Preface to the special issue "Pain".

This preface introduces the Journal of Neurochemistry Special Issue on pain research. While acute pain provides important sensory information, which aids in the protection of an organism, it can in some cases transition into a chronic state. Unfortunately, chronic pain is a highly disabling state characterised by intense and abnormal pain sensations, which are exacerbated by problematic psychosocial disturbances that are poorly treated by current drugs. This issue includes several reviews that address current issues spanning basic to clinical research on a range of pain syndromes. Also included is a collection of basic research articles investigating important aspects of pain signalling through to whole body aspects of pain integration.

European quality indicators developed by the European Commission Initiative on Breast Cancer: a first nationwide assessment for the Dutch setting.

PURPOSE: This observational study aims to assess the feasibility of calculating indicators developed by the European Commission Initiative on Breast Cancer (ECIBC) for the Dutch breast cancer population. METHODS: Patients diagnosed with invasive or in situ breast cancer between 2012 and 2018 were selected from the Netherlands Cancer Registry (NCR). Outcomes of the quality indicators (QI) were presented as mean scores and were compared to a stated norm. Variation between hospitals was assessed by standard deviations and funnel plots and trends over time were evaluated. The quality indicator calculator (QIC) was validated by comparing these outcomes with the outcomes of constructed algorithms in Stata. RESULTS: In total, 133,527 patients were included. Data for 24 out of 26 QIs were available in the NCR. For 67% and 67% of the QIs, a mean score above the norm and low or medium hospital variation was observed, respectively. The proportion of patients undergoing a breast reconstruction or neoadjuvant systemic therapy increased over time. The proportion treated within 4 weeks from diagnosis, having >10 lymph nodes removed or estrogen negative breast cancer who underwent adjuvant chemotherapy decreased. The outcomes of the constructed algorithms in this study and the QIC showed 100% similarity. CONCLUSION: Data from the NCR could be used for the calculation of more than 92% of the ECIBC indicators. The quality of breast cancer care in the Netherlands is high, as more than half of the QIs already score above the norm and medium hospital variation was observed. The QIC can be easy and reliably applied.

In situ and General Multidentate Ligand Passivation Achieves Efficient and Ultra-Stable CsPbX3 Perovskite Quantum Dots for White Light-Emitting Diodes.

Inorganic CsPbX3 perovskite quantum dots (PeQDs) show great potential in white light-emitting diodes (WLEDs) due to excellent optoelectronic properties, but their practical application is hampered by low photoluminescence quantum yield (PLQY) and especially poor stability. Herein,  we developed an in-situ and general multidentate ligand passivation strategy that allows for CsPbX3 PeQDs not only near-unit PLQY, but significantly improved stability against storage, heat, and polar solvent. The enhanced optical property arises from high effectiveness of the multidentate ligand, diethylenetriaminepentaacetic acid (DTPA) with five carboxyl groups, in passivating uncoordinated Pb2+ defects and suppressing nonradiative recombination. First-principles calculations reveal that the excellent stability is attributed to tridentate binding mode of DTPA that remarkably boosts the adsorption capacity to PeQD core. Finally, combining the green and red PeQDs with blue chip,  we demonstrated highly luminous WLEDs with distinctly enhanced operation stability, a wide color gamut of 121.3% of national television system committee, standard white light of (0.33,0.33) in CIE 1931, and tunable color temperatures from warm to cold white light readily by emitters' ratio. This study provides an operando yet general approach to achieve efficient and stable PeQDs for WLEDs and accelerates their progress to commercialization.

The ethics of induction of labor at 39 weeks in low-risk nulliparas in research and clinical practice.

The "A Randomized Trial of Induction Versus Expectant Management" trial (ARRIVE trial) published in 2018 suggested that induction of labor can be considered a "reasonable option" for low-risk nulliparous women at ≥39 weeks of gestation. The study results led some professional societies to endorse the option for elective induction of labor at 39 weeks of gestation in low-risk nulliparas, and this has begun to change obstetrical practice. The ARRIVE trial provided valuable information supporting the benefits of induction of labor; however, the trial is insufficient to serve as the primary justification for widespread elective induction of labor at 39 weeks of gestation in low-risk nulliparas because of concerns about external validity. Thus, the French ARRIVE trial was designed to test the hypothesis in a different setting that elective induction of labor at 39 weeks of gestation in low-risk nulliparas leads to a lower cesarean delivery rate than expectant management. This ongoing trial has been criticized as "pseudoscientific" and telling "women where, when, and how to give birth." We reject these allegations and extensively examine the ethical framework that should govern clinical and research interventions, including elective induction of labor at 39 weeks of gestation in low-risk nulliparas. This study aimed to discuss the ethical issues that emerge from randomized trials of elective induction of labor at 39 weeks of gestation in low-risk nulliparas and the ethics of the clinical practice itself. The analysis of existing evidence shows the importance of further research on induction of labor at 39 weeks of gestation in low-risk women. Certain aspects of research ethics in this area, particularly the consent of pregnant women in a context where autonomy remains fragile, call for vigilance. In addition, we emphasize that childbirth is not only a medical object but also a social phenomenon that cannot be regarded only from the perspective of a health risk to be managed by clinical research. Further research on this issue is needed to allow pregnant women to make informed decisions, and the results should be integrated with social issues. The perspective of women is required in constructing, evaluating, and implementing medical interventions in childbirth, such as induction of labor at 39 weeks of gestation.

Effects of mercury chloride on antioxidant and inflammatory cytokines in zebrafish embryos.

In this study, a zebrafish embryo toxicity model was employed, utilizing 24 h postfertilization (hpf) zebrafish embryos. These embryos were treated with varying concentrations of mercuric chloride for 96 h under static conditions. We assessed multiple parameters that reflected developmental abnormalities, behavioral alterations, morphological anomalies, antioxidant enzyme activities, including those of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), and glutathione S-transferase (GST), immune messenger RNA transcription levels of key factors such as tumor necrosis factor α (TNF-α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and cyclooxygenase 2 (COX-2), as well as protein expression of TNF-α. The results revealed that embryos exposed to higher concentrations of mercury exhibited reduced hatchability and increased rates of morphological abnormalities and mortality at 48, 72, and 96 hpf. In addition, a concentration-dependent increase in developmental abnormalities, including cardiac edema, reduced body length, yolk sac edema, scoliosis, and bent tails, was observed. Larval behaviors, such as touch-induced escape responses, startle reactions, and turning actions, were found to be diminished in a concentration-dependent manner. Additionally, the activities of various antioxidative enzymes, such as SOD, CAT, and GST, exhibited an increase at higher mercury concentrations, with the exception of GPX activity, which decreased significantly in a dose-dependent manner (p < 0.05). Pro-inflammatory cytokine transcription levels, specifically TNF-α, IL-1ß, IL-6, and COX-2, were significantly upregulated in a dose-dependent manner in the mercuric (II) chloride (HgCl2 ) treatment group compared with the control group. TNF-α protein expression was notably elevated in the larvae group treated with 300 and 400 nM HgCl2 .

Exploring clinical specialists' perspectives on the future role of AI: evaluating replacement perceptions, benefits, and drawbacks.

BACKGROUND OF STUDY: Over the past few decades, the utilization of Artificial Intelligence (AI) has surged in popularity, and its application in the medical field is witnessing a global increase. Nevertheless, the implementation of AI-based healthcare solutions has been slow in developing nations like Pakistan. This unique study aims to assess the opinion of clinical specialists on the future replacement of AI, its associated benefits, and its drawbacks in form southern region of Pakistan. MATERIAL AND METHODS: A cross-sectional selective study was conducted from 140 clinical specialists (Surgery = 24, Pathology = 31, Radiology = 35, Gynecology = 35, Pediatric = 17) from the neglected southern Punjab region of Pakistan. The study was analyzed using χ2 - the test of association and the nexus between different factors was examined by multinomial logistic regression. RESULTS: Out of 140 respondents, 34 (24.3%) believed hospitals were ready for AI, while 81 (57.9%) disagreed. Additionally, 42(30.0%) were concerned about privacy violations, and 70(50%) feared AI could lead to unemployment. Specialists with less than 6 years of experience are more likely to embrace AI (p = 0.0327, OR = 3.184, 95% C.I; 0.262, 3.556) and those who firmly believe that AI knowledge will not replace their future tasks exhibit a lower likelihood of accepting AI (p = 0.015, OR = 0.235, 95% C.I: (0.073, 0.758). Clinical specialists who perceive AI as a technology that encompasses both drawbacks and benefits demonstrated a higher likelihood of accepting its adoption (p = 0.084, OR = 2.969, 95% C.I; 0.865, 5.187). CONCLUSION: Clinical specialists have embraced AI as the future of the medical field while acknowledging concerns about privacy and unemployment.

Landscape analysis of healthcare workforce and resilience actions in the Sahelian context of high security challenge areas: The case of Burkina Faso.

INTRODUCTION: Access to health services is a major challenge in developing countries in general, particularly those affected by insecurity. The availability of sufficient quantity and quality of equitably distributed healthcare workforce is a major obstacle, yet it is an essential pillar of an effective and efficient national health system. Burkina Faso, similar to other countries in the Sahel, has been affected by an unprecedented security crisis that has severely tested the functionality of health facilities and the availability of healthcare workforce. OBJECTIVE: To describe the landscape of healthcare workforce and to analyse the actions taken by the government and other stakeholders to improve the resilience of the system and the retention of healthcare workers in the context of major security challenges. METHODS: This is a transversal, descriptive and analytical study carried out in Burkina Faso in 2023 through a documentary review, analyses of databases collected from health districts and regional directorates, focus groups and a national triangulation workshop with key informants. RESULTS: The study shows that, with the closure and minimal functioning of certain health facilities in security-challenged areas, healthcare workforceare concentrated in the urban areas of regional and district capitals, to the detriment of rural areas. Some staff become in an irregular situation regarding the administration. To strengthen resilience to the crisis, the main solutions have been implemented: (i) enhancing the community platform with the recruitment of 15,000 community-based health volunteers, (ii) delegating tasks to community health agents, (iii) simplified approaches, (iv) advanced health posts and mobile clinics, (v) redeployment to the most stable structures, (vi) thinking about legislation in crisis situations. CONCLUSION: Community resilience through the delegation of tasks to community-based health workers and strengthening of the community health platform has helped ensure the continuity of care in insecure areas. However, the optimization of innovative and attractive strategies will further improve the retention and return of healthcare workers in rural areas affected.

A Method for Determining the Directional Angle of a Railway Route Based on Field Measurements.

The most effective method for determining the coordinates of the railway track axis is based on using mobile satellite measurements. However, there are situations in which the satellite signal may be disturbed (due to field obstructions) or completely disappear (e.g., in tunnels). In these situations, the ability to measure the value of the directional angle of a moving rail vehicle using an inertial system is useful. The directional angle is determined on a topographic map as the angle between the direction of the vehicle's longitudinal axis (or the direction of a tangent to the track axis) and the reference direction, which is the north. This article presents a method for determining the directional angle of a railway line based on appropriate measurement data. The latter should be Cartesian coordinates of the track axis, allowing for the visualization of a given railway route and permitting a general orientation of its course to be obtained. The presented proposal for solving the problem refers to the assumptions made in the method for determining the curvature of the railway track axis using the moving chord. The assumptions of the proposed method for determining the directional angle of the railway route are discussed, along with the appropriate computational algorithms. The accuracy of this method is assessed using the adopted model geometric layout. Reference is also made to the appropriate method for determining the curvature of the railway track axis. In conclusion, we provide an example of determining the directional angle based on measurement data.

Petroleum wastewater: Environmental protection, treatment, and safe reuse: An overview.

Oil petroleum production consumes about 1.0-7.2 bbl. The needed water for such production ranges between 0.47 and 7.2 L water to 1.0 L crude. Between 80 and 90% of the consumed water is disposed of as wasted effluents. Consequently, there is an important connection between petroleum production and the contamination of the environment and surface water in addition to their ecotoxicological effects. The objective of the present review is to through light on the hazardous impact of petroleum wastewater on the environment and water ways. The present study presents several wastewater treatment technologies in handling the petroleum produced water (PPW) and reducing the hazardous impact to the environment. Safe reuse is also presented including simple, advanced, and environmentally friendly techniques. The reported treatment technologies are divided into five main categories: membrane technologies, biological treatment processes, electro-chemical coagulation, physical/chemical treatment processes (dissolved air flotation (DAF)/air flotation (IAF), adsorption, and chemical flocculation), and catalytic oxidation including chemicals such as advanced and Fenton oxidation processes (AOPs). The analysis and observation of each treatment process are also presented. Implementing of these processes in sequential and/or in combined to avoid the drawbacks of any poor treatment are discussed. The present review discusses; also, in detail each of these treatment technologies and their efficiency including the observation and conclusions of each one. The study shows; also; how the final treated effluent can be reused for non-potable purposes as an additional water resource according to the degree of decontamination. An additional advantage of treatment is protection of both the environment and the water ways by avoiding any discharge of such hazardous wastewater.

Identifying Core Issues for Basin Management: The Issue Generating Assessment (IGA) Methodology.

Effective stakeholder engagement is essential for basin management, requiring structured approaches to foster collaboration and consensus. This paper applies the Issue Generating Assessment (IGA) method, which identifies core issues for stakeholder discussion, to basin management. Focusing on the Israeli part of the Hadera Basin, we identify the core issues that should be discussed by stakeholders using the IGA method. To this end 39 participants across 14 sectors evaluating three generic basin management strategies were asked to qualitatively explain their evaluations. By analyzing these explanations utilizing the IGA method, four core issues emerged: (1) Managing uncertainty: addressing climate change and land use impacts on stream flow; (2) Mutual impacts management: handling interactions between the stream and its surroundings; (3) Integration of uses: balancing various stream utilization priorities; (4) Defining natural system functions: determining the role of natural systems. For each core issue, we proposed questions to guide stakeholder discussions. The IGA method is thus found to be useful, and has the potential to foster meaningful dialogue in structured stakeholder meetings, thereby focusing discussions and allowing understandings among stakeholders to be reached as a basis for basin management plans. Such early understandings may contribute to the development of strategies for sustainable basin management.

Wound complication risk factors following open reduction and internal fixation of ankle fractures.

This study was designed to identify risk factors for wound complications including surgical site infection (SSI) and wound healing issues following open reduction and internal fixation (ORIF) of ankle fractures. A retrospective analysis of individuals with ankle fractures treated with ORIF was undertaken. Study subjects were divided into a wound complications (WC) group and a no wound complication (NWC) group. The WC group was further divided into an SSI group and wound healing issues group. Twenty-one potential risk factors associated with wound complications after ORIF were tracked. Uni- and multivariate binary logistical regression analyses were used to identify risk factors associated with wound complications, ISS and wound healing issues. In total, 613 individuals, who had undergone surgery for ankle fractures formed the study cohort. The incidence of postoperative wound complications was 10.3% (63 cases), including 5.2% of SSI (32 cases) and 5.1% of wound healing issues (31 cases). The independent risk factors for wound complications were age 65 years or older, preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture, fewer than seven cases per year in surgical volume, and attending surgeon level. The independent risk factors for SSI were age 65 years or older, preoperative serum albumin level below 35 g/L, open fracture and fewer than seven cases per year in surgical volume. The independent risk factors for wound healing issues were preoperative serum albumin level below 35 g/L, peripheral neuropathy, open fracture and attending surgeon level. Herein we found both factors inherent to the injury and individual and those pertaining to the surgical team affected the frequency of wound complications after ORIF of ankle fractures. Specifically, advanced age and low surgical volume were associated with a greater risk of SSI. Peripheral neuropathy and the low expertise level on the part of the surgeon were associated with a greater risk of wound healing issues. Hypoproteinaemia and open fracture were both associated with a greater risk of both SSI and wound healing issues.

Examining influences of personal factors on the first- and third-person evaluations of public health issues among young adults.

Both health and the environment are critical public health issues that have a considerable impact on young adults. However, they have different characteristics that influence how messaging is received. In our study, we examine the influence of three personal factors (issue involvement, behavioral change intention, and product use) on young adults' perception of messages for these two public health issues from both first- and third-person perspectives. We found various patterns when comparing the two public health issues, first-person and third-person measures, and the perceived threat and likelihood of contributing to the issues. We also discuss practical implications and suggestions based on our findings.

On or off topic? Understanding the effects of issue-related political targeted ads.

Whilst data-driven strategies are allegedly prevalent in political campaigns, evidence regarding their actual effectiveness is scarce. This study investigates, from an individual perspective, the effect of issue congruency in political ads on immediate responses and voting behaviors. To reach our goal, we combined different types of data collection: mobile experience sampling method (mESM), panel survey, and content analysis. The combined approach allowed us to effectively study targeted ads within the cross-device and cross-platform environment. The results showed that voters perceive online political ads that are about a topic that they care about as more interesting, informative, and persuasive regardless of their partisanship. This positive ad perception subsequently leads to a higher probability of voting for the promoted party in the ad. We also found that an ad discussing a topic in line with the receiver's concerns positively affects the evaluation of the promoted party in the ad only when the party is already favored by the voter. Taken together, this study provides insights into the conditional effectiveness of data-driven strategies in political campaigns.

Paying for ads or getting into the news? How parties persuade citizens of their issue competence during an election campaign.

During campaigns, parties must defend their reputation of competence on issues to persuade citizens to vote for them (issue ownership). Consequently, what are the most effective strategies to achieve this? I argue that direct (advertising) and indirect (media coverage) communication strategies have different effects on citizens' perception of party competence. To analyze the impact of campaign dynamics on citizens, I use three data sources: an individual rolling cross-section panel, a media coverage analysis, and a parties' advertisements analysis. I link those data on a daily basis to capture the dynamics of parties' communication and citizens' opinion. The results show that advertisements help parties to win and maintain their issue ownership, while media coverage only helps parties to maintain their ownership. The study has scientific and practical implications with regard to party strategy, campaigns, and citizens' perceptions of parties.

Correlation between measured and predicted mismatch with valve hemodynamics in transcatheter aortic valve replacement: A sex-based analysis.

BACKGROUND: Data regarding the reliability of predicted effective orifice area indexed (pEOAi) is scarce in transcatheter aortic valve replacement (TAVR). AIMS: To assess the validity of the pEOAi in TAVR by correlating its value with echocardiography-derived hemodynamic data. METHODS: A single-center retrospective cohort study of TAVR patients from 2012 to 2021 with available echocardiograms was conducted. Patient-prosthesis mismatch (PPM) was defined based on the Valve Academic Research Consortium 3 criteria. The main endpoints were the congruence of measured effective orifice area indexed (EOAi) and pEOAi with the hemodynamic data obtained by echocardiography. The secondary endpoint included a correlation of predicted PPM (pPPM) and measured PPM (mPPM) with postoperative New York Heart Association (NYHA) status. RESULTS: A total of 318 patients were included. pPPM was more frequent than mPPM (54 [17%]; all moderate PPM vs. 39 [12.3%]: 32 moderate and 7 severe PPM). Predicted and measured EOAi were statistically correlated with postprocedural transvalvular mean gradient and Doppler velocity index (all p < 0.001), including in both sex-based subgroups. The positive predictive value and negative predictive value (NPV) of pPPM for postprocedural transvalvular mean gradient ≥ 20 mmHg were 16% and 97%, respectively. Only pPPM was significantly more prevalent in the group in which NYHA failed to improve than in those with symptom improvement (30.1% vs. 16%, p = 0.027). CONCLUSION: Predicted PPM has an excellent NPV for postprocedural transvalvular mean gradient ≥ 20 mmHg and seems to be a good predictor of NYHA status evolution as opposed to measured PPM. Predicted EOAi can be used in procedural planning to reduce the risk of PPM in both TAVR male and female patients.

Primary Care Physicians' and Patients' Perspectives on Equity and Health Security of Infectious Disease Digital Surveillance.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic facilitated the rapid development of digital detection surveillance (DDS) for outbreaks. This qualitative study examined how DDS for infectious diseases (ID) was perceived and experienced by primary care physicians and patients in order to highlight ethical considerations for promoting patients' autonomy and health care rights. METHODS: In-depth interviews were conducted with a purposefully selected group of 16 primary care physicians and 24 of their patients. The group was reflective of a range of ages, educational attainment, and clinical experiences from urban areas in northern and southern China. Interviews were audio recorded, transcribed, and translated. Two researchers coded data and organized it into themes. A third researcher reviewed 15% of the data and discussed findings with the other researchers to assure accuracy. RESULTS: Five themes were identified: ambiguity around the need for informed consent with usage of DDS; importance of autonomous decision making; potential for discrimination against vulnerable users of DDS for ID; risk of social inequity and disparate care outcomes; and authoritarian institutions' responsibility for maintaining health data security. The adoption of DDS meant some patients would be reluctant to go to the hospital for fear of either being discriminated against or forced into quarantine. Certain groups (older people and children) were thought to be vulnerable to DDS misappropriation. CONCLUSIONS: These findings indicate the paramount importance of establishing national and international ethical frameworks for DDS implementation. Frameworks should guide all aspects of ID surveillance, addressing privacy protection and health security, and underscored by principles of social equity and accountability.Annals "Online First" article.

Causes of Death in Cutaneous T-Cell Lymphoma Patients.

BACKGROUND: The advancing evolution toward a Th2 immune environment confers a progressive immunosuppression in patients with longstanding cutaneous T-cell lymphoma (CTCL). The conjunction of the disease-related immunosuppression as well as the immunosuppressive character of some CTCL treatments increase the risk of infectious and neoplastic diseases, sometimes with fatal outcomes. OBJECTIVES: The aim of the study was to prospectively study the causes of death in a cohort of CTCL patients, in a tertiary university skin cancer center. METHODS: All CTCL patients who died between 2008 and 2020 were included. The cause of the death was classified as directly or indirectly related or unrelated to CTCL. RESULTS: Over the study period, 31 (13F/18m) patients with CTCL died (mean age: 75.2 years), mean delay between diagnosis and death: 3.2 years (min: 1, max: 12 years), 58.1% of death causes were classified as indirect (infection), 12.9% directly related (blastic transformation), 22.5% unrelated, and 6.5% of unknown cause. 51.6% of mycosis fungoides (MF) patients who died had early-stage disease (1A-2A) or were on remission. 45.2% of dead patients had advanced-stage MF (2B-4B). Mean CRP level is increased in patients who died from infection whereas LDH level increased in patients with blastosis. A tertiary center is expected to manage of a higher proportion of CTCL patients with advanced-stage disease. CONCLUSIONS: As infection represented more than 50% of the causes of death in CTCL patients, particular attention should be given to preventive measures such as anti-infective vaccination. Regular surveillance of CRP and LDH levels could be helpful for follow-up of MF patients, respectively, with regards to infection and blastosis.

What is a mental disorder? Evaluating the lay concept of Mental Ill Health in the United States.

PURPOSE: How "mental disorder" should be defined has been the focus of extensive theoretical and philosophical debate, but how the concept is understood by laypeople has received much less attention. The study aimed to examine the content (distinctive features and inclusiveness) of these concepts, their degree of correspondence to the DSM-5 definition, and whether alternative concept labels ("mental disorder", "mental illness", "mental health problem", "psychological issue") have similar or different meanings. METHODS: We investigated concepts of mental disorder in a nationally representative sample of 600 U.S. residents. Subsets of participants made judgments about vignettes describing people with 37 DSM-5 disorders and 24 non-DSM phenomena including neurological conditions, character flaws, bad habits, and culture-specific syndromes. RESULTS: Findings indicated that concepts of mental disorder were primarily based on judgments that a condition is associated with emotional distress and impairment, and that it is rare and aberrant. Disorder judgments were only weakly associated with the DSM-5: many DSM-5 conditions were not judged to be disorders and many non-DSM conditions were so judged. "Mental disorder", "mental illness", and "mental health problem" were effectively identical in meaning, but "psychological issue" was somewhat more inclusive, capturing a broader range of conditions. CONCLUSION: These findings clarify important issues surrounding how laypeople conceptualize mental disorder. Our findings point to some significant points of disagreement between professional and public understandings of disorder, while also establishing that laypeople's concepts of mental disorder are systematic and structured.

Long-term exposure to low concentrations of air pollution and decline in lung function in people with idiopathic pulmonary fibrosis: Evidence from Australia.

BACKGROUND AND OBJECTIVE: Little is known about the association between ambient air pollution and idiopathic pulmonary fibrosis (IPF) in areas with lower levels of exposure. We aimed to investigate the impact of air pollution on lung function and rapid progression of IPF in Australia. METHODS: Participants were recruited from the Australian IPF Registry (n = 570). The impact of air pollution on changes in lung function was assessed using linear mixed models and Cox regression was used to investigate the association with rapid progression. RESULTS: Median (25th-75th percentiles) annual fine particulate matter (<2.5 µm, PM2.5 ) and nitrogen dioxide (NO2 ) were 6.8 (5.7, 7.9) µg/m3 and 6.7 (4.9, 8.2) ppb, respectively. Compared to living more than 100 m from a major road, living within 100 m was associated with a 1.3% predicted/year (95% confidence interval [CI] -2.4 to -0.3) faster annual decline in diffusing capacity of the lungs for carbon monoxide (DLco). Each interquartile range (IQR) of 2.2 µg/m3 increase in PM2.5 was associated with a 0.9% predicted/year (95% CI -1.6 to -0.3) faster annual decline in DLco, while there was no association observed with NO2 . There was also no association between air pollution and rapid progression of IPF. CONCLUSION: Living near a major road and increased PM2.5 were both associated with an increased rate of annual decline in DLco. This study adds to the evidence supporting the negative effects of air pollution on lung function decline in people with IPF living at low-level concentrations of exposure.

Defensive medicine through the lens of the managerial perspective: a literature review.

PURPOSE: Several studies have been carried out on defensive medicine, but research from the managerial viewpoint is still scarce. Therefore, the aim of the present study is to conduct a literature review to better understand defensive medicine from a managerial perspective. DESIGN/METHODOLOGY/APPROACH: A literature review was conducted of studies focusing on the organisational (meso) level of healthcare providers and managerial practices. A final sample of 28 studies was processed. FINDINGS: Defensive medicine has mainly been studied in the USA, and scholars have principally used quantitative surveys. High-risk specialities have been a critical field of investigation, and a large portion of the papers are published in journals that cover medicine, health policy, education and law fields. The analysis showed that operations and the organisation of staffing were the most discussed managerial practices. No study considered planning and budgeting aspects. ORIGINALITY/VALUE: The review confirmed that the managerial aspect of defensive medicine has not been fully addressed. Stimulated by this gap, this study analyses the managerial background of the defensive medicine phenomenon and shows which managerial practices have been most analysed. This paper also contributes to developing the literature on defensive medicine from the managerial side. Areas for future research include qualitative studies to investigate the behaviour of managers of healthcare companies to give a different perspective on defensive medicine and organisations' decision-making. RESEARCH LIMITATIONS/IMPLICATIONS: Some important publications might have been missed in this work because of the choice of only two databases. A further limit could be imposed by the use of the English language as an inclusion criterion.