Intraoperative Intraocular Lens Waste: Incidence, Cost and Reasons.

PURPOSE: To evaluate the incidence and cost of intraocular lens(IOL) waste during IOL implantation, as well as the reasons for it. METHODS: A retrospective analysis was conducted on the data of 485 patients from the IOL waste registers of a single tertiary eye hospital in China during 2016-2020. The primary outcomes were the incidence, cost, and reasons for different IOL properties. Cases were examined to ascertain IOL material, design, procedural details, and causes of waste. RESULTS: IOL waste occurred in 485 (6.62‰) of the 73,246 IOL implantations during the study period. The total cost of IOL waste was 429, 850.26 Chinese Yuan (CNY) related to waste with an average cost of 2, 442.33 CNY per procedure during the study period. Comparisons between IOL properties showed that polymethyl methacrylate (PMMA) material (39, 2.05%), three-piece design (142, 1.49%), and secondary IOL implantation (26, 2.16%) were associated with IOL wastage, and the difference was statistically significant. The causes of IOL waste were damage (107, 60.80%), patient reasons (37, 21.26%), aseptic errors (22, 12.50%), IOL quality problems (8, 4.55%), and loss (2, 1.14%). CONCLUSIONS: The incidence of IOL waste is low, but still leads to a significant cost burden due to a large number of cataract surgeries. PMMA material, three-piece design, and secondary implantation were identified as factors increasing IOL waste. Damage emerged as the primary reason for waste, largely attributed to human error. Therefore, the development of strategies to mitigate IOL waste is imperative.

Studies of Mycotoxins in Medicinal Plants Conducted Worldwide over the Last Decade: A Systematic Review, Meta-Analysis, and Exposure Risk Assessment.

BACKGROUND: Mycotoxins have been reported to be present in medicinal plants. With the growing usage of medicinal plants, contamination of mycotoxins has emerged as one of the biggest threats to global food hygiene and ecological environment, posing a severe threat to human health. PURPOSE: This study aimed to determine the mycotoxin prevalence and levels in medicinal plants and conduct a risk assessment by conducting a systematic review and meta-analysis. METHODS: A thorough search on Web of Science and PubMed was conducted for the last decade, resulting in 54 studies (meeting the inclusion criteria) with 2829 data items that were included in the meta-analysis. RESULTS: The combined prevalence of mycotoxins in medicinal plants was 1.7% (95% confidence interval, CI = 1.1% - 2.4%), with a mean mycotoxin concentration in medicinal plants of 3.551 µg/kg (95% CI = 3.461 - 3.641 µg/kg). Risk assessment results indicated that aflatoxins and ochratoxin A found in several medicinal plants posed a health risk to humans; additionally, emerging enniatins exhibited possible health risks. CONCLUSION: Therefore, the study underlines the need for establishing stringent control measures to reduce the severity of mycotoxin contamination in medicinal plants.

Animal welfare deserts: human and nonhuman animal inequities.

Residents of distressed areas of inner cities have less access to many of life's necessities and amenities than their more well-off counterparts. Geographic proximity has been identified as a primary barrier to accessing care for pets potentially creating animal welfare deserts. This project addresses three questions: Are there visible animal welfare deserts in distressed urban centers?; What human inequities are most strongly related to animal welfare deserts?; and What might be done to address these inequities? Using business location and census data in the city of Detroit, this research identifies distinct animal welfare deserts finding that more prosperous areas have more pet support resources and that the need for services is not related to the location of pet stores and veterinary offices. The study concludes that the overlap between human economic distress and pet resource deserts presents a threat to the goals of One Health. Potential policy solutions are proposed to address inequities in the distribution of animal welfare resources.

Mutagenicity of PM2.5 and Ethnic Susceptibility in Chengdu-Chongqing Economic Circle, China.

PM2.5 seriously endangers human health, and its mutagenicity is considered an important pathogenic mechanism. However, the mutagenicity of PM2.5 is mainly determined by traditional bioassays, which are limited in the large-scale identification of mutation sites. Single nucleoside polymorphisms (SNPs) can be used for the large-scale analysis of DNA mutation sites but have not yet been used on the mutagenicity of PM2.5. The Chengdu-Chongqing Economic Circle is one of China's four major economic circles and five major urban agglomerations, and the relationship between the mutagenicity of PM2.5 and ethnic susceptibility in this circle remains unclear. In this study, the representative samples are PM2.5 from Chengdu in summer (CDSUM), Chengdu in winter (CDWIN), Chongqing in summer (CQSUM) and Chongqing in winter (CQWIN) respectively. PM2.5 from CDWIN, CDSUM and CQSUM induce the highest levels of mutation in the regions of exon/5'Utr, upstream/splice site and downstream/3'Utr respectively. PM2.5 from CQWIN, CDWIN and CDSUM induce the highest ratio of missense, nonsense and synonymous mutation respectively. PM2.5 from CQWIN and CDWIN induce the highest transition and transversion mutations respectively. The ability of PM2.5 from the four groups to induce disruptive mutation effects is similar. For ethnic susceptibility, PM2.5 in this economic circle is more likely to induce DNA mutation in Chinese Dai from Xishuangbanna among Chinese ethnic groups. PM2.5 from CDSUM, CDWIN, CQSUM and CQWIN may particularly tend to induce Southern Han Chinese, Dai in Xishuangbanna, Dai in Xishuangbanna and Southern Han Chinese respectively. These findings may assist in the development of a new method for analyzing the mutagenicity of PM2.5. Moreover, this study not only promotes attention to ethnic susceptibility to PM2.5, but also introduces public protection policies for the susceptible population.

Cost Efficiency Analysis for Spasticity Management Based on Physician Botulinum Toxin Prescribing Habits.

OBJECTIVE: To estimate differences in botulinum toxin type A (BoNT-A) treatment costs per patient for spasticity-injecting physicians, with a focus on physicians' use of alternative BoNT-A agents other than onabotulinumtoxinA. DESIGN: Retrospective cohort study. SETTING: National Medicare data for fee-for-service beneficiaries in 2017. PARTICIPANTS: A total of 116 physicians, 6829 BoNT-A procedures, and 3051 patients were included in this analysis. Most physicians were physiatrists (84%) and used only onabotulinumtoxinA (82%). INTERVENTIONS: Type of BoNT-A selected by physicians was the independent variable of interest. Included physicians were separated into 2 groups: (1) onabotulinumtoxinA only injectors and (2) abobotulinumtoxinA and/or incobotulinumtoxinA injectors (may still use onabotulinumtoxinA). MAIN OUTCOME MEASURE: Average cost per patient per year. RESULTS: The total average BoNT-A cost per patient per year was significantly less for physicians who used abobotulinumtoxinA and/or incobotulinumtoxinA vs those who used only onabotulinumtoxinA ($3684 vs $4739; P=.01). Patients' average annual out-of-pocket costs also reflected a similar difference ($855 vs $1082; P=.02) between the groups. Doses used and numbers of injections per patient per year were not significantly different between groups. CONCLUSIONS: The present analysis demonstrated lower cost per patient for both the payer and patient when physicians used types of BoNT-A other than onabotulinumtoxinA for spasticity. Nevertheless, most physicians in this spasticity-focused study used exclusively onabotulinumtoxinA, the most expensive BoNT-A available. Reasons for this are complex and include history on the market and approved indications beyond those associated with spasticity. However, future research should continue to identify such issues with a goal of finding solutions to improve cost inefficiencies.

Comparing the cycling behaviours of Australian, Chinese and Colombian cyclists using a behavioural questionnaire paradigm.

Cyclists are vulnerable road users and face disproportionately high rates of road trauma, especially in low- and middle-income countries. Behaviour of road users is a system outcome, and thus studying cyclist behaviours can identify problems in the whole road transport system and assist in generating long-lasting, cost-effective solutions to promote cyclist safety. This study aims to investigate the similarities and disparities of cycling behaviour among countries with different income levels and cycling prevalence, and the relationships among cyclist demographic characteristics, behaviours and crash involvement. It applies the Cycling Behaviour Questionnaire (CBQ) to measure the behaviour of cyclists in three countries: Australia (high-income, emerging cycling country), China (mid-income, traditional cycling country) and Colombia (low-income, emerging cycling country). A total of 1094 cyclists (Australia 347, China 368, and Colombia 379) with a mean age of 31.8 years completed the online questionnaire. Confirmatory Factor Analysis was used to examine the factorial structure of the CBQ. The results showed that the three-factor CBQ (i.e., Traffic Violations, Errors and Positive Behaviours) had a stable and uniform factorial structure across all three countries. Cyclists reported more frequent positive behaviours than risky behaviours across all three countries. The Australian cyclists reported more positive behaviours and fewer violations than cyclists from the other countries, which is likely to reflect the road environment, policy and enforcement differences. Male cyclists tended to engage in more risky riding than females and reported more crash involvement. Older cyclists reported less risky riding and less involvement in crashes than younger cyclists. Cyclists who rode more often reported more frequent risky riding. The study helps understand the prevalence of risky/positive cyclist behaviours among countries and provides insights for developing systematic countermeasures to improve cycling environment and cyclist safety.

Adaptive Contrast for Image Regression in Computer-Aided Disease Assessment.

Image regression tasks for medical applications, such as bone mineral density (BMD) estimation and left-ventricular ejection fraction (LVEF) prediction, play an important role in computer-aided disease assessment. Most deep regression methods train the neural network with a single regression loss function like MSE or L1 loss. In this paper, we propose the first contrastive learning framework for deep image regression, namely AdaCon, which consists of a feature learning branch via a novel adaptive-margin contrastive loss and a regression prediction branch. Our method incorporates label distance relationships as part of the learned feature representations, which allows for better performance in downstream regression tasks. Moreover, it can be used as a plug-and-play module to improve performance of existing regression methods. We demonstrate the effectiveness of AdaCon on two medical image regression tasks, i.e., bone mineral density estimation from X-ray images and left-ventricular ejection fraction prediction from echocardiogram videos. AdaCon leads to relative improvements of 3.3% and 5.9% in MAE over state-of-the-art BMD estimation and LVEF prediction methods, respectively.

Bioinformatics analysis and quantitative weight of evidence assessment to map the potential mode of actions of bisphenol A.

Bisphenol A (BPA) is a classical chemical contaminant in food, and the mode of action (MOA) of BPA remains unclear, constraining the progress of risk assessment. This study aims to assess the potential MOAs of BPA regarding reproductive/developmental toxicity, neurological toxicity, and proliferative effects on the mammary gland and the prostate potentially related to carcinogenesis by using the Comparative Toxicogenomics Database (CTD)-based bioinformatics analysis and the quantitative weight of evidence (QWOE) approach on the basis of the principles of Toxicity Testing in the 21st Century. The CTD-based bioinformatics analysis results showed that estrogen receptor 1, estrogen receptor 2, mitogen-activated protein kinase (MAPK) 1, MAPK3, BCL2 apoptosis regulator, caspase 3, BAX, androgen receptor, and AKT serine/threonine kinase 1 could be the common target genes, and the apoptotic process, cell proliferation, testosterone biosynthetic process, and estrogen biosynthetic process might be the shared phenotypes for different target organs. In addition, the KEGG pathways of the BPA-induced action might involve the estrogen signaling pathway and pathways in cancer. After the QWOE evaluation, two potential estrogen receptor-related MOAs of BPA-induced testis dysfunction and learning-memory deficit were proposed. However, the confidence and the human relevance of the two MOAs were moderate, prompting studies to improve the MOA-based risk assessment of BPA.

An updated weight of evidence approach for deriving a health-based guidance value for 4-nonylphenol.

4-Nonylphenol (NP) is a persistent estrogen-active compound. Human exposure to NP is primarily through water and food. Although risk assessments of NP have been conducted by the European Union and a few other countries, only the Danish Veterinary and Food Administration, in 2000, proposed a tolerable daily intake of 0.005 mg kg-1 body weight (bw) day-1 . New data have been accumulated since then, prompting an update on the risk assessment of NP. A weight of evidence approach is recommended for use in scientific assessments by several agencies, e.g., European Food Safety Authority, etc. Based on the results of a weight of evidence approach, two methods were used to derive the health-based guidance value (HBGV) for NP in this study, namely a no observed adverse effects level/lowest observable adverse effect level method, and a benchmark dose method. Considering the considerable uncertainty of benchmark dose model fitting of the available data, a tolerable daily intake value of 0.025 mg kg-1 bw day-1 was derived as a provisional HBGV for NP based on the lowest observable adverse effect level value of 15 mg kg-1 bw day-1 of the renal toxicity in rats, together with the uncertainty factor of 600. However, the HBGV of NP still needs further investigation.

A rear-end collision risk assessment model based on drivers' collision avoidance process under influences of cell phone use and gender-A driving simulator based study.

Driver's collision avoidance performance has a direct link to the collision risk and crash severity. Previous studies demonstrated that the distracted driving, such as using a cell phone while driving, disrupted the driver's performance on road. This study aimed to investigate the manner and extent to which cell phone use and driver's gender affected driving performance and collision risk in a rear-end collision avoidance process. Forty-two licensed drivers completed the driving simulation experiment in three phone use conditions: no phone use, hands-free, and hand-held, in which the drivers drove in a car-following situation with potential rear-end collision risks caused by the leading vehicle's sudden deceleration. Based on the experiment data, a rear-end collision risk assessment model was developed to assess the influence of cell phone use and driver's gender. The cell phone use and driver's gender were found to be significant factors that affected the braking performances in the rear-end collision avoidance process, including the brake reaction time, the deceleration adjusting time and the maximum deceleration rate. The minimum headway distance between the leading vehicle and the simulator during the rear-end collision avoidance process was the final output variable, which could be used to measure the rear-end collision risk and judge whether a collision occurred. The results showed that although cell phone use drivers took some compensatory behaviors in the collision avoidance process to reduce the mental workload, the collision risk in cell phone use conditions was still higher than that without the phone use. More importantly, the results proved that the hands-free condition did not eliminate the safety problem associated with distracted driving because it impaired the driving performance in the same way as much as the use of hand-held phones. In addition, the gender effect indicated that although female drivers had longer reaction time than male drivers in critical situation, they were more quickly in braking with larger maximum deceleration rate, and they tended to keep a larger safety margin with the leading vehicle compared to male drivers. The findings shed some light on the further development of advanced collision avoidance technologies and the targeted intervention strategies about cell phone use while driving.