Periprocedural Management and Multidisciplinary Care Pathways for Patients With Cardiac Implantable Electronic Devices: A Scientific Statement From the American Heart Association.

The rapid technological advancements in cardiac implantable electronic devices such as pacemakers, implantable cardioverter defibrillators, and loop recorders, coupled with a rise in the number of patients with these devices, necessitate an updated clinical framework for periprocedural management. The introduction of leadless pacemakers, subcutaneous and extravascular defibrillators, and novel device communication protocols underscores the imperative for clinical updates. This scientific statement provides an inclusive framework for the periprocedural management of patients with these devices, encompassing the planning phase, procedure, and subsequent care coordinated with the primary device managing clinic. Expert contributions from anesthesiologists, cardiac electrophysiologists, and cardiac nurses are consolidated to appraise current evidence, offer patient and health system management strategies, and highlight key areas for future research. The statement, pertinent to a wide range of health care professionals, underscores the importance of quality care pathways for patient safety, optimal device function, and minimization of hemodynamic disturbances or arrhythmias during procedures. Our primary objective is to deliver quality care to the expanding patient cohort with cardiac implanted electronic devices, offering direction in the era of evolving technologies and laying a foundation for sustained education and practice enhancement.

Do healthcare providers consider the social determinants of health? Results from a nationwide cross-sectional study in the United States.

BACKGROUND: While the social determinants of health (SDOH) have a greater impact on individual health outcomes than the healthcare services a person receives, healthcare providers face barriers to addressing these factors in clinical settings. Previous studies have shown that providers often lack the necessary knowledge and resources to adequately screen for and otherwise assist patients with unmet social needs. This study explores the perceptions and behaviors related to SDOH among healthcare providers in the United States (US). METHODS: This cross-sectional study analyzed data from a 22-item online survey using Reaction Data's research platform of healthcare professionals in the US. Survey items included demographic questions as well as Likert scale questions about healthcare providers' perceptions and behaviors related to SDOH. Descriptive statistics were calculated, and further analyses were conducted using t-tests and analysis of variance. RESULTS: A total of 563 respondents completed the survey, with the majority being male (72.6%), White (81%), and located in urban areas (82.2%). In terms of perceptions, most providers agreed or strongly agreed that SDOH affect the health outcomes of all patients (68.5%), while only 24.1% agreed or strongly agreed that their healthcare setting was set up to address SDOH. In terms of behavior, fewer than half currently screened for SDOH (48.6%) or addressed (42.7%) SDOH in other ways. Most providers (55.7%) wanted additional resources to focus on SDOH. Statistical analyses showed significant differences by gender, with females being more likely than males to prioritize SDOH, and by specialty, with psychiatrists, pediatricians, and family/general medicine practitioners being more likely to prioritize SDOH. CONCLUSION: Most healthcare providers understand the connection between unmet social needs and their patients' health, but they also feel limited in their ability to address these issues. Ongoing efforts to improve medical education and shift the healthcare system to allow for payment and delivery of more holistic care that considers SDOH will likely provide new opportunities for healthcare providers. In addition to what they can do at the institutional and patient levels, providers have the potential to advocate for policy and system changes at the societal level that can better address the root causes of social issues.

Clinical, electrophysiological, and imaging findings in childhood brachial plexus injury.

AIM: To assess the prognostic capabilities of various diagnostic modalities for childhood brachial plexus injuries (BPIs) and brachial plexus birth injury (BPBI) and postneonatal BPI. METHOD: In this single-center retrospective cross-sectional study, we examined children with BPIs diagnosed or confirmed by electrodiagnostic studies between 2013 and 2020, and compared the prognostic value of various components of the electrophysiologic findings, magnetic resonance imaging (MRI) data, and the Active Movement Scale (AMS). We developed scoring systems for electrodiagnostic studies and MRI findings, including various components of nerve conduction studies and electromyography (EMG) for electrodiagnostic studies. RESULTS: We identified 21 children (10 females and 11 males) aged 8 days to 21 years (mean 8y 6.95mo) who had a total of 30 electrodiagnostic studies, 14 brachial plexus MRI studies, and 10 surgical procedures. Among the diagnostic modalities assessed, brachial plexus MRI scores, EMG denervation scores, and mean total EMG scores were the most valuable in predicting surgical versus non-surgical outcomes. Correspondingly, a combined MRI/mean total EMG score provided prognostic value. INTERPRETATION: Brachial plexus MRI scores and specific electrodiagnostic scores provide the most accurate prognostic information for children with BPI. Our grading scales can assist a multidisciplinary team in quantifying results of these studies and determining prognosis in this setting. WHAT THIS PAPER ADDS: A new scoring system to quantify results of electrodiagnostic and magnetic resonance imaging (MRI) studies is presented. Severity of denervation has good prognostic value for childhood brachial plexus injuries (BPIs). Composite electromyography scores have good prognostic value for childhood BPIs. Brachial plexus MRI has good prognostic value for childhood BPIs.

A Prediction Model for Positive Infant Meconium and Urine Drug Tests.

OBJECTIVE: This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model. STUDY DESIGN: This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed. RESULTS: Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each p-value was less than 0.0001. A model with an indicator for having at least one of these four predictors had a sensitivity of 94% and a specificity of 69%. Application of this screen to our population would have decreased drug testing by 57%. No infants had a positive urine drug test when their mother's urine drug test was negative. CONCLUSION: This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative. KEY POINTS: · Many common drug screening criteria are not predictive.. · Four criteria predicted positive infant drug tests.. · No infant urine drug test is needed if the mother tests negative..

The Massachusetts Racial Equity Data Road Map: Data as a Tool Toward Ending Structural Racism.

BACKGROUND: In 2015, the Massachusetts Department of Public Health (MDPH) adopted a Title V maternal and child health priority to "promote health and racial equity by addressing racial justice and reducing disparities." A survey assessing staff capacity to support this priority identified data collection and use as opportunities for improvement. In response, MDPH initiated a quality improvement project to improve use of data for action to promote racial equity. METHODS: MDPH conducted value stream mapping to understand existing processes for using data to inform racial equity work. Key informant interviews and a survey of program directors identified challenges to using data to promote racial equity. MDPH used a cause-and-effect diagram to identify and organize challenges to using data to inform racial equity work and better understand opportunities for improvement and potential solutions. RESULTS: Key informants highlighted the need to consider structural factors and historical and community contexts when interpreting data. Program directors noted limited staff time, lack of performance metrics, competing priorities, low data quality, and unclear expectations as challenges. To address the identified challenges, the team identified potential solutions and prioritized development and piloting of the MDPH Racial Equity Data Road Map (Road Map). CONCLUSIONS: The Road Map framework provides strategies for data collection and use that support the direction of actionable data-driven resources to racial inequities. The Road Map is a resource to support programs to authentically engage communities; frame data in the broader contexts that impact health; and design solutions that address root causes. With this starting point, public health systems can work toward creating data-driven programs and policies to improve racial equity.

Moyamoya disease in children and its anesthetic implications: A review.

Moyamoya disease is a rare, progressive cerebral vasculopathy which most commonly presents in the first and fourth decades of life. The mainstay of treatment is surgical revascularization; without treatment, most patients experience ischemic or hemorrhagic strokes. This report reviews moyamoya disease, its associated conditions, surgical treatment techniques, and anesthetic management of patients with moyamoya disease.

Dental Cleaning, Community Water Fluoridation and Preterm Birth, Massachusetts: 2009-2016.

Objectives Data on the potential effect of dental cleaning and community water fluoridation (CWF) on pregnancy outcomes are scarce. While numerous studies confirm the cost-effectiveness of fluoride in preventing dental caries, the benefit of CWF during pregnancy has not been well established. Methods This cross-sectional study used data from 2009 to 2016 Massachusetts Pregnancy Risk Assessment Monitoring System and restricted to singleton live births (n = 9234, weighted response rate = 64.3%). Our exposures were: (1) dental cleaning alone during pregnancy; (2) CWF alone; and (3) dental cleaning and CWF combined (DC-CWF). Women without dental cleaning during pregnancy and CWF comprised our reference group. The outcome was preterm birth, (birth < 37 weeks gestation). This study used multivariate logistic regression modeling, controlling for maternal sociodemographic characteristics, previous medical risk and behavioral factors, and calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results During 2009-2016, the prevalence of preterm birth among women with a singleton live birth was 8.5% in Massachusetts. Overall, 58.7% of women had dental cleaning during pregnancy, and 63.6% lived in CWF. After adjusting for potential confounders, the associations between dental cleaning alone and preterm birth (aRR = 0.74 [95% CI 0.55-0.98]), and DC-CWF and preterm birth (aRR = 0.74 [95% CI 0.57-0.95]) were significant, while the association between CWF alone and preterm birth was not significant (aRR = 0.81 [95% CI 0.63-1.05]), compared to women without dental cleaning and CWF. Conclusions for Practice This study shows that the prevalence of preterm birth was lower among women with DC only and DC-CWF.

Severe Maternal Morbidity, A Tale of 2 States Using Data for Action-Ohio and Massachusetts.

Purpose Describe how Ohio and Massachusetts explored severe maternal morbidity (SMM) data, and used these data for increasing awareness and driving practice changes to reduce maternal morbidity and mortality. Description For 2008-2013, Ohio used de-identified hospital discharge records and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify delivery hospitalizations. Massachusetts used existing linked data system infrastructure to identify delivery hospitalizations from birth certificates linked to hospital discharge records. To identify delivery hospitalizations complicated by one or more of 25 SMMs, both states applied an algorithm of ICD-9-CM diagnosis and procedure codes. Ohio calculated a 2013 SMM rate of 144 per 10,000 delivery hospitalizations; Massachusetts calculated a rate of 162. Ohio observed no increase in the SMM rate from 2008 to 2013; Massachusetts observed a 33% increase. Both identified disparities in SMM rates by maternal race, age, and insurance type. Assessment Ohio and Massachusetts engaged stakeholders, including perinatal quality collaboratives and maternal mortality review committees, to share results and raise awareness about the SMM rates and identified high-risk populations. Both states are applying findings to inform strategies for improving perinatal outcomes, such as simulation training for obstetrical emergencies, licensure rules for maternity units, and a focus on health equity. Conclusion Despite data access differences, examination of SMM data informed public health practice in both states. Ohio and Massachusetts maximized available state data for SMM investigation, which other states might similarly use to understand trends, identify high risk populations, and suggest clinical or population level interventions to improve maternal morbidity and mortality.

Use of scanning and image recognition technology to semi-automate larval development assessment in toxicity tests with a tropical copepod.

There is a high demand for the development of reliable chronic toxicity tests using tropical marine species for subsequent use in tropical risk assessment. However, many chronic test endpoints can be laborious and time-consuming to assess, particularly if the endpoints require measurements of individuals (e.g. growth, size) or advanced taxonomic expertise (e.g. differentiating between larval development stages). In this study, we used scanning and image recognition (SIR) technology to develop and validate a chronic toxicity test with larvae of the tropical euryhaline copepod, Acartia sinjiensis. Optimisation steps are described, and included egg age, and effect of algal food type and salinity on toxicity. Comparisons were made between traditional endpoints measured using microscopy and those measured using SIR. Traditional endpoints of larval development ratio (LDR) and survival achieved using microscope examination and SIR were almost identical (R2 = 0.96-0.97). Additional endpoints made possible by SIR included larval development index (LDI; based on the number of animals at different stages of development), and a range of size measurements (e.g. surface area, perimeter and length) for individual animals and for total populations (i.e. a proxy for biomass). The SIR-derived endpoints were based on measurements that had concentration-dependant responses to tested toxicants (copper, nickel, ammonia), and were a sub-set of the full range of metrics provided by the software. Toxicity values based on SIR-measurements were similar to or more sensitive than the traditional LDR endpoint. SIR technology provides a major opportunity to improve and modernise larval development tests for a range for species, but comes at a cost of increased data size and complexity. Therefore, as a research tool, SIR has significant advantages over traditional microscope methods, but for routine toxicity testing, SIR incorporation into invertebrate toxicity testing will benefit from further improvements to the associated software and data management systems.

Using Multiphase Optimization Strategy and Human-Centered Design to Create an Integrated Model of Palliative Care Skills in Home-Based Physical Therapy for Advanced Heart Failure.

Background: Many older adults with advanced heart failure receive home health rehabilitation after hospitalization. Yet, integration of palliative care skills into rehabilitation is limited. Objective: Describe using the Multiphase Optimization Strategy (MOST) framework with human-centered design principles to engage clinical partners in the Preparation phase of palliative physical therapy intervention development. Design: We convened a home-based physical therapy advisory team (four clinicians, three clinical leaders) to identify physical therapist needs and preferences for incorporating palliative care skills in rehabilitation and design an intervention prototype. Results: Between 2022 and 2023, we held five advisory team meetings. Initial feedback on palliative care skill preferences and training needs directly informed refinement of our conceptual model and skills in the intervention prototype. Later feedback focused on reviewing and revising intervention content, delivery strategy, and training considerations. Conclusion: Incorporating human-centered design principles within the MOST provided a useful framework to partner with clinical colleagues in intervention design.

Diversity, seasonal abundance, and environmental drivers of chaetognath populations in North Inlet Estuary, South Carolina, USA.

Chaetognaths (Phylum: Chaetognatha) are one of the most abundant phyla of zooplankton worldwide and play an important role in marine trophic interactions. Although the role of chaetognaths in global ecosystems is well understood, the spatial variation and environmental drivers of estuarine chaetognath populations is poorly understood. To provide the first known record of chaetognath species composition in a coastal estuary in the south-eastern USA, chaetognaths were identified and quantified from zooplankton samples collected on a monthly basis in 2019 and 2020 from North Inlet Estuary in South Carolina. Parasagitta tenuis was the most abundant species of the five found, making up 33% of total abundance. The egg presence of these chaetognaths was further analyzed to gauge reproductive cycles. Abundance and egg presence were compared with surface and bottom measurements of temperature, salinity, and dissolved oxygen levels to determine the driving abiotic factors behind chaetognath's seasonal variability and reproductive cycles. Temperature, salinity, and dissolved oxygen all had low (r < ±.29), non-significant correlations with abundance. Chaetognath egg production was most significantly associated with dissolved oxygen (p < .001) and seasonal changes in temperature (p < .001). Our initial findings indicate the continued abundance of chaetognath in a local estuary are dependent on abiotic factors that are strongly influenced by a changing climate.

Stressful Life Events, Postpartum Depressive Symptoms, and Partner and Social Support Among Pregnant People with Disabilities.

INTRODUCTION: As an increasing number of people with disabilities become pregnant and give birth, understanding their vulnerabilities for poor mental health and life stress can help to improve their health and well-being. We examined whether people with disabilities are more likely to experience stressful life events 12 months before childbirth, postpartum depressive symptoms (PDS), and lack of postpartum partner and social support, and compared these associations by race/ethnicity. METHODS: Using the Massachusetts Pregnancy Risk Assessment Monitoring System 2016-2020 data (n = 6,483), we used univariate and multivariable logistic regression models to estimate the associations of disability with stressful life events, PDS, and postpartum partner and social support, and calculated risk ratio (RR), adjusted RR, and 95% confidence interval (CI). We also conducted stratified analyses by race/ethnicity. RESULTS: The prevalence of disability was 10.7% overall, and 8.8% among White non-Hispanic people, 14.3% among Black non-Hispanic people, 15.5% among Hispanic people, and 8.3% among Asian non-Hispanic people. Compared with people without disabilities, those with disabilities were more likely to report emotional stress (RR, 1.54; 95% CI, 1.36-1.74), partner-related stress (RR, 2.55; 95% CI, 2.23-2.91), financial stress (RR, 1.55; 95% CI, 1.44-1.68), traumatic stress (RR, 2.27; 95% CI, 1.85-2.79), and PDS (RR, 3.77; 95% CI, 3.13-4.53). People with disabilities were also more likely to lack a partner's emotional support (RR, 2.57; 95% CI, 2.21-2.97), financial support from the newborn's father (RR, 2.89; 95% CI, 2.39-3.51), and social support while feeling tired or frustrated (RR, 2.05; 95% CI, 1.68-2.52). These associations remained statistically significant after adjustment for maternal factors and newborn's birth year. Strong associations of disability with stressful life events (including emotional stress and partner-related stress), PDS, lacking partner's emotional support, and social support existed across racial/ethnic groups. CONCLUSIONS: Pregnant people with disabilities may benefit from additional screening for stressful life events and depression during pregnancy and postpartum. Multidisciplinary efforts that combine mental health screening and treatment, peer support groups, increased health care provider training about caring for people with disabilities during pregnancy, and better access to care for pregnant people with disabilities are needed to improve their health and support their desire to become parents.

The Effects of Nickel and Copper on Tropical Marine and Freshwater Microalgae Using Single and Multispecies Tests.

Microalgae are key components of aquatic food chains and are known to be sensitive to a range of contaminants. Much of the available data on metal toxicity to microalgae have been derived from temperate single-species tests with temperate data used to supplement tropical toxicity data sets to derive guideline values. In the present study, we used single-species and multispecies tests to investigate the toxicity of nickel and copper to tropical freshwater and marine microalgae, including the free-swimming stage of Symbiodinium sp., a worldwide coral endosymbiont. Based on the 10% effect concentration (EC10) for growth rate, copper was two to four times more toxic than nickel to all species tested. The temperate strain of Ceratoneis closterium was eight to 10 times more sensitive to nickel than the two tropical strains. Freshwater Monoraphidium arcuatum was less sensitive to copper and nickel in the multispecies tests compared with the single-species tests (EC10 values increasing from 0.45 to 1.4 µg Cu/L and from 62 to 330 µg Ni/L). The Symbiodinium sp. was sensitive to copper (EC10 of 3.1 µg Cu/L) and less sensitive to nickel (EC50 >1600 µg Ni/L). This is an important contribution of data on the chronic toxicity of nickel to Symbiodinium sp. A key result from the present study was that three microalgal species had EC10 values below the current copper water quality guideline value for 95% species protection in slightly to moderately disturbed systems in Australia and New Zealand, indicating that they may not be adequately protected by the current copper guideline value. By contrast, toxicity of nickel to microalgae is unlikely to occur at exposure concentrations typically found in fresh and marine waters. Environ Toxicol Chem 2023;42:901-913. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

A Descriptive Analysis of Redemption Patterns by Vendor Type Among: WIC Participants in Massachusetts.

BACKGROUND: The retail environment is an important determinant of food package redemption in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). OBJECTIVE: The objectives of this study were to describe where Massachusetts WIC households redeemed their food benefits each month and monthly variations in benefit redemption depending on a household's most frequently used vendor type each month. DESIGN: These were cross-sectional and longitudinal analyses of administrative data provided by Massachusetts WIC. PARTICIPANTS/SETTING: Monthly redemption data for 209,973 households shopping at approximately 1,000 unique vendors between January 2015 and August 2019 were analyzed. MAIN OUTCOME MEASURES: Outcomes were mean monthly percentage of households that relied on each vendor type when redeeming benefits and mean monthly percent redemption for each benefit category. STATISTICAL ANALYSES PERFORMED: For each month, households were classified as using 1 of 8 vendor types. The monthly percentage of households redeeming at each vendor type was calculated, as well as the monthly percent redemption for each benefit category by vendor type. The averages of these monthly percentages were computed for 2015 and 2019. Data from months when households did not redeem any benefits were excluded from primary analyses because it was not possible to determine their vendor type for that month. RESULTS: On average across months in 2019, the majority of Massachusetts WIC households (63%) relied on large vendors only (ie, superstores, supermarkets, and large grocery stores) when redeeming benefits, and 5% relied on small grocery or convenience stores only. Between 2015 and 2019, mean monthly reliance on small grocery and convenience stores decreased by 3.1 and 0.7 percentage points, respectively. Compared with other vendor types, households that redeemed benefits at superstores only had, in an average month, lower redemption levels for most benefit categories. For example, in the 2019 mean across months, percent redemption of breakfast cereal was 53% among households redeeming at superstores only compared with 74% for those redeeming at small grocery stores only. By contrast, households that relied on small grocery stores only had, in an average month, lower redemption levels for yogurt and cash value benefit compared with other vendor types; for example, in the 2019 mean across months, percent redemption of yogurt was 34% among households redeeming at small grocery stores only compared with 62% among those redeeming at supermarkets only. CONCLUSIONS: Results suggest that retail-based efforts to increase redemption should consider vendor-type reliance. Strategies to increase redemption may be especially important for WIC shoppers relying on superstores.

COVID-19 and Psychosocial Well-Being: Did COVID-19 Worsen U.S. Frontline Healthcare Workers' Burnout, Anxiety, and Depression?

Healthcare workers are highly regarded for their compassion, dedication, and composure. However, COVID-19 created unprecedented demands that rendered healthcare workers vulnerable to increased burnout, anxiety, and depression. This cross-sectional study assessed the psychosocial impact of COVID-19 on U.S. healthcare frontliners using a 38-item online survey administered by Reaction Data between September and December 2020. The survey included five validated scales to assess self-reported burnout (Maslach Summative Burnout Scale), anxiety (GAD-7), depression (PHQ-2), resilience (Brief Resilience Coping Scale), and self-efficacy (New Self-Efficacy Scale-8). We used regression to assess the relationships between demographic variables and the psychosocial scales index scores and found that COVID-19 amplified preexisting burnout (54.8%), anxiety (138.5%), and depression (166.7%), and reduced resilience (5.70%) and self-efficacy (6.5%) among 557 respondents (52.6% male, 47.5% female). High patient volume, extended work hours, staff shortages, and lack of personal protective equipment (PPE) and resources fueled burnout, anxiety, and depression. Respondents were anxious about the indefinite duration of the pandemic/uncertain return to normal (54.8%), were anxious of infecting family (48.3%), and felt conflicted about protecting themselves versus fulfilling their duty to patients (44.3%). Respondents derived strength from their capacity to perform well in tough times (74.15%), emotional support from family/friends (67.2%), and time off work (62.8%). Strategies to promote emotional well-being and job satisfaction can focus on multilevel resilience, safety, and social connectedness.

Self and other dialogue in infancy: normal versus compromised developmental pathways.

Dialogical Self Theory, co-regulation, and foundational movement analysis are used to present a description of the development of the dialogical self during the first five months of life using observations of two mother-infant dyads. Susan and her mother illustrate normative emergence of the dialogical self. Susan's I-positions emerge through positive interactions with her mother, for example, through body positioning and dialogue in a flexible yield-push pattern. Peter, another infant we observed, and his mother show how the development of the dialogical self may be disrupted or delayed as rigid boundaries are formed between the mother and infant. Peter's tendency to withdraw, coupled with his mother's persistence at diminishing his positions, results in both avoidant and ambiguous monological positions in relation to his mother.

Pulse-Exposure Toxicity of Ammonia and Propoxur to the Tropical Copepod Acartia sinjiensis.

Toxicity risk assessments of short-term discharges of contaminated waters to the aquatic environment have shown that receptor organisms can tolerate higher pulse-exposure than continuous-exposure concentrations of some contaminants. However, these observations are influenced by the mode of toxicity of the contaminants present and the concentration-time profile of the exposure. For common metal contaminants, the time-weighted average concentration (TAC) of the exposure has been useful for predicting risk of toxicity to multiple species, including the tropical, euryhaline copepod Acartia sinjiensis. To increase our understanding of the application and limitations of the TAC approach, the present study examined how varied pulse-exposure durations affect the toxicity of fast-acting contaminants, ammonia, and the common pesticide propoxur to this copepod species. Copepod larvae were exposed under continuous-exposure conditions (all life stages from eggs to nauplii to copepodites exposed) and as 6- and 18-h pulse exposures applied during the most sensitive life stage only (24-h-old nauplii) within 78-h tests. Larval development ratio and population size were assessed as test endpoints. Generally, increased exposure duration resulted in increased toxicity. Trends observed for ammonia and propoxur were slightly different for larval development and population size. Larvae tolerated greater concentrations of contaminants in a 6-h pulse (higher 10% effect concentration) than in an 18-h pulse, or a continuous 78-h exposure, whereas toxicity responses converged for the 18- and 78-h exposures. Continuous toxicity thresholds were always protective of pulse exposures, providing a conservative toxicity threshold for all durations of pulse exposures. Although generalizations for predictions of risk based on TACs are frequently effective for common metal contaminants, the TAC approach was not effective for ammonia and propoxur. Environ Toxicol Chem 2022;41:208-218. © 2021 SETAC.

Exposure duration and composition are important variables to predict short-term toxicity of effluents to a tropical copepod, Acartia sinjiensis.

Predicting the toxicity of effluent exposures, which vary in duration, composition, and concentration, poses a challenge for ecological risk assessments. Effluent discharges may frequently result in the exposure of aquatic organisms to high concentrations of mixed contaminants for short durations. In the receiving environment effluents will undergo dilution and physical or chemical processes that further reduce contaminant concentrations at varying rates. To date, most studies comparing toxicity risks of continuous and pulsed contaminant exposures have focused on individual contaminants. In this study, the toxicity to the tropical euryhaline copepod Acartia sinjiensis of two complex effluents was assessed, comparing 6- and 18-h pulses and 78-h continuous exposures. Observations of larval development success and population size were completed after a 78-h incubation period, to observe for latent effects after pulse exposures. The chemical compositions of the effluents were assessed over time and different contaminants (i.e., metals, ammonia or organics) declined at differing rates. These were characterized as either a minimal, steady, or rapid decline. Nauplii development and population after 78 h were more impacted by effluent exposures following an 18-h pulse, compared to a 6-h pulse. Based on pulse-exposure concentrations, the 50% effect concentrations (EC50) were similar for continuous and 18-h exposures but up to 3-fold greater (lower toxicity) for the shorter 6-h exposures. Time-weighted average concentrations did not accurately predict toxicity from pulse exposures of the effluents. Concentration-addition toxicity modelling using toxicity data from pulse exposures of single contaminants was useful for predicting the toxicity of chemical mixtures exposed for varying durations. Recommendations for modified approaches to assessing risks of short-term effluent discharges are discussed.

Risk Factors, Screening, Diagnosis, and Treatment of Osteoporosis in HIV-Infected Adults in an HIV Primary Care Clinic.

Background: The population of people living with HIV is aging, and with aging come emergent comorbidities, including osteoporosis, for which screening and treatment are becoming increasingly important. Osteoporosis prevalence among those living with HIV is 3 times greater than among HIV-uninfected controls. Objective: To assess and describe osteoporosis risk factors, screening, diagnosis, and treatment for people 50 years of age or older living with HIV and receiving care at a multidisciplinary HIV primary care clinic. Methods: A retrospective chart review of people 50 years of age or older living with HIV was conducted at the John Ruedy Clinic in Vancouver, British Columbia, between June 1, 2016, and June 1, 2019. Patients who had had fewer than 2 yearly follow-up appointments were excluded. Results: A total of 146 patients were included in the analysis; most were male (n = 134, 92%), and the median age was 55 years. Patients had a median of 3 osteoporosis risk factors (in addition to age and HIV infection), and 145 patients had at least 1 risk factor. All screening for osteoporosis was conducted by dual-energy X-ray absorptiometry (DXA). Thirty-nine (27%) of the patients were screened with DXA, 92 (63%) were not screened, and 15 (10%) already had a diagnosis of osteoporosis. The DXA screening identified osteoporosis in an additional 10 patients and osteopenia in 22 patients. Treatments for patients with osteoporosis included bisphosphonates (n = 15, 60%) and vitamin D or calcium (or both), without any other medications (n = 4, 16%). In the overall study population, 32 (22%) of the patients were taking calcium and 46 (32%) were taking vitamin D. Conclusions: Many patients aged 50 years or older and receiving HIV care at the John Ruedy Clinic had or were at risk for osteoporosis. An opportunity exists to increase screening and treatment of these individuals. A multidisciplinary team may be crucial in achieving this goal.

Contexte: La population des personnes vivant avec le VIH vieillit et, avec le vieillissement, des comorbidités émergent, dont l'ostéoporose, pour laquelle le dépistage et le traitement sont de plus en plus importants. La prévalence de l'ostéoporose chez les personnes vivant avec le VIH est 3 fois plus élevée que chez les témoins non infectés. Objectif: Évaluer et décrire les facteurs de risque, le dépistage, le diagnostic et le traitement de l'ostéoporose chez les personnes d'au moins 50 ans vivant avec le VIH et qui reçoivent des soins dans une clinique pluridisciplinaire de soins primaires pour le VIH. Méthodes: Un examen rétrospectif des dossiers des personnes d'au moins 50 ans vivant avec le VIH a été effectué à la clinique John Ruedy à Vancouver (Colombie-Britannique) entre le 1er juin 2016 et le 1er juin 2019. Les patients qui avaient eu moins de 2 rendez-vous de suivi annuels ont été exclus de l'étude. Résultats: Au total, 146 patients ont été inclus dans l'analyse; la plupart étaient des hommes (n = 134, 92 %) et l'âge médian était de 55 ans. Les patients avaient une médiane de 3 facteurs de risque d'ostéoporose (en plus de l'âge et de l'infection par le VIH), et 145 patients avaient au moins 1 facteur de risque. Tous les dépistages de l'ostéoporose ont été réalisés par absorption biphotonique à rayons X (DXA). Trente-neuf patients (27 %) ont été dépistés par DXA, 92 (63 %) ne l'ont pas été et 15 (10 %) avaient déjà un diagnostic d'ostéoporose. Le dépistage par DXA a permis d'identifier l'ostéoporose chez 10 patients supplémentaires et l'ostéopénie chez 22 patients. Le traitement des patients atteints d'ostéoporose comprenait des bisphosphonates (n = 15, 60 %) et de la vitamine D ou du calcium (ou les deux) sans autre médicament (n = 4, 16 %). Dans la population générale de l'étude, 32 patients (22 %) prenaient du calcium et 46 (32 %) prenaient de la vitamine D. Conclusions: De nombreux patients d'au moins 50 ans recevant des soins pour le VIH à la clinique John Ruedy présentaient un risque d'ostéoporose ou l'avaient déjà développée. Il est possible d'accroître leur dépistage et leur traitement, et une équipe multidisciplinaire peut être cruciale pour atteindre cet objectif.