-risk (IPS ≤ 3) and 14 (26.5%) as high-risk (IPS > 3). The first-line treatment was ABVD in 40 cases (75.5%) and BEACOPP in 13 patients (24.5%). Radiotherapy was performed in 27 (50.9%) patients. Tumor PS presented more dense (p<0.01), organized (p<0.01) and uniform (p=0.02) fibers than sclerosis in RL. NS capsule had only a more organized collagen than RL (p=0.02). Considering solely NS, we found significant correlations of collagen fibers quantity (r=0.67), uniformity (r=0.78) and organization (r=0.49) between capsule and PS, suggesting a proportional deposition of collagen in these compartments. When clinical data were analyzed in the entire patient group, the presence of more organized PS collagen was associated with low-risk IPS (p=0.03), grade 2 tumors (p= 0.04), extranodal disease (p=0.003) and a higher risk of death (p=0.02). On the other hand, a higher fiber organization in NS capsule was only associated with low-risk IPS (p=0.03). The presence of high-risk IPS was associated with a shorter EFS (p=0.002), but had no relationship to OS. Collagen parameters had no impact on EFS. However, in univariate Cox regression, higher collagen quantity (p=0.04) in PS was the only factor associated with a worse OS. When only high-risk IPS cases were analyzed in Cox regression model, PS collagen had association with unfavorable OS regarding higher collagen quantity (p=0.03) and uniformity (p<0.01). In this setting, a higher quantity of capsular collagen was also associated with a worse OS (p=0.02). We did not perform multivariate analysis in this group due to the small amount of patients (14). Also in the high-risk cases, using the mean value of PS collagen quantity (15.19) as a threshold to binarize data, we found a trend to worse OS in cases with a higher collagen quantity (p=0.05, figure 1). Considering only low-risk IPS cases, collagen factors had no association with OS. Conclusion: Collagen parameters in NS have distinct features than in RL and affect clinical presentation of the tumor. Moreover, collagen quantity and uniformity in cases with high-risk IPS were associated with survival, which indicates that incorporation of collagen information might be relevant in the prognostication of NS. Figure 1. Survival curve of high-risk patients (n=14) stratified according to the perinodular collagen (pCOL) quantity threshold. Figure 1. Survival curve of high-risk patients (n=14) stratified according to the perinodular collagen (pCOL) quantity threshold. Disclosures No relevant conflicts of interest to declare.

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Sernbo score predicts survival after intracapsular hip fracture in the elderly

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609954653 ◽

2013 ◽

Vol 95 (1) ◽

pp. 29-33 ◽

Cited By ~ 20

Author(s):

EJC Dawe ◽

E Lindisfarne ◽

T Singh ◽

I McFadyen ◽

P Stott

Keyword(s):

Hip Fracture ◽

High Risk ◽

Risk Group ◽

Characteristic Curve ◽

Social Situation ◽

High Risk Group ◽

Low Risk ◽

Risk Of Death ◽

Intracapsular Hip Fracture ◽

The Mean

Introduction The Sernbo score uses four factors (age, social situation, mobility and mental state) to divide patients into a high-risk and a low-risk group. This study sought to assess the use of the Sernbo score in predicting mortality after an intracapsular hip fracture. Methods A total of 259 patients with displaced intracapsular hip fractures were included in the study. Data from prospectively generated databases provided 22 descriptive variables for each patient. These included operative management, blood tests and co-mobidities. Multivariate analysis was used to identify significant predictors of mortality. Results The mean patient age was 85 years and the mean follow-up duration was 1.5 years. The one-year survival rate was 92% (±0.03) in the low-risk group and 65% (±0.046) in the high-risk group. Four variables predicted mortality: Sernbo score >15 (p=0.0023), blood creatinine (p=0.0026), ASA (American Society of Anaesthesiologists) grade >3 (p=0.0038) and non-operative treatment (p=0.0377). Receiver operating characteristic curve analysis showed the Sernbo score as the only predictor of 30-day mortality (area under curve 0.71 [0.65–0.76]). The score had a sensitivity of 92% and a specificity of 51% for prediction of death at 30 days. Conclusions The Sernbo score identifies patients at high risk of death in the 30 days following injury. This very simple score could be used to direct extra early multidisciplinary input to high-risk patients on admission with an intracapsular hip fracture.

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Spatial-time Visualization of Cutaneous Leishmaniasis in an Urban Area: Informing Health Policy and Practice

10.21203/rs.3.rs-125091/v1 ◽

2020 ◽

Author(s):

Neda Firouraghi ◽

Sayyed Mostafa Mostafavi ◽

Amene Raouf-Rahmati ◽

Alireza Mohammadi ◽

Reza Saemi ◽

...

Keyword(s):

High Risk ◽

Incidence Rate ◽

Urban Area ◽

Incidence Rates ◽

Low Risk ◽

Health Concern ◽

Surveillance Systems ◽

Cross Sectional ◽

Targeted Interventions ◽

Risk Areas

Abstract Background:Cutaneous leishmaniasis (CL) is an important public health concern worldwide. Iran is among the most CL-affected countries, being listed as one of the first six endemic countries in the world. In order to develop targeted interventions, we performed a spatial-time visualization of CL cases in an urban area to identify high-risk and low-risk areas during 2016-2019.Methods:This cross-sectional study was conducted in the city of Mashhad. Patient data were gathered from Mashhad health centers. All cases (n=2425) were diagnosed in two stages; the initial diagnosis was based on clinical findings. Subsequently, clinical manifestation was confirmed by parasitological tests. The data were aggregated at the neighborhood and district levels and smoothed CL incidence rates per 100,000 individuals were calculated using the spatial empirical Bayesian approach. Furthermore, we used the Anselin Local Moran’s I statistic to identify clusters and outliers of CL distribution during 2016-2019 in Mashhad. Results:The overall incidence rates decreased from 34.6 per 100,000 in 2016 to 19.9 per 100,000 individuals in 2019. Both cluster analyses by crude incidence rate and smoothed incidence rate identified high-risk areas in southwestern Mashhad over the study period. Furthermore, the analyses revealed low-risk areas in northeastern Mashhad over the same 3-year period.Conclusions:The southwestern area of Mashhad had the highest CL incidence rates. This piece of information might be of value to design tailored interventions such as running effective resource allocation models, informed control plans and implementation of efficient surveillance systems. Furthermore, this study generates new hypotheses to test potential relationships between socio-economic and environmental risk factors and incidence of CL in areas with higher associated risks.

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Abstract 187: Cardiac Arrest Incidence, Bystander Cardiopulmonary Resuscitation Rates, and Community Characteristics Differ by High and Low Risk Areas

Circulation ◽

10.1161/circ.140.suppl_2.187 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Rebecca Cash ◽

Madison K Rivard ◽

Eric Cortez ◽

David Keseg ◽

Ashish Panchal

Keyword(s):

Cardiac Arrest ◽

High Risk ◽

Cardiopulmonary Resuscitation ◽

Low Risk ◽

Poverty Level ◽

Community Characteristics ◽

Franklin County ◽

Census Tracts ◽

Bystander Cardiopulmonary Resuscitation ◽

Risk Areas

Introduction: Survival from out-of-hospital cardiac arrest (OHCA) has significant variation which may be due to differing rates of bystander cardiopulmonary resuscitation (BCPR). Defining and understanding the community characteristics of high-risk areas (census tracts with low BCPR rates and high OHCA incidence) can help inform novel interventions to improve outcomes. Our objectives were to identify high and low risk census tracts in Franklin County, Ohio and to compare the OHCA incidence, BCPR rates, and community characteristics. Methods: This was a cross-sectional analysis of OHCA events treated by Columbus Division of Fire in Franklin County, Ohio from the Cardiac Arrest Registry to Enhance Survival between 1/1/2010-12/31/2017. Included cases were 18 and older, with a cardiac etiology OHCA in a non-healthcare setting, with EMS resuscitation attempted. After geocoding to census tracts, Local Moran’s I and quartiles were used to determine clustering in high risk areas based on spatial Empirical Bayes smoothed rates. Community characteristics, from the 2014 American Community Survey, were compared between high and low risk areas. Results: From the 3,841 included OHCA cases, the mean adjusted OHCA incidence per census tract was 0.67 per 1,000 with a mean adjusted BCPR rate of 31% and mean adjusted survival to discharge of 9.4%. In the 25 census tracts identified as high-risk areas, there were significant differences in characteristics compared to low-risk areas, including a higher proportion of African Americans (64% vs. 21%, p<0.001), lower median household income ($30,948 vs. $54,388, p<0.001), and a higher proportion living below the poverty level (36% vs. 20%, p<0.001). There was a 3-fold increase in the adjusted OHCA incidence between high and low risk areas (1.68 vs. 0.57 per 1,000, p<0.001) with BCPR rates of 27% and 31% (p=0.31), respectively. Compared to a previous analysis, 9 (36%) census tracts persisted as high-risk but an additional 16 were newly identified. Conclusions: Neighborhood-level variations in OHCA incidence are dramatic with marked disparities in characteristics between high and low risk areas. It is possible that improving OHCA outcomes requires multifaceted interventions to address social determinants of health.

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Landslide Hazard Knowledge, Risk Perception and Preparedness in Southeast Bangladesh

Sustainability ◽

10.3390/su12166305 ◽

2020 ◽

Vol 12 (16) ◽

pp. 6305 ◽

Cited By ~ 1

Author(s):

Edris Alam

Keyword(s):

Risk Perception ◽

High Risk ◽

Economic Status ◽

Informal Settlements ◽

Landslide Hazard ◽

Low Risk ◽

Community Members ◽

Landslide Occurrence ◽

Hilly Region ◽

Risk Areas

Over the last thirty years, Bangladesh has been experiencing hill cutting problems and subsequent landslide occurrence in its southeastern hilly region. Since 2000, landslides have caused over 500 deaths, mostly in informal settlements in southeast Bangladesh. The most significant single event was the 2007 landslide causing 127 deaths in Chittagong’s informal settlements. The landslide events took over 110 people in Rangamati on 12 June 2017. In the scenario of rising deaths by landslides in the southeastern region, this research aimed to understand communities’ landslide hazard knowledge, reasons for living in at-risk areas, risk perception and preparedness. This research applied both quantitative (i.e., structural questionnaire) and qualitative (i.e., semi-structured and open-ended questionnaire and informal interviews) data collection techniques to assess hill-top and hill-side dwellers knowledge, risk perception and preparedness to landslides in southeast Bangladesh. The investigation conducted face-to-face interviews with 208 community members, 15 key informant interviews, three Focus Group Discussions (FGDs) and field observations and visits in southeast Bangladesh. The findings suggest that unplanned development activities, overpopulation, settlement along hill slopes and ineffective disaster risk reduction efforts are the anthropogenic contributories accompanying climate-change induced increased torrential rainfall are the main reasons for the increase of landslide occurrence. The results suggest that community members perceive a low-risk for landslides, despite the community’s location in high-risk areas. The community’s perception of low risk results in a lack of preparedness and an unwillingness to relocate a comparatively safer place. It was noted that landslide disaster preparation depends on the communities’ development maturity, house ownership, ethnicity, gender and economic status of the residents. It is suggested that the place of relocation for residents living in the high-risk areas should be selected with full consideration of psychosocial aspects of the community, particularly providing acceptable livelihood options.

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Ecological risk assessment of geohazards in Natural World Heritage Sites: an empirical analysis of Bogda, Tianshan

Open Geosciences ◽

10.1515/geo-2019-0026 ◽

2019 ◽

Vol 11 (1) ◽

pp. 327-340 ◽

Cited By ~ 4

Author(s):

Qin Liu ◽

Zhaoping Yang ◽

Hui Shi ◽

Zhi Wang

Keyword(s):

Risk Assessment ◽

High Risk ◽

Ecological Risk ◽

Ecological Risk Assessment ◽

World Heritage ◽

Natural World ◽

Low Risk ◽

World Heritage Site ◽

Heritage Site ◽

Risk Areas

Abstract Ecological risk assessment plays an important role in avoiding disasters and reducing losses. Natural world heritage site is the most precious natural assets on earth, yet few studies have assessed ecological risks from the perspective of world heritage conservation and management. A methodology for considering ecological threats and vulnerabilities and focusing on heritage value was introduced and discussed for the Bogda component of the Xinjiang Tianshan Natural World Heritage Site. Three important results are presented. (1) Criteria layers and ecological risk showed obvious spatial heterogeneity. Extremely high-risk and high-risk areas, accounting for 13.60% and 32.56%, respectively, were mainly gathered at Tianchi Lake and Bogda Glacier, whereas the extremely low-risk and low-risk areas, covering 1.33% and 17.51% of the site,were mainly distributed to the north and scattered around in the southwest montane region. (2) The level of risk was positively correlated with the type of risk, and as the level of risk increases, the types of risk increase. Only two risk types were observed in the extremely low-risk areas, whereas six risk types were observed in the high-risk areas and eight risk types were observed in the extremely high-risk areas. (3) From the perspective of risk probability and ecological damage, four risk management categories were proposed, and correlative strategies were proposed to reduce the possibility of ecological risk and to sustain or enhance heritage value.

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Gastric Cancer Mortality Trends in Tuscany, Italy, 1971–2004

Tumori Journal ◽

10.1177/030089160809400602 ◽

2008 ◽

Vol 94 (6) ◽

pp. 787-792 ◽

Cited By ~ 2

Author(s):

Giuseppe Gorini ◽

Lucia Giovannetti ◽

Giovanna Masala ◽

Elisabetta Chellini ◽

Andrea Martini ◽

...

Keyword(s):

Gastric Cancer ◽

High Risk ◽

Birth Cohort ◽

Cancer Mortality ◽

Cohort Effect ◽

Low Risk ◽

Period Effect ◽

Mortality Trends ◽

Risk Areas ◽

Birth Cohort Effect

Aims, Background, and Methods In Tuscany, Italy, gastric cancer mortality has been decreasing since 1950, although with relevant geographical variability across the region. In Eastern Tuscan areas close to the mountains (high risk areas), gastric cancer mortality has been and is still significantly higher than that recorded in Western coastal areas and in the city of Florence (low risk areas). High-risk areas also showed higher Helicobacter pylori seroprevalence. Aim of this paper is to study gastric cancer mortality trends in high and low-risk areas, during the period 1971–2004, using age-period-cohort models. Results In high-risk areas, gastric cancer mortality rates declined from 61.4 per 100,000 in 1971–74 to 19.8 in 2000–2004 and in low-risk areas from 34.9 to 9.8. Mortality decline in high-risk areas was mainly attributable to a birth cohort effect, whereas in low-risk areas it was due either to a birth cohort effect or a period effect. In low- and high-risk areas, birth-cohort risks of dying decreased over subsequent generations, except for the birth cohorts born around the second world war. Conclusions Gastric cancer mortality in areas with higher H. pylori seroprevalence in Tuscany (high-risk areas) showed a predominant decline by birth cohort, in particular for younger generations, possibly due to the decrease of the infection for improvement of living conditions.

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Mixed-species herding levels the landscape of fear

Proceedings of The Royal Society B Biological Sciences ◽

10.1098/rspb.2019.2555 ◽

2020 ◽

Vol 287 (1922) ◽

pp. 20192555 ◽

Cited By ~ 1

Author(s):

Keenan Stears ◽

Melissa H. Schmitt ◽

Christopher C. Wilmers ◽

Adrian M. Shrader

Keyword(s):

High Risk ◽

Predation Risk ◽

Social Information ◽

Single Species ◽

Herd Size ◽

Low Risk ◽

Mixed Species ◽

Landscape Of Fear ◽

Trade Off ◽

Risk Areas

Prey anti-predator behaviours are influenced by perceived predation risk in a landscape and social information gleaned from herd mates regarding predation risk. It is well documented that high-quality social information about risk can come from heterospecific herd mates. Here, we integrate social information with the landscape of fear to quantify how these landscapes are modified by mixed-species herding. To do this, we investigated zebra vigilance in single- and mixed-species herds across different levels of predation risk (lion versus no lion), and assessed how they manage herd size and the competition–information trade-off associated with grouping behaviour. Overall, zebra performed higher vigilance in high-risk areas. However, mixed-species herding reduced vigilance levels. We estimate that zebra in single-species herds would have to feed for approximately 35 min more per day in low-risk areas and approximately 51 min more in high-risk areas to compensate for the cost of higher vigilance. Furthermore, zebra benefitted from the competition–information trade-off by increasing the number of heterospecifics while keeping the number of zebra in a herd constant. Ultimately, we show that mixed-species herding reduces the effects of predation risk, whereby zebra in mixed-species herds, under high predation risk, perform similar levels of vigilance compared with zebra in low-risk scenarios.

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Applying International Standards in Response to Oil Spills in Remote Areas

International Oil Spill Conference Proceedings ◽

10.7901/2169-3358-2014.1.1859 ◽

2014 ◽

Vol 2014 (1) ◽

pp. 1859-1868 ◽

Cited By ~ 1

Author(s):

Kelly Reynolds

Keyword(s):

High Risk ◽

Oil Spill ◽

Low Risk ◽

International Standards ◽

Contingency Planning ◽

Remote Areas ◽

Remote Locations ◽

Highly Sensitive ◽

Risk Areas

ABSTRACT It is accepted international practice that the level of effort invested in oil spill contingency planning and preparedness should be related to the best available, location-specific risk evaluations. Accordingly, high risk and/or highly sensitive areas often see greater degrees of planning and pre-incident resource allocation than low risk areas. High risk areas typically include navigational ‘choke points’ for shipping or approaches to ports; highly sensitive areas would include areas of intense coastal tourism, mari-culture, or natural resources (e.g. coral reefs or mangroves). Naturally, levels of preparedness vary between countries for a variety of reasons including availability of resources (i.e. funding) or priorities. Whilst logical, this approach to contingency planning leaves open a gap in response capacity in so far as incidents do still occur from time to time in what are normally thought of as extremely low risk areas. Good examples are the infrequent, yet still important, incidents that occur from passing vessel traffic on long-distance, inter-continental routes. Other examples are incidents from scheduled shipping routes servicing remote areas or even passenger vessels visiting remote locations such as the Arctic or the Antarctic. Because remote areas are often characterised by a general lack of infrastructure and because local authorities in remote locations typically do not have appropriate funds, training and manpower to deal with unexpected oil spill incidents, the intensity and quality of emergency response and post-incident follow-up tends to depend on the involvement of outside parties. The question arises, what is appropriate “international practice” in response operations in terms of the types/methods of work undertaken, the termination standards applied, health and safety issues, and post-incident follow-up, such as monitoring studies. The intent of this paper is to discuss the meaning of “international standards” for oil spill response in the context of remote operations. Practical examples will be drawn from remote spills world-wide, including incidents in Tristan da Cunha (in South Atlantic), Madagascar, and Papua New Guinea.

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