Risk assessment models for PICC-related venous thrombosis in adult patients with cancer: A network meta-analysis.

OBJECTIVES: This review aims to compare the performance of available risk assessment models (RAMs) for predicting peripherally inserted central catheter-related venous thrombosis (PICC-RVT) in adult patients with cancer. METHODS: A systematic search was conducted across ten databases from inception to October 20, 2023. Studies were eligible if they compared the accuracy of a RAM to that of another RAM for predicting the risk of PICC-RVT in adult patients with cancer. Two reviewers independently performed the study selection, data extraction and risk of bias assessments. A Bayesian network meta-analysis (NMA) was used to evaluate the performance of the RAMs. RESULTS: A total of 1931 studies were screened, and 7 studies with 10 RAMs were included in the review. The most widely used RAMs were the Caprini (4 studies), Padua prediction score (3 studies), Autar (3 studies), Michigan risk score (2 studies) and Seeley score (2 studies). The sensitivity, specificity and accuracy varied markedly between the models. Notably, the Caprini score achieved higher sensitivity than 4 RAMs (Wells, Revised Geneva, modified MRS, MRS). The Michigan risk score had greater specificity than did the other 6 RAMs (Caprini, Autar, Padua, Seeley, the novel RAM, Wells). The predictive accuracy of the MRS is significantly greater than that of the Caprini and Autar RAM. CONCLUSION: The MRS could be the most accurate RAM for identifying patients at high risk of PICC-RVT. However, as limited studies are available, more rigorous studies should be conducted to examine the accuracy of the Michigan risk score for PICC-RVT in different contexts.

PROTOCOL: Key characteristics of effective preschool-based interventions to promote self-regulation: A systematic review and meta-analysis.

This is the protocol for a Cochrane Review. The objectives are as follows: The aim of this systematic review is to advance our understanding of the key characteristics of effective preschool-based interventions designed to foster self-regulation. To accomplish this, the review addresses the following questions: 1. What types of preschool-based interventions have been developed to promote self-regulation? 2. What is the average effect of these preschool-based interventions on self-regulation, focusing on four key constructs: integrative effortful control, integrative executive function, self-regulation, and self-regulated learning? 3. What characteristics-such as Resource Allocation, Activity Type, and Instruction Method-could potentially contribute to the effects of preschool-based interventions in promoting self-regulation?

Modes of North Atlantic Western boundary current variability at 36° N.

The surface-intensified, poleward-flowing Gulf Stream (GS) encounters the equatorward-flowing Deep Western Boundary Current (DWBC) at 36° N off Cape Hatteras. In this study, daily output from a data-assimilative, high-resolution (800 m), regional ocean reanalysis was examined to quantify variability in the velocity structure of the GS and DWBC during 2017-2018. The validity of this reanalysis was confirmed with independent observations of ocean velocity and density that demonstrate a high level of realism in the model's representation of the regional circulation. The model's daily velocity time series across a transect off Cape Hatteras was examined using rotated Empirical Orthogonal Function analysis, and analysis suggests three leading modes that characterize the variability of the western boundary currents throughout the water column. The first mode, related to meandering of the GS current, accounts for 55.3% of the variance, followed by a "wind-forced mode", which accounts for 12.5% of the variance. The third mode, influenced by the DWBC and upper-ocean eddies, accounts for 7.1% of the variance.

Current situation and influencing factors of the nursing practice environment in five tertiary general hospitals in Shenzhen: a cross-sectional study.

Objective: This study investigates the current situation and influencing factors of the nursing practice environment in Shenzhen, China, and provides suggestions for improving it. Background: Nursing shortage is an urgent global problem and also of concern in China. Studies have shown that better work environments are related to high job satisfaction and better patient outcomes. Methods: The 37-item Practice Environment Scale was used to assess the nursing practice environment. Respondents were 1116 nurses from five general tertiary hospitals in Shenzhen. Results: The mean satisfaction score for the nursing practice environment was 3.63 ± 0.72 (where 5 is the highest possible score). Position, being a specialist nurse, choice of nursing major, educational attainment, and night shifts significantly affected nurses' working environment satisfaction. Conclusion: The practice environment of nurses was satisfactory. We recommend reducing the workload and encouraging nurses to complete specialist training, and supporting nurses to expand their roles in hospitals and society to improve the nursing practice environment.

The exposures and health effects of benzene, toluene and naphthalene for Chinese chefs in multiple cooking styles of kitchens.

Commercial cooking has higher intensity and more severe instantaneous cooking pollution from volatile organic chemicals compared to home cooking, making health risk assessment of occupational exposure for chefs a priority. In this study, chefs from three cooking styles of kitchens, including steaming, frying, and grilling, were selected to investigate the external and internal exposures, health risks and effects of several typical aromatic hydrocarbons (benzene, toluene and naphthalene). Naphthalene was found to be the most concentrated contaminant in air samples among the different kitchens, while benzene had the lowest concentration. The concentration of toluene in frying kitchens was significantly higher than that in steaming kitchens. Air concentrations of toluene in frying kitchens, as well as benzene concentrations in grilling kitchens exceeded the standard level according to indoor air quality standard (GB/T18883-2002). Regarding the metabolites of pollutants in urine, the content of S-benzylmercapturic acids (S-BMA) for frying chefs was significantly higher than that for other cooking styles of chefs, which was consistent with the relatively higher air concentrations of toluene. There was a good correlation between internal and external exposure of the pollutants. The level of oxidative stress was influenced by 2-hydroxynaphthalene (2-OHN) and S-BMA, indicating the potential health risks of these occupational exposed chefs. This study indicates the need to improve the monitoring of typical aromatic hydrocarbons, as well as to investigate their potential health effects in large-scale groups, and improve the ventilation in kitchens.

Towards integrated modeling of the long-term impacts of oil spills.

Although great progress has been made to advance the scientific understanding of oil spills, tools for integrated assessment modeling of the long-term impacts on ecosystems, socioeconomics and human health are lacking. The objective of this study was to develop a conceptual framework that could be used to answer stakeholder questions about oil spill impacts and to identify knowledge gaps and future integration priorities. The framework was initially separated into four knowledge domains (ocean environment, biological ecosystems, socioeconomics, and human health) whose interactions were explored by gathering stakeholder questions through public engagement, assimilating expert input about existing models, and consolidating information through a system dynamics approach. This synthesis resulted in a causal loop diagram from which the interconnectivity of the system could be visualized. Results of this analysis indicate that the system naturally separates into two tiers, ocean environment and biological ecosystems versus socioeconomics and human health. As a result, ocean environment and ecosystem models could be used to provide input to explore human health and socioeconomic variables in hypothetical scenarios. At decadal-plus time scales, the analysis emphasized that human domains influence the natural domains through changes in oil-spill related laws and regulations. Although data gaps were identified in all four model domains, the socioeconomics and human health domains are the least established. Considerable future work is needed to address research gaps and to create fully coupled quantitative integrative assessment models that can be used in strategic decision-making that will optimize recoveries from future large oil spills.

Dynamics of an intense Alexandrium catenella red tide in the Gulf of Maine: satellite observations and numerical modeling.

In July 2009, an unusually intense bloom of the toxic dinoflagellate Alexandrium catenella occurred in the Gulf of Maine. The bloom reached high concentrations (from hundreds of thousands to one million cells L-1) that discolored the water and exceeded normal bloom concentrations by a factor of 1000. Using Medium Resolution Imaging Spectrometer (MERIS) imagery processed to target chlorophyll concentrations (>2 µg L-1), patches of intense A. catenella concentration were identified that were consistent with the highly localized cell concentrations observed from ship surveys. The bloom patches were generally aligned with the edge of coastal waters with high-absorption. Dense bloom patches moved onshore in response to a downwelling event, persisted for approximately one week, then dispersed rapidly over a few days and did not reappear. Coupled physical-biological model simulations showed that wind forcing was an important factor in transporting cells onshore. Upward swimming behavior facilitated the horizontal cell aggregation, increasing the simulated maximum depth-integrated cell concentration by up to a factor of 40. Vertical convergence of cells, due to active swimming of A. catenella from the subsurface to the top layer, could explain the additional 25-fold intensification (25 × 40=1000-fold) needed to reach the bloom concentrations that discolored the water. A model simulation that considered upward swimming overestimated cell concentrations downstream of the intense aggregation. This discrepancy between model and observed concentrations suggested a loss of cells from the water column at a time that corresponded to the start of encystment. These results indicated that the joint effect of upward swimming, horizontal convergence, and wind-driven flow contributed to the red water event, which might have promoted the sexual reproduction event that preceded the encystment process.

Quantitative Analysis of Health Risk Perception, Exposure Levels, and Willingness to Pay/Accept of PM2.5 during the 2014 Nanjing Youth Olympic Games.

Local governments in China regularly implement short-term emission control measures to improve air quality during important sporting events. As a condition for hosting the 2014 Youth Olympic Games (YOG), the Nanjing government agreed to temporarily and substantially improve air quality. Regression analysis, Spearman correlation analysis, χ2 test, and the contingent valuation method were used to explore the effects of robust, short-term air pollution control measures on risk perception, daily exposure to PM2.5, risk acceptance levels, and willingness to pay/accept (WTP/WTA) for reductions in air pollution for the benefit of reducing health risks. Postimplementation, the respondents' risk perception levels presented the following changes: during the YOG, the respondents perceived the lowest effects of haze pollution while after the YOG, they perceived the highest effects. The changes in risk acceptance levels showed the same tendency. Furthermore, after the YOG, the respondents asked for the most economic compensation, and their willingness to pay for risk reduction also reached the highest level. This study reveals the need to increase the public's understanding of the health risks of air pollution, protect those populations most exposed to high levels of PM2.5, and take more effective long-term measures to meet local residents' demands for improved air quality.

Risk perception of heat waves and its spatial variation in Nanjing, China.

The intensity, frequency, and duration of heat waves are expected to increase with climate change. In this study, we found a significant difference of public perceived effects of heat waves and trust in government among urban, suburban, and rural districts. Rural residents had a significant higher effect perception than urbanites and also showed stronger willingness to have medical insurance or regular physical examinations. Meanwhile, suburban residents had the lowest trust perception in government among these three districts, which may be due to suburban districts' unique social structure and complex social issues. Besides, we assessed the relationship between the factor effect and demographic variables. The results showed that urban respondents' effect perception was significantly related to heat wave experiences. Suburban respondents' effect perception was significantly related to age, income, and heat wave experiences. And rural respondents' effect perception was significantly related to income and chronic diseases. Based on our results, much more attention needs to be paid to rural districts. The government should strengthen infrastructure construction such as cooling centers, improve emergency response plans and mechanisms, and increase reserves of emergency supplies in rural districts. Also, targeted risk communication is of the equal importance to aid the policy-makers improving the relationship with the public and regaining the public's trust and support.

Marine Hydrokinetic Energy from Western Boundary Currents.

The kinetic energy in ocean currents, or marine hydrokinetic (MHK) energy, is a renewable energy resource that can help meet global energy requirements. An ocean circulation model-based census shows that subtropical surface western boundary currents (WBCs) are the only nearshore, large-scale currents swift enough to drive large electricity-generating ocean turbines envisioned for future use. We review several WBCs in the context of kinetic energy extraction. The power density in the Gulf Stream off North Carolina at times reaches several thousand watts per square meter at 75 m below the surface, and the annual average power is approximately 500-1,000 W m-2. Significant fluctuations occur with periods of 3-20 days (Gulf Stream meanders) and weeks to months (Gulf Stream path shifts). Interannual variations in annual average power occur because of year-to-year changes in these WBC motions. No large-scale turbines presently exist, and the road to establishing MHK facilities in WBCs will encounter challenges that are similar in many aspects to those associated with the development of offshore wind power.

Variational Data Assimilative Modeling of the Gulf of Maine Circulation in Spring and Summer 2010.

A data assimilative ocean circulation model is used to hindcast the Gulf of Maine (GOM) circulation in spring and summer 2010. Using the recently developed incremental strong constraint 4D Variational data assimilation algorithm, the model assimilates satellite sea surface temperature and in situ temperature and salinity profiles measured by expendable bathythermograph, Argo floats, and shipboard CTD casts. Validation against independent observations shows that the model skill is significantly improved after data assimilation. The data-assimilative model hindcast reproduces the temporal and spatial evolution of the ocean state, showing that a sea level depression southwest of the Scotian Shelf played a critical role in shaping the gulf-wide circulation. Heat budget analysis further demonstrates that both advection and surface heat flux contribute to temperature variability. The estimated time scale for coastal water to travel from the Scotian Shelf to the Jordan Basin is around 60 days, which is consistent with previous estimates based on in situ observations. Our study highlights the importance of resolving upstream and offshore forcing conditions in predicting the coastal circulation in the GOM.

Large increase in dissolved inorganic carbon flux from the Mississippi River to Gulf of Mexico due to climatic and anthropogenic changes over the 21st century.

It is recognized that anthropogenic factors have had a major impact on carbon fluxes from land to the ocean during the past two centuries. However, little is known about how future changes in climate, atmospheric CO2, and land use may affect riverine carbon fluxes over the 21st century. Using a coupled hydrological-biogeochemical model, the Dynamic Land Ecosystem Model, this study examines potential changes in dissolved inorganic carbon (DIC) export from the Mississippi River basin to the Gulf of Mexico during 2010-2099 attributable to climate-related conditions (temperature and precipitation), atmospheric CO2, and land use change. Rates of annual DIC export are projected to increase by 65% under the high emission scenario (A2) and 35% under the low emission scenario (B1) between the 2000s and the 2090s. Climate-related changes along with rising atmospheric CO2 together would account for over 90% of the total increase in DIC export throughout the 21st century. The predicted increase in DIC export from the Mississippi River basin would alter chemistry of the coastal ocean unless appropriate climate mitigation actions are taken in the near future.

Seasonal and Interannual Variability in Gulf of Maine Hydrodynamics: 2002-2011.

In situ observations including long-term moored meteorological and oceanographic measurements and multi-year gulf-wide ship survey data are used to quantify interannual variability of surface wind, river runoff, and hydrographic conditions in the Gulf of Maine during summers 2002-2011. The cumulative upwelling index shows that upwelling (downwelling)-favorable wind conditions were most persistent in 2010 (2005) over the 10-year study period. River discharge was highest in 2005; peak runoff occurred in early April in 2010 as opposed to late April to middle May in other years. Moored time series show that coastal water temperature was 0.5-2 °C warmer than average in summer 2010, and about 2 °C colder than average in 2004. Coastal salinity in April 2010 was the lowest in the 10-year study period. Both moored Acoustic Doppler Current Profiler (ADCP) current measurements and dynamic height/geostrophic velocity calculations based on gulf-wide ship survey data show May-June 2010 had one of the weakest alongshore transports in the western Gulf of Maine during the 10-year study period, likely associated with intrusions of warm slope water and fresher-than-usual Scotian Shelf water. Comparisons of coastal currents to the Paralytic Shellfish Poisoning (PSP) closure maps resulting from A. fundyense blooms suggest a linkage between alongshore transport and the downstream extent of toxicity.

Predicting the distribution of oceanic-stage Kemp's ridley sea turtles.

The inaccessibility of open ocean habitat and the cryptic nature of small animals are fundamental problems when assessing the distribution of oceanic-stage sea turtles and other marine animals sharing similar life-history traits. Most methods that estimate patterns of abundance cannot be applied in situations that are extremely data limited. Here, we use a movement ecology framework to generate the first predicted distributions for the oceanic stage of the Kemp's ridley sea turtle (Lepidochelys kempii). Our simulations of particle dispersal within ocean circulation models reveal substantial annual variation in distribution and survival among simulated cohorts. Such techniques can help prioritize areas for conservation, and supply inputs for more realistic demographic models attempting to characterize population trends.

Tracking the long-distance dispersal of marine organisms: sensitivity to ocean model resolution.

Ocean circulation models are widely used to simulate organism transport in the open sea, where challenges of directly tracking organisms across vast spatial and temporal scales are daunting. Many recent studies tout the use of 'high-resolution' models, which are forced with atmospheric data on the scale of several hours and integrated with a time step of several minutes or seconds. However, in many cases, the model's outputs that are used to simulate organism movement have been averaged to considerably coarser resolutions (e.g. monthly mean velocity fields). To examine the sensitivity of tracking results to ocean circulation model output resolution, we took the native model output of one of the most sophisticated ocean circulation models available, the Global Hybrid Coordinate Ocean Model, and averaged it to commonly implemented spatial and temporal resolutions in studies of basin-scale dispersal. Comparisons between simulated particle trajectories and in situ near-surface drifter trajectories indicated that 'over averaging' model output yields predictions inconsistent with observations. Further analyses focused on the dispersal of juvenile sea turtles indicate that very different inferences regarding the pelagic ecology of these animals are obtained depending on the resolution of model output. We conclude that physical processes occurring at the scale of days and tens of kilometres should be preserved in ocean circulation model output to realistically depict the movement marine organisms and the resulting ecological and evolutionary processes.

Dispersal of deep-sea larvae from the intra-American seas: simulations of trajectories using ocean models.

Using data on ocean circulation with a Lagrangian larval transport model, we modeled the potential dispersal distances for seven species of bathyal invertebrates whose durations of larval life have been estimated from laboratory rearing, MOCNESS plankton sampling, spawning times, and recruitment. Species associated with methane seeps in the Gulf of Mexico and/or Barbados included the bivalve "Bathymodiolus" childressi, the gastropod Bathynerita naticoidea, the siboglinid polychaete tube worm Lamellibrachia luymesi, and the asteroid Sclerasterias tanneri. Non-seep species included the echinoids Cidaris blakei and Stylocidaris lineata from sedimented slopes in the Bahamas and the wood-dwelling sipunculan Phascolosoma turnerae, found in Barbados, the Bahamas, and the Gulf of Mexico. Durations of the planktonic larval stages ranged from 3 weeks in lecithotrophic tubeworms to more than 2 years in planktotrophic starfish. Planktotrophic sipunculan larvae from the northern Gulf of Mexico were capable of reaching the mid-Atlantic off Newfoundland, a distance of more than 3000 km, during a 7- to 14-month drifting period, but the proportion retained in the Gulf of Mexico varied significantly among years. Larvae drifting in the upper water column often had longer median dispersal distances than larvae drifting for the same amount of time below the permanent thermocline, although the shapes of the distance-frequency curves varied with depth only in the species with the longest larval trajectories. Even species drifting for >2 years did not cross the ocean in the North Atlantic Drift.

Investigation of the 2006 Alexandrium fundyense Bloom in the Gulf of Maine: In situ Observations and Numerical Modeling.

In situ observations and a coupled bio-physical model were used to study the germination, initiation, and development of the Gulf of Maine (GOM) Alexandrium fundyense bloom in 2006. Hydrographic measurements and comparisons with GOM climatology indicate that 2006 was a year with normal coastal water temperature, salinity, current and river runoff conditions. A. fundyense cyst abundance in bottom sediments preceding the 2006 bloom was at a moderate level compared to other recent annual cyst survey data. We used the coupled bio-physical model to hindcast coastal circulation and A. fundyense cell concentrations. Field data including water temperature, salinity, velocity time series and surface A. fundyense cell concentration maps were applied to gauge the model's fidelity. The coupled model is capable of reproducing the hydrodynamics and the temporal and spatial distributions of A. fundyense cell concentration reasonably well. Model hindcast solutions were further used to diagnose physical and biological factors controlling the bloom dynamics. Surface wind fields modulated the bloom's horizontal and vertical distribution. The initial cyst distribution was found to be the dominant factor affecting the severity and the interannual variability of the A. fundyense bloom. Initial cyst abundance for the 2006 bloom was about 50% of that prior to the 2005 bloom. As the result, the time-averaged gulf-wide cell concentration in 2006 was also only about 60% of that in 2005. In addition, weaker alongshore currents and episodic upwelling-favorable winds in 2006 reduced the spatial extent of the bloom as compared with 2005.

Gulf of Maine Harmful Algal Bloom in summer 2005 - Part 2: Coupled Bio-physical Numerical Modeling.

A coupled physical/biological modeling system was used to hindcast the 2005 Alexandrium fundyense bloom in the Gulf of Maine and investigate the relative importance of factors governing the bloom's initiation and development. The coupled system consists of a state-of-the-art, free-surface primitive equation Regional Ocean Modeling System (ROMS) tailored for the Gulf of Maine (GOM) using a multi-nested configuration, and a population dynamics model for A. fundyense. The system was forced by realistic momentum and buoyancy fluxes, tides, river runoff, observed A. fundyense benthic cyst abundance, and climatological nutrient fields. Extensive comparisons were made between simulated (both physical and biological) fields and in-situ observations, revealing that the hindcast model is capable of reproducing the temporal evolution and spatial distribution of the 2005 bloom. Sensitivity experiments were then performed to distinguish the roles of three major factors hypothesized to contribute to the bloom: 1) the high abundance of cysts in western GOM sediments; 2) strong northeaster storms with prevailing downwelling-favorable winds; and 3) a large amount of fresh water input due to abundant rainfall and heavy snowmelt. Results suggested that the high abundance of cysts in western GOM was the primary factor of the 2005 bloom. Wind forcing was an important regulator, as episodic bursts of northeast winds caused onshore advection of offshore populations. These downwelling favorable winds accelerated the alongshore flow, resulting in transport of high cell concentrations into Massachusetts Bay. A large regional bloom would still have happened, however, even with normal or typical winds for that period. Anomalously high river runoff in 2005 resulted in stronger buoyant plumes/currents, which facilitated the transport of cell population to the western GOM. While affecting nearshore cell abundance in Massachusetts Bay, the buoyant plumes were confined near to the coast, and had limited impact on the gulf-wide bloom distribution.

Gulf of Maine Harmful Algal Bloom in summer 2005 - Part 1: In Situ Observations of Coastal Hydrography and Circulation.

An extensive Alexandrium fundyense bloom occurred along the coast of the Gulf of Maine in late spring and early summer, 2005. To understand the physical aspects of bloom's initiation and development, in-situ observations from both a gulf-wide ship survey and the coastal observing network were used to characterize coastal circulation and hydrography during that time period. Comparisons between these in-situ observations and their respective long term means revealed anomalous ocean conditions during May 2005: waters were warmer and fresher gulf-wide due to more surface heating and river runoff; coastal currents were at least two times stronger than their climatological means. Surface winds were also anomalous in the form of both episodic burst of northeaster storms and downwelling favorable mean condition. These factors may have favored more vigorous along-shore transport and near shore aggregation of toxic A. fundyense cells (a red tide) in 2005.