Development of the headspace gas chromatography-tandem mass spectrometry method for ethylene oxide and ethylene chlorohydrin residue in medical devices.

RATIONALE: Ethylene oxide (EO) sterilization is commonly employed for the sterilization of medical devices and has a very high market share. However, EO and its metabolite ethylene chlorohydrin (ECH) are toxic to humans. In compliance with the classification and residue limits of medical devices defined by ISO 10993-7, our study established two extraction methods for the testing of EO and ECH. METHODS: The first method involves simulated-use extraction using water as the extraction solvent. While the second, exhaustive extraction, directly extracts sample through headspace sampling analysis. Gas chromatography-tandem mass spectrometry in multiple reaction monitoring mode was utilized, requiring only 16 min. Then, the developed method was applied to assess 10 commercially available medical devices sterilized by EO. RESULTS: In simulated-use extraction, calibration curves were evaluated in the range of 1-100 and 5-500 µg for EO and ECH, respectively (r > 0.999). Inter-day recoveries ranged from 85.0% to 95.2% and from 94.8% to 102.4%. In exhaustive extraction, calibration curves spanned 0.5-50 and 2-200 µg for EO and ECH, respectively (r > 0.999). Inter-day recoveries ranged from 101.6% to 102.1% for EO and from 98.1% to 102.2% for ECH. After analysis of the 10 commercially available medical devices, two cotton swabs were found to have ECH of 35.1 and 28.4 µg per device, and four medical devices were found to have EO with concentration below the limit of quantification. Meanwhile, we found that the EO internal standard (propylene oxide) recommended by ISO 10993-7 had interference problems with other similar substances and was not suitable as an internal standard for EO. CONCLUSIONS: This study offers a sensitive and straightforward analytical approach to EO and ECH residues in a variety of medical devices. In addition, the results show that the EO or ECH content of these types of medical devices in our study falls below the regulatory limits, therefore instilling confidence among consumers regarding their safe use.

The rise of baobab trees in Madagascar.

The baobab trees (genus Adansonia) have attracted tremendous attention because of their striking shape and distinctive relationships with fauna1. These spectacular trees have also influenced human culture, inspiring innumerable arts, folklore and traditions. Here we sequenced genomes of all eight extant baobab species and argue that Madagascar should be considered the centre of origin for the extant lineages, a key issue in their evolutionary history2,3. Integrated genomic and ecological analyses revealed the reticulate evolution of baobabs, which eventually led to the species diversity seen today. Past population dynamics of Malagasy baobabs may have been influenced by both interspecific competition and the geological history of the island, especially changes in local sea levels. We propose that further attention should be paid to the conservation status of Malagasy baobabs, especially of Adansonia suarezensis and Adansonia grandidieri, and that intensive monitoring of populations of Adansonia za is required, given its propensity for negatively impacting the critically endangered Adansonia perrieri.

Occlusion-Based Three-Dimensional Craniofacial Anthropometric and Symmetric Evaluation in Preadolescences: A Comparative COHORT Study.

BACKGROUND: The importance of early diagnosis of pediatric malocclusion and early intervention has been emphasized. Without use of radiation, 3D imaging holds the potential to be an alternative for evaluating facial features in school-aged populations. METHODS: Students aged 9 and 10 years were recruited. We performed annual 3D stereophotogrammetry of the participants' heads. A total of 37 recognizable anatomical landmarks were identified for linear, angular, and asymmetric analyses using the MATLAB program. RESULTS: This study included 139 healthy Taiwanese children with a mean age of 9.13, of whom 74 had class I occlusion, 50 had class II malocclusion, and 15 had class III malocclusion. The class III group had lower soft-tissue convexity (p = 0.01) than the class II group. The boys with class II malocclusion had greater dimensions in the anteroposterior position of the mid-face (p = 0.024) at age 10. Overall asymmetry showed no significance (p > 0.05). Heat maps of the 3D models exhibited asymmetry in the mid-face of the class II group and in the lower face of the class III group. CONCLUSION: Various types of malocclusion exhibited distinct facial traits in preadolescents. Those with class II malocclusion had a protruded maxilla and convex facial profile, whereas those with class III malocclusion had a less convex facial profile. Asymmetry was noted in facial areas with relatively prominent soft-tissue features among different malocclusion types.

Craniofacial Growth and Asymmetry in Newborns: A Longitudinal 3D Assessment.

OBJECTIVE: To evaluate the development of the craniofacial region in healthy infants and analyze the asymmetry pattern in the first year of life. METHODS: The participants were grouped by sex and age (1, 2, 4, 6, 9, and 12 months) to receive three-dimensional (3D) photographs. Stereoscopic craniofacial photos were captured and transformed into a series of craniofacial meshes in each group. The growth patterns of the anthropometric indices and the degree of craniofacial asymmetry were measured, and average craniofacial meshes and color-asymmetry maps with craniofacial asymmetry scores were calculated. RESULTS: A total of 373 photographs from 66 infants were obtained. In both genders, the highest and lowest growth rates for all anthropometric indices were noted between 1 and 2 months and between 9 and 12 months, respectively. Overall, male infants had higher anthropometric indices, head volume, and head circumference than female infants. The craniofacial asymmetry score was presented with a descending pattern from 1 to 12 months of age in both sex groups. Both sex groups showed decreased left-sided laterality in the temporal-parietal-occipital region between 1 and 4 months of age and increased right frontal-temporal prominence between 6 and 12 months of age. CONCLUSIONS: A longitudinal evaluation of the craniofacial growth of healthy infants during their first year of life was presented.

Evaluation of the dual-process approach for in-situ groundwater arsenic removal.

While the worldwide distribution of geogenic arsenic (As)-affected groundwater is highly overlapped with the areas with abundant groundwater, utilization of As-contained groundwater is an inevitable compromise in those areas where surface water is not enough for irrigation. Since the occurrence of As in groundwater is often accompanied by high iron (Fe) contents, the facilitation of As and Fe precipitation without adding additional oxidizers and adsorbents is considered an environmental-friendly approach to removing As in groundwater. In the present study, the oxidation/filtration dual-process with sprinkling height of 25 cm and 120 kg filter media efficiently increased the dissolved oxygen (DO) concentration (0.36-1.52 mg/L) and oxidation-reduction potential (ORP) (24-63 mV), which facilitated the formation of Fe oxides and As co-precipitation. The correlation of As removal efficiencies with their respective flow rates indicated that a decrease in groundwater Fe and an increase of Fe in sands and gravels filters as the flow rate increased evidenced the rapid oxidation of Fe to form the Fe hydroxides. In a 40-hour continuous aeration/filtration operation, As and Fe concentrations in groundwater were reduced by 79.5% and 64.88% within 40 hrs, respectively. The ease of filter replacement and cost-effectiveness in operation can be the major attractions and innovations for future field practices.

Converting non-Mesogenic to Mesogenic Stacking of Amino-s-Triazine-Based Dendrons with p-CN Phenyl Unit by Eliminating Peripheral Dipole.

Three new amino-s-triazine-based dendrons, 1a, 1b, and 1c, containing an aryl-CN moiety in the dendritic skeleton were prepared in 72-81% yields (1a: R1 = - N(n-C8H17)2, R2 = n-OC8H17, 1b: R1 = R2 = - N(n-C8H17)2, 1c: R1 = - N(n-C8H17)2, R2 = - N(n-C4H9)2). Dendrons 1a with N(n-C8H17)2 and n-OC8H17 peripheral substituents, surprisingly, did not show any mesogenic phase during the thermal process. However, non-mesogenic 1a can be converted to mesogenic 1b or 1c by eliminating the peripheral dipole arising from the alkoxy substituent; dendron 1b only comprising the same N(n-C8H17)2 peripheral groups showed a ~25 °C mesogenic range on heating and ~108 °C mesogenic range on cooling. In contrast, dendron 1c possessing different N(n-CmH2m+1)2 (m = 8 versus m = 4) peripheral units, having similar stacking as 1b, exhibited a columnar phase on thermal treatment, but its mesogenic range (~9 and ~66 °C on heating and cooling, respectively) was much narrower than that of 1b, attributed to 1c's less flexible alkyl chains in the peripheral part of dendron. Dendron 1a with the alkoxy substituent in the peripheral skeleton, creating additional dipole correspondingly, thus, leads to the dendritic molecules having a non-mesogenic stacking. Without the peripheral dipole for intermolecular side-by-side interaction, dendrons 1b and 1c exhibit a columnar phase on thermal treatment because of the vibration from the peripheral alkyl chain.

Study on Antibacterial Activity and Structure of Chemically Modified Lysozyme.

Lysozyme is a natural protein with a good bacteriostatic effect, but its poor inhibition of Gram-negative bacteria limits its development potential as a natural preservative. Therefore, the modification of natural lysozyme to expand the antimicrobial spectrum become the focus of lysozyme study. Egg white lysozyme has low cost, rich content in nature, is easy to obtain, strong stability, and high enzyme activity, so it can be applied in the modification of lysozyme. Egg white lysozyme was modified by chemical methods using organic acids. Caffeic acid and p-coumaric acid in organic acids were used as modifiers, and 1-Ethyl-3- (3-dimethylaminopropyl) carbodiimide hydrochloride and N-hydroxy succinimide were used as dehydration condensation agents during modification. A certain degree of modified lysozyme was obtained through appropriate modification conditions. The antibacterial properties and structure of the obtained two organic acid-modified lysozymes were compared with natural enzymes. The results showed that compared with the native enzyme, the activity of modified lysozyme decreased, but the inhibitory effect on Gram-negative bacteria was enhanced. The minimum inhibitory concentrations of caffeic acid-modified enzyme and p-coumaric acid-modified enzyme on Escherichia coli and Pseudomonas aeruginosa were 0.5 mg/mL and 0.75 mg/mL, respectively. However, the antibacterial ability of modified lysozyme to Gram-positive bacteria was lower than that of the natural enzyme. The minimum inhibitory concentration of caffeic acid-modified enzyme and p-coumaric acid-modified enzyme to Staphylococcus aureus and Bacillus subtilis was 1.25 mg/mL. The peak fitting results of the amide-I band absorption peak in the infrared spectroscopy showed that the content of the secondary structure of the two modified enzymes obtained after modification was different from that of natural enzymes. In the study, two organic acids were used to modify egg white lysozyme, which enhanced the enzyme's inhibition of Gram-negative bacteria, and analyzed the mechanisms for the change in the enzyme's antibacterial ability from the perspective of the structural change of the modified enzyme, providing a new idea for lysozyme modification.

A Machine Learning Approach for Spatial Mapping of the Health Risk Associated with Arsenic-Contaminated Groundwater in Taiwan's Lanyang Plain.

Groundwater resources are abundant and widely used in Taiwan's Lanyang Plain. However, in some places the groundwater arsenic (As) concentrations far exceed the World Health Organization's standards for drinking water quality. Measurements of the As concentrations in groundwater show considerable spatial variability, which means that the associated risk to human health would also vary from region to region. This study aims to adapt a back-propagation neural network (BPNN) method to carry out more reliable spatial mapping of the As concentrations in the groundwater for comparison with the geostatistical ordinary kriging (OK) method results. Cross validation is performed to evaluate the prediction performance by dividing the As monitoring data into three sets. The cross-validation results show that the average determination coefficients (R2) for the As concentrations obtained with BPNN and OK are 0.55 and 0.49, whereas the average root mean square errors (RMSE) are 0.49 and 0.54, respectively. Given the better prediction performance of the BPNN, it is recommended as a more reliable tool for the spatial mapping of the groundwater As concentration. Subsequently, the As concentrations estimated obtained using the BPNN are applied to develop a spatial map illustrating the risk to human health associated with the ingestion of As-containing groundwater based on the noncarcinogenic hazard quotient (HQ) and carcinogenic target risk (TR) standards established by the U.S. Environmental Protection Agency. Such maps can be used to demarcate the areas where residents are at higher risk due to the ingestion of As-containing groundwater, and prioritize the areas where more intensive monitoring of groundwater quality is required. The spatial mapping of As concentrations from the BPNN was also used to demarcate the regions where the groundwater is suitable for farmland and fishponds based on the water quality standards for As for irrigation and aquaculture.

Anaerobic co-digestion of agricultural wastes toward circular bioeconomy.

A huge amount of agricultural wastes and waste activated-sludge are being generated every year around the world. Anaerobic co-digestion (AcD) has been considered as an alternative for the utilization of organic matters from such organic wastes by producing bioenergy and biochemicals to realize a circular bioeconomy. Despite recent advancement in AcD processes, the effect of feedstock compositions and operating conditions on the biomethane production processe has not been critically explored. In this paper, we have reviewed the effects of feedstock (organic wastes) characteristics, including particle size, carbon-to-nitrogen ratio, and pretreatment options, on the performance of an anaerobic digestion process. In addition, we provided an overview of the effect of key control parameters, including retention time, temperature, pH of digestate, volatile fatty acids content, total solids content, and organic loading rate. Lastly, based on the findings from the literature, we have presented several perspectives and prospects on priority research to promote AcD to a steppingstone for a circular bioeconomy.

Modeling impacts of climate change on the potential distribution of six endemic baobab species in Madagascar.

Madagascar, a globally renowned biodiversity hotspot characterized by high rates of endemism, is one of the few remaining refugia for many plants and animal species. However, global climate change has greatly affected the natural ecosystem and endemic species living in Madagascar, and will likely continue to influence species distribution in the future. Madagascar is home to six endemic baobab (Adansonia spp., Bombacoideae [Malvaceae]) species (Adansonia grandidieri, A. suarezensis, A. madagascariensis, A. perrieri, A. rubrostipa, A. za), which are remarkable and endangered plants. This study aimed to model the current distribution of suitable habitat for each baobab species endemic to Madagascar and determine the effect that climate change will have on suitable baobab habitat by the years 2050 and 2070. The distribution was modeled using MaxEnt based on locality information of 245 occurrence sites of six species from both online database and our own field work. A total of seven climatic variables were used for the modeling process. The present distribution of all six Madagascar's baobabs was largely influenced by temperature-related factors. Although both expansion and contraction of suitable habitat are predicted for all species, loss of original suitable habitat is predicted to be extensive. For the most widespread Madagascar baobab, A. za, more than 40% of its original habitat is predicted to be lost because of climate change. Based on these findings, we recommend that areas predicted to contract in response to climate change should be designated key protection regions for baobab conservation.

Non-conventional water reuse in agriculture: A circular water economy.

Due to the growing and diverse demands on water supply, exploitation of non-conventional sources of water has received much attention. Since water consumption for irrigation is the major contributor to total water withdrawal, the utilization of non-conventional sources of water for the purpose of irrigation is critical to assuring the sustainability of water resources. Although numerous studies have been conducted to evaluate and manage non-conventional water sources, little research has reviewed the suitability of available water technologies for improving water quality, so that water reclaimed from non-conventional supplies could be an alternative water resource for irrigation. This article provides a systematic overview of all aspects of regulation, technology and management to enable the innovative technology, thereby promoting and facilitating the reuse of non-conventional water. The study first reviews the requirements for water quantity and quality (i.e., physical, chemical, and biological parameters) for agricultural irrigation. Five candidate sources of non-conventional water were evaluated in terms of quantity and quality, namely rainfall/stormwater runoff, industrial cooling water, hydraulic fracturing wastewater, process wastewater, and domestic sewage. Water quality issues, such as suspended solids, biochemical/chemical oxygen demand, total dissolved solids, total nitrogen, bacteria, and emerging contaminates, were assessed. Available technologies for improving the quality of non-conventional water were comprehensively investigated. The potential risks to plants, human health, and the environment posed by non-conventional water reuse for irrigation are also discussed. Lastly, three priority research directions, including efficient collection of non-conventional water, design of fit-for-purpose treatment, and deployment of energy-efficient processes, were proposed to provide guidance on the potential for future research.

Brackish water desalination using reverse osmosis and capacitive deionization at the water-energy nexus.

In this article, we present a critical review of the reported performance of reverse osmosis (RO) and capacitive deionization (CDI) for brackish water (salinity < 5.0 g/L) desalination from the aspects of engineering, energy, economy and environment. We first illustrate the criteria and the key performance indicators to evaluate the performance of brackish water desalination. We then systematically summarize technological information of RO and CDI, focusing on the effect of key parameters on desalination performance, as well as energy-water efficiency, economic costs and environmental impacts (including carbon footprint). We provide in-depth discussion on the interconnectivity between desalination and energy, and the trade-off between kinetics and energetics for RO and CDI as critical factors for comparison. We also critique the results of technical-economic assessment for RO and CDI plants in the context of large-scale deployment, with focus on lifetime-oriented consideration to total costs, balance between energy efficiency and clean water production, and pretreatment/post-treatment requirements. Finally, we illustrate the challenges and opportunities for future brackish water desalination, including hybridization for energy-efficient brackish water desalination, co-removal of specific components in brackish water, and sustainable brine management with innovative utilization. Our study reveals that both RO and CDI should play important roles in water reclamation and resource recovery from brackish water, especially for inland cities or rural regions.

Entry of Scotophilus Bat Coronavirus-512 and Severe Acute Respiratory Syndrome Coronavirus in Human and Multiple Animal Cells.

Bats are natural reservoirs of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome CoV (MERS-CoV). Scotophilus bat CoV-512 demonstrates potential for cross-species transmission because its viral RNA and specific antibodies have been detected in three bat species of Taiwan. Understanding the cell tropism of Scotophilus bat CoV-512 is the first step for studying the mechanism of cross-species transmission. In this study, a lentivirus-based pseudovirus was produced using the spike (S) protein of Scotophilus bat CoV-512 or SARS-CoV as a surface protein to test the interaction between coronaviral S protein and its cell receptor on 11 different cells. Susceptible cells expressed red fluorescence protein (RFP) after the entry of RFP-bound green fluorescence protein (GFP)-fused S protein of Scotophilus bat CoV-512 (RFP-Sco-S-eGFP) or RFP-SARS-S pseudovirus, and firefly luciferase (FLuc) activity expressed by cells infected with FLuc-Sco-S-eGFP or FLuc-SARS-S pseudovirus was quantified. Scotophilus bat CoV-512 pseudovirus had significantly higher entry efficiencies in Madin Darby dog kidney epithelial cells (MDCK), black flying fox brain cells (Pabr), and rat small intestine epithelial cells (IEC-6). SARS-CoV pseudovirus had significantly higher entry efficiencies in human embryonic kidney epithelial cells (HEK-293T), pig kidney epithelial cells (PK15), and MDCK cells. These findings demonstrated that Scotophilus bat CoV-512 had a broad host range for cross-species transmission like SARS-CoV.

Quantifying normal head form and craniofacial asymmetry of elementary school students in Taiwan.

BACKGROUND: Defining three-dimensional (3D) normal craniofacial morphology in healthy children could provide craniofacial surgeons a reference point to assess disease, plan surgical reconstruction, and evaluate treatment outcome. The purposes of this study were to report normal craniofacial form and quantify craniofacial asymmetry of healthy children in Taiwan by implementing the 3D stereophotogrammetry technique. METHODS: Healthy Taiwanese elementary school children (n = 652) aged 6-12 years with no known craniofacial anomaly were recruited. After the 3dMD scanning procedure, 32 landmarks were manually placed on the 3D cranial images. Thin plate spline algorithm based on landmarks and closest point matching was applied to deform a symmetric 3D template into the scale of each scanned images. Skull asymmetry and facial asymmetry were calculated using 3dMD vultus and MATLAB. Average head shape models were also presented. RESULTS: Overall, the mean head transverse width, height, anteroposterior length, and circumferences were 163.02, 220.79, 179.07, and 526.55 mm, respectively. On average, the skull asymmetry and facial asymmetry were 2.47 ± 1.26 mm and 0.96 ± 0.53 mm, respectively, with no significant (all p > 0.05) differences found when comparing males and females. In the average head shape model, certain craniofacial areas on the right side were found to be more protruded than those on the left side. CONCLUSIONS: This study shows that the baseline craniofacial form of the Taiwanese elementary school children is asymmetric with a tendency of more protrusion of the head on the right side.

Determination of polycyclic aromatic hydrocarbons (PAHs) in cosmetic products by gas chromatography-tandem mass spectrometry.

A gas chromatography coupled with tandem mass spectrometry (GC-MS/MS) method is developed to determine 18 representative polycyclic aromatic hydrocarbons (PAHs) in cosmetics, including Benzo[a]pyrene (BaP) and others. The method offers high sensitivity and selectivity under selected reaction monitoring (SRM) mode to satisfy the requirements of both quantitation and qualitation. The extraction solvent system used in this study is acetone/hexane 1:1 (v/v) and other purification procedure is unnecessary. The linearities of 18 PAHs are validated in different concentration in the range of 0.25-20 ng/mL individually with coefficient correlation (r) higher than 0.996. The recoveries for spiking 3 different concentrations are from 87.40% to 120.44% for 18 PAHs and the coefficient of variation (CV) are below 12.32%. Limit of quantification (LOQ) of 18 PAHs is in the range of 0.05-0.2 mg/kg. A matrix enhancement effect is observed and can be compensated with deuterated internal standard. The method has been successfully applied to 73 samples, over 40 of them are lipsticks. The results show none of the samples detect Benzo[a]pyrene (BaP) and Dibenzo[a,h]anthracene (DBA), both are classified as the most carcinogenic. 8 PAHs are detected and the average value between 0.08 and 0.27 mg/kg. This study offers a sensitive and simple method to analyze 18 representative PAHs successfully and can be applied to cosmetic products and raw materials.

Identifying Three-Dimensional Facial Fluctuating Asymmetry in Normal Pediatric Individuals: A Panel Assessment Outcome Study of Clinicians and Observers.

This study measured three-dimensional facial fluctuating asymmetry in 600 normal and healthy Taiwanese individuals (6 to 12 years old) and assessed the perceptions of increasing levels of facial fluctuating asymmetric severity by using a panel composed of 20 clinicians (surgical professionals), as well as 20 adult and 40 pre-adolescent observers. On average, this normal cohort presented a facial fluctuating asymmetry of 0.96 ± 0.52 mm, with 0.52 ± 0.05, 0.67 ± 0.09, 1.01 ± 0.10, and 1.71 ± 0.36 mm for levels I, II, III, and IV of severity, respectively. For all categories of raters, significant differences in the average symmetry-asymmetry scale values were observed, with level I < level II < level III = level IV (all p < 0.01, except for level III vs. IV comparisons with p > 0.05). For level I, pre-adolescent observers presented a significantly (p < 0.05) higher symmetry-asymmetry scale value than adult observers, with no significant (all p > 0.05) differences for other comparisons. For overall facial asymmetry and levels II, III, and IV, no significant (all p > 0.05) differences were observed. This study reveals that the normal pediatric face is asymmetric and the panel assessment of facial fluctuating asymmetry was influenced by the level of severity and the category of raters and contributes to the literature by revealing that pre-adolescent raters present a similar or higher perception of facial asymmetry than adult raters.

Healthcare costs associated with rivaroxaban or warfarin use for the treatment of venous thromboembolism.

INTRODUCTION: Rivaroxaban has been shown to have similar efficacy but less major bleeding than warfarin in randomized trials of patients experiencing venous thromboembolism (VTE). This report sought to assess healthcare costs up to 12-months following an index VTE in patients prescribed either rivaroxaban or warfarin. MATERIALS AND METHODS: This study analyzed claims from the MarketScan Commercial Claims and Encounters Database from November 2011-July 2015. It selected adults newly-diagnosed with VTE (deep vein thrombosis [DVT] or pulmonary embolism [PE]) if they had an outpatient prescription claim for rivaroxaban or warfarin within 7-days of the index event. Warfarin users were 2:1 propensity-score matched to rivaroxaban users and followed until the end of insurance coverage, end of data availability or 12-months of follow-up. Total per patient healthcare costs, including inpatient, outpatient, and overall pharmacy costs, were compared using a multivariable generalized linear model. RESULTS: In total, 10,929 rivaroxaban patients were matched to 21,858 warfarin patients. Mean follow-up for rivaroxaban and warfarin patients was 317- and 321-days for those experiencing an index DVT, and 313- and 318-days for those with PE. Mean overall treatment costs per patient were lower for rivaroxaban vs warfarin users (-$1,116, p = .0016). This cost difference was driven by lower inpatient (-$622) and outpatient (-$1,156) treatment costs, and the higher pharmacy costs ($661) were, therefore, fully offset. Results were similar when analysis was restricted to DVT patients. No significant difference in total costs was observed in patients experiencing an index PE. LIMITATIONS: Claims databases are subject to inaccuracies and missing data. Prescription claims may not fully reflect actual medication utilization. Despite propensity-score matching and regression, residual confounding cannot be excluded. CONCLUSIONS: Rivaroxaban was associated with significantly lower total per patient VTE treatment costs, despite higher pharmacy costs. These savings are the result of decreased inpatient and outpatient healthcare utilization costs associated with rivaroxaban.

Prescribers' behavior following below- versus above-range international normalized ratio values in warfarin-treated deep vein thrombosis patients.

Maintaining acceptable international normalized ratio (INR) control among deep vein thrombosis (DVT) patients taking warfarin is challenging. We evaluated prescribers' behavior to out-of-range INRs in DVT patients following initial INR stabilization. Following INR stabilization, a below-range INR was associated with fewer subsequent measurements and warfarin-dosing adjustments, and a longer time to re-achieve a therapeutic INR compared to an above-range INR.

Health risk assessment of groundwater arsenic pollution in southern Taiwan.

Residents of the Pingtung Plain, Taiwan, use groundwater for drinking. However, monitoring results showed that a considerable portion of groundwater has an As concentration higher than the safe drinking water regulation of 10 µg/L. Considering residents of the Pingtung Plain continue to use groundwater for drinking, this study attempted to evaluate the exposure and health risk from drinking groundwater. The health risk from drinking groundwater was evaluated based on the hazard quotient (HQ) and target risk (TR) established by the US Environmental Protection Agency. The results showed that the 95th percentile of HQ exceeded 1 and TR was above the safe value of threshold value of 10-6. To illustrate significant variability of the drinking water consumption rate and body weight of each individual, health risk assessments were also performed using a spectrum of daily water intake rate and body weight to reasonably and conservatively assess the exposure and health risk for the specific subgroups of population of the Pingtung Plain. The assessment results showed that 0.01-7.50 % of the population's HQ levels are higher than 1 and as much as 77.7-93.3 % of the population being in high cancer risk category and having a TR value >10-6. The TR estimation results implied that groundwater use for drinking purpose places people at risk of As exposure. The government must make great efforts to provide safe drinking water for residents of the Pingtung Plain.

Characterization of heavy-metal-contaminated sediment by using unsupervised multivariate techniques and health risk assessment.

This study characterized the sediment quality of the severely contaminated Erjen River in Taiwan by using multivariate analysis methods-including factor analysis (FA), self-organizing maps (SOMs), and positive matrix factorization (PMF)-and health risk assessment. The SOMs classified the dataset with similar heavy-metal-contaminated sediment into five groups. FA extracted three major factors-traditional electroplating and metal-surface processing factor, nontraditional heavy-metal-industry factor, and natural geological factor-which accounted for 80.8% of the variance. The SOMs and FA revealed the heavy-metal-contaminated-sediment hotspots in the middle and upper reaches of the major tributary in the dry season. The hazardous index value for health risk via ingestion was 0.302. PMF further qualified the source apportionment, indicating that traditional electroplating and metal-surface-processing industries comprised 47% of the health risk posed by heavy-metal-contaminated sediment. Contaminants discharged from traditional electroplating and metal-surface-processing industries in the middle and upper reaches of the major tributary must be eliminated first to improve the sediment quality in Erjen River. The proposed assessment framework for heavy-metal-contaminated sediment can be applied to contaminated-sediment river sites in other regions.