Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model.

BACKGROUND: Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions. METHODS: Adult psychiatric inpatients on forensic and general wards in three psychiatric hospitals were recruited and followed up prospectively for 6 months. Information on modifiable (dynamic) risk factors were collected every 1-4 weeks, and baseline background factors. Data were transferred to a web-based monitoring system (FOxWeb) to calculate a total dynamic risk score. Outcomes were extracted from an incident-reporting system recording aggression and interpersonal violence. The association between total dynamic score and violent incidents was assessed by multilevel logistic regression and compared with dynamic score excluded. RESULTS: We recruited 89 patients and conducted 624 separate assessments (median 5/patient). Mean age was 39 (s.d. 12.5) years with 20% (n = 18) female. Common diagnoses were schizophrenia-spectrum disorders (70%, n = 62) and personality disorders (20%, n = 18). There were 93 violent incidents. Factors contributing to violence risk were a total dynamic score of ⩾1 (OR 3.39, 95% CI 1.25-9.20), 10-year increase in age (OR 0.67, 0.47-0.96), and female sex (OR 2.78, 1.04-7.40). Non-significant associations with schizophrenia-spectrum disorder were found (OR 0.50, 0.20-1.21). In a fixed-effect model using all covariates, AUC was 0.77 (0.72-0.82) and 0.75 (0.70-0.80) when the dynamic score was excluded. CONCLUSIONS: In predicting violence risk in individuals with psychiatric disorders, modifiable factors added little incremental value beyond static ones in a psychiatric inpatient setting. Future work should make a clear distinction between risk factors that assist in prediction and those linked to needs.

The positive environmental impact of virtual isotretinoin management.

BACKGROUND/OBJECTIVES: Other medical specialties have studied how their practices influence the environment, but environmental impact studies in the field of dermatology remain limited. With respect to dermatology, vehicle emissions by patients traveling to and from appointments are an important factor influencing climate change. This study was undertaken to determine the greenhouse gas emissions avoided by managing isotretinoin virtually at West Virginia University Hospital. METHODS: A retrospective cross-sectional study was conducted during the COVID-19 outbreak from March 25 to December 1, 2020, where travel data were acquired and converted to emission data. RESULTS: 5,137 kg of GHG emissions in CO2 equivalents were prevented by managing isotretinoin virtually during the study period. 49 400 kg of GHG emissions in CO2 equivalents would be prevented annually. This is the emission load released when 24 690 kg of coal are burned. CONCLUSIONS: Environmental impact studies in the field of dermatology remain limited. GHG emissions were significantly reduced by virtually managing isotretinoin at a single institution. The practice of dermatology could reduce its carbon footprint by managing isotretinoin virtually, even in non-pandemic periods. Given that isotretinoin management represents a small percentage of the overall carbon footprint associated with dermatology, dermatologists should identify other conditions amenable to virtual medicine to produce greater environmental impact.

Development and characterization of a CNS-penetrant benzhydryl hydroxamic acid class IIa histone deacetylase inhibitor.

We have identified a potent, cell permeable and CNS penetrant class IIa histone deacetylase (HDAC) inhibitor 22, with >500-fold selectivity over class I HDACs (1,2,3) and ∼150-fold selectivity over HDAC8 and the class IIb HDAC6 isoform. Dose escalation pharmacokinetic analysis demonstrated that upon oral administration, compound 22 can reach exposure levels in mouse plasma, muscle and brain in excess of cellular class IIa HDAC IC50 levels for ∼8 h. Given the interest in aberrant class IIa HDAC function for a number of neurodegenerative, neuromuscular, cardiac and oncology indications, compound 22 (also known as CHDI-390576) provides a selective and potent compound to query the role of class IIa HDAC biology, and the impact of class IIa catalytic site occupancy in vitro and in vivo.

One-dimensional defective photonic crystals for the sensing and detection of protein.

The sensing of protein is of great importance because of its prominent role in building and repairing tissues. In this work, we present a simple design for the detection and sensing of protein using one-dimensional defective photonic crystals. The main idea of our work is included in the theoretical investigation of the transmittance properties of the resonant mode produced inside the photonic band gap. Our study uses the characteristic matrix method and curve fitting. The main reason for our study is to detect the concentration of a protein solution using an efficient, accurate, and simple method. Here, the defect layer is filled with a protein solution. Our idea depends on two hypotheses, and the first one is based on the appearance of a resonant peak on the photonic band gap. The second one depends on a change in the position of this resonant peak with the concentration of the protein solution. The effect of many parameters on the performance of our sensor, such as the thickness of the defect layer and the sensitivity, is demonstrated. The numerical results could present a simple way to design an accurate, stable, efficient, and low-cost protein sensor compared to other current methods and techniques.

Boron increases root elongation by reducing aluminum induced disorganized distribution of HG epitopes and alterations in subcellular cell wall structure of trifoliate orange roots.

Aluminum toxicity limits the plant growth by inducing inhibition of root elongation. Although several mechanisms have been proposed regarding the phytotoxic effects of aluminum on inhibition of root elongation; the primary causes of aluminum induced root inhibition and its mitigation by boron (B) are still elusive. The present study was carried out to explore the mechanisms of B induced mitigation of aluminum toxicity and to investigate the changes in well wall structure under aluminum toxicity coupled with the techniques of confocal laser microscope, lumogallion and transmission electron microscope. The results revealed that aluminum toxicity severely hampered the root elongation and plant biomass. Moreover, alteration in subcellular structure were observed under aluminum toxicity, however, such negative effects were further exacerbated with B deficiency. Aluminum toxicity indicated disorganized distribution of HG (homogalacturonan) epitopes with higher accumulation of apoplastic aluminum. Nevertheless, B supply improved root elongation, and reduced the aluminum uptake. Taken together, it is concluded that B application can reduce aluminum toxicity and improve root elongation by decreasing Al3+ accumulation to cell wall, alteration in the cell wall structure and reducing the distribution of HG epitopes in the roots of trifoliate (Poncirus trifoliate) orange.

Mechanisms of organic acids and boron induced tolerance of aluminum toxicity: A review.

Aluminum is a major limiting abiotic factor for plant growth and productivity on acidic soils. The primary disorder of aluminum toxicity is the rapid cessation of root elongation. The root apex is the most sensitive part of this organ. Although significant literature evidence and hypothesis exist on aluminum toxicity, the explicit mechanism through which aluminum ceases root growth is still indefinable. The mechanisms of tolerance in plants have been the focus of intense research. Some plant species growing on acidic soils have developed tolerance mechanisms to overcome and mitigate aluminum toxicity, either by avoiding entry of Al3+ into roots (exclusion mechanism) or by being able to counterbalance toxic Al3+ engrossed by the root system (internal tolerance mechanism). Genes belonging to ALMT (Aluminum-activated malate transporter) and MATE (Multidrug and toxin compounds extrusion) have been identified that are involved in the aluminum-activated secretion of organic acids from roots. However, different plant species show different gene expression pattern. On the other hand, boron (B) (indispensable micronutrient) is a promising nutrient in the tolerance to aluminum toxicity. It not only hinders the adsorption of aluminum to the cell wall but also improves plant growth. This review mainly explains the critical roles of organic acid and B-induced tolerance to aluminum by summarizing the mechanisms of ALMT, MATE, internal detoxification, molecular traits and genetic engineering of crops.

Boron reduces aluminum-induced growth inhibition, oxidative damage and alterations in the cell wall components in the roots of trifoliate orange.

Aluminum (Al) toxicity is a major restriction for crops production on acidic soils. The primary symptom of aluminum toxicity is visible in the roots of plants. Recently, several studies reported the alleviation of Al toxicity by the application of Boron (B), however, the information how B alleviates Al toxicity is not well understood. Thus, we investigated the ameliorative response of B on Al-induced growth inhibition, oxidative damages, and variations in the cell wall components in trifoliate orange roots. The results indicated that plants under Al stress experienced a substantial decrement in root length and overall plant growth. The supply of B improved the root elongation by eliminating oxidative stress, membrane peroxidation, membrane leakage, and cell death produced under Al toxicity. Moreover, accumulation of Al on the cell wall and alteration in the cell wall components might be one of the causes resulting in the quick inhibition of root elongation under B-starvation circumstances by providing susceptible negative charges on pectin matrix for binding of Al. The results provide a useful understanding of the insight into mechanisms of B-induced mitigation of Al toxicity especially in the trifoliate orange that might be helpful in the production of crops on acidic soils.

Boron alleviates the aluminum toxicity in trifoliate orange by regulating antioxidant defense system and reducing root cell injury.

Aluminium (Al) toxicity is the most important soil constraint for plant growth and development in acid soils (pH < 5.5) globally in agricultural regions. Boron (B) is an essential micronutrient for the growth and development of higher plants. The results of previous studies propose that B might ameliorate Al toxicity; however, none of the studies have been conducted on trifoliate orange to study this effect. Thus, a study was carried out in hydroponics comprising of two different Al concentrations, 0 and 400 µM. For every concentration, two B treatments (0 and 10 µM as H3BO3) were applied to investigate the B-induced alleviation of Al toxicity and exploring the underneath mechanisms. The results revealed that Al toxicity under B deficiency severely hampered the root growth and physiology of plant, caused oxidative stress and membrane damage, leading to severe root injury and damage. However, application of B under Al toxicity improved the root elongation and photosynthesis, while reduced Al uptake and mobilization into plant parts. Moreover, B supply regulated the activities of antioxidant enzymes, proline, secondary metabolites (phenylalanine ammonia lyase and polyphenol oxidase) contents, and stabilized integrity of proteins. Our study results imply that B supply promoted root growth as well as defense system by reducing reactive oxygen species (ROS) and Al concentrations in plant parts thus B induced alleviation of Al toxicity; a fact that might be significant for higher productivity of agricultural plants grown in acidic conditions.

Comparative Effects of Biochar, Slag and Ferrous-Mn Ore on Lead and Cadmium Immobilization in Soil.

A variety of remediation approaches have been applied to the heavy metals-contaminated soils, however, the immobilization of metals in co-contaminated soils still not cleared. Therefore, an incubation study was conducted to evaluate the instantaneous effects of different concentrations of biochar (BC), slag (SL) and Fe-Mn ore (FMO) on immobilization of Pb and Cd through the Toxicity Characteristic Leaching Procedure (TCLP) by following the the European Community Bureau of Reference (BCR), CaCl2 and NH4NO3. The sequential extraction of BCR showed decrease in acid soluble fractions, while the residual proportions of Pb and Cd were enhanced with increasing concentrations of SL and BC. Addition of BC significantly lowered the extractable fractions of both metals by TCLP, NH4NO3 and CaCl2 as compared to SL and FMO. Among all amendments, BC incorporation into co-contaminated soil offered promising results for Pb and Cd immobilization. Overall, all amendments showed positive and long-term impact on the reclamation of co-contaminated soil with heavy metals and could deserve advance monitoring studies on a field scale.

Screening and Optimization of the Reaction of Polymyxin B Sulphate with NBD-Cl for the Synchronous Spectrofluorimetric Determination of Polymyxin B Sulphate in Human Plasma.

An accurate and sensitive synchronous spectrofluorimetric method has been developed for the determination of Polymyxin B sulphate (Poly B) in human plasma. The method is based on the reaction of non-fluorescent Poly B with 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole (NBD-Cl) in borate buffer of pH 7 producing a yellow color with maximum relative fluorescence at 440 nm using a constant wavelength difference Δλ = 80 nm. Reaction conditions and other analytical parameters were studied and optimized using factorial design. Three level factorial designs have been employed for the screening, optimization of all experimental variables and determination of their interactions on the final product formation. The variables under investigation were: pH of borate buffer, volume of buffer, volume of NBD-Cl, temperature, time of heating and volume of sulfuric acid. A linear plot between relative fluorescence and concentration was obtained over the concentration range 100.00-1200.00 ng mL(-1). The limit of detection (LOD) and limit of quantification (LOQ) were found to be 10.31 and 31.24 ng mL(-1), respectively. The proposed method was validated according to ICH guidelines and successfully applied for the determination of Poly B in human plasma, where satisfactory results were obtained. The results obtained were statistically compared with those of a published method, where no significant difference was observed.

Simultaneous Determination of Octinoxate, Oxybenzone, and Octocrylene in a Sunscreen Formulation Using Validated Spectrophotometric and Chemometric Methods.

Accurate, reliable, and sensitive spectrophotometric and chemometric methods were developed for simultaneous determination of octinoxate (OMC), oxybenzone (OXY), and octocrylene (OCR) in a sunscreen formulation without prior separation steps, including derivative ratio spectra zero crossing (DRSZ), double divisor ratio spectra derivative (DDRD), mean centering ratio spectra (MCR), and partial least squares (PLS-2). With the DRSZ technique, the UV filters could be determined in the ranges of 0.5-13.0, 0.3-9.0, and 0.5-9.0 µg/mL at 265.2, 246.6, and 261.8 nm, respectively. By utilizing the DDRD technique, UV filters could be determined in the above ranges at 237.8, 241.0, and 254.2 nm, respectively. With the MCR technique, the UV filters could be determined in the above ranges at 381.7, 383.2, and 355.6 nm, respectively. The PLS-2 technique successfully quantified the examined UV filters in the ranges of 0.5-9.3, 0.3-7.1, and 0.5-6.9 µg/mL, respectively. All the methods were validated according to the International Conference on Harmonization guidelines and successfully applied to determine the UV filters in pure form, laboratory-prepared mixtures, and a sunscreen formulation. The obtained results were statistically compared with reference and reported methods of analysis for OXY, OMC, and OCR, and there were no significant differences with respect to accuracy and precision of the adopted techniques.

Relative linkages of canopy-level CO2 fluxes with the climatic and environmental variables for US deciduous forests.

We used a simple, systematic data-analytics approach to determine the relative linkages of different climate and environmental variables with the canopy-level, half-hourly CO2 fluxes of US deciduous forests. Multivariate pattern recognition techniques of principal component and factor analyses were utilized to classify and group climatic, environmental, and ecological variables based on their similarity as drivers, examining their interrelation patterns at different sites. Explanatory partial least squares regression models were developed to estimate the relative linkages of CO2 fluxes with the climatic and environmental variables. Three biophysical process components adequately described the system-data variances. The 'radiation-energy' component had the strongest linkage with CO2 fluxes, whereas the 'aerodynamic' and 'temperature-hydrology' components were low to moderately linked with the carbon fluxes. On average, the 'radiation-energy' component showed 5 and 8 times stronger carbon flux linkages than that of the 'temperature-hydrology' and 'aerodynamic' components, respectively. The similarity of observed patterns among different study sites (representing gradients in climate, canopy heights and soil-formations) indicates that the findings are potentially transferable to other deciduous forests. The similarities also highlight the scope of developing parsimonious data-driven models to predict the potential sequestration of ecosystem carbon under a changing climate and environment. The presented data-analytics provides an objective, empirical foundation to obtain crucial mechanistic insights; complementing process-based model building with a warranted complexity. Model efficiency and accuracy (R(2) = 0.55-0.81; ratio of root-mean-square error to the observed standard deviations, RSR = 0.44-0.67) reiterate the usefulness of multivariate analytics models for gap-filling of instantaneous flux data.

Novel Comparative Synchronous Spectrofluorimetric Study of Benzo(a)pyrene Using Beta-Cyclodextrin and Calix(8)arene as Fluorescence Enhancers.

Successfully benzo(a)pyrene could be quantitified in environmental samples by a novel synchronous spectrofluorimetric techniques at a constant wavelength difference Δλ = 120 nm, using beta-cyclodextrin 'ß-CD' and calix(8)arene as fluorescence enhancers, where a linear calibration curve was obtained in a concentration range of 900-14,400 pg mL(-1) and 18-360 pg mL(-1) and the detection limit of 380.00 pg mL(-1) and 12.08 pg mL(-1) (which is well below the maximum contaminant concentration for benzo(a)pyrene set by the Environmental Protection Agency 'EPA') using both enhancers, respectively. The method can be easily adopted for determination of benzo(a)pyrene in aqueous media including tap water, river water and complex water samples. The recoveries obtained were 85.13-113.36 % with RSD < 4 %. The proposed method was validated according to International Conference of Harmonization (ICH) guide lines and successfully applied to determine benzo(a)pyrene in pure form and in water samples including contaminated environmental water samples. All the results obtained were compared with those of a published method, where no significant difference was observed.

Novel method for determination of anthracene by coupling dispersive liquid-liquid extraction to first-derivative synchronous spectrofluorimetry.

A novel method could be adopted successfully for determination of anthracene in environmental samples, utilizing dispersive liquid-liquid extraction followed by first-derivative synchronous fluorimetry at a constant wavelength difference Δλ = 165 nm, where a linear calibration curve was obtained in a concentration range of 0.5-100 ng mL(-1) at 244 nm. The detection limit was 0.1 ng mL(-1). The method can be easily adopted for determination of anthracene in aqueous media including tap water and river water. The recoveries obtained were 85.40-108.02%. The proposed method was validated according to International Conference of Harmonization (ICH) guide lines and successfully applied to determine anthracene in pure form and in water samples including real life water samples from different sources. All the results obtained were compared with those of published method, where no a significant difference was observed.

The Community Health Response Team: a culturally and linguistically tailored community response to COVID-19 addressing barriers to testing and vaccinations for refugee, immigrant and migrant communities in Atlanta, Georgia.

The International Rescue Committee (IRC) in Atlanta and Community Organized Relief Effort (CORE) established a Community Health Response Team in May 2020. The team members represented refugee, immigrant and migrant populations and had expertise in health care and public health. These 18 individuals were recruited from IRC Atlanta's Career Development program, had a variety of backgrounds and spoke 20 languages. They implemented a community-centered COVID-response intervention model of pairing education and outreach efforts with testing and vaccination clinics. Due to their team makeup, the Community Health Response Team conducted tailored outreach and education that was culturally and linguistically congruent with their target communities. They administered over 16,000 COVID-19 tests at mobile community sites within the first 6 months. Once COVID-19 vaccinations were available, the Community Health Response Team coordinated a total of 834 vaccination events in communities with a high number of refugees and in partnership with refugee- and immigrant-trusted community-based organizations, resulting in 31,888 vaccinations. Hiring staff from refugee, immigrant and migrant populations created a sustainable staffing model. Also, embedding culturally specific strategies in their model of pairing education and outreach led to long-term relationships and greater trust with community members. This approach of engaging and empowering community members to create tailored public health responses should serve as guidance for future public health campaigns.

Angiojet™ mechanical thrombectomy-induced hemolysis triggering blood-leak alarms.

Blood leak alarms are increasingly rare and may be triggered by rupture of the dialyzer membrane, or intravascular hemolysis. We report two patients who developed hemolysis following Angiojet™ thrombolysis and thrombectomy of thrombosed arteriovenous fistulas, triggering blood leak alarms on hemodialysis, the occurrence of which has not been reported before. AngioJet™-induced hemolysis should be considered in the differential diagnosis for blood leak alarms occurring soon after an intervention on an arterio-venous (AV) fistula.

Determination of emergency nurse practitioner and plastic surgery trainee disposition decision agreement for plastic surgery emergency department presentations: A prospective study.

OBJECTIVE: To examine if there was a high degree of agreement for disposition decisions of emergency nurse practitioners (ENP) compared to plastic surgery trainees (PST) for plastic surgery presentations. METHODS: A prospective study of disposition decision agreement from February 2020 to January 2021 for patients who required plastic surgery consultation and managed exclusively by an ENP. Absolute percentages were used to determine the exact disposition decision accuracy of ENP and the PST, while Cohen's kappa compared disposition decision agreement. Sub-analyses of age, gender, ENP experience and presenting condition agreement were also completed. To mitigate confounding factors, operative management (OM) and non-OM groups were analysed. RESULTS: The study recruited 342 patients who presented mostly with finger or hand-related conditions (82%, n = 279) and managed by an ENP with less than 10 years of experience (65%, n = 224). Disposition decisions by ENP compared to PST were the same in 80% (n = 274) of cases. Disposition agreement for all patients was 0.72 (95% confidence interval 0.66-0.78). For the OM and non-OM groups, disposition decisions were the same in 94% (n = 320), with a Cohen's kappa 0.85 (95% confidence interval 0.79-0.91). Seven patients (2%) were discharged to GP care by the ENP when determined to need further plastic surgery involvement by the PST. CONCLUSIONS: Disposition decisions by ENP and PST were the same in most cases and had a high overall level of agreement. This may lead to greater autonomy of ENP care and reduced ED length of stay and occupancy.

Medical ethics of long-duration spaceflight.

With the advent of novel and emerging technologies, long duration spaceflight will become more common; along with it, an increase in its inherent health risks. However, health-related ethical issues arising during long-duration spaceflight remain poorly characterized, uncertain and unpredictable. Medical ethics is defined as a set of moral principles, beliefs and values that guides choices about medical care. This set of principles, founded in our sense of right and wrong, helps us make fair and just decisions. The paper conceptually and analytically investigates the ethical issues likely to arise from medical complications during spaceflight, mapping unfilled gaps of the current status quo. Furthermore, this paper explores broad ethical themes of autonomy, nonmaleficence, beneficence and justice, while also delving deeper into specific scenarios within each theme. The manuscript represents an up-to-date review of the available literature in the field of space medical ethics and recommends guiding ethical principles and a framework for their application to negotiate the resolution of complex ethical scenarios during long-duration spaceflight.

The effects of large roughness elements on the in-stream transport and retention of polystyrene microplastics.

The mechanisms controlling transport and retention of microplastics (MPs) in riverine systems are not understood well. We investigated the impact of large roughness elements (LREs) on in-stream transport and retention of the ubiquitous polystyrene-microplastics (PS-MPs). Scaled experiments were conducted with and without LREs under various shear Reynolds numbers (Re*) in an ecohydraulics flume. Our results, for the first time, demonstrated a clear dependence of the MPs' velocity on Re* in LREs-dominated channel. Two distinct regimes and thresholds were identified: lower Re* (≤ 15,000) regime corresponding to higher velocities of MPs ([Formula: see text]> 0.45), and higher Re* (> 15,000) to lower [Formula: see text]< 0.45). The presence and higher density of LREs increased Re*, decreased [Formula: see text], and enhanced the PS-MPs capture. The LREs-generated turbulence kinetic energy (TKE) was found to be a good predictor of PS-MPs transport and retention rates, indicating the effectiveness of LREs in retaining PS-MPs in streams and rivers.

Severe Crohn's Disease With Intra-abdominal Fistula: First Reported Case From Tanzania.

We describe a case of Crohn's disease occurring in a young Tanzanian female. Crohn's disease is rare in Africa and not encountered normally. The presentation of Crohn's disease overlaps with many other abdominal disorders that are common in an African setting, such as tuberculosis and schistosomiasis. The disease is probably underdiagnosed in Africa due to limitations in diagnostic testing and rarity.