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Krutz NL, Kimber I, Winget J, Nguyen MN, Limviphuvadh V, Maurer-Stroh S, Mahony C, Gerberick GF. Identification and semi-quantification of protein allergens in complex mixtures using proteomic and AllerCatPro 2.0 bioinformatic analyses: a proof-of-concept investigation. J Immunotoxicol 2024; 21:2305452. [PMID: 38291955 DOI: 10.1080/1547691x.2024.2305452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024] Open
Abstract
The demand for botanicals and natural substances in consumer products has increased in recent years. These substances usually contain proteins and these, in turn, can pose a risk for immunoglobulin E (IgE)-mediated sensitization and allergy. However, no method has yet been accepted or validated for assessment of potential allergenic hazards in such materials. In the studies here, a dual proteomic-bioinformatic approach is proposed to evaluate holistically allergenic hazards in complex mixtures of plants, insects, or animal proteins. Twelve commercial preparations of source materials (plant products, dust mite extract, and preparations of animal dander) known to contain allergenic proteins were analyzed by label-free proteomic analyses to identify and semi-quantify proteins. These were then evaluated by bioinformatics using AllerCatPro 2.0 (https://allercatpro.bii.a-star.edu.sg/) to predict no, weak, or strong evidence for allergenicity and similarity to source-specific allergens. In total, 4,586 protein sequences were identified in the 12 source materials combined. Of these, 1,665 sequences were predicted with weak or strong evidence for allergenic potential. This first-tier approach provided top-level information about the occurrence and abundance of proteins and potential allergens. With regards to source-specific allergens, 129 allergens were identified. The sum of the relative abundance of these allergens ranged from 0.8% (lamb's quarters) to 63% (olive pollen). It is proposed here that this dual proteomic-bioinformatic approach has the potential to provide detailed information on the presence and relative abundance of allergens, and can play an important role in identifying potential allergenic hazards in complex protein mixtures for the purposes of safety assessments.
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Affiliation(s)
- Nora L Krutz
- NV Procter & Gamble Services Company SA, Global Product Stewardship, Strombeek-Bever, Belgium
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Minh N Nguyen
- Agency for Science, Technology and Research (A*STAR), Bioinformatics Institute, Singapore, Singapore
| | - Vachiranee Limviphuvadh
- Agency for Science, Technology and Research (A*STAR), Bioinformatics Institute, Singapore, Singapore
| | - Sebastian Maurer-Stroh
- Agency for Science, Technology and Research (A*STAR), Bioinformatics Institute, Singapore, Singapore
- Yong Loo Lin School of Medicine and Department of Biological Sciences, National University of Singapore (NUS), Singapore, Singapore
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2
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Vidal LM, Pimentel E, Escobar-Alarcón L, Cruces MP, Jiménez E, Suárez H, Leyva Y. Toxicity evaluation of novel imidacloprid nanoribbons, using somatic mutation and fitness indexes in Drosophila melanogaster. J Toxicol Environ Health A 2024; 87:398-418. [PMID: 38385605 DOI: 10.1080/15287394.2024.2316649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Nanoribbons of imidacloprid, a systemic and chloronicotinyl insecticide, were successfully synthesized by laser-induced fragmentation/exfoliation of imidacloprid powders suspended in water, with widths ranging from 160 to 470 nm, lengths in the micron scale, and thickness of a few atoms layers. The aim of the present study was to examine the effects of acute and chronic exposure to imidacloprid (IMC) bulk and compare its effects with synthesized imidacloprid nanoribbons (IMCNR) on larval and adult viability, developmental time, olfactory capacity, longevity, productivity, and genotoxicity in Drosophila melanogaster. Larvae or adults were exposed at 0.01, 0.02, or 0.03 ppm to IMC or IMCNR. Results demonstrated that IMCNR produced a significant reduction in viability and olfactory ability. IMC did not significantly alter viability and olfactory ability. Similarly, marked differences on longevity were detected between treatment with IMC and IMCNR where the lifespan of males treated with IMC was significantly higher than control while IMCNR produced a reduction. As for productivity, developmental time, and genotoxicity, no marked differences were found between both forms of IMC.
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Affiliation(s)
- Luz M Vidal
- Departamento de Biología, Instituto Nacional de Investigaciones Nucleares (ININ), Ocoyoacac, México
| | - Emilio Pimentel
- Departamento de Biología, Instituto Nacional de Investigaciones Nucleares (ININ), Ocoyoacac, México
| | - Luis Escobar-Alarcón
- Departamento de Física, Instituto Nacional de Investigaciones Nucleares (ININ), Ocoyoacac, México
| | - Martha P Cruces
- Departamento de Biología, Instituto Nacional de Investigaciones Nucleares (ININ), Ocoyoacac, México
| | - Elizabeth Jiménez
- Facultad de Ciencias, Universidad Autónoma del Estado de México, Toluca, México
| | - Hugo Suárez
- Departamento de Biología, Instituto Nacional de Investigaciones Nucleares (ININ), Ocoyoacac, México
| | - Yosary Leyva
- Departamento de Biología, Instituto Nacional de Investigaciones Nucleares (ININ), Ocoyoacac, México
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Sewell F, Alexander-White C, Brescia S, Currie RA, Roberts R, Roper C, Vickers C, Westmoreland C, Kimber I. New approach methodologies (NAMs): identifying and overcoming hurdles to accelerated adoption. Toxicol Res (Camb) 2024; 13:tfae044. [PMID: 38533179 PMCID: PMC10964841 DOI: 10.1093/toxres/tfae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/07/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
New approach methodologies (NAMs) can deliver improved chemical safety assessment through the provision of more protective and/or relevant models that have a reduced reliance on animals. Despite the widely acknowledged benefits offered by NAMs, there continue to be barriers that prevent or limit their application for decision-making in chemical safety assessment. These include barriers related to real and perceived scientific, technical, legislative and economic issues, as well as cultural and societal obstacles that may relate to inertia, familiarity, and comfort with established methods, and perceptions around regulatory expectations and acceptance. This article focuses on chemical safety science, exposure, hazard, and risk assessment, and explores the nature of these barriers and how they can be overcome to drive the wider exploitation and acceptance of NAMs. Short-, mid- and longer-term goals are outlined that embrace the opportunities provided by NAMs to deliver improved protection of human health and environmental security as part of a new paradigm that incorporates exposure science and a culture that promotes the use of protective toxicological risk assessments.
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Affiliation(s)
- Fiona Sewell
- UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), Gibbs Building, 215 Euston Road, London, NW1 2BE, United Kingdom
| | | | - Susy Brescia
- UK Chemicals Regulation Division, Health and Safety Executive, Redgrave Court, Bootle, Merseyside, L20 7HS, United Kingdom
| | - Richard A Currie
- Jealotts Hill International Research Centre, Syngenta, Bracknell, RG42 6EX, United Kingdom
| | - Ruth Roberts
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
- ApconiX, BioHub at Alderley Park, Alderley Edge, SK10 4TG, United Kingdom
| | - Clive Roper
- Roper Toxicology Consulting Limited, 6 St Colme Street, Edinburgh, EH3 6AD, United Kingdom
| | - Catherine Vickers
- UK National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), Gibbs Building, 215 Euston Road, London, NW1 2BE, United Kingdom
| | - Carl Westmoreland
- Safety & Environmental Assurance Centre, Unilever, Colworth Science Park, Sharnbrook, Bedfordshire, MK44 1LQ, United Kingdom
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
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Olorunnado GB, Muhammad HK, Apeh DO, Salubuyi S, Akanya HO, Gbashi S, Kumphanda J, Njobeh PB, Makun HA. Incidence and health risk assessment of hydrogen cyanide and multi-mycotoxins in Nigerian garri. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2024; 41:410-423. [PMID: 38315775 DOI: 10.1080/19440049.2024.2312247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
Garri is a granular, starchy food prepared by the fermentation of mashed cassava. Hydrogen cyanide (HCN) and mycotoxins are contaminants in certain foods at different points along the food value chain. The incidence and contamination levels of HCN and multi-mycotoxins in garri from five agroecological zones of Nigeria were determined using a spectrophotometric method and ultra-high-performance liquid chromatography-tandem mass spectroscopy (UHPLC-MS/MS), respectively. The health risk associated with the consumption of contaminated garri was assessed. The health risk assessment model was used to calculate the dietary exposure of humans to the mycotoxins in garri. This was done by estimating the daily intake (EDI), the percentage tolerable daily intake (%TDI), the annual hepatocellular carcinoma (HCC) cases attributable to exposure to aflatoxins (AFs) in garri, as well as the HCC risk. The average intake of garri was estimated at 0.303 kg/day for a Nigerian adult. The incidence of HCN was 98.3% (0.056-2.463 mg/kg), and fermentation reduced the HCN level in garri more than other processing steps. The twenty-one mycotoxins identified and quantified were all within maximum levels, as applicable to those that are regulated by the EU. The %TDI for the other mycotoxins, with the exception of AFs, showed no alarming health risk with garri consumption. Annual HCC cases resulting from AF in garri were estimated at 10-60 cases for HBsAg + ve individuals and 4-23 cases for HBsAg - ve individuals based on 8.1% hepatitis B virus (HBV) incidence. Results further revealed no interdependence between HCN levels and mycotoxin content. This work suggests an unlikely chance of acute toxicity from HCN and major mycotoxins from a garri-based diet in Nigeria. Hence, it is recommended that concerned regulatory bodies maintain the existing permissible limits for HCN in Garri.
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Affiliation(s)
- Gabriel Babatunde Olorunnado
- Department of Biochemistry, Africa Centre of Excellence for Mycotoxin and Food Safety, Federal University of Technology Minna, Minna, Nigeria
- Department of Science, School of Preliminary Studies, Kogi State Polytechnic, Lokoja, Nigeria
| | - Hadiza Kudu Muhammad
- Department of Biochemistry, Africa Centre of Excellence for Mycotoxin and Food Safety, Federal University of Technology Minna, Minna, Nigeria
| | - Daniel Ojochenemi Apeh
- Department of Biochemistry, Confluence University of Science and Technology Osara, Osara, Nigeria
| | - Susan Salubuyi
- Department of Biochemistry, Africa Centre of Excellence for Mycotoxin and Food Safety, Federal University of Technology Minna, Minna, Nigeria
| | - Helmina Olufunmilayo Akanya
- Department of Biochemistry, Africa Centre of Excellence for Mycotoxin and Food Safety, Federal University of Technology Minna, Minna, Nigeria
| | - Sefater Gbashi
- Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Gauteng, South Africa
| | - Joseph Kumphanda
- Department of Biochemistry, Africa Centre of Excellence for Mycotoxin and Food Safety, Federal University of Technology Minna, Minna, Nigeria
- Department of Basic Sciences, Malawi University of Science and Technology, Limbe, Malawi
| | - Patrick Berka Njobeh
- Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Gauteng, South Africa
| | - Hussaini Anthony Makun
- Department of Biochemistry, Africa Centre of Excellence for Mycotoxin and Food Safety, Federal University of Technology Minna, Minna, Nigeria
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Holper L, Mokros A, Habermeyer E. Moderators of Sexual Recidivism as Indicator of Treatment Effectiveness in Persons With Sexual Offense Histories: An Updated Meta-analysis. Sex Abuse 2024; 36:255-291. [PMID: 36927218 PMCID: PMC10880427 DOI: 10.1177/10790632231159071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The present meta-analysis is an update of the meta-analysis by Schmucker and Lösel [Campbell Syst. Rev. 2017; 13: 1-75], which synthesized evidence on sexual recidivism as an indicator of treatment effectiveness in persons with sexual offense histories. The updated meta-analysis includes 37 samples comprising a total of 30,394 individuals with sexual offense histories, which is nearly three times the sample size reported by Schmucker and Lösel (2017: 28 samples, N = 9781). In line with Schmucker and Lösel (2017), the mean treatment effect was small with an odds ratio of 1.54 [95% CI 1.22, 1.95] (p < .001). A moderator analysis suggested three predictors of importance, i.e., risk level, treatment specialization, and author confounding. Greater treatment effectiveness was suggested in high- and medium-compared to low-risk individuals and in specialized compared to non-specialized treatments. Authors affiliated with treatment programs reported larger effectiveness than independent authors. These findings were overall in line with Schmucker and Lösel (2017), though the effects of risk level and treatment specialization were stronger in the current meta-analysis. The findings of the updated meta-analysis reinforce the evidence for the first and second principle of the Risk-Need-Responsivity model. The results may support researchers and decision-makers in interpreting the current evidence on sexual recidivism as an indicator of treatment effectiveness, and, based on that, implement and carry out informative, methodologically sound evaluations of ongoing treatment programs in persons with sexual offense histories.
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Affiliation(s)
- Lisa Holper
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Andreas Mokros
- Department of Psychology, FernUniversität in Hagen, Hagen, Germany
| | - Elmar Habermeyer
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Momtaz D, Ghali A, Ahmad F, Gonuguntla R, Kotzur T, Wang RJ, Ghilzai U, Abbas A, Wu C. Effective Risk Assessment for Distal Radius Fractures: A Rigorous Multivariable Regression Analysis, Using a Novel 8-Item Modified Frailty Index. J Wrist Surg 2024; 13:120-126. [PMID: 38505209 PMCID: PMC10948243 DOI: 10.1055/s-0043-1764203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/24/2023] [Indexed: 03/21/2024]
Abstract
Introduction Distal radius fractures (DRFs) are among the most common orthopaedic injuries. The prevalence of DRFs is increasing across all age groups but remains the second most common fracture in the elderly. The modified frailty index (MFI) often predicts morbidity and mortality in orthopaedic injuries. This study aims to determine the predictive value of MFI on complication rates following DRF and the patient length of stay and discharge outcomes. Methods We utilized our MFI to perform a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Results In a total of 22,313 patients, the average age was 46 ± 16. An increase in MFI led to an increase in the odds ratio of readmission and reoperation ( p < 0.001). MFI predicted complications, doubling the rate as the score increased from 1 to 2 ( p < 0.001). An MFI of 2 also led to a delayed hospital stay of 5 days ( p < 0.001), as well as an increase in the odds of patients not being sent home at discharge ( p < 0.001). Finally, life-threatening complications were also predicted with an increased MFI, the odds of a life-threatening complication increasing 488.20 times at an MFI of 3 ( p < 0.001). Discussion and Conclusion While surgical decision-making for frail patients with DRFs remains contentious, this novel 8-item MFI score was significantly associated with the probability of hospital readmission/reoperation, postoperative complications, and delayed hospital length of stay. Three new parameters were incorporated into our 8-item score compared with the conventional 5; hypoalbuminemia status (< 3.5 mg/dL), previous diagnosis of osteoporosis, and severe obesity (body mass index > 35) enhancing its sensitivity. Future studies are warranted for its prospective utility in ruling out postsurgical comorbidity.
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Affiliation(s)
- David Momtaz
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
| | - Farhan Ahmad
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - Rishi Gonuguntla
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Travis Kotzur
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Rebecca J. Wang
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
| | - Umar Ghilzai
- Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
| | - Adam Abbas
- Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
| | - Chia Wu
- Department of Orthopaedics, Baylor College of Medicine, Houston, Texas
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Otto M, Papastefanou P, Fahse L. Pressure from insect-resistant maize on protected butterflies and moths. Conserv Biol 2024; 38:e14222. [PMID: 37990833 DOI: 10.1111/cobi.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/31/2023] [Accepted: 09/21/2023] [Indexed: 11/23/2023]
Abstract
Intensification in agriculture affects many insect species, including butterflies. Insect-resistant crops, such as Bt (Bacillus thuringiensis) maize, which produces a toxin active against Lepidoptera, are an alternative to insecticide sprays. Genetically modified crops are regulated in most countries and require an environmental risk assessment. In the European Union, such assessments include the use of simulation models to predict the effects on nontarget Lepidoptera (NTL). To support the assessment of protected NTL, we extended an individual-based, stochastic, spatially explicit mathematical model (LepiX) to include a wider range of exposure scenarios, a species-sensitivity distribution, and an option for repeated exposure of individuals. We applied the model to transgenic maize DAS-1507, which expresses a high concentration of Bt toxin in pollen that may be consumed by NTL larvae on their host plants nearby. Even in the most conservative scenario without repeated exposure, mortality estimates for highly sensitive species ranged from 41% to 6% at distances of 10-1000 m from the nearest maize field. Repeated exposure can cause additional mortality and thus is relevant for the overall risk assessment. Uncertainties in both exposure and ecotoxicity estimates strongly influenced the predicted mortalities. Care should be taken to include these uncertainties in the model scenarios used for decision-making. In accordance with other modeling results, our simulations demonstrated that mean mortality may not be safe for protected species. With its high pollen expression, DAS-1507 maize may pose risks to sensitive and protected butterfly and moth species that may be difficult to manage. High expression of Bt toxin in pollen is unnecessary for controlling target pests. Consequently, we suggest that Bt maize with high pollen expression not be cultivated in regions where protected butterflies are to be conserved.
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Affiliation(s)
- Mathias Otto
- Federal Agency for Nature Conservation (BfN), Bonn, Germany
| | - Phillip Papastefanou
- TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Lorenz Fahse
- Institute for Environmental Sciences, University of Koblenz-Landau, Renamed Rhineland-Palatinate Technical University Kaiserlautern, Landau, Germany
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Mahmudiono T, Mansur Khalaf Al-Khazaleh J, Mohammadi H, Daraei H, Javid A, Sarafraz M, Heidarinejad Z, Fakhri Y, Atamaleki A, Mousavi Khaneghah A. The concentration of Potentially Toxic elements (PTEs) in the muscle of crabs: a global systematic review, meta-analysis, and health risk assessment. Int J Environ Health Res 2024; 34:2140-2166. [PMID: 37272268 DOI: 10.1080/09603123.2023.2218294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
The concentration of PTEs in the muscle of crabs, was meta-analyzed using a random-effects model based on countries' subgroups. The non-carcinogenic and carcinogenic risks related to the ingestion of PTEs via the consumption of crab fish were estimated. The meta-analysis included one hundred and eight papers with 109 data reports. The rank order of PTEs based on pooled (mean) concentration in the muscle of crabs was Ni (4.490 mg/kg-ww) > Pb (1.891 mg/kg-ww) >As (1.601 mg/kg-ww) > Cd (1.101 mg/kg-ww). The results showed that adults and children consumers in many countries are at risk of non-carcinogenicity due to ingestion of Ni, Pb, As, and Cd and carcinogenicity risk due to As. Therefore, the bioaccumulation of PTEs in the muscle of crabs can be considered a global health risk. Hence, to decrease the health risk of PTEs in the muscle of crabs, continuous monitoring and reducing the emission of PTEs in aquatic environments are recommended.
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Affiliation(s)
- Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | | | - Hossein Mohammadi
- Department of Bioimaging, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasti Daraei
- Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Environmental Health Engineering, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Allahbakhsh Javid
- School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
- Environmental and Occupational Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mansour Sarafraz
- School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zoha Heidarinejad
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Yadolah Fakhri
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ali Atamaleki
- Department of Environmental Health Engineering, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Amin Mousavi Khaneghah
- Department of Fruit and Vegetable Product Technology, Prof. Wacław Dąbrowski -Institute of Agricultural and Food Biotechnology, Warsaw, Poland
- Department of Technology of Chemistry, Azerbaijan State Oil and Industry University, Baku, Azerbaijan
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Roth S, M'Pembele R, Nienhaus J, Mauermann E, Ionescu D, Szczeklik W, De Hert S, Filipovic M, Beck-Schimmer B, Spadaro S, Matute P, Bolliger D, Turhan SC, van Waes J, Lagarto F, Theodoraki K, Gupta A, Gillmann HJ, Guzzetti L, Kotfis K, Wulf H, Larmann J, Corneci D, Chammartin F, Howell SJ, Lurati Buse G. Association between self-reported functional capacity and general postoperative complications: analysis of predefined outcomes of the MET-REPAIR international cohort study. Br J Anaesth 2024; 132:811-814. [PMID: 38326210 DOI: 10.1016/j.bja.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- Sebastian Roth
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; CARID (Cardiovascular Research Institute Düsseldorf), University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - René M'Pembele
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; CARID (Cardiovascular Research Institute Düsseldorf), University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | - Johannes Nienhaus
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; CARID (Cardiovascular Research Institute Düsseldorf), University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eckhard Mauermann
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Daniela Ionescu
- Department of Anaesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Stefan De Hert
- Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Miodrag Filipovic
- Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Beatrice Beck-Schimmer
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Savino Spadaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Purificación Matute
- Department of Anaesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Daniel Bolliger
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sanem C Turhan
- Department of Anesthesiology and ICU, Ankara University Medical School, Ankara, Turkey
| | - Judith van Waes
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Filipa Lagarto
- Department of Anesthesiology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Kassiani Theodoraki
- Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anil Gupta
- Department of Perioperative Medicine and Intensive Care, Karolinska Hospital and Institution for Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Jörg Gillmann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Luca Guzzetti
- Anesthesia and Intensive Care Department, University Hospital, Varese, Italy
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Hinnerk Wulf
- Department of Anesthesiology and Critical Care Medicine, University Hospital Marburg, Marburg, Germany
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dan Corneci
- Carol Davila University of Medicine and Pharmacy Bucharest Head of Anesthesia and Intensive Care Department I, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Simon J Howell
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Giovanna Lurati Buse
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; CARID (Cardiovascular Research Institute Düsseldorf), University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Hammer Y, Xie J, Yang G, Bitar A, Haft JW, Cascino TM, Likosky DS, Pagani FD, Zhang M, Aaronson KD. Gastrointestinal bleeding following Heartmate 3 left ventricular assist device implantation: The Michigan Bleeding Risk Model. J Heart Lung Transplant 2024; 43:604-614. [PMID: 38065237 DOI: 10.1016/j.healun.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) results in frequent hospitalizations and impairs quality of life in durable left ventricular assist device (LVAD) recipients. Anticipation of these events before implantation could have important implications for patient selection and management. METHODS The study population included all adult HeartMate 3 (HM3) primary LVAD recipients enrolled in the STS Intermacs registry from January 2017 to December 2020. Using multivariable modeling methodologies, we investigated the relationships between preimplantation characteristics and postimplant bleeding, bleeding and death, and additional bleeding episodes on subsequent bleeding episodes and created a risk score to predict the likelihood of post-LVAD GIB based solely on preimplantation factors. RESULTS Of 6,425 patients who received an HM3 LVAD, 1,010 (15.7%) patients experienced GIB. Thirteen preimplantation factors were independent predictors of post-LVAD GIB. A risk score was created from these factors and calculated for each patient. By 3 years postimplant, GIB occurred in 11%, 26%, and 43% of low-, medium- and high-risk patients, respectively. Experiencing 1 post-LVAD GIB event was associated with an increased risk for further GIB events, with 33.9% of patients experiencing at least 1 recurrence. While post-LVAD GIB was associated with mortality, there was no relationship between number of GIB events and death. CONCLUSIONS The Michigan Bleeding Risk Model is a simple tool, which facilitates the prediction of post-LVAD GIB in HM3 recipients using 13 preimplant variables. The implementation of this tool may help in the risk stratification process and may have therapeutic and clinical implications in HM3 LVAD recipients.
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Affiliation(s)
- Yoav Hammer
- Division of Cardiovascular Disease, Michigan Medicine - University of Michigan, Ann Arbor, Michigan.
| | - Jiaheng Xie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Guangyu Yang
- Institute of Statistics and Big Data, Renmin University of China, Beijing, China
| | - Abbas Bitar
- Division of Cardiovascular Disease, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Jonathan W Haft
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Thomas M Cascino
- Division of Cardiovascular Disease, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Min Zhang
- Tsinghua Univeristy, Vanke School of Public Health, Beijing, China
| | - Keith D Aaronson
- Division of Cardiovascular Disease, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
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11
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He Y, Hu L, Wu S, Li L, Zhong K, Li J, Liu N, Sun X, Wang Q, Sun C, Wu L. Nutritional screening and assessment tools for patients with cirrhosis based on the Global Leadership Initiative on Malnutrition criteria. J Hum Nutr Diet 2024; 37:430-439. [PMID: 37932103 DOI: 10.1111/jhn.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Malnutrition is highly prevalent and associated with complications and mortality in patients with cirrhosis. METHODS This was a prospective observational study. Patients with cirrhosis were screened using the Nutritional Risk Screening 2002, the Royal Free Hospital-Nutritional Prioritizing Tool and the Skeletal Muscle Index. Then, the sensitivity, specificity, positive and negative predictive values, and consistency with the Global Leadership Initiative on Malnutrition criteria results were calculated. We also analysed the association between nutritional status and short-term prognosis. RESULTS We enrolled 125 patients with cirrhosis, of whom 59.20% and 60.00% were malnourished based on the Global Leadership Initiative on Malnutrition criteria and Skeletal Muscle Index. Some 53.60% and 65.60%, respectively, were classified medium-to-high nutritional risk by Nutritional Risk Screening 2002 and the Royal Free Hospital-Nutritional Prioritizing Tool. The Royal Free Hospital-Nutritional Prioritizing Tool had the best predictive value, and it was more sensitive and had a better negative predictive value than the Nutritional Risk Screening 2002 Tool. The Skeletal Muscle Index also had good sensitivity and predictive value. The Royal Free Hospital-Nutritional Prioritizing Tool, Skeletal Muscle Index and Global Leadership Initiative on Malnutrition criteria showed high concordance. The 3- and 6-month mortality rates were significantly higher for patients with moderate-to-high nutritional risk or malnutrition, regardless of the tool. CONCLUSIONS When assessing cirrhosis with the Global Leadership Initiative on Malnutrition criteria, the Royal Free Hospital-Nutritional Prioritizing Tool is best for nutritional screening and the Skeletal Muscle Index is also a good nutritional assessment tool.
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Affiliation(s)
- Yumei He
- North Sichuan Medical College, Nanchong, China
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Ling Hu
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Shiyan Wu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lu Li
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ke Zhong
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Jiazhen Li
- Department of Clinical Nutrition, The Third People's Hospital of Chengdu, Chengdu, China
| | - Na Liu
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Xiaobin Sun
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Qiong Wang
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Liping Wu
- Department of Gastroenterology, The Third People's Hospital of Chengdu, Chengdu, China
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12
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Englund H. Improving suicide risk screening in the emergency department. Emerg Nurse 2024:e2198. [PMID: 38528802 DOI: 10.7748/en.2024.e2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 03/27/2024]
Abstract
Suicide is a significant and increasing public health concern. Research has shown that screening for suicide risk is inconsistent in acute care settings and that a variety of different tools are used for that purpose. The Columbia-Suicide Severity Risk Scale (C-SSRS) has emerged as a validated and recognised suicide risk screening tool. This article describes a quality improvement project designed to improve the screening of patients for suicide risk in a large hospital system in the Midwestern US. As part of the project, 97% of nurses working in the organisation's emergency departments self-completed a 30-minute interactive learning module on the background, relevance and application of the C-SSRS. The C-SSRS enables nurses to classify the severity of suicide risk, which helps to provide interventions commensurate with patients' level of risk. Following completion of the module, there was a significant increase in the percentage of patients screened for suicide risk.
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13
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Zelencik S, VanDine A, Campos-Bovee M, Goitia K, Cela V, Walblay K, Galanto D, Pacilli M, Kim DY, Black SR. Health Care Personnel Exposure Risk Assessment and Management During a Mpox Outbreak in Chicago, Illinois, 17 May to 8 July 2022. J Infect Dis 2024; 229:S207-S212. [PMID: 38019754 DOI: 10.1093/infdis/jiad531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023] Open
Abstract
This report summarizes risk assessment interviews and follow-up with health care personnel (HCP) after exposure to patients with mpox disease during 17 May to 8 July 2022. HCP-case interactions were assessed using a standard questionnaire to categorize the risk associated with patient encounters. We assessed 150 interactions among 142 HCP and 30 cases. Four (2.7%) interactions were defined as high risk, 5 (3.3%) intermediate, 107 (71.3%) low, and 31 (20.7%) no risk. High and intermediate exposures were offered postexposure prophylaxis; 4 accepted. No documented mpox transmission after exposure was identified. These findings suggest transmission risk in health care settings during routine patient care is low.
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Affiliation(s)
- Shane Zelencik
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Alison VanDine
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | | | - Valbona Cela
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Kelly Walblay
- Chicago Department of Public Health, Chicago, Illinois, USA
| | - Daniel Galanto
- Chicago Department of Public Health, Chicago, Illinois, USA
| | | | - Do Young Kim
- Chicago Department of Public Health, Chicago, Illinois, USA
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14
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Scheirich L, Maguire T, Daffern M. Testing a recovery-oriented nursing communication framework to encourage collaboration and discussion about aggression prevention: A mixed methods study. Int J Ment Health Nurs 2024. [PMID: 38532536 DOI: 10.1111/inm.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/21/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
Recovery-oriented practice is essential in healthcare, yet research exploring methods for integrating recovery-oriented principles in forensic mental health settings is limited. This study involved the co-development, with mental health care nurses and a lived experience expert, and testing of a recovery-oriented script for forensic mental health nurses to use when communicating with consumers at high-risk of imminent aggression. The aim was to examine whether nurses perceived the script as more empathic when the script included specific references to empathy, compared to an equivalent script that did not include empathic statements, and to explore nurses' perspectives on whether the script could help prevent aggression. Nurses (n = 54) working in a secure forensic mental health hospital were randomly allocated to read a script containing statements representing nine recovery-oriented principles that also included empathic statements, or an equivalent script that did not include empathic statements. After reading the script, the participants completed a questionnaire involving a recovery-oriented practice scale developed by the authors, measuring the extent to which the scripts reflected recovery-oriented principles, and open-ended questions about the script's potential to prevent aggression. Results revealed no significant difference in nurse perceptions of empathy between the two scripts. Content analysis indicated that nurses perceived the scripts could help prevent aggression.
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Affiliation(s)
- Laura Scheirich
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
| | - Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia
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15
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Sun Z, An Q, Li Y, Gao X, Wang H. Epidemiological characterization and risk assessment of rabbit haemorrhagic disease virus 2 (RHDV2/b/GI.2) in the world. Vet Res 2024; 55:38. [PMID: 38532494 DOI: 10.1186/s13567-024-01286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/02/2024] [Indexed: 03/28/2024] Open
Abstract
A novel variant of rabbit haemorrhagic disease virus, designated RHDV2/b/GI.2, was first discovered in France in 2010. Subsequently, RHDV2 rapidly spread to Africa, North America, Australia, and Asia. RHDV2 outbreaks have resulted in significant economic losses in the global rabbit industry and disrupted the balance of natural ecosystems. Our study investigated the seasonal characteristics of RHDV2 outbreaks using seasonal indices. RHDV2 is prone to causing significant outbreaks within domestic and wild rabbit populations during the spring season and is more likely to induce outbreaks within wild rabbit populations during late autumn in the Southern Hemisphere. Furthermore, based on outbreak data for domestic and wild rabbits and environmental variables, our study established two MaxEnt models to explore the relationship between RHDV2 outbreaks and the environmental factors and conducted outbreak risk predictions for RHDV2 in global domestic and wild rabbit populations. Both models demonstrated good predictive performance, with AUC values of 0.960 and 0.974, respectively. Road density, isothermality, and population density were identified as important variables in the outbreak of RHDV2 in domestic rabbits, while road density, normalized difference vegetation index, and mean annual solar radiation were considered key variables in the outbreak of RHDV2 in wild rabbits. The environmental factors associated with RHDV2 outbreaks identified in our study and the outbreak risk prediction maps generated in our study will aid in the formulation of appropriate RHDV2 control measures to reduce the risk of morbidity in domestic and wild rabbits.
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Affiliation(s)
- Zhuo Sun
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
- Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Qi An
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
- Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Yuepeng Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
- Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Xiang Gao
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
- Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Hongbin Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China.
- Key Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China.
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16
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Sood E, Newburger JW, Anixt JS, Cassidy AR, Jackson JL, Jonas RA, Lisanti AJ, Lopez KN, Peyvandi S, Marino BS. Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk-Stratification, Evaluation, and Management: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e997-e1022. [PMID: 38385268 DOI: 10.1161/cir.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Over the past decade, new research has advanced scientific knowledge of neurodevelopmental trajectories, factors that increase neurodevelopmental risk, and neuroprotective strategies for individuals with congenital heart disease. In addition, best practices for evaluation and management of developmental delays and disorders in this high-risk patient population have been formulated based on literature review and expert consensus. This American Heart Association scientific statement serves as an update to the 2012 statement on the evaluation and management of neurodevelopmental outcomes in children with congenital heart disease. It includes revised risk categories for developmental delay or disorder and an updated list of factors that increase neurodevelopmental risk in individuals with congenital heart disease according to current evidence, including genetic predisposition, fetal and perinatal factors, surgical and perioperative factors, socioeconomic disadvantage, and parental psychological distress. It also includes an updated algorithm for referral, evaluation, and management of individuals at high risk. Risk stratification of individuals with congenital heart disease with the updated categories and risk factors will identify a large and growing population of survivors at high risk for developmental delay or disorder and associated impacts across the life span. Critical next steps must include efforts to prevent and mitigate developmental delays and disorders. The goal of this scientific statement is to inform health care professionals caring for patients with congenital heart disease and other key stakeholders about the current state of knowledge of neurodevelopmental outcomes for individuals with congenital heart disease and best practices for neuroprotection, risk stratification, evaluation, and management.
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17
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Mlaver E, Meyer CH, Codner JA, Solomon G, Sharma J, Krause M, Vassy WM, Dente CJ, Todd SR, Ayoung-Chee P. Accuracy of Trauma Surgeons Prospective Estimation of the Injury Severity Score: A Pilot Study. Am Surg 2024:31348241241630. [PMID: 38523563 DOI: 10.1177/00031348241241630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Injury Severity Score (ISS) has limited utility as a prospective predictor of trauma outcomes as it is currently scored by abstractors post-discharge. This study aimed to determine accuracy of ISS estimation at time of admission. Attending trauma surgeons assessed the Abbreviated Injury Scale of each body region for patients admitted during their call, from which estimated ISS (eISS) was calculated. The eISS was considered concordant to abstracted ISS (aISS) if both were in the same category: mild (<9), moderate (9-15), severe (16-25), or critical (>25). Ten surgeons completed 132 surveys. Overall ISS concordance was 52.2%; 87.5%, 30.8%, 34.8%, and 61.7% for patients with mild, moderate, severe, and critical aISS, respectively; unweighted k = .36, weighted k = .69. This preliminarily supports attending trauma surgeons' ability to predict severity of injury in real time, which has important clinical and research implications.
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Affiliation(s)
- Eli Mlaver
- Department of Surgery, Emory University, Atlanta, GA, USA
- Georgia Quality Improvement Program, Madison, GA, USA
| | | | - Jesse A Codner
- Department of Surgery, Emory University, Atlanta, GA, USA
- Georgia Quality Improvement Program, Madison, GA, USA
| | - Gina Solomon
- Georgia Quality Improvement Program, Madison, GA, USA
| | - Jyotirmay Sharma
- Department of Surgery, Emory University, Atlanta, GA, USA
- Georgia Quality Improvement Program, Madison, GA, USA
| | - Morgan Krause
- Northeast Georgia Medical Center, Gainesville, GA, USA
| | - W Matthew Vassy
- Georgia Quality Improvement Program, Madison, GA, USA
- Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Christopher J Dente
- Department of Surgery, Emory University, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - S Rob Todd
- Department of Surgery, Emory University, Atlanta, GA, USA
- Georgia Quality Improvement Program, Madison, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Patricia Ayoung-Chee
- Grady Memorial Hospital, Atlanta, GA, USA
- Department of Surgery, Morehouse University, Atlanta, GA, USA
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18
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Shah SJ, van Walraven C, Jeon SY, Boscardin J, Hobbs FDR, Connolly SJ, Ezekowitz MD, Covinsky KE, Fang MC, Singer DE. Estimating Vitamin K Antagonist Anticoagulation Benefit in People With Atrial Fibrillation Accounting for Competing Risks: Evidence From 12 Randomized Trials. Circ Cardiovasc Qual Outcomes 2024:e010269. [PMID: 38525596 DOI: 10.1161/circoutcomes.123.010269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 01/16/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Patients with atrial fibrillation have a high mortality rate that is only partially attributable to vascular outcomes. The competing risk of death may affect the expected anticoagulant benefit. We determined if competing risks materially affect the guideline-endorsed estimate of anticoagulant benefit. METHODS We conducted a secondary analysis of 12 randomized controlled trials that randomized patients with atrial fibrillation to vitamin K antagonists (VKAs) or either placebo or antiplatelets. For each participant, we estimated the absolute risk reduction (ARR) of VKAs to prevent stroke or systemic embolism using 2 methods-first using a guideline-endorsed model (CHA2DS2-VASc) and then again using a competing risk model that uses the same inputs as CHA2DS2-VASc but accounts for the competing risk of death and allows for nonlinear growth in benefit. We compared the absolute and relative differences in estimated benefit and whether the differences varied by life expectancy. RESULTS A total of 7933 participants (median age, 73 years, 36% women) had a median life expectancy of 8 years (interquartile range, 6-12), determined by comorbidity-adjusted life tables and 43% were randomized to VKAs. The CHA2DS2-VASc model estimated a larger ARR than the competing risk model (median ARR at 3 years, 6.9% [interquartile range, 4.7%-10.0%] versus 5.2% [interquartile range, 3.5%-7.4%]; P<0.001). ARR differences varied by life expectancies: for those with life expectancies in the highest decile, 3-year ARR difference (CHA2DS2-VASc model - competing risk model 3-year risk) was -1.3% (95% CI, -1.3% to -1.2%); for those with life expectancies in the lowest decile, 3-year ARR difference was 4.7% (95% CI, 4.5%-5.0%). CONCLUSIONS VKA anticoagulants were exceptionally effective at reducing stroke risk. However, VKA benefits were misestimated with CHA2DS2-VASc, which does not account for the competing risk of death nor decelerating treatment benefit over time. Overestimation was most pronounced when life expectancy was low and when the benefit was estimated over a multiyear horizon.
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Affiliation(s)
- Sachin J Shah
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (S.J.S., D.E.S.)
| | - Carl van Walraven
- Departments of Medicine and Epidemiology and Community Medicine, University of Ottawa, ON, Canada (C.v.W.)
| | - Sun Young Jeon
- Department of Medicine, University of California San Francisco, San Francisco, CA. (S.Y.J., W.J.B., K.E.C., M.C.F.)
| | - John Boscardin
- Department of Medicine, University of California San Francisco, San Francisco, CA. (S.Y.J., W.J.B., K.E.C., M.C.F.)
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA. (W.J.B.)
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK (F.D.R.H.)
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.C.)
| | - Michael D Ezekowitz
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA (M.E.)
- Cardiovascular Medicine, Lankenau Institute for Medical Research, Wynnewood, PA (M.E.)
| | - Kenneth E Covinsky
- Department of Medicine, University of California San Francisco, San Francisco, CA. (S.Y.J., W.J.B., K.E.C., M.C.F.)
| | - Margaret C Fang
- Department of Medicine, University of California San Francisco, San Francisco, CA. (S.Y.J., W.J.B., K.E.C., M.C.F.)
| | - Daniel E Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (S.J.S., D.E.S.)
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19
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Budi HS, Catalan Opulencia MJ, Afra A, Abdelbasset WK, Abdullaev D, Majdi A, Taherian M, Ekrami HA, Mohammadi MJ. Source, toxicity and carcinogenic health risk assessment of heavy metals. Rev Environ Health 2024; 39:77-90. [PMID: 36181731 DOI: 10.1515/reveh-2022-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Heavy metals are chemical elements with unique properties that are toxic even in low concentrations and affect human health with different functions. Agricultural and industrial activities, improper disposal of household solid waste and residues related to industrial producers, discharge of household wastewater and agricultural fertilizers are the most important ways in which toxic heavy metals enter the environment, which harms human health and life. A narrative review of the literature was done from 2000 to 2022 based on searched databases included Google Scholar, PubMed, Springer, Web of Science, and Science Direct (Scopus). All relevant studies published 2000 until 2022 gathered. According to the databases, 820 articles were retrieved. 186 and 50 articles were found and selected based on records identified through database searching and additional records identified through other sources. In the next stage, 97 studies were screened after review and 64 full-text articles entered into the analysis process. Finally, 45 articles were selected in this study. Adverse effects of heavy metals on various conditions in the body depend on a number of factors, including dose, route of exposure and chemical species, as well as age, sex, genetics, nutritional status, and duration of exposure to the heavy metal. The existence of significant relationships between long-term and short-term exposure to toxic heavy metals and their adverse effects, including carcinogenicity, has been extensively studied and proven through numerous experiments. However, the mechanisms associated with this complication have not been properly identified, so in future research, there is a great need for comprehensive studies on the carcinogenicity of heavy metals.
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Affiliation(s)
- Hendrik Setia Budi
- Department of Oral Biology, Dental Pharmacology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, 60132 Indonesia
| | | | - Arghavan Afra
- Department of Nursing, School of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Walid Kamal Abdelbasset
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Dilmurod Abdullaev
- Dean of the Pediatric Dentistry, Tashkent State Dental Institute, Tashkent, Uzbekistan
- Research Scholar, Department of Scientific affairs, Samarkand State Medical Institute, Samarkand, Uzbekistan
| | - Ali Majdi
- Al-Mustaqbal University College: Civil Engineering Al-Hilla, Babylon, Iraq
| | - Masoume Taherian
- Student Research Komiteh, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hafez Ajam Ekrami
- Student Research Komiteh, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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20
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Marufi N, Oliveri Conti G, Ahmadinejad P, Ferrante M, Mohammadi AA. Carcinogenic and non-carcinogenic human health risk assessments of heavy metals contamination in drinking water supplies in Iran: a systematic review. Rev Environ Health 2024; 39:91-100. [PMID: 36181734 DOI: 10.1515/reveh-2022-0060] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
The contamination of water due to heavy metals (HMs) is a big concern for humankind; particularly in developing countries. This research is a systematic review, conducted by searching google scholar, Web of Science, Science Direct, PubMed, Springer, and Scopus databases for related published papers from 2010 to July 2021, resulting in including 40 articles. Among the analyzed HMs in the presented review, the average content of Cr, Pb, Ba, Al, As, Zn, and Cd exceeded the permissible limits suggested by the World Health Organization (WHO) and 1,053 Iranian standards. Also, the rank order of Hazard Quotient (HQ) of HMs was defined as Cd>As>Cr>Pb>Li for children which means Cd has the highest non-carcinogenic risk and Li has the least. This verifies to the current order As>Cr>Pb>Fe=Zn=Cu>Cd for adults. The corresponded values of HQ and Hazard Index (HI) in most cities and villages were investigated and the results indicated a lower than 1 value, which means consumers are not at non-carcinogenic risk (HQ). Carcinogenic risk (CR) of As in the adult and children consumers in most of the samples (58.82% of samples for both groups) were investigated too, and it was more than>1.00E-04 value, which determines that consumers are at significant CR.
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Affiliation(s)
- Nilufar Marufi
- Student Research Committee, Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gea Oliveri Conti
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Parvin Ahmadinejad
- Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Margherita Ferrante
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Ali Akbar Mohammadi
- Department of Environmental Health Engineering, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Martinho MGD, Rocha AR, Dos Santos NR, de Jesus VSP, Gomes Júnior EA, Menezes-Filho JA. Aflatoxins in maize flour produced in Mozambique and its risk assessment. Food Addit Contam Part B Surveill 2024:1-9. [PMID: 38515402 DOI: 10.1080/19393210.2024.2331630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
This study investigated the occurrence of aflatoxins (B1, B2, G1, and G2) in maize flour produced in Mozambique and to assess the associated carcinogenic risk. At different opportunities, 30 samples of maize flour were collected in five flour processing factories. These were determined by high-performance liquid chromatography (HPLC) with fluorescence detection. AFB1 concentrations ranged from 0.25 to 0.33 μg kg-1. The levels of total aflatoxins ranged from 0.55 to 1.05 μg kg-1, with a mean of 0.89 μg kg-1, for which maximum limits (MLs) are 10 and 4 μg kg-1 for Mozambique and the European Union, respectively. The calculated Margin of Exposure (MOE) for men and women was 243 and 231, respectively, so several folds below the risk cut-off level, indicating that consumption of such maize flour poses a potential risk of hepatocarcinoma related to aflatoxin exposure due to high intake of this food, a staple diet in most African countries.
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Affiliation(s)
| | - Andrea Rebouças Rocha
- Engineering, Center for Energy and Sustainability, Federal University of the Bahia's Recôncavo, Cruz das Almas, Brazil
| | - Nathália Ribeiro Dos Santos
- Engineering, Center for Energy and Sustainability, Federal University of the Bahia's Recôncavo, Cruz das Almas, Brazil
| | | | | | - José Antonio Menezes-Filho
- Graduate Program in Food Science, College of Pharmacy, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Slavador, Brazil
- Laboratory of Toxicology, Federal University of Bahia, Slavador, Brazil
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22
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Morisaki K, Matsuda D, Guntani A, Kinoshita G, Yoshino S, Inoue K, Honma K, Yamaoka T, Mii S, Yoshizumi T. Infra-inguinal Bypass Surgery versus Endovascular Revascularization for Chronic Limb-Threatening Ischemia in Average and High risk Patients. J Vasc Surg 2024:S0741-5214(24)00505-6. [PMID: 38522583 DOI: 10.1016/j.jvs.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE This study aimed to evaluate treatment outcomes after bypass surgery or endovascular therapy (EVT) in average- and high-risk patients with chronic limb-threatening ischemia (CLTI). METHODS We retrospectively analyzed multicenter data of patients who underwent infra-inguinal revascularization for CLTI between 2015 and 2022. A high-risk patient was defined as one with estimated 30-day mortality rate ≥ 5% or 2-year survival rate ≤ 50%, as determined by the Surgical Reconstruction Versus Peripheral Intervention in Patients With Critical Limb Ischemia (SPINACH) calculator. The amputation-free survival (AFS), limb salvage (LS), wound healing, and 30-day mortality were compared separately for the average- and high-risk patients between the bypass and EVT with propensity score matching. RESULTS We analyzed 239 and 31 propensity score matched pairs in the average- and high-risk patients with CLTI. In the average-risk patients, the 2-year AFS and LS rates were 78.1% and 94.4% in the bypass group and 63.0% and 87.7% in the EVT group (p < .001 and p = .007). The 1-year wound healing rates were 88.6% in the bypass group and 76.8% in the EVT group, respectively (p < .001). The 30-day mortality was 0.8% in the bypass surgery and 0.8% in the EVT group (p = .996). In the high-risk patients, there was no differences in the AFS, LS, and wound healing between the groups (p = .591, p = .148, and p = .074). The 30-day mortality was 3.2% in the bypass group and 3.2% in the EVT group (p = .991). CONCLUSION Bypass surgery is superior to EVT with respect to the AFS, LS, and wound healing in the average-risk patients. EVT is a feasible first-line treatment strategy for high-risk patients with CLTI undergoing revascularization, based on the lack of significant differences in the 2-year AFS rate, between the bypass surgery and EVT cohorts.
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Affiliation(s)
- Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Daisuke Matsuda
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Atsushi Guntani
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan
| | - Go Kinoshita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichiro Yoshino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kentaro Inoue
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Honma
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Shinsuke Mii
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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23
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Shung DL, Laine L. Review article: Upper gastrointestinal bleeding - review of current evidence and implications for management. Aliment Pharmacol Ther 2024. [PMID: 38517201 DOI: 10.1111/apt.17949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/27/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Acute upper gastrointestinal bleeding (UGIB) is a common emergency requiring hospital-based care. Advances in care across pre-endoscopic, endoscopic and post-endoscopic phases have led to improvements in clinical outcomes. AIMS To provide a detailed, evidence-based update on major aspects of care across pre-endoscopic, endoscopic and post-endoscopic phases. METHODS We performed a structured bibliographic database search for each topic. If a recent high-quality meta-analysis was not available, we performed a meta-analysis with random effects methods and odds ratios with 95% confidence intervals. RESULTS Pre-endoscopic management of UGIB includes risk stratification, a restrictive red blood cell transfusion policy unless the patient has cardiovascular disease, and pharmacologic therapy with erythromycin and a proton pump inhibitor. Patients with cirrhosis should be treated with prophylactic antibiotics and vasoactive medications. Tranexamic acid should not be used. Endoscopic management of UGIB depends on the aetiology. For peptic ulcer disease (PUD) with high-risk stigmata, endoscopic therapy, including over-the-scope clips (OTSCs) and TC-325 powder spray, should be performed. For variceal bleeding, treatment should be customised by severity and anatomic location. Post-endoscopic management includes early enteral feeding for all UGIB patients. For high-risk PUD, PPI should be continued for 72 h, and rebleeding should initially be evaluated with a repeat endoscopy. For variceal bleeding, high-risk patients or those with further bleeding, a transjugular intrahepatic portosystemic shunt can be considered. CONCLUSIONS Management of acute UGIB should include treatment plans for pre-endoscopic, endoscopic and post-endoscopic phases of care, and customise treatment decisions based on aetiology and severity of bleeding.
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Affiliation(s)
| | - Loren Laine
- Yale School of Medicine, New Haven, Connecticut, USA
- West Haven Veterans Affairs Medical Center, West Haven, Connecticut, USA
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24
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Aldridge Z, Harrison Dening K. Risk management and decision-making in dementia care. Nurs Older People 2024:e1460. [PMID: 38504558 DOI: 10.7748/nop.2024.e1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 03/21/2024]
Abstract
What constitutes a risk for a person living with dementia may be perceived and prioritised differently by nurses from varying clinical backgrounds. Furthermore, risk may be perceived differently according to the context. This article outlines some of the social, psychological and physical risk factors relevant to people living with dementia across the life course of the condition. It is important that nurses understand their role in identifying, assessing and managing risk and are aware of the resources, policies, legislation and processes designed to support decision-making and minimise the risk of harm to people living with dementia, their families and carers. The authors hope that this article will support nurses to become more confident in identifying risk while encouraging them to adopt a proactive and person-centred approach to risk assessment and management.
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25
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Sharpe K, McCallum S, O'Neill JC, Paterson C, McCormick J, Sexton K. Occupational skin dose from radionuclide contamination: One country's approach at standardising skin dose estimates using Varskin. J Radiol Prot 2024. [PMID: 38507787 DOI: 10.1088/1361-6498/ad35ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The manipulation of unsealed radiopharmaceuticals by healthcare workers can cause accidental personal contamination leading to occupational radiation skin dose. The UK Ionising Radiations Regulations 2017 (IRR17) require that potential skin doses arising from reasonably foreseeable accident scenarios are included in risk assessments. Workers must be designated as classified if these dose estimates exceed 150 mSv equivalent dose averaged over 1 cm2. Updates from the UK Health and Safety Executive (HSE) recently prompted many in the UK to review the classification of workers in Nuclear Medicine. Skin dose from contamination cannot be measured, it must be estimated. Varskin+ is a code that is widely recommended for estimating skin dose. The subjective choices made by users when defining modelled scenarios in Varskin+ lead to significant variation in the calculated skin doses. At the time of writing there is no definitive calculation method and all calculations rely on theoretical models. NHS Health Boards in Scotland have adopted a standardised framework for performing skin dose estimates for risk assessments. The parametric sensitivity of Varskin+ inputs were examined and the available evidence was reviewed. Generic, reasonably forseeable, worst-case accident scenarios were decided upon for: direct skin contamination, glove contamination and needlestick injury. Standardised inputs and assumptions for each scenario were compiled in a protocol that has been adopted by the Scottish Health Boards. The protocol allows for differences in practice between departments, but standardises most inputs. While significant uncertainty remains in the estimated skin doses, this approach reduces variation and enables the comparison of estimated skin doses between departments. The framework facilitates continuous improvement as more evidence is gathered to refine the standardised assumptions. Task by task skin dose estimates were made for workers in Nuclear Medicine in Scotland and many workers were designated classified as a result.
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Affiliation(s)
- Katherine Sharpe
- Medical Physics Department, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Stephen McCallum
- Department of Medical Physics, NHS Grampian, Aberdeen, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Janice C O'Neill
- Dept Medical Physics, NHS Tayside, Dundee, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Carolyn Paterson
- NHS Greater Glasgow and Clyde, Glasgow, Glasgow, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Jennifer McCormick
- Department of Medical Physics, NHS Grampian, Aberdeen, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Kate Sexton
- Department of Medical Physics, NHS Lothian, Edinburgh, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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26
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Everett BM. The Confusing Landscape of Cardiovascular Health Assessment, Promotion, and Prediction. Circulation 2024; 149:914-916. [PMID: 38498613 DOI: 10.1161/circulationaha.123.067982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Brendan M Everett
- Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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27
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Edwards AJ, King MF, Noakes CJ, Peckham D, López-García M. The Wells-Riley model revisited: Randomness, heterogeneity, and transient behaviours. Risk Anal 2024. [PMID: 38501447 DOI: 10.1111/risa.14295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/20/2024]
Abstract
The Wells-Riley model has been widely used to estimate airborne infection risk, typically from a deterministic point of view (i.e., focusing on the average number of infections) or in terms of a per capita probability of infection. Some of its main limitations relate to considering well-mixed air, steady-state concentration of pathogen in the air, a particular amount of time for the indoor interaction, and that all individuals are homogeneous and behave equally. Here, we revisit the Wells-Riley model, providing a mathematical formalism for its stochastic version, where the number of infected individuals follows a Binomial distribution. Then, we extend the Wells-Riley methodology to consider transient behaviours, randomness, and population heterogeneity. In particular, we provide analytical solutions for the number of infections and the per capita probability of infection when: (i) susceptible individuals remain in the room after the infector leaves, (ii) the duration of the indoor interaction is random/unknown, and (iii) infectors have heterogeneous quanta production rates (or the quanta production rate of the infector is random/unknown). We illustrate the applicability of our new formulations through two case studies: infection risk due to an infectious healthcare worker (HCW) visiting a patient, and exposure during lunch for uncertain meal times in different dining settings. Our results highlight that infection risk to a susceptible who remains in the space after the infector leaves can be nonnegligible, and highlight the importance of incorporating uncertainty in the duration of the indoor interaction and the infectivity of the infector when estimating risk.
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Affiliation(s)
- Alexander J Edwards
- EPSRC Centre for Doctoral Training in Fluid Dynamics, University of Leeds, Leeds, UK
| | | | | | - Daniel Peckham
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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28
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Cobos-Vargas A, Acosta-Romero M, Camado-Sojo L, Alba-Fernández C, Rodriguez-Delgado E, Colmenero M. Predictive validity of a pressure injury risk assessment tool at different time-points in patients admitted to the intensive care unit. Nurs Crit Care 2024. [PMID: 38503407 DOI: 10.1111/nicc.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Multiple risk assessment scales are available for predicting the development of pressure injuries (PIs) in patients in the intensive care unit (ICU). Most PI risk assessment tools have been validated at the time of admission; however, another time point during treatment could better reflect clinical changes and therefore, the risk of PIs. AIMS The study aimed to examine the predictive validity of PI risk assessment scale designed for ICU patients, the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index, at several time points or intervals during ICU stay. STUDY DESIGN This was an observational prospective study undertaken over a period of 1 year (July 2021-June 2022). Patients admitted to ICU for >3 days were included. The number, location and degree of the PIs were recorded. The level of risk for developing PIs during the stay was determined by calculating the COMHON scores at admission, and 72 h, as well as the highest and mean score. Predictive validity was studied using accuracy parameters and areas under the receiver operating characteristic curve (AUC). The best cutoff point was also determined and used to compare risk between categories. RESULTS Of the 286 patients included in the study, 160 (59%) were male. The level of severity evaluated using the APACHE II scale was 18.4 ± 5.8 points. Invasive mechanical ventilation was used in 32.1% (n = 92) of the patients and 20.6% (n = 59) received high flow oxygen therapy. The incidence of PI was 15.4% (n = 44), with sacral location in 47.7% (n = 21) and grade II in 75% (n = 33) of the patients. The AUC was 0.907 (0.872-0.942); 0.881 (0.842-0.920); 0.877 (0.835-0.920) and 0.749 (0.667-0.831) at the mean, the highest, 72 h and ICU admission scores, respectively. The best cutoff point was 13 in all patients. The risk of developing a PI was 6.4 times higher in the high-risk group (>13 points). CONCLUSIONS The best predictive capacity for the COMHON index risk assessment was the mean and highest scores. The predictive accuracy was higher on the third day of the patient's stay than on admission, and this was attributed to the clinical changes observed in some patients over the course of their critical illness. RELEVANCE FOR CLINICAL PRACTICE Patients in ICU are at high risk of developing PIs, therefore, preventive measures should be maximized. Risk assessment should be carried out sequentially owing to the changes that patients present throughout their ICU stay and preventive measures should be used according to the risk level.
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Affiliation(s)
- Angel Cobos-Vargas
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Maria Acosta-Romero
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Luis Camado-Sojo
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | | | - Manuel Colmenero
- Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain
- ibs.GRANADA Instituto de Investigación Biosanitaria, Granada, Spain
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29
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Castaño-Trias M, Rodríguez-Mozaz S, Verlicchi P, Buttiglieri G. Selection of pharmaceuticals of concern in reclaimed water for crop irrigation in the Mediterranean area. J Hazard Mater 2024; 466:133538. [PMID: 38290335 DOI: 10.1016/j.jhazmat.2024.133538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 02/01/2024]
Abstract
The reuse of reclaimed water in agriculture is being fostered in areas suffering from water scarcity. However, water pollutants can compromise food safety and pose a risk for the environment. This study aims to select the pharmaceutical compounds worth monitoring and investigating when reclaimed water is used for tomato and lettuce irrigation. A comprehensive study was first conducted to identify the pharmaceuticals frequently detected in secondary wastewater effluents in Catalonia (Northeast Spain). Priority pharmaceuticals were further selected based on their occurrence in secondary effluents, persistence (removal in conventional treatment), bioaccumulation potential, toxicity for aquatic organisms, and the risks they pose to the terrestrial environment and human health (through the consumption of crops). Out of the 47 preselected priority compounds, six could pose a risk to organisms living in soil irrigated with reclaimed water and seven could be potentially taken up by the crops. Nonetheless, no risk for human consumption was foreseen.
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Affiliation(s)
- M Castaño-Trias
- Catalan Institute for Water Research (ICRA-CERCA), C/Emili Grahit 101, 17003 Girona, Spain; University of Girona, Spain
| | - S Rodríguez-Mozaz
- Catalan Institute for Water Research (ICRA-CERCA), C/Emili Grahit 101, 17003 Girona, Spain; University of Girona, Spain.
| | - P Verlicchi
- Department of Engineering, University of Ferrara, Via Saragat 1, 44121 Ferrara, Italy
| | - G Buttiglieri
- Catalan Institute for Water Research (ICRA-CERCA), C/Emili Grahit 101, 17003 Girona, Spain; University of Girona, Spain.
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30
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Choi H, Choi B, Han S, Lee M, Shin GT, Kim H, Son M, Kim KH, Kwon JM, Park RW, Park I. Applicable Machine Learning Model for Predicting Contrast-induced Nephropathy Based on Pre-catheterization Variables. Intern Med 2024; 63:773-780. [PMID: 37558487 DOI: 10.2169/internalmedicine.1459-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Objective Contrast agents used for radiological examinations are an important cause of acute kidney injury (AKI). We developed and validated a machine learning and clinical scoring prediction model to stratify the risk of contrast-induced nephropathy, considering the limitations of current classical and machine learning models. Methods This retrospective study included 38,481 percutaneous coronary intervention cases from 23,703 patients in a tertiary hospital. We divided the cases into development and internal test sets (8:2). Using the development set, we trained a gradient boosting machine prediction model (complex model). We then developed a simple model using seven variables based on variable importance. We validated the performance of the models using an internal test set and tested them externally in two other hospitals. Results The complex model had the best area under the receiver operating characteristic (AUROC) curve at 0.885 [95% confidence interval (CI) 0.876-0.894] in the internal test set and 0.837 (95% CI 0.819-0.854) and 0.850 (95% CI 0.781-0.918) in two different external validation sets. The simple model showed an AUROC of 0.795 (95% CI 0.781-0.808) in the internal test set and 0.766 (95% CI 0.744-0.789) and 0.782 (95% CI 0.687-0.877) in the two different external validation sets. This was higher than the value in the well-known scoring system (Mehran criteria, AUROC=0.67). The seven precatheterization variables selected for the simple model were age, known chronic kidney disease, hematocrit, troponin I, blood urea nitrogen, base excess, and N-terminal pro-brain natriuretic peptide. The simple model is available at http://52.78.230.235:8081/Conclusions We developed an AKI prediction machine learning model with reliable performance. This can aid in bedside clinical decision making.
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Affiliation(s)
- Heejung Choi
- Department of Nephrology, Ajou University School of Medicine, Korea
| | - Byungjin Choi
- Department of Biomedical Informatics, Ajou University School of Medicine, Korea
| | | | - Minjeong Lee
- Department of Nephrology, Ajou University School of Medicine, Korea
| | - Gyu-Tae Shin
- Department of Nephrology, Ajou University School of Medicine, Korea
| | - Heungsoo Kim
- Department of Nephrology, Ajou University School of Medicine, Korea
| | - Minkook Son
- Department of Physiology, College of Medicine, Dong-A University, Korea
| | - Kyung-Hee Kim
- Department of Cardiology, Cardiovascular Center, Incheon Sejong Hospital, Korea
| | - Joon-Myoung Kwon
- Department of Critical Care and Emergency Medicine, Incheon Sejong Hospital, Korea
- Artificial Intelligence and Big Data Research Center, Sejong Medical Research Institute, Korea
- Medical Research Team, Medical AI, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Korea
| | - Inwhee Park
- Department of Nephrology, Ajou University School of Medicine, Korea
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31
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Gilsenan M, Van Der Linde S, Hill G, Lambros B. Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey. Transpl Infect Dis 2024:e14268. [PMID: 38477039 DOI: 10.1111/tid.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant-related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. METHODS This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. RESULTS No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection.
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Affiliation(s)
- Maddie Gilsenan
- Children's Cancer Centre, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Sam Van Der Linde
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Geoff Hill
- Health Sciences Library, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Belinda Lambros
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Sanz-Serrano J, Callewaert E, De Boever S, Drees A, Verhoeven A, Vinken M. Chemical-induced liver cancer: an adverse outcome pathway perspective. Expert Opin Drug Saf 2024:1-14. [PMID: 38430529 DOI: 10.1080/14740338.2024.2326479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/29/2024] [Indexed: 03/04/2024]
Abstract
INTRODUCTION The evaluation of the potential carcinogenicity is a key consideration in the risk assessment of chemicals. Predictive toxicology is currently switching toward non-animal approaches that rely on the mechanistic understanding of toxicity. AREAS COVERED Adverse outcome pathways (AOPs) present toxicological processes, including chemical-induced carcinogenicity, in a visual and comprehensive manner, which serve as the conceptual backbone for the development of non-animal approaches eligible for hazard identification. The current review provides an overview of the available AOPs leading to liver cancer and discusses their use in advanced testing of liver carcinogenic chemicals. Moreover, the challenges related to their use in risk assessment are outlined, including the exploitation of available data, the need for semantic ontologies, and the development of quantitative AOPs. EXPERT OPINION To exploit the potential of liver cancer AOPs in the field of risk assessment, 3 immediate prerequisites need to be fulfilled. These include developing human relevant AOPs for chemical-induced liver cancer, increasing the number of AOPs integrating quantitative toxicodynamic and toxicokinetic data, and developing a liver cancer AOP network. As AOPs and other areas in the field continue to evolve, liver cancer AOPs will progress into a reliable and robust tool serving future risk assessment and management.
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Affiliation(s)
- Julen Sanz-Serrano
- In Vitro Toxicology and Dermato-Cosmetology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ellen Callewaert
- In Vitro Toxicology and Dermato-Cosmetology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sybren De Boever
- In Vitro Toxicology and Dermato-Cosmetology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annika Drees
- In Vitro Toxicology and Dermato-Cosmetology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anouk Verhoeven
- In Vitro Toxicology and Dermato-Cosmetology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mathieu Vinken
- In Vitro Toxicology and Dermato-Cosmetology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Therkorn JH, Mathewson BA, Laursen CJ, Maberti S, Aizenberg V, Dinkelacker BT, Rege S. Methods to assess dermal exposures in occupational settings: a scoping review. Ann Work Expo Health 2024:wxae015. [PMID: 38466914 DOI: 10.1093/annweh/wxae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/27/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES The dermal exposure route is expected to become increasingly significant relative to total worker exposure as inhalational exposure limits continue to decrease. However, standardization of occupational exposure assessment methods and scientific consensus are needed. This is the first scoping review mapping the literature across all dermal exposure assessment methods and their targeted substances/chemicals in occupational settings. METHODS Eligibility criteria broadly included studies reporting any noninvasive dermal exposure assessment method in an occupational setting. The literature search (Web of Science and MEDLINE) was restricted to peer-reviewed, primary literature published in the last 20 years (2002-2022). Titles/abstracts were dual independently screened. Data charting was performed by a single reviewer using standard template. All stages were pilot tested. The JBI (formerly, the Joanna Briggs Institute) scoping review methods and PRISMA-ScR checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) were used. RESULTS In total, 493 articles were data charted and categorized by 4 study types: methods development (22%), exposure assessment (51%), health outcomes (21%), and controls assessment (6%). Fourteen types of dermal exposure assessment methods were charted with biomarkers (51%), dosimeters (21%), and qualitative assessments such as questionnaires or surveys (17%) most common. Seventeen different chemicals/substances were charted; pesticides (28%) and polycyclic aromatic hydrocarbons (PAHs) (22%) associated with crude oil products and combustion were most common. Mapping between substances and exposure assessment method categories, pesticide dosimeters (11%), and PAH biomarker studies (14%) were most reported. Literature gaps were identified for cleaning agents, hair dyes, glycol ether, N,N-dimethylformamide/N-methyl-2-pyrrolidone, dioxins, and bisphenol A. CONCLUSIONS To foster scientific consensus, standardization across study reporting is needed for describing: (i) exposure assessment methods used, (ii) worker tasking/conditions, (iii) targeted substances and substance state, and (iv) targeted exposure routes. Overall, this review categorizes, maps, and defines the scope of literature for occupational dermal exposure assessment methods.
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Affiliation(s)
- Jennifer H Therkorn
- ExxonMobil Biomedical Sciences, Inc., 1545 U.S. Highway 22 East, Annandale, NJ, United States
| | - Brittany A Mathewson
- ExxonMobil Biomedical Sciences, Inc., 1545 U.S. Highway 22 East, Annandale, NJ, United States
| | - Christopher J Laursen
- ExxonMobil Technology & Engineering, 22777 Springwoods Village Parkway, Spring, TX, United States
| | - Silvia Maberti
- ExxonMobil Biomedical Sciences, Inc., 1545 U.S. Highway 22 East, Annandale, NJ, United States
| | - Vitaly Aizenberg
- ExxonMobil Biomedical Sciences, Inc., 1545 U.S. Highway 22 East, Annandale, NJ, United States
| | - Brian T Dinkelacker
- ExxonMobil Biomedical Sciences, Inc., 1545 U.S. Highway 22 East, Annandale, NJ, United States
| | - Saumitra Rege
- ExxonMobil Biomedical Sciences, Inc., 1545 U.S. Highway 22 East, Annandale, NJ, United States
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Hayek SS, Zaha VG, Bogle C, Deswal A, Langston A, Rotz S, Vasbinder A, Yang E, Okwuosa T. Cardiovascular Management of Patients Undergoing Hematopoietic Stem Cell Transplantation: From Pretransplantation to Survivorship: A Scientific Statement From the American Heart Association. Circulation 2024. [PMID: 38465648 DOI: 10.1161/cir.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Hematopoietic stem cell transplantation can cure various disorders but poses cardiovascular risks, especially for elderly patients and those with cardiovascular diseases. Cardiovascular evaluations are crucial in pretransplantation assessments, but guidelines are lacking. This American Heart Association scientific statement summarizes the data on transplantation-related complications and provides guidance for the cardiovascular management throughout transplantation. Hematopoietic stem cell transplantation consists of 4 phases: pretransplantation workup, conditioning therapy and infusion, immediate posttransplantation period, and long-term survivorship. Complications can occur during each phase, with long-term survivors facing increased risks for late effects such as cardiovascular disease, secondary malignancies, and endocrinopathies. In adults, arrhythmias such as atrial fibrillation and flutter are the most frequent acute cardiovascular complication. Acute heart failure has an incidence ranging from 0.4% to 2.2%. In pediatric patients, left ventricular systolic dysfunction and pericardial effusion are the most common cardiovascular complications. Factors influencing the incidence and risk of complications include pretransplantation therapies, transplantation type (autologous versus allogeneic), conditioning regimen, comorbid conditions, and patient age. The pretransplantation cardiovascular evaluation consists of 4 steps: (1) initial risk stratification, (2) exclusion of high-risk cardiovascular disease, (3) assessment of cardiac reserve, and (4) optimization of cardiovascular reserve. Clinical risk scores could be useful tools for the risk stratification of adult patients. Long-term cardiovascular management of hematopoietic stem cell transplantation survivors includes optimizing risk factors, monitoring, and maintaining a low threshold for evaluating cardiovascular causes of symptoms. Future research should prioritize refining risk stratification and creating evidence-based guidelines and strategies to optimize outcomes in this growing patient population.
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35
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Morris CS, Keen MA, White C, Ingram PB, Mitchell SM, Victor SE. Determining the MMPI-3 SUI scale's cross-sectional and prospective utility in suicide risk assessment. J Clin Psychol 2024. [PMID: 38466342 DOI: 10.1002/jclp.23664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE In-depth suicide risk assessments are particularly important to long-term suicide prevention. Broadband measures of psychopathology, such as the Minnesota Multiphasic Personality Inventory (MMPI) instruments, assess suicide risk factors and various mental health comorbidities. With the recent release of the MMPI-3, the Suicidal/Death Ideation (SUI) scale underwent revisions to improve its construct validity and detection of suicide risk factors. Thus, we hypothesized the MMPI-3 SUI scale would demonstrate medium to large associations with suicidal experience and behaviors, future ideation, and interpersonal risk factors of suicide. METHODS A sample of 124 college students screened for elevated depressive symptoms completed a brief longitudinal study. Participants completed a baseline session including the MMPI-3 and criterion measures and three brief follow-ups every 2 weeks. RESULTS SUI scores were most robustly associated with increased risk for past suicidal ideation, planning, and perceived burdensomeness. Prospectively assessed suicidal ideation was also meaningfully associated with SUI. SUI scale elevations indicate an increased risk of suicide-related risk factors. CONCLUSION The MMPI-3 is a valuable tool to inform long-term suicide prevention for those experiencing elevated depressive symptoms as the SUI scale can assess past, current, and future suicide-related risk factors, including suicidal ideation and behaviors.
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Affiliation(s)
- Cole S Morris
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Megan A Keen
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Chloe White
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Sean M Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Sarah E Victor
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
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Nair M, Lundgren LE, Soliman A, Dryselius P, Fogelberg E, Petersson M, Hamed O, Triantafyllou M, Nygren J. Machine Learning Model for Readmission Prediction of Patients With Heart Failure Based on Electronic Health Records: Protocol for a Quasi-Experimental Study for Impact Assessment. JMIR Res Protoc 2024; 13:e52744. [PMID: 38466983 DOI: 10.2196/52744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Care for patients with heart failure (HF) causes a substantial load on health care systems where a prominent challenge is the elevated rate of readmissions within 30 days following initial discharge. Clinical professionals face high levels of uncertainty and subjectivity in the decision-making process on the optimal timing of discharge. Unwanted hospital stays generate costs and cause stress to patients and potentially have an impact on care outcomes. Recent studies have aimed to mitigate the uncertainty by developing and testing risk assessment tools and predictive models to identify patients at risk of readmission, often using novel methods such as machine learning (ML). OBJECTIVE This study aims to investigate how a developed clinical decision support (CDS) tool alters the decision-making processes of health care professionals in the specific context of discharging patients with HF, and if so, in which ways. Additionally, the aim is to capture the experiences of health care practitioners as they engage with the system's outputs to analyze usability aspects and obtain insights related to future implementation. METHODS A quasi-experimental design with randomized crossover assessment will be conducted with health care professionals on HF patients' scenarios in a region located in the South of Sweden. In total, 12 physicians and nurses will be randomized into control and test groups. The groups shall be provided with 20 scenarios of purposefully sampled patients. The clinicians will be asked to take decisions on the next action regarding a patient. The test group will be provided with the 10 scenarios containing patient data from electronic health records and an outcome from an ML-based CDS model on the risk level for readmission of the same patients. The control group will have 10 other scenarios without the CDS model output and containing only the patients' data from electronic medical records. The groups will switch roles for the next 10 scenarios. This study will collect data through interviews and observations. The key outcome measures are decision consistency, decision quality, work efficiency, perceived benefits of using the CDS model, reliability, validity, and confidence in the CDS model outcome, integrability in the routine workflow, ease of use, and intention to use. This study will be carried out in collaboration with Cambio Healthcare Systems. RESULTS The project is part of the Center for Applied Intelligent Systems Research Health research profile, funded by the Knowledge Foundation (2021-2028). Ethical approval for this study was granted by the Swedish ethical review authority (2022-07287-02). The recruitment process of the clinicians and the patient scenario selection will start in September 2023 and last till March 2024. CONCLUSIONS This study protocol will contribute to the development of future formative evaluation studies to test ML models with clinical professionals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52744.
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Affiliation(s)
- Monika Nair
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Lina E Lundgren
- School of Business, Innovation and Sustainability, Halmstad University, Halmstad, Sweden
| | - Amira Soliman
- School of Information Technology, Halmstad University, Halmstad, Sweden
| | | | | | | | - Omar Hamed
- School of Information Technology, Halmstad University, Halmstad, Sweden
| | | | - Jens Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Zhang RX, Liu YJ, Luo YN, Li JQ, Li CX, Li JJ, Zhang C. [Spatial and Temporal Distribution and Risk Assessment of Heavy Metals in Surface Water of Changshou Lake Reservoir, Chongqing]. Huan Jing Ke Xue 2024; 45:1428-1438. [PMID: 38471858 DOI: 10.13227/j.hjkx.202304147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
To understand the water pollution status and environmental risks of Changshou Lake, the concentrations of heavy metals (Cr, Cu, Zn, As, Cd, and Pb) in the water were collected and analyzed during different seasons. The study investigated temporal and spatial variations, distribution characteristics, pollution levels, and health risks associated with heavy metals in Changshou Lake. The results showed that all six heavy metals were below than the Class Ⅰ standard of the Surface Water Environmental Quality Standard (GB 3838-2002), but recent years have witnessed an increasing trend, with Cu, As, and Pb showing a significant increase (P<0.05). The temporal and spatial distributions of these heavy metals were different. Temporally, Cr and Cd concentrations in surface water were higher in summer, As and Zn were higher in spring, and Pb and Cu were higher in autumn and winter. Spatially, the concentrations of Cr, As, Cu, Zn, and Pb showed higher concentrations in the southern outlet of the reservoir, the northwestern Longxi River inlet, and the central part of the reservoir, whereas Cd was higher in the northern stagnant area. The overall levels of heavy metals in the water body of Changshou Lake were low, with Cr and Cu slightly polluted, while other heavy metals were identified as having an insignificant pollution level. Drinking water was the primary exposure pathway to carcinogenic and non-carcinogenic heavy metals in surface water bodies. The health risk values of Cr and As in water bodies were high, ranging from 6.2×10-10 to 3.0×10-4 and 5.1×10-8 to 3.9×10-5, respectively. The corresponding contribution rates for children and adults to the total health risk were high, with Cr accounting for 87.18% and 87.20%, respectively, while As accounted for 12.73% and 12.71%, respectively. Therefore, it is crucial to prioritize environmental risks associated with Cr and Cu, as well as the health risks associated with Cr and As in Changshou Lake These findings provide a scientific foundation for water pollution control and environmental quality improvement in Changshou Lake, and rational development and utilization of water resources.
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Affiliation(s)
- Rui-Xi Zhang
- College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Ya-Jun Liu
- College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Yong-Nan Luo
- College of Resources and Environment, Southwest University, Chongqing 400715, China
- Yellow River Conservancy Commission Hydrology and Water Resources Bureau of Henan, Zhengzhou 450008, China
| | - Jie-Qin Li
- College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Cai-Xia Li
- College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Jia-Jia Li
- College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Cheng Zhang
- College of Resources and Environment, Southwest University, Chongqing 400715, China
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Zhao CM, He B, Li HT, Zhang RQ, Li YY, Zhang FW, Gui X, Ma L. [Occurrence Characteristic and Risk Assessment of Microplastics in Sishui River (Xingyang Section)]. Huan Jing Ke Xue 2024; 45:1457-1467. [PMID: 38471861 DOI: 10.13227/j.hjkx.202304057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Urban rivers are the main receptors and transporters of microplastic pollution. Understanding the occurrence and environmental risk of microplastics in urban rivers can provide theoretical basis for further control of microplastic pollution. The Sishui River, a tributary of the Yellow River, was selected as the research object. A total of nine water samples were collected from sewage outlets of the Sishui River (Xingyang section). The microplastics in the collected samples were characterized by their sizes, shapes, and colors using a microscope. It was found that microplastics were mostly in the form of transparent fibers and fragments in the water body of sewage outlets, of which the size below 500 μm was relatively high. In addition, PET and PE polymers were identified as the main types using a laser infrared imager. The correlation analysis showed that there was a significant correlation between the PET and PE, indicating that they were similar in origin. The results of the environmental risk assessment showed that the type of microplastics was the main factor affecting the assessment results, whereas the risk values of six sewage samples containing PVC were high. However, the value of pollution load index revealed a low risk level of pollutants in the study area.
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Affiliation(s)
- Chang-Min Zhao
- Zhengzhou Ecological Environment Monitoring Center of Henan Province, Zhengzhou 450007, China
| | - Bing He
- Zhengzhou Ecological Environment Monitoring Center of Henan Province, Zhengzhou 450007, China
| | - He-Tong Li
- Zhengzhou Ecological Environment Monitoring Center of Henan Province, Zhengzhou 450007, China
| | - Rui-Qi Zhang
- College of Forestry, Henan Agricultural University, Zhengzhou 450046, China
| | - Yin-Yue Li
- College of Forestry, Henan Agricultural University, Zhengzhou 450046, China
| | - Fa-Wen Zhang
- College of Forestry, Henan Agricultural University, Zhengzhou 450046, China
| | - Xin Gui
- College of Forestry, Henan Agricultural University, Zhengzhou 450046, China
| | - Li Ma
- College of Forestry, Henan Agricultural University, Zhengzhou 450046, China
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Fulbrook P, Lovegrove J, Ven S, Miles SJ. Pressure injury risk assessment and prescription of preventative interventions using a structured tool versus clinical judgement: An interrater agreement study. J Adv Nurs 2024. [PMID: 38450740 DOI: 10.1111/jan.16142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
AIM To assess agreement of pressure injury risk level and differences in preventative intervention prescription between nurses using a structured risk assessment tool compared with clinical judgement. DESIGN Interrater agreement study. METHODS Data were collected from November 2019 to December 2022. Paired nurse-assessors were allocated randomly to independently assess pressure injury risk using a structured tool (incorporating the Waterlow Score), or clinical judgement; then prescribe preventative interventions. Assessments were conducted on 150 acute patient participants in a general tertiary hospital. Agreement of risk level was analysed using absolute agreement proportions, weighted kappa and prevalence-adjusted and bias-adjusted kappa. RESULTS Ninety-four nurse assessors participated. Absolute agreement of not-at-risk versus at-risk-any-level was substantial, but absolute agreement of risk-level was only fair. Clinical judgement assessors tended to underestimate risk. Where risk level was agreed, prescribed intervention frequencies were similar, although structured tool assessors prescribed more interventions mandated by standard care, while clinical judgement assessors prescribed more additional/optional interventions. Structured tool assessors prescribed more interventions targeted at lower-risk patients, whereas assessors using clinical judgement prescribed more interventions targeted at higher-risk patients. CONCLUSION There were clear differences in pressure injury risk-level assessment between nurses using the two methods, with important differences in intervention prescription frequencies found. Further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk, with emphasis on the impact of risk assessments on subsequent preventative intervention implementation. IMPACT The results of this study are important for clinical practice as they demonstrate the influence of using a structured pressure injury risk assessment tool compared to clinical judgement. Whilst further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk and prescribe interventions, our findings do not support a change in practice that would exclude the use of a structured pressure injury risk assessment tool. REPORTING METHOD This study adhered to the GRRAS reporting guideline. PATIENT/PUBLIC CONTRIBUTION No patient or public involvement in this study. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Educators and researchers can use the findings to guide teaching about pressure injury risk assessment and preventative intervention and to direct future studies. For clinical nurses and patients, a change in clinical practice that would exclude the use of a structured risk assessment tool is not recommended and further work is needed to validate the role of clinical judgement to assess risk and its impact on preventative intervention.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland, Australia
| | - Saroeun Ven
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Sandra J Miles
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Australia
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Caballé-Pérez M, Santos-Hermoso J, López-Ossorio JJ, Soria-Verde MA, Amor PJ, González-Álvarez JL. Risk Factors for Multiple Violations of Protective Orders in Intimate Partner Violence Against Women. Violence Vict 2024; 39:21-37. [PMID: 38453372 DOI: 10.1891/vv-2021-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
This study examined 1,134 cases of violence against women in intimate partner relationships with violations of protective orders in a monitoring period of up to 15 months. The dynamics of time and violence were analyzed in the cases of multiple violation versus one-time violation, with the objective of identifying and thus neutralizing the risk factors for this type of recidivism. The results showed that early violation, serious physical violence, death threats, as well as jealousy, harassment, and control are related to multiple violation. This article discusses the results in comparison with other research and proposes measures to avoid revictimizations.
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Affiliation(s)
- Marta Caballé-Pérez
- Profiling and Criminal Behavior Analysis Group (PACC-UB), Faculty of Law, University of Barcelona, Barcelona, Spain
| | - Jorge Santos-Hermoso
- Department of Criminology, Faculty of Legal Sciences, Universidad a Distancia de Madrid (UDIMA), Madrid, Spain
| | - Juan José López-Ossorio
- Research and Training Area, Secretary of State for Security, Ministry of the Interior, Madrid, Spain
- Institute of Forensic Sciences and Security, Autonomous University of Madrid, Madrid, Spain
| | - Miguel Angel Soria-Verde
- Profiling and Criminal Behavior Analysis Group (PACC-UB), Faculty of Law, University of Barcelona, Barcelona, Spain
- Department of Social and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Pedro J Amor
- Department of Personality, Assessment, and Psychological Treatment, Faculty of Psychology, National Distance Education University, Madrid, Spain
| | - José Luis González-Álvarez
- Research and Training Area, Secretary of State for Security, Ministry of the Interior, Madrid, Spain
- Institute of Forensic Sciences and Security, Autonomous University of Madrid, Madrid, Spain
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Kornas K, Tait C, Negatu E, Rosella LC. External validation and application of the Diabetes Population Risk Tool (DPoRT) for prediction of type 2 diabetes onset in the US population. BMJ Open Diabetes Res Care 2024; 12:e003905. [PMID: 38453237 PMCID: PMC10921488 DOI: 10.1136/bmjdrc-2023-003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Characterizing diabetes risk in the population is important for population health assessment and diabetes prevention planning. We aimed to externally validate an existing 10-year population risk model for type 2 diabetes in the USA and model the population benefit of diabetes prevention approaches using population survey data. RESEARCH DESIGN AND METHODS The Diabetes Population Risk Tool (DPoRT), originally derived and validated in Canada, was applied to an external validation cohort of 23 477 adults from the 2009 National Health Interview Survey (NHIS). We assessed predictive performance for discrimination (C-statistic) and calibration plots against observed incident diabetes cases identified from the NHIS 2009-2018 cycles. We applied DPoRT to the 2018 NHIS cohort (n=21 187) to generate 10-year risk prediction estimates and characterize the preventive benefit of three diabetes prevention scenarios: (1) community-wide strategy; (2) high-risk strategy and (3) combined approach. RESULTS DPoRT demonstrated good discrimination (C-statistic=0.778 (males); 0.787 (females)) and good calibration across the range of risk. We predicted a baseline risk of 10.2% and 21 076 000 new cases of diabetes in the USA from 2018 to 2028. The community-wide strategy and high-risk strategy estimated diabetes risk reductions of 0.2% and 0.3%, respectively. The combined approach estimated a 0.4% risk reduction and 843 000 diabetes cases averted in 10 years. CONCLUSIONS DPoRT has transportability for predicting population-level diabetes risk in the USA using routinely collected survey data. We demonstrate the model's applicability for population health assessment and diabetes prevention planning. Our modeling predicted that the combination of community-wide and targeted prevention approaches for those at highest risk are needed to reduce diabetes burden in the USA.
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Affiliation(s)
- Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Tait
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ednah Negatu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Temerty Faculty of Medicine, Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada
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Li C, Li X, Bank MS, Dong T, Fang JKH, Leusch FDL, Rillig MC, Wang J, Wang L, Xia Y, Xu EG, Yang Y, Zhang C, Zhu D, Liu J, Jin L. The "Microplastome" - A Holistic Perspective to Capture the Real-World Ecology of Microplastics. Environ Sci Technol 2024; 58:4060-4069. [PMID: 38331396 PMCID: PMC10919093 DOI: 10.1021/acs.est.3c08849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
Microplastic pollution, an emerging pollution issue, has become a significant environmental concern globally due to its ubiquitous, persistent, complex, toxic, and ever-increasing nature. As a multifaceted and diverse suite of small plastic particles with different physicochemical properties and associated matters such as absorbed chemicals and microbes, future research on microplastics will need to comprehensively consider their multidimensional attributes. Here, we introduce a novel, conceptual framework of the "microplastome", defined as the entirety of various plastic particles (<5 mm), and their associated matters such as chemicals and microbes, found within a sample and its overall environmental and toxicological impacts. As a novel concept, this paper aims to emphasize and call for a collective quantification and characterization of microplastics and for a more holistic understanding regarding the differences, connections, and effects of microplastics in different biotic and abiotic ecosystem compartments. Deriving from this lens, we present our insights and prospective trajectories for characterization, risk assessment, and source apportionment of microplastics. We hope this new paradigm can guide and propel microplastic research toward a more holistic era and contribute to an informed strategy for combating this globally important environmental pollution issue.
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Affiliation(s)
- Changchao Li
- Environment
Research Institute, Shandong University, Qingdao 266237, China
- Department
of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Kowloon 999077, Hong Kong
| | - Xinyu Li
- Department
of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Kowloon 999077, Hong Kong
| | - Michael S. Bank
- Institute
of Marine Research, 5005 Bergen, Norway
- University
of Massachusetts Amherst, Amherst, Massachusetts 01003, United States
| | - Tao Dong
- Department
of Immunology and Microbiology, School of Life Sciences, Southern University of Science and Technology, Shenzhen 518055, China
| | - James Kar-Hei Fang
- Department
of Food Science and Nutrition and Research Institute for Future Food, The Hong Kong Polytechnic University, Kowloon 999077, Hong Kong
- State Key
Laboratory of Marine Pollution, City University
of Hong Kong, Kowloon Tong 999077, Hong Kong
| | - Frederic D. L. Leusch
- Australian
Rivers Institute, School of Environment and Science, Griffith University, Gold Coast, 4222 Queensland, Australia
| | | | - Jie Wang
- Beijing
Key Laboratory of Farmland Soil Pollution Prevention and Remediation,
College of Resources and Environmental Sciences, China Agricultural University, Beijing 100193, China
| | - Lei Wang
- MOE Key
Laboratory of Pollution Processes and Environmental Criteria, College
of Environmental Science and Engineering, Nankai University, Tianjin 300350, China
| | - Yu Xia
- School
of Environmental Science and Engineering, College of Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Elvis Genbo Xu
- Department
of Biology, University of Southern Denmark, Odense 5230, Denmark
| | - Yuyi Yang
- Key Laboratory
of Aquatic Botany and Watershed Ecology, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan 430070, China
| | - Chao Zhang
- Environment
Research Institute, Shandong University, Qingdao 266237, China
| | - Dong Zhu
- Key Laboratory
of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China
| | - Jian Liu
- Environment
Research Institute, Shandong University, Qingdao 266237, China
| | - Ling Jin
- Department
of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Kowloon 999077, Hong Kong
- State Key
Laboratory of Marine Pollution, City University
of Hong Kong, Kowloon Tong 999077, Hong Kong
- Department
of Health Technology and Informatics, The
Hong Kong Polytechnic University, Kowloon 999077, Hong Kong
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Fowler L, Vara A, Ng L. Psychiatric trainees' experiences of workplace violence: qualitative analysis. BJPsych Bull 2024:1-6. [PMID: 38436095 DOI: 10.1192/bjb.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
AIMS AND METHOD We aimed to explore experiences of workplace violence in a New Zealand sample of psychiatric trainees and to identify barriers to achieving safe practice and ways of enhancing workplace safety. In a qualitative study, we used interpretive description to inform and design in-depth exploration of participants' experiences. We interviewed 12 psychiatric trainees. Data were analysed using reflexive thematic analysis. RESULTS There were three main themes: (a) violence as 'part of the job', leading to a culture of silence; (b) empowering trainees to address a sense of learned helplessness; and (c) conflict embedded within the unique nature of psychiatry. CLINICAL IMPLICATIONS Organisation-led systems-based procedures are instrumental in promoting workplace safety. Specific measures include peer-based support and implementing clear, tailored safety protocols, particularly for situations of crisis assessment. Training should include culturally focused education with specific guidance to mitigate violence.
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Affiliation(s)
| | - Alisha Vara
- University of Auckland, Auckland, New Zealand
| | - Lillian Ng
- University of Auckland, Auckland, New Zealand
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Ben-Menachem E, Ashes C, Lepar G, Deacon J, Glavan N, Molan V, Watson A. Smaller rectus femoris size measured by ultrasound is associated with poorer outcomes after cardiac surgery. J Thorac Cardiovasc Surg 2024; 167:1115-1122.e5. [PMID: 35995604 DOI: 10.1016/j.jtcvs.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to evaluate the association of low rectus femoris cross-sectional area (RFCSA) with hospital length of stay and poorer outcomes in patients undergoing cardiac surgery. METHODS A single right-leg RFCSA was measured with ultrasound preoperatively and baseline characteristics, clinical data, and outcomes recorded. Patients were categorized as low rectus femoris muscle size (lowRF) or normal rectus femoris muscle size (normalRF), if they were in the lowest quartile or not, respectively. All analyses were performed on both body surface area (BSA)- and sex-adjusted RFCSA. RESULTS One hundred eight-four patients had a RFCSA measured with a mean of 5.01 cm2 (1.41 cm2), and range of 0.71 to 8.77 cm2. When analyzing the BSA-adjusted RFCSA, we found the lowRF group had a longer hospital stay, 11.0 days [7.0-16.3] versus 8.0 days [6.0-10.0] for the normalRF group (P < .001), and a greater proportion of extended hospital stay (≥18.5 days) of 19.6% compared with 6.2% (P = .010). When the RFCSA was adjusted for sex, the lowRF group had a greater length of hospital stay, 9.0 days [7.0-14.5] versus 8.0 days [6.0-11.0] (P = .049). In both the BSA- and sex-adjusted RFCSA, the lowRF group suffered greater morbidity and were more likely discharged to a destination other than home. In multivariate analyses adjusting for European System for Cardiac Operative Risk Evaluation II, BSA-adjusted lowRF but not sex-adjusted lowRF was independently associated with log-transformed hospital length of stay. LowRF was not independently associated with increased major morbidity and death for both BSA and sex-adjusted RFCSA. CONCLUSIONS Low RFCSA has a significant association with increased hospital length of stay, morbidity, and nonhome discharge in patients undergoing cardiac procedures. TRIAL REGISTRY NUMBER ACTRN12620000678998.
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Affiliation(s)
- Erez Ben-Menachem
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; Notre Dame School of Medicine, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.
| | - Catherine Ashes
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Gila Lepar
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - James Deacon
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Nicole Glavan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Veronique Molan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Alasdair Watson
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia; Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
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de Kort P, Jensen E, Spence MW, Plehiers PM. Risk assessment-based verification of the CertiPUR TM limit values for toluene diamine and methylene dianiline in flexible polyurethane foam. Toxicol Ind Health 2024; 40:104-116. [PMID: 38166466 PMCID: PMC10851636 DOI: 10.1177/07482337231224514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/04/2024]
Abstract
Flexible polyurethane foams (PUF) are used in many consumer products. PUF may contain trace levels of aromatic diamine impurities that could represent a potential health risk. The risk associated with sleeping on a PUF mattress was evaluated. Toxicity benchmarks for sensitization and non-cancer endpoints were derived from the respective points-of-departure using standard assessment factors. For the cancer endpoints, toxicity benchmarks were derived from the 25th-percentile values of animal studies. Recently published emission and migration data allowed to link exposure with the CertiPURTM voluntary quality limits of ≤5 mg.kg-1 for 2,4-toluene diamine and 4,4'-methylene dianiline in PUF. Using conservative exposure scenarios, lifetime-average daily internal doses from the combined inhalation and dermal exposures were calculated. Margins of safety for non-cancer and sensitization endpoints were >104. The theoretical excess cancer risk was ≤1.5 × 10-7. It is concluded that sleeping on a mattress that satisfies the CertiPUR limit value does not pose undue risk to consumers.
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Affiliation(s)
| | | | - Mark W Spence
- International Isocyanate Institute, Inc, Mountain Lakes, NJ, USA
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46
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Lee JY, Kim M, Kim J, Im H, Kim YS. Monitoring, exposure and risk assessment of formaldehyde in alcoholic beverages in Korea. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2024; 41:237-248. [PMID: 38315754 DOI: 10.1080/19440049.2024.2306540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024]
Abstract
Formaldehyde occurs naturally in food and alcoholic beverages. Formaldehyde and alcoholic beverages can cause various health problems, including irritation of the eyes, nose, and throat, respiratory problems, and skin rashes. Alcoholic beverage samples (N = 236) were collected and analyzed for formaldehyde by liquid chromatography-tandem mass spectrometry. The highest average concentrations were detected in fruit wines (1.71 µg/g), followed by wines (1.15 µg/g), cheongju (0.95 µg/g), soju (0.85 µg/g), takju (0.64 µg/g) and beers (0.61 µg/g). We assessed the exposure and risk assessment to formaldehyde from alcoholic beverages based on the monitoring data for the general population and consumers in Korea using various schemes for point estimation. The daily intakes of formaldehyde for the general population and consumers were estimated to be 83 µg and 1202 µg, respectively. The mean hazard indexes (HI) for the general population and consumers in Korea were 0.009 and 0.132, respectively. On the other hand, the mean hazard indexes (HI) for the general population and consumers in Korea were 0.009 and 0.132, respectively. The exposure to formaldehyde in these alcoholic beverages for the Korean population was shown to be of low concern, but it is necessary to monitor the level of formaldehyde in alcoholic beverages and continuously conduct exposure assessment for consumers.
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Affiliation(s)
- Ji-Yoon Lee
- Department of Food Science and Biotechnology, Ewha Womans University, Seoul, Republic of Korea
| | - Meehye Kim
- Department of Food Science and Biotechnology, Ewha Womans University, Seoul, Republic of Korea
| | - Jongdae Kim
- PeakmanSP CO., LTD, Hanam, Gyeonggi-do, Republic of Korea
| | - Hobin Im
- PeakmanSP CO., LTD, Hanam, Gyeonggi-do, Republic of Korea
| | - Young-Suk Kim
- Department of Food Science and Biotechnology, Ewha Womans University, Seoul, Republic of Korea
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47
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Zhang Y, Jiao B, Zhao Q, Wang C, Chen A, Cui Y, He Y, Li J. Determination, temporal variation and potential health risk assessment of pesticide residues in grapes from South and Southwest China. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2024; 41:287-302. [PMID: 38295304 DOI: 10.1080/19440049.2024.2309256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
Pesticide residues in grapes from South and Southwest China were determined using the QuEChERS procedure and UHPLC-MS/MS and GC-MS/MS methods. The 4-year monitoring and survey showed 94.6% of the 1341 samples of grapes collected from eight main production areas contained one or multiple pesticide residues (above the respective LOQs). Overall, 40 pesticides were detected, including 24 fungicides, 12 insecticides, 2 acaricides and 2 plant growth modulators, of which one pesticide was unauthorised for use in treating grapes. Two or more pesticide residues were discovered in 87.4% of the samples (above the respective LOQs), and pesticide residues in 5.7% of the samples exceeded the MRLs, such as difenoconazole, cyhalothrin, propiconazole, etc. The main risk factors affecting the safety of grape before 2019 were difenoconazole, cyhalothrin and cyazofamid. After 2019, however, the frequency of occurrence of the above pesticides significantly declined, and the banned or restricted pesticides including omethoate were not found, which was credited to the stricter supervision and management policies by local governments. Despite the high detection rates and multi-residue occurrence of pesticides in grapes, about 84% of the samples were compliant with regulatory standards. Moreover, the accumulative chronic diet risk determined from ADI is very low. This study and timely monitoring can ensure that grape growers comply with GAP and minimise the occurrence of residues.
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Affiliation(s)
- Yaohai Zhang
- Citrus Research Institute, Southwest University, Chongqing, PR China
- Quality Supervision and Testing Center for Citrus and Seedling, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Key Laboratory of Quality and Safety Control of Citrus Fruits, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Laboratory of Quality and Safety Risk Assessment for Citrus Products, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- National Citrus Engineering Research Center, Chongqing, PR China
| | - Bining Jiao
- Citrus Research Institute, Southwest University, Chongqing, PR China
- Quality Supervision and Testing Center for Citrus and Seedling, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Key Laboratory of Quality and Safety Control of Citrus Fruits, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Laboratory of Quality and Safety Risk Assessment for Citrus Products, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- National Citrus Engineering Research Center, Chongqing, PR China
| | - Qiyang Zhao
- Citrus Research Institute, Southwest University, Chongqing, PR China
- Quality Supervision and Testing Center for Citrus and Seedling, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Key Laboratory of Quality and Safety Control of Citrus Fruits, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Laboratory of Quality and Safety Risk Assessment for Citrus Products, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- National Citrus Engineering Research Center, Chongqing, PR China
| | - Chengqiu Wang
- Citrus Research Institute, Southwest University, Chongqing, PR China
- Quality Supervision and Testing Center for Citrus and Seedling, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Key Laboratory of Quality and Safety Control of Citrus Fruits, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Laboratory of Quality and Safety Risk Assessment for Citrus Products, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- National Citrus Engineering Research Center, Chongqing, PR China
| | - Aihua Chen
- Citrus Research Institute, Southwest University, Chongqing, PR China
- Quality Supervision and Testing Center for Citrus and Seedling, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Key Laboratory of Quality and Safety Control of Citrus Fruits, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Laboratory of Quality and Safety Risk Assessment for Citrus Products, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- National Citrus Engineering Research Center, Chongqing, PR China
| | - Yongliang Cui
- Citrus Research Institute, Southwest University, Chongqing, PR China
- Quality Supervision and Testing Center for Citrus and Seedling, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Key Laboratory of Quality and Safety Control of Citrus Fruits, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Laboratory of Quality and Safety Risk Assessment for Citrus Products, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- National Citrus Engineering Research Center, Chongqing, PR China
| | - Yue He
- Citrus Research Institute, Southwest University, Chongqing, PR China
- Quality Supervision and Testing Center for Citrus and Seedling, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Key Laboratory of Quality and Safety Control of Citrus Fruits, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Laboratory of Quality and Safety Risk Assessment for Citrus Products, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- National Citrus Engineering Research Center, Chongqing, PR China
| | - Jing Li
- Citrus Research Institute, Southwest University, Chongqing, PR China
- Quality Supervision and Testing Center for Citrus and Seedling, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Key Laboratory of Quality and Safety Control of Citrus Fruits, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- Laboratory of Quality and Safety Risk Assessment for Citrus Products, Ministry of Agriculture and Rural Affairs, Chongqing, PR China
- National Citrus Engineering Research Center, Chongqing, PR China
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Choi E, Luo SJ, Ding VY, Wu JT, Kumar AV, Wampfler J, Tammemägi MC, Wilkens LR, Aredo JV, Backhus LM, Neal JW, Leung AN, Freedman ND, Hung RJ, Amos CI, Marchand LL, Cheng I, Wakelee HA, Yang P, Han SS. Risk model-based management for second primary lung cancer among lung cancer survivors through a validated risk prediction model. Cancer 2024; 130:770-780. [PMID: 37877788 PMCID: PMC10922086 DOI: 10.1002/cncr.35069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Recent therapeutic advances and screening technologies have improved survival among patients with lung cancer, who are now at high risk of developing second primary lung cancer (SPLC). Recently, an SPLC risk-prediction model (called SPLC-RAT) was developed and validated using data from population-based epidemiological cohorts and clinical trials, but real-world validation has been lacking. The predictive performance of SPLC-RAT was evaluated in a hospital-based cohort of lung cancer survivors. METHODS The authors analyzed data from 8448 ever-smoking patients diagnosed with initial primary lung cancer (IPLC) in 1997-2006 at Mayo Clinic, with each patient followed for SPLC through 2018. The predictive performance of SPLC-RAT and further explored the potential of improving SPLC detection through risk model-based surveillance using SPLC-RAT versus existing clinical surveillance guidelines. RESULTS Of 8448 IPLC patients, 483 (5.7%) developed SPLC over 26,470 person-years. The application of SPLC-RAT showed high discrimination area under the receiver operating characteristics curve: 0.81). When the cohort was stratified by a 10-year risk threshold of ≥5.6% (i.e., 80th percentile from the SPLC-RAT development cohort), the observed SPLC incidence was significantly elevated in the high-risk versus low-risk subgroup (13.1% vs. 1.1%, p < 1 × 10-6 ). The risk-based surveillance through SPLC-RAT (≥5.6% threshold) outperformed the National Comprehensive Cancer Network guidelines with higher sensitivity (86.4% vs. 79.4%) and specificity (38.9% vs. 30.4%) and required 20% fewer computed tomography follow-ups needed to detect one SPLC (162 vs. 202). CONCLUSION In a large, hospital-based cohort, the authors validated the predictive performance of SPLC-RAT in identifying high-risk survivors of SPLC and showed its potential to improve SPLC detection through risk-based surveillance. PLAIN LANGUAGE SUMMARY Lung cancer survivors have a high risk of developing second primary lung cancer (SPLC). However, no evidence-based guidelines for SPLC surveillance are available for lung cancer survivors. Recently, an SPLC risk-prediction model was developed and validated using data from population-based epidemiological cohorts and clinical trials, but real-world validation has been lacking. Using a large, real-world cohort of lung cancer survivors, we showed the high predictive accuracy and risk-stratification ability of the SPLC risk-prediction model. Furthermore, we demonstrated the potential to enhance efficiency in detecting SPLC using risk model-based surveillance strategies compared to the existing consensus-based clinical guidelines, including the National Comprehensive Cancer Network.
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Affiliation(s)
- Eunji Choi
- Stanford University School of Medicine, Stanford, CA, USA
| | - Sophia J. Luo
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Julie T. Wu
- Stanford University School of Medicine, Stanford, CA, USA
| | - Ashok V. Kumar
- Department of Quantitative Health Science, Mayo Clinic, Scottsdale, AZ, USA
| | - Jason Wampfler
- Department of Quantitative Health Science, Mayo Clinic, Rochester, MN, USA
| | - Martin C. Tammemägi
- Department of Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Lynne R. Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | | | - Leah M. Backhus
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Joel W. Neal
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | - Ann N. Leung
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Neal D. Freedman
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rayjean J. Hung
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | | | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Heather A. Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | - Ping Yang
- Department of Quantitative Health Science, Mayo Clinic, Scottsdale, AZ, USA
| | - Summer S. Han
- Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Alhammad A, Yusof MM, Jambari DI. Towards an evaluation framework for medical device-integrated electronic medical record. Expert Rev Med Devices 2024; 21:217-229. [PMID: 38318674 DOI: 10.1080/17434440.2024.2315024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Medical device (MD)-integrated (I) electronic medical record (EMR) (MDI-EMR) poses cyber threats that undermine patient safety, and thus, they require effective control mechanisms. We reviewed the related literature, including existing EMR and MD risk assessment approaches, to identify MDI-EMR comprehensive evaluation dimensions and measures. AREAS COVERED We searched multiple databases, including PubMed, Web of Knowledge, Scopus, ACM, Embase, IEEE and Ingenta. We explored various evaluation aspects of MD and EMR to gain a better understanding of their complex integration. We reviewed numerous risk management and assessment frameworks related to MD and EMR security aspects and mitigation controls and then identified their common evaluation aspects. Our review indicated that previous evaluation frameworks assessed MD and EMR independently. To address this gap, we proposed an evaluation framework based on the sociotechnical dimensions of health information systems and risk assessment approaches for MDs to evaluate MDI-EMR integratively. EXPERT OPINION The emergence of MDI-EMR cyber threats requires appropriate evaluation tools to ensure the safe development and application of MDI-EMR. Consequently, our proposed framework will continue to evolve through subsequent validations and refinements. This process aims to establish its applicability in informing stakeholders of the safety level and assessing its effectiveness in mitigating risks for future improvements.
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Affiliation(s)
- Aeshah Alhammad
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Maryati Mohd Yusof
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Dian Indrayani Jambari
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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50
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Tafur AJ, Caprini JA. Dissecting the rationale for thromboprophylaxis in challenging surgical cases. J Thromb Haemost 2024; 22:613-619. [PMID: 38184204 DOI: 10.1016/j.jtha.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/02/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
Pulmonary embolism (PE) is a leading preventable cause of death in surgical patients, and rates of fatal PE are increasing. Individual assessment, to balance the risks of thrombosis and bleeding, is the key to providing appropriate prophylaxis. The risk assessment process includes use of evidence-based guidelines, literature published since the latest guidelines, large registries, and risk scoring systems together with clinical experience and judgment. Risk assessment is a dynamic process and needs to be updated both during the hospital stay and just prior to discharge since clinical events may change the level of risk. The final assessment may identify patients who require ongoing anticoagulant prophylaxis after discharge. The Caprini risk score is widely used in surgical patients and is a composite of the number of risk factors and their relative weights. The Caprini risk score set point for risk levels requiring anticoagulant prophylaxis varies depending on the type of surgical procedure, surgical population, and number of risk factors. Mandatory implementation of evidence-based care pathways is helpful in lowering PE-related mortality. This review presents several challenging cases, emphasizing the importance of employing all available assessment tools, including dynamic assessment of risk during hospitalization. Finally, the limitations of evidence-based guidelines in complex scenarios and the need to employ all available tools to properly protect very high-risk patients are emphasized.
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Affiliation(s)
- Alfonso J Tafur
- NorthShore University HealthSystem, Cardiovascular Institute, Evanston, Illinois, USA; University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
| | - Joseph A Caprini
- Emeritus NorthShore University HealthSystem, Evanston, Illinois, USA
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