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Krohn LM, Klimpel F, Béziat P, Bau M. Impacts of COVID-19 and climate change on wastewater-derived substances in urban drinking water: Evidence from gadolinium-based contrast agents in tap water from Berlin, Germany. WATER RESEARCH 2024; 259:121847. [PMID: 38852394 DOI: 10.1016/j.watres.2024.121847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/08/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
Anthropogenic gadolinium from MRI contrast agents has been detected in surface waters worldwide. It is released with the treated effluents of wastewater treatment plants, similar to other wastewater-derived substances (WWDS) such as pharmaceuticals and personal care products. We determined concentrations of the rare earth elements in tap water from Berlin, Germany, using an automated preconcentration procedure that is both time- and cost-efficient. Anthropogenic gadolinium concentrations in Berlin's tap water increased on average 30-fold between 2009 and 2021. However, the tap water composition responded quickly to the reduced number of MRI scans during the COVID-19 pandemic, and some districts show a decrease from 2016 to 2021. Since climate change causes groundwater levels to decline in many regions, this needs to be mitigated by artificial groundwater recharge with surface water. This will inevitably lead to an increase in WWDS in potable water, which can be cost-efficiently monitored using anthropogenic gadolinium as tracer.
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Affiliation(s)
- Lea M Krohn
- Critical Metals for Enabling Technologies - CritMET, School of Science, Constructor University, Campus Ring 1, 29759 Bremen, Germany
| | - Franziska Klimpel
- Critical Metals for Enabling Technologies - CritMET, School of Science, Constructor University, Campus Ring 1, 29759 Bremen, Germany.
| | - Pauline Béziat
- Critical Metals for Enabling Technologies - CritMET, School of Science, Constructor University, Campus Ring 1, 29759 Bremen, Germany; Institute of Biogeochemistry & Pollutant Dynamics, Dept. of Environmental Sciences, Swiss Federal Institute of Technology, Universitätstrasse 16, 8092 Zurich, Switzerland
| | - Michael Bau
- Critical Metals for Enabling Technologies - CritMET, School of Science, Constructor University, Campus Ring 1, 29759 Bremen, Germany.
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Welch TR, Yaqub A, Aiti D, Prevedello LM, Ajam ZA, Nguyen XV. Quantifying effects of blood pressure control on neuroimaging utilization in a large multi-institutional healthcare population. PLoS One 2024; 19:e0298685. [PMID: 38687816 PMCID: PMC11060572 DOI: 10.1371/journal.pone.0298685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/30/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES Essential hypertension is a common chronic condition that can exacerbate or complicate various neurological diseases that may necessitate neuroimaging. Given growing medical imaging costs and the need to understand relationships between population blood pressure control and neuroimaging utilization, we seek to quantify the relationship between maximum blood pressure recorded in a given year and same-year utilization of neuroimaging CT or MR in a large healthcare population. METHODS A retrospective population-based cohort study was performed by extracting aggregate data from a multi-institutional dataset of patient encounters from 2016, 2018, and 2020 using an informatics platform (Cosmos) consisting of de-duplicated data from over 140 academic and non-academic health systems, comprising over 137 million unique patients. A population-based sample of all patients with recorded blood pressures of at least 50 mmHg DBP or 90 mmHg SBP were included. Cohorts were identified based on maximum annual SBP and DBP meeting or exceeding pre-defined thresholds. For each cohort, we assessed neuroimaging CT and MR utilization, defined as the percentage of patients undergoing ≥1 neuroimaging exam of interest in the same calendar year. RESULTS The multi-institutional population consisted of >38 million patients for the most recent calendar year analyzed, with overall utilization of 3.8-5.1% for CT and 1.5-2.0% for MR across the study period. Neuroimaging utilization increased substantially with increasing annual maximum BP. Even a modest BP increase to 140 mmHg systolic or 90 mmHg diastolic is associated with 3-4-fold increases in MR and 5-7-fold increases in CT same-year imaging compared to BP values below 120 mmHg / 80 mmHg. CONCLUSION Higher annual maximum recorded blood pressure is associated with higher same-year neuroimaging CT and MR utilization rates. These observations are relevant to public health efforts on hypertension management to mitigate costs associated with growing imaging utilization.
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Affiliation(s)
- Theodore R. Welch
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Aliza Yaqub
- Bahria University Medical and Dental College, Karachi, Pakistan
| | - Danny Aiti
- Canton Medical Education Foundation, Canton, Ohio, United States of America
| | - Luciano M. Prevedello
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Zarar A. Ajam
- The Ohio State University, Columbus, Ohio, United States of America
| | - Xuan V. Nguyen
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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Gharaibeh M, El-Obeid E, Khasawneh R, Karrar M, Salman M, Farah A, Ahmmed S, Al-Omari M, Elheis M, Abualigah L. Impact of the COVID-19 pandemic on imaging case volumes in King Abdullah University Hospitals (KAUH). Front Med (Lausanne) 2023; 10:1103083. [PMID: 36844230 PMCID: PMC9947495 DOI: 10.3389/fmed.2023.1103083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Objective COVID-19 has an increased burden on the delivery of services because the measures taken by the governments forced hospitals to cancel most of their elective procedures and led to the shutting down of outpatient clinics. This study aimed to evaluate the impact COVID-19 pandemic on the volume of radiology exams based on patient service locations and imaging modality in the North of Jordan. Methods The imaging case volumes that were performed at the King Abdullah University Hospital (KAUH), Jordan, from 1 January 2020 to 8 May 2020, were retrospectively collected and compared to those from 1 January 2019 to 28 May 2019, to determine the impact of the pandemic of COVID-19 on the volume of radiological examinations. The 2020 study period was chosen to cover the peak of COVID-19 cases and to record the effects on imaging case volumes. Results A total of 46,194 imaging case volumes were performed at our tertiary center in 2020 compared to 65,441 imaging cases in 2019. Overall, the imaging case volume in 2020 decreased by 29.4% relative to the same period in 2019. The imaging case volumes decreased for all imaging modalities relative to 2019. The number of nuclear images showed the highest decline (41.0%) in 2020, followed by the number of ultrasounds (33.2%). Interventional radiology was the least affected imaging modality by this decline, with about a 22.9% decline. Conclusion The number of imaging case volumes decreased significantly during the COVID-19 pandemic and its associated lockdown. The outpatient service location was the most affected by this decline. Effective strategies must be adopted to avoid the aforementioned effect on the healthcare system in future pandemics.
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Affiliation(s)
- Maha Gharaibeh
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan,*Correspondence: Maha Gharaibeh,
| | - Eyhab El-Obeid
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan,Faculty of Medicine, Department of Diagnostic Radiology, Omdurman Islamic University, Omdurman, Sudan
| | - Ruba Khasawneh
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Musaab Karrar
- Faculty of Medicine, Department of Emergency, Jordan University of Science and Technology, Irbid, Jordan,Faculty of Medicine, Department of Emergency, Omdurman Islamic University, Omdurman, Sudan
| | - Mohamed Salman
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Farah
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Sammah Ahmmed
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Mamoon Al-Omari
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Mwaffaq Elheis
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Laith Abualigah
- Prince Hussein Bin Abdullah Faculty for Information Technology, Computer Science Department, Al al-Bayt University, Mafraq, Jordan,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan,Faculty of Information Technology, Middle East University, Amman, Jordan,Applied Science Research Center, Applied Science Private University, Amman, Jordan,School of Computer Sciences, Universiti Sains Malaysia, Penang, Malaysia,Laith Abualigah,
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Saban M, Sosna J, Singer C, Vaknin S, Myers V, Shaham D, Assaf J, Hershko A, Feder-Bubis P, Wilf-Miron R, Luxenburg O. Clinical decision support system recommendations: how often do radiologists and clinicians accept them? Eur Radiol 2022; 32:4218-4224. [PMID: 35024948 DOI: 10.1007/s00330-021-08479-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the acceptance and reliability of clinical decision support system (CDSS) imaging referral scores (ESR iGuide). METHODS A pilot study was conducted in a tertiary hospital. Four different experts were invited to rate 40 simulated clinical cases on a 5-level scale, for the level of agreement with the ESR iGuide's recommended procedures. In cases of disagreement, physicians were asked to indicate the reason. Descriptive measures were calculated for the level of agreement. We also explored the degree of agreement between four different specialists, and examined the cases in which clinicians disagreed with ESR iGuide best practice recommendations. RESULTS The mean rating of the four experts for the 40 clinical simulated cases was 4.17 ± 0.65, median 4.25 (on a scale of 1-5). All four raters totally agreed with the system recommendation in 75% of cases. No significant relationship was found between the degree of agreement and the number of indications and the patient's age or gender. In an optimistic scenario, using a binary agree/disagree variable, the Overall Percentage Agreement for the rating of the 40 simulated cases between the four experts was 77.28%. There were a total of 20 disagreements out of 160 cases with the ESR iGuide, of which 7 were among the two radiologists. CONCLUSIONS CDSS can be an effective tool for guiding the selection of appropriate imaging examinations, thus cutting costs due to unnecessary imaging scans. Since this is a pilot study, further research on a larger scale, preferably at national level, is required. KEY POINTS • The average of the mean rating of the four experts was 4.17 ± 0.65, median 4.25, on a scale of 1-5 where 5 represents total agreement with the CDSS tool. • In an optimistic scenario, using a binary agree/disagree variable, the Overall Percentage Agreement between the four experts was 77.28%. • Radiologists had fewer disagreements with the recommendations of the CDSS tool than other physicians, indicating a better fit of the support system to radiology experts' perspective.
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Affiliation(s)
- Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel.
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Clara Singer
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Sharona Vaknin
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Dorit Shaham
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Assaf
- Emergency Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alon Hershko
- Internal Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Paula Feder-Bubis
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel.,School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
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