Development and validation of betel-year: a clinical tool for quantifying exposure to betel quid chewing, utilizing nuclear morphometric analysis and validated by cytomorphological analysis.

BACKGROUND: Betel quid chewing, prevalent in Southeast Asia and South Asia, involves components such as betel leaf, areca nut, slaked lime, and sometimes tobacco. This study aims to assess buccal mucosa changes in betel quid chewers, develop a clinical tool for assessing exposure, and investigate its usability in predicting dysplasia. METHODS: After obtaining ethical approval and informed consent, patients were recruited from the Out-Patient Department of Government Medical College, Omandurar, Government Estate, India. A target sample size of 200 was calculated. The data included the history of betel quid chewing, buccal mucosa cells obtained by oral cytology, and the severity of dysplasia of the slides assessed by pathologists. We utilized principal component analysis (PCA) and confirmatory factor analysis (CFA) to validate a new outcome variable reflecting nuclear morphometric parameters (NMPs). Multiplicative regression models were developed for betel years based on betel exposure and additives. Spearman correlation and Kruskal-Wallis test was used to check the association between betel years and dysplasia. RESULTS: Significant differences in NMPs were observed among different betel chewing groups. We derived multiplicative regression models for betel years. In the logarithmic transformation approach, betel year = 0.05×betel-exposure×0.09×slaked-lime use×0.11×tobacco-use. In the original variable approach, betel year = 5.05×betel-exposure^0.00048×slaked-lime-use^0.18133×tobacco-use^1.47513. Spearman correlation and Kruskal-Wallis tests confirmed associations with dysplasia. CONCLUSION: Betel year is a pioneering tool for assessing lifetime betel quid exposure, similar to pack years for smoking. It could aid in risk stratification, targeted interventions and shaping public health policies. Despite limitations, betel year holds promise for revolutionizing oral health risk assessment, and future research can expand its scope globally, considering diverse betel quid compositions.

Marginal Bone Level Changes Evaluation of Long-term Functional Dental Implants with the Implant Disease Risk Assessment Diagram: A 2 to 6 Years Follow-up Retrospective Study.

Purpose: This study aimed to evaluate the relationship between risk profile assessments of dental implants that have been in function for at least two-year and peri-implant marginal bone loss during the follow-up period using the Implant Disease Risk Assessment Diagram. Material and Methods: A total of 70 patients and 170 implants who had been functionally loaded for at least two years and who attended follow-up sessions were included in the study. Full-mouth plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing, clinical attachment level (CAL), and peri-implant modified plaque index, modified bleeding index, PD, keratinized mucosal width (KMW), CAL and GR were recorded. According to the IDRA risk diagram, participants and dental implants were divided into low, moderate, and high-risk groups. Marginal bone level (MBL) was measured on periapical radiographs obtained at functional loading (T0) and at the last follow-up session (T1), and mesial and distal marginal bone level changes (ΔMBL) were calculated as T1-T0. Results: A statistically significant correlation was found between the periodontitis history and periodontitis susceptibility and IDRA classification at the patient-level. Full-mouth GI, PD, and BOP were found to be statistically higher in the high-risk IDRA group. No statistically significant result was found between the mesial and distal ΔMBL between the IDRA risk groups.Conclusions: In this study, IDRA risk level increased especially by periodontitis susceptibility and periodontitis history, but no significant difference was found between risk groups in terms of ΔMBL.

Applying a semi-quantitative risk assessment on petroleum production unit.

Applying safety means in the industry, especially in the petroleum industry is very important to maintain the industrial facility. A semi-quantitative risk assessment as Layers of Protection Analysis (LOPA) is used widely to quantify data after qualitative risk analysis as HAZOP using a simpler way than quantitative risk analysis 'QRA' as fault tree analysis 'FTA'. This determines if a new safety integrity function 'SIF' is needed. This paper introduces a novel fuzzy logic system to solve the failure of crude oil shipping pumps. Several models are studied to select the most appropriate fuzzy membership functions. Results are compared with results from the LOPA model, which shows the advantages of using the proposed model to reduce the RRF for the potential hazard and achieve a simple and reliable control method.

GARDskin dose-response assay and its application in conducting Quantitative Risk Assessment (QRA) for fragrance materials using a Next Generation Risk Assessment (NGRA) framework.

Development of New Approach Methodologies (NAMs) capable of providing a No Expected Sensitization Induction Level (NESIL) value remains a high priority for the fragrance industry for conducting a Quantitative Risk Assesment (QRA) to evaluate dermal sensitization. The in vitro GARDskin assay was recently adopted by the OECD (TG 442E) for the hazard identification of skin sensitizers. Continuous potency predictions are derived using a modified protocol that incorporates dose-response measurements. Linear regression models have been developed to predict human NESIL values. The aim of the study was to evaluate the precision and reproducibility of the continuous potency predictions from the GARDskin Dose-Response (DR) assay and its application in conducting QRA for fragrance materials using a Next Generation Risk Assessment (NGRA) framework. Results indicated that the GARDskin Dose-Response model predicted human NESIL values with a good degree of concordance with published NESIL values, which were also reproducible in 3 separate experiments. Using Isocyclocitral as an example, a QRA was conducted to determine its safe use levels in different consumer product types using a NGRA framework. This study represents a major step towards the establishment of the assay to derive NESIL values for conducting QRA evaluations for fragrance materials using a NGRA framework.

From hazard identification to risk assessment: The role of the prevention technician in the carcinogenic risk assessment for formaldehyde.

The Prevention Technician in the Environment and Workplaces (PTEW) is a health professional who works in the identification, assessment, and management of risk in living and working places. The PTEW implements specific corrective actions at reducing exposure levels to chemicals such as formaldehyde. The aim of this report was to update the formaldehyde risk assessment document (RAD). The risk assessment process was divided into three steps as follows: (1) preliminary data collection, (2) an on-site visit to identify the use patterns and process, and (3) application of the algorithm to calculate the exposure levels of healthcare workers. In addition, with the introduction of closed-circuit systems, 23 devices were evaluated to identify possible airborne dispersion of formaldehyde. The algorithm was applied in 31 hospital units and the results allowed us to classify the staff in two levels of exposure for each hospital unit; healthcare workers were classified as "exposed" or "potentially exposed." Most of the HCWs are categorized as potentially exposed, and only workers working in laboratories are considered to be exposed. The results showed that devices must be used properly according to the user manual. To increase the level of worker safety, we have proposed to introduce closed-circuit safe handling systems and keeping the duration and intensity of exposure at the lowest possible levels according to the "ALARA" principle. The assignment of the Italian PTEW is to achieve excellence in the levels of health and safety of patients and hospital workers by pursuing a shared mission: improving the quality of public health.

Critical gaps in nanoplastics research and their connection to risk assessment.

Reports of plastics, at higher levels than previously thought, in the water that we drink and the air that we breathe, are generating considerable interest and concern. Plastics have been recorded in almost every environment in the world with estimates on the order of trillions of microplastic pieces. Yet, this may very well be an underestimate of plastic pollution as a whole. Once microplastics (<5 mm) break down in the environment, they nominally enter the nanoscale (<1,000 nm), where they cannot be seen by the naked eye or even with the use of a typical laboratory microscope. Thus far, research has focused on plastics in the macro- (>25 mm) and micro-size ranges, which are easier to detect and identify, leaving large knowledge gaps in our understanding of nanoplastic debris. Our ability to ask and answer questions relating to the transport, fate, and potential toxicity of these particles is disadvantaged by the detection and identification limits of current technology. Furthermore, laboratory exposures have been substantially constrained to the study of commercially available nanoplastics; i.e., polystyrene spheres, which do not adequately reflect the composition of environmental plastic debris. While a great deal of plastic-focused research has been published in recent years, the pattern of the work does not answer a number of key factors vital to calculating risk that takes into account the smallest plastic particles; namely, sources, fate and transport, exposure measures, toxicity and effects. These data are critical to inform regulatory decision making and to implement adaptive management strategies that mitigate risk to human health and the environment. This paper reviews the current state-of-the-science on nanoplastic research, highlighting areas where data are needed to establish robust risk assessments that take into account plastics pollution. Where nanoplastic-specific data are not available, suggested substitutions are indicated.

Estimating the economic burden attributable to online only child sexual abuse offenders: implications for police strategy.

Evidence is beginning to emerge of the serious negative effects online only child sexual abuse (OOCSA) can have on victims. Establishing the scale and nature of the problem could assist police in prioritizing suspects. In study 1, scoping review identified eleven studies that examined OOCSA's impact on victims. Five themes emerged from narrative review; definitional issues, a new normal, OOCSA grooming processes, comparisons with offline CSA, mechanisms between OOCSA and harm. In study 2, OOCSA national prevalence was estimated by applying 2.9% rate of OOCSA observed from original police data to a lower bound ("sexual communication with a child" crimes recorded by the police), middle (scaling up to estimate undetected offenses) and upper bound estimate of the national offender pool (self-reported sexual solicitation offenders). Recent UK Home Office figures were adapted to establish economic costs. Lifetime costs estimates attributable to OOCSA are £7.4 million (police reports), £59.6 million (including undetected offenders) and £1.4 billion (national prevalence estimates). Over 75% of this is non-financial costs borne by victims in terms of emotional harm and lost output. Government bears around 20% of the cost burden, mostly non-financial costs for police forces. Findings are discussed in relation to evidence-led recommendations for prioritization and wider police actions that can be taken to avoid the considerable economic and social burden associated with OOCSA offenses.

Use of new approach methodologies (NAMs) to meet regulatory requirements for the assessment of industrial chemicals and pesticides for effects on human health.

New approach methodologies (NAMs) are increasingly being used for regulatory decision making by agencies worldwide because of their potential to reliably and efficiently produce information that is fit for purpose while reducing animal use. This article summarizes the ability to use NAMs for the assessment of human health effects of industrial chemicals and pesticides within the United States, Canada, and European Union regulatory frameworks. While all regulations include some flexibility to allow for the use of NAMs, the implementation of this flexibility varies across product type and regulatory scheme. This article provides an overview of various agencies' guidelines and strategic plans on the use of NAMs, and specific examples of the successful application of NAMs to meet regulatory requirements. It also summarizes intra- and inter-agency collaborations that strengthen scientific, regulatory, and public confidence in NAMs, thereby fostering their global use as reliable and relevant tools for toxicological evaluations. Ultimately, understanding the current regulatory landscape helps inform the scientific community on the steps needed to further advance timely uptake of approaches that best protect human health and the environment.

Application of Multi-Criteria Decision Analysis Techniques for Informing Select Agent Designation and Decision Making.

The Centers for Disease Control and Prevention (CDC) Select Agent Program establishes a list of biological agents and toxins that potentially threaten public health and safety, the procedures governing the possession, utilization, and transfer of those agents, and training requirements for entities working with them. Every 2 years the Program reviews the select agent list, utilizing subject matter expert (SME) assessments to rank the agents. In this study, we explore the applicability of multi-criteria decision analysis (MCDA) techniques and logic tree analysis to support the CDC Select Agent Program biennial review process, applying the approach broadly to include non-select agents to evaluate its generality. We conducted a literature search for over 70 pathogens against 15 criteria for assessing public health and bioterrorism risk and documented the findings for archiving. The most prominent data gaps were found for aerosol stability and human infectious dose by inhalation and ingestion routes. Technical review of published data and associated scoring recommendations by pathogen-specific SMEs was found to be critical for accuracy, particularly for pathogens with very few known cases, or where proxy data (e.g., from animal models or similar organisms) were used to address data gaps. Analysis of results obtained from a two-dimensional plot of weighted scores for difficulty of attack (i.e., exposure and production criteria) vs. consequences of an attack (i.e., consequence and mitigation criteria) provided greater fidelity for understanding agent placement compared to a 1-to-n ranking and was used to define a region in the upper right-hand quadrant for identifying pathogens for consideration as select agents. A sensitivity analysis varied the numerical weights attributed to various properties of the pathogens to identify potential quantitative (x and y) thresholds for classifying select agents. The results indicate while there is some clustering of agent scores to suggest thresholds, there are still pathogens that score close to any threshold, suggesting that thresholding "by eye" may not be sufficient. The sensitivity analysis indicates quantitative thresholds are plausible, and there is good agreement of the analytical results with select agent designations. A second analytical approach that applied the data using a logic tree format to rule out pathogens for consideration as select agents arrived at similar conclusions.

Amassing of heavy metals in soils, vegetables and crop plants irrigated with wastewater: Health risk assessment of heavy metals in Dera Ghazi Khan, Punjab, Pakistan.

Human health is the main concern related to use of crop products irrigated with contaminated irrigation sources. Present research has been conducted to explore heavy metal status of sewage and industrial wastewater being used up for irrigation purpose in the peri-urban areas of the district Dera Ghazi Khan which has not been explored widely before. The analysis also followed heavy metal detection in the subsequent irrigated soil and vegetables/crop plants in relation to assessment of health risk to the consumer to plan the future monitoring in this area. An unremitting boost of heavy metals into the environment from wastewater irrigation has become a global issue. These heavy metals enter the food chain and pose health assumptions to consumers upon utilization. In the present study, an investigation has been conducted to determine metal concentrations in the wastewater, soil, and different plant species. For wastewater samples, pH, total dissolved solids (TDS), electrical conductivity (EC), and selected heavy metals such as Al, As, Cr, Cu, Fe, Mn, Pb, Zn, and Ni were determined. The mean values of heavy metals in the soil samples were within the WHO/FAO safe limit, while Cr and Pb were the most frequent (100%) among the metals. However, differentiating the sites, the concentration of Cr and Cu, Ni, and Fe were elevated. The metal transfer was highly effective from soil to the growing plants i.e. brinjal, red corn, wheat, tomato, and spinach than other plant species. Among the metals, Cr, Ni, Mn, and Pb in plant samples were exceeding the WHO/FAO safe limit. Health risk index (HRI) have revealed the possible potential risk of heavy metal contaminated plant species in the order of spinach (6.4) > wheat (6.4) > brinjal (5.9) > tomato (4.7) > red corn (4.5) > apple gourd (4.3) > white corn (3.8) > cabbage (3.1) > luffa (2.9). Likewise, HRI of different metals was calculated as Cu (19.6) > Zn (17.9) > Cr (2.95) > Ni (0.85) > Mn (0.48) > Fe (0.15) > Cd (0.11) > Pb (0.05) > As (0.00001). The level of HRI through the use of dietary plants revealed an elevated risk level than the acceptable limit (HRI > 1) for Cu > Zn > Cr in adults. Our findings suggest that there would be a serious health risk to the consumers due to the consumption of these plant species being irrigated with the wastewater. Therefore, a strict regulatory mechanism is proposed for the safety of food plants in the study area including monitoring and recycling of crop plants, and building water treatment plants to remove pollutants and clean wastewater.

Risk assessment of COVID-19 pandemic using deep learning model for J&K in India: a district level analysis.

The coronavirus disease 2019 (COVID-19) is an ongoing pandemic with high morbidity and mortality rates. Current epidemiological studies urge the need of implementing sophisticated methods to appraise the evolution of COVID-19. In this study, we analysed the data for 228 days (1 May to 15 December 2020) of daily incidence of COVID-19 cases for a district level analysis in the region of Jammu and Kashmir in the northern Himalayan belt of India. We used a deep learning-based incremental learning technique to model the current trend of COVID-19 transmission and to predict the future trends with 60-day forecasting. The results not only indicate high rates of morbidity and mortality but also forecast high rise in the incidence of COVID-19 in different districts of the study region. We used geographic information system (GIS) for storing, analysing, and presenting the spread of COVID-19 which provides key insights in understanding, planning, and implementing mitigating measures to tackle the current spread of the pandemic and its possible future scenarios. The existing disparity in health care facilities at district level is shown in relation to the spread of disease. The study results also highlight the need to upgrade health care infrastructure in the study region to control the current and future pandemics. These results could be useful for administration and scientific community to develop efficient short-term and long-term strategies against such diseases.

Evaluation of the Effect of Age, Menopausal Status, and Parity on Breast Parenchyma Stiffness by Multiparametric Shear Wave Elastography.

RATIONALE AND OBJECTIVES: To evaluate the relationship between quantitative breast parenchyma stiffness by using multiparametric shear wave elastography (mpSWE) and the potential risk factors of breast cancer. MATERIAL AND METHODS: The Vmean, Vmax, Vmin, Vsd values were measured with mpSWE from each breast and each quadrant in all cases under and over the age of 40. Statistical analysis was performed to evaluate the relationship between breast stiffness and age, side, quadrant, menopausal status, mammographic breast density, and obstetric history. RESULTS: The study cohort included 964 breasts of 482 patients, where 342 patients were ≥40 years of age; and 140 cases were <40 years of age with a mean age of 45.07 ± 10.96. No significant difference in breast stiffness was detected between right and left breasts (p > 0.05); however, upper quadrants were found to be stiffer than the lower quadrants (p < 0.05). The effect of age on all values was found to be significant (p < 0.05), and stiffness increased with age. All mpSWE values of post-menopausal cases were significantly higher (p < 0.05) than premenopausal cases. Nulliparous cases had higher values than cases with prior parity (p < 0.05). Cases with Type C and D breast density had higher stiffness values than those with Type A and Type B breast density. CONCLUSION: Breast parenchyma shows increased stiffness in in post-menopausal, nulliparous and older patients and patients with dense breast density. Similar to the mammographic increased breast density, elastographically increased breast parenchymal stiffness may be used as a possible risk factor for breast cancer or as a predictor of breast cancer.

Application of the Threshold of Toxicological Concern (TTC) in Food Safety: Challenges and Opportunities.

The safety assessment of chemicals added or found in food has traditionally made use of data from in vivo studies performed on experimental animals. The nature and amount of data required to carry out a risk assessment is generally stipulated either in the different food legislations or in sectoral guidance documents. However, there are still cases where no or only limited experimental data are available or not specified by law, for example for contaminants or for some minor metabolites from active substances in plant protection products. For such cases, the Threshold of Toxicological Concern (TTC) can be applied. This review explores the use of the TTC approach in food safety in the European Union, in relation to the different food sectors, legal requirements and future opportunities.

Macroelements and toxic trace elements in muscle and liver of fish species from the largest three reservoirs in Turkey and human risk assessment based on the worst-case scenarios.

Macroelement (Na, K, Ca, Mg and P) and toxic trace element (As, Cd and Pb) contents were investigated in muscle and liver of the two fish species (common carp and trout barb) from the largest three reservoirs (Atatürk, Keban and Karakaya) in Turkey. Also, human health risks for consumers using the worst-case scenarios were assessed. Potassium was the most abundant macroelement in muscle of both fish species in all reservoirs, whereas phosphorus was the most abundant in liver. Toxic trace element contents in the liver of the two fish species from the three reservoirs were higher than those in muscle. The mean levels of As and Pb in muscle and liver of fish species from the Karakaya Reservoir were higher than those from the other two reservoirs. Three-way ANOVA showed that the interaction between fish species, reservoir and fish tissue was significant for only Cd (p < 0.01). The maximum levels of As, Cd and Pb in muscle and liver of fish species from the three reservoirs were below permissible limits. The estimated daily intakes of toxic trace elements in fish species were much lower than their corresponding tolerable daily intakes. The target hazard quotient (THQ) and total THQ values in fish species were below 1, which indicated that non-carcinogenic health effects are not expected. The carcinogenic risk values for inorganic arsenic were within acceptable range. The results revealed that toxic trace elements in common carp and trout barb from the Atatürk, Keban and Karakaya reservoirs do not pose a significant health risk to consumers.

Ecological risk and estimates of organophosphate pesticides loads into the Central Mediterranean Sea from Volturno River, the river of the "Land of Fires" area, southern Italy.

The organophosphate pesticides pollution in the Volturno River and its environmental impact on the Tyrrhenian Sea (Central Mediterranean Sea) were estimated. Eight selected organophosphate pesticides (diazinon, dimethoate, malathion, chlorpyrifos, pirimiphos-methyl, fenitrothion, methidathion and tolclofos-methyl) were determined in the water dissolved phase, suspended particulate matter and sediment samples collected from 10 sites in different seasons. Total organophosphate pesticides concentrations ranged from 0.12 to 65.09 ng L-1 in water (as the sum of the water dissolved phase and suspended particulate matter) and from 1.19 to 23.17 ng g-1 in sediment samples. It has been calculated that the discharge of pollutants from the Volturno river into the Tyrrhenian Sea was about 71.815, 31 g year-1; for this reason the river is to be considered one of the main mouths of organophosphate pesticides in the Tyrrhenian Sea. In relation to environmental risk assessment, the concentrations of most OPPs in water and sediments from the Volturno River and its estuary were lower than guideline values, but the mean concentration of chlorpyrifos (5.41 ng L-1) in the Volturno River and Estuary has been shown that the ecological integrity of the river watercourse is possibly at risk.

The Quick Exposure Check (QEC) - Inter-rater reliability in total score and individual items.

The development of musculoskeletal disorders has been linked to various risk factors in the work environment including lifting heavy loads, machine and materials handling, work postures, repetitive work, work with handheld vibrating tools, and work stress. The Quick Exposure Check (QEC) was designed to assess exposure to work-related musculoskeletal risk factors affecting the back, shoulder/arm, wrist/hand, and neck. We investigated the inter-rater reliability of the summary scores and individual items of the QEC by comparing two simultaneous assessments of 51 work tasks, performed by 14 different workers. The work tasks were mainly "light" to "moderately heavy". For total scores, the level of disagreement for shoulder/arm had a Relative Position of 0.13 (95% CI: 0.02; 0.23) and no statistically significant random disagreement. Percentage agreement was 63-100% for individual items and 71-88% for total score. Weighted Kappa of agreement for the individual items rated by the assessors were -0.94-0.77; highest for back motion, and lowest for wrist/hand position. The Swedish translation of the Quick Exposure Check has moderate to very good inter-rater reliability with fair to slight levels of systematic disagreement. There was no statistically significant random disagreement.

Environmental risk assessment of engineered nano-SiO2 , nano iron oxides, nano-CeO2 , nano-Al2 O3 , and quantum dots.

Many research studies have endeavored to investigate the ecotoxicological hazards of engineered nanomaterials (ENMs). However, little is known regarding the actual environmental risks of ENMs, combining both hazard and exposure data. The aim of the present study was to quantify the environmental risks for nano-Al2 O3 , nano-SiO2 , nano iron oxides, nano-CeO2 , and quantum dots by comparing the predicted environmental concentrations (PECs) with the predicted-no-effect concentrations (PNECs). The PEC values of these 5 ENMs in freshwaters in 2020 for northern Europe and southeastern Europe were taken from a published dynamic probabilistic material flow analysis model. The PNEC values were calculated using probabilistic species sensitivity distribution (SSD). The order of the PNEC values was quantum dots < nano-CeO2 < nano iron oxides < nano-Al2 O3 < nano-SiO2 . The risks posed by these 5 ENMs were demonstrated to be in the reverse order: nano-Al2 O3 > nano-SiO2 > nano iron oxides > nano-CeO2 > quantum dots. However, all risk characterization values are 4 to 8 orders of magnitude lower than 1, and no risk was therefore predicted for any of the investigated ENMs at the estimated release level in 2020. Compared to static models, the dynamic material flow model allowed us to use PEC values based on a more complex parameterization, considering a dynamic input over time and time-dependent release of ENMs. The probabilistic SSD approach makes it possible to include all available data to estimate hazards of ENMs by considering the whole range of variability between studies and material types. The risk-assessment approach is therefore able to handle the uncertainty and variability associated with the collected data. The results of the present study provide a scientific foundation for risk-based regulatory decisions of the investigated ENMs. Environ Toxicol Chem 2018;37:1387-1395. © 2018 SETAC.

Estimation of Injury by Falls for Risk Assessment of Robotic Care Devices.

In order for manufacturers of robotic devices for nursing care to predict injury in accidents related to their products, risk assessments are carried out according to various standards e.g. ISO 12100. Probabilities of death, bone fracture and head injury are estimated by analysing data published in Japan and U.S.